@article {13781, title = {Return Migration and Disability by Life Course Stage of Return: Evidence Against the Salmon Bias.}, journal = {The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: Life course theory points to unique characteristics among older immigrants that may differentiate older age return migration from return at younger ages in terms of health. To investigate how the health of returnees may differ by age-at-return, this analysis compares disability between 3 groups of Mexican adults with a history of migration to the United States: those who return to Mexico before age 50, those who return at 50 and older, and those who remain in the United States at age 50 and older.

METHODS: Data from two nationally representative data sets, the U.S. Health and Retirement Study and the Mexican Health and Aging Study, are combined to create a data set representing Mexicans 50 and older with a history of migration to the United States. Adopting a life course perspective, activity of daily living (ADL) difficulty is compared by return status and age-at-return to account for differential selection into return by life stage.

RESULTS: Mexican immigrants who remain in the United States past age 50 have a higher probability of at least 1 ADL compared to those who return to Mexico, regardless of life course timing of return. The immigrant disadvantage persists after adjusting for differences in demographic, childhood, and adult characteristics between groups.

DISCUSSION: These findings are noteworthy because they stand in opposition to hypotheses based on life course and health-selective return migration theories and because they mean that Mexican immigrants remaining in the United States into midlife and older adulthood may be vulnerable to heightened prevalence of disability.

}, keywords = {Disabled Persons, Emigrants and Immigrants, Emigration and Immigration, Humans, Life Change Events, Mexican Americans, Mexico, Middle Aged, North American People, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbad171}, author = {Sheftel, Mara Getz} } @article {12936, title = {Attribution for everyday discrimination typologies and mortality risk among older black adults: Evidence from the health and retirement study?}, journal = {Social Science and Medicine}, volume = {316}, year = {2023}, pages = {115166}, abstract = {

BACKGROUND: The present study assessed how attributions of everyday discrimination typologies relate to all-cause mortality risk among older Black adults.

METHODS: This study utilized data from a subsample of older Black adults from the 2006/2008 Health and Retirement Study (HRS). Attributions for everyday discrimination (i.e., ancestry, age, gender, race, physical appearance, physical disability, sexual orientation, weight, and other factors) were based on self-reports, while their vital statuses were obtained from the National Death Index and reports from key informants (spanning 2006-2019). We applied latent class analysis (LCA) to identify subgroups of older Black adults based on their attributions to everyday discrimination. Cox proportional hazards models were used to analyze time to death as a function of LCA group membership and other covariates.

RESULTS: Based on fit statistics, we selected a four-class model that places respondents into one of the following classes: Class One (7\%) attributed everyday discrimination to age, race, and physical disability; Class Two (72\%) attributed everyday discrimination to few/no sources, Class Three (19\%) attributed everyday discrimination to race and national origin; and Class Four (2\%) attributed everyday discrimination to almost every reason. After adjusting for sociodemographic, behavioral, multisystem physiological dysregulation, and socioeconomic characteristics, we found that the relative risk of death remained higher for the respondents in Class One (Hazard Ratio [H.R.]: 1.80, 95\% Confidence Interval [C.I.]: (1.09-2.98) and Class Four (H.R.: 3.92, 95\% C.I.: 1.62-9.49) compared to respondents in Class Two.

CONCLUSIONS: Our findings illustrate the utility of using attribution for everyday discrimination typologies in research on the psychosocial dimensions of mortality risk among older Black adults. Future research should assess the mechanisms that undergird the link between everyday discrimination classes and all-cause mortality risk among older Black adults.

}, keywords = {Black People, Disabled Persons, Minority health, Perceived Discrimination, Psychosocial factors, Public Health, Retirement, Social Perception}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2022.115166}, author = {Cobb, Ryon J and Rodriguez, Violeta J and Brown, Tyson H and Louie, Patricia and Farmer, Heather R and Sheehan, Connor M and Mouzon, Dawne M and Thorpe, Roland J} } @article {13506, title = {The devil{\textquoteright}s in the details: Variation in estimates of late-life activity limitations across national cohort studies.}, journal = {J of the American Geriatric Society}, volume = {71}, year = {2023}, pages = {858-868}, abstract = {

BACKGROUND: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS).

METHODS: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing.

RESULTS: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4\% [95\% confidence interval (CI) 11.5\%-13.4\%] of the cohort received help with dressing, while in HRS this figure was 6.4\% [95\% CI 5.7\%-7.2\%] and MCBS 5.3\% [95\% CI 4.7\%-5.8\%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability.

CONCLUSIONS: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

}, keywords = {Activities of Daily Living, Cohort Studies, Disabled Persons, Medicare, Self Care}, issn = {1532-5415}, doi = {10.1111/jgs.18158}, author = {Ankuda, Claire K and Covinsky, Kenneth and Freedman, Vicki A and Kenneth M. Langa and Aldridge, Melissa D and Yee, Cynthia and Kelley, Amy S} } @article {13467, title = {Examining racial and ethnic differences in disability among older adults: A polysocial score approach.}, journal = {Maturitas}, volume = {172}, year = {2023}, pages = {1-8}, abstract = {

OBJECTIVES: Racial and ethnic disparities in disability in activities of daily living (ADL) continue to be a public concern. We evaluated whether the polysocial score approach could provide a more comprehensive method for modifying racial and ethnic differences in such disability.

STUDY DESIGN: Cohort study.

MAIN OUTCOME MEASURES: We included 5833 participants from the Health and Retirement Study, who were aged 65~years or more and were initially free of ADL disability. We considered six ADLs: bathing, eating, using the toilet, dressing, walking across a room, and getting in/out of bed. We included 20 social factors spanning economic stability, neighborhood and physical environment, education, community and social context, and health system. We used forward stepwise logistic regression to derive a polysocial score for ADL disability. We created a polysocial score using 12 social factors and categorized the score as low (0-19), intermediate (20-30), and high (31+). We used multivariable logistic regression to estimate the incident risk of ADL disability and examine additive interactions between race/ethnicity and polysocial score.

RESULTS: A higher polysocial score is associated with a lower incidence of ADL disability among older adults in the United States. We found additive interactions between race/ethnicity and polysocial score categories. In the low polysocial score category, White and Black/Hispanic participants had a 18.5~\% and 24.4~\% risk of ADL disability, respectively. Among White participants, the risk of ADL disability decreased to 14.1~\% and 12.1~\% in the intermediate and high polysocial score categories, respectively; among Black/Hispanic participants, those in the intermediate and high categories had a 11.9~\% and 8.7~\% risk of ADL disability, respectively.

CONCLUSIONS: The polysocial score approach provides a new opportunity for explaining racial/ethnic disparities in functional capacity among older adults.

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, Disabled Persons, ethnicity, Health Status Disparities, Humans, Racial Groups, United States}, issn = {1873-4111}, doi = {10.1016/j.maturitas.2023.03.010}, author = {Tang, Junhan and Chen, Ying and Liu, Hua and Wu, Chenkai} } @article {13468, title = {Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study.}, journal = {Gerontology}, volume = {69}, year = {2023}, pages = {826-838}, abstract = {

INTRODUCTION: Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear.

METHODS: Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58\% female, 25\% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score.

RESULTS: Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95\% CI = 1.01-1.20), diabetes (IRR = 1.19, 95\% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95\% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95\% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95\% CI = 1.02-1.11), hypertension (IRR = 1.06, 95\% CI = 1.02-1.11), heart disease (IRR = 1.06, 95\% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95\% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men.

CONCLUSION: The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.

}, keywords = {Activities of Daily Living, Aged, Arthritis, C-reactive protein, Diabetes Mellitus, Disabled Persons, Female, Glycated Hemoglobin, Heart Diseases, Humans, Hypertension, Inflammation, Longitudinal Studies, Male, multimorbidity, Prospective Studies, Stroke}, issn = {1423-0003}, doi = {10.1159/000528648}, author = {Botoseneanu, Anda and Markwardt, Sheila and Qui{\~n}ones, Ana R} } @article {12942, title = {Perceived discrimination in middle-aged and older adults: Comparison between England and the United States.}, journal = {Frontiers in Public Health}, volume = {10}, year = {2022}, pages = {975776}, abstract = {

OBJECTIVES: This study examined differences in perceived discrimination across multiple characteristics in England and the United States (US), in middle- and older-aged adults.

METHODS: Using data from the English Longitudinal Study of Aging ( = 8,671) and the US-based Health and Retirement Study ( = 7,927), we assessed cross-national differences in perceived discrimination attributed to disability, financial status, sex, race, sexual orientation, and weight. We also compared how perceived discrimination varied with socioeconomic position (SEP) based on wealth.

RESULTS: Perceived discrimination due to financial status was more common in England (6.65\%) than in the US (2.14\%) adjusting for age, sex, and wealth [Odds Ratio (OR) = 1.09, 95\% CI (1.07; 1.10)]. This affected people of low but not high SEP. Sexual orientation discrimination was more common in England [0.72 vs. 0.15\%, OR = 4.61, 95\% CI (2.48; 8.57)]. Sex-based perceived discrimination was more prevalent in the US (12.42\%) than England (9.07\%) adjusting for age and wealth [OR = 0.87, 95\% CI (0.86; 0.89)]. Cross-national differences in sex discrimination did not vary with SEP. Racism was the most common type of perceived discrimination reported in both samples (England: 17.84\%, US: 19.80\%), with no significant cross-national differences after adjustment for sex.

DISCUSSION: Perceived discrimination attributed to financial status and sexual orientation were more prevalent in England, while more women perceived sex discrimination in the US. This study suggests that country-specific and socioeconomic factors affect the prevalence of perceived discrimination. This may be relevant when targeting interventions aimed at reducing perceived discrimination.

}, keywords = {Aging, Disabled Persons, ELSA, Perceived Discrimination, Socioeconomic factors}, issn = {2296-2565}, doi = {10.3389/fpubh.2022.975776}, author = {Amirova, Aliya and Rimes, Katharine A and Hackett, Ruth A} } @article {8576, title = {Differences in the Progression of Disability: A U.S.-Mexico Comparison.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {913-922}, abstract = {

Objectives: This article seeks to document the progression of disability in a developing country by implementing a model to examine how this process compares to a developed country.

Methods: Data come from the Mexican Health and Aging Study (MHAS), including a baseline survey in 2001 and a follow-up in 2003, and from the U.S. Health and Retirement Study (HRS), using the 2000 and 2002 waves. An ordinal logistic regression approach is used to examine a progression of disability that considers (a) no disability, (b) mobility problems, (c) mobility plus limitations with instrumental activities of daily living, (d) mobility plus limitations with activities of daily living (ADLs), (e) limitations in all three areas and (f) death.

Results: In both data sets, approximately 44\% of the sample remained in the same level of disability at the 2-year follow-up. However, the progression of limitations with two disabilities differs by gender in the MHAS but is consistent for both men and women in the HRS.

Discussion: Our model reflects the importance of ADLs in the disablement process in Mexico. We speculate that the difference in lifetime risk profiles and cultural context might be responsible for the divergence in the progression of disability by gender.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Disabled Persons, disease progression, Female, Humans, Male, Mexico, MHAS}, issn = {1758-5368}, doi = {10.1093/geronb/gbw082}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27436102}, author = {D{\'\i}az-Venegas, Carlos and Timothy A Reistetter and Rebeca Wong} } @article {8598, title = {"Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 09 20}, pages = {1278-1291}, chapter = {1278-1291}, abstract = {

Objectives: Recovery from self-reported walking limitation may be a turning point in an individual{\textquoteright}s health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans.

Data and Methods: Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later).

Results: Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes.

Discussion: This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult{\textquoteright}s functional health trajectory.

}, keywords = {Age Factors, Aged, Disabled Persons, Female, Humans, Logistic Models, Male, Mobility Limitation, Mortality, Recovery of Function, Risk Factors, Self Report, Sex Factors, Socioeconomic factors, Walking}, issn = {1758-5368}, doi = {10.1093/geronb/gbw113}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw113}, author = {Kenzie Latham} } @article {8805, title = {Associations between community-level disaster exposure and individual-level changes in disability and risk of death for older Americans.}, journal = {Soc Sci Med}, volume = {173}, year = {2017}, month = {2017 01}, pages = {118-125}, abstract = {

Disasters occur frequently in the United States (US) and their impact on acute morbidity, mortality and short-term increased health needs has been well described. However, barring mental health, little is known about the medium or longer-term health impacts of disasters. This study sought to determine if there is an association between community-level disaster exposure and individual-level changes in disability and/or the risk of death for older Americans. Using the US Federal Emergency Management Agency{\textquoteright}s database of disaster declarations, 602 disasters occurred between August 1998 and December 2010 and were characterized by their presence, intensity, duration and type. Repeated measurements of a disability score (based on activities of daily living) and dates of death were observed between January 2000 and November 2010 for 18,102 American individuals aged 50-89 years, who were participating in the national longitudinal Health and Retirement Study. Longitudinal (disability) and time-to-event (death) data were modelled simultaneously using a {\textquoteright}joint modelling{\textquoteright} approach. There was no evidence of an association between community-level disaster exposure and individual-level changes in disability or the risk of death. Our results suggest that future research should focus on individual-level disaster exposures, moderate to severe disaster events, or higher-risk groups of individuals.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Community Participation, Continental Population Groups, Disabled Persons, Disaster Planning, Disasters, Female, Humans, Income, Longitudinal Studies, Male, Middle Aged, Mortality, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.12.007}, url = {https://www.sciencedirect.com/science/article/abs/pii/S0277953616306785?via\%3Dihub}, author = {Samuel L. Brilleman and Wolfe, Rory and Moreno-Betancur, Margarita and Anne E Sales and Kenneth M. Langa and Yun Li and Elizabeth L. Daugher Biddison and Rubinson, Lewis and Theodore J Iwashyna} } @article {8855, title = {Identifying adults aging with disability using existing data: The case of the Health and Retirement Study.}, journal = {Disabil Health J}, volume = {10}, year = {2017}, month = {2017 Oct}, pages = {611-615}, abstract = {

BACKGROUND: The population of persons aging with disabilities is growing. Being able to segment aging with disability sub-populations within national data sets is becoming increasingly important in order to understand the relationship of aging with disability to a range of outcomes in later life including health and wellness, economic security, and health and long-term service and support need and use.

OBJECTIVE: The purpose of this study was to identify viable sub-samples of adults aging with disabilities within the Health and Retirement Study, one of the most used secondary data sets to study aging and older adults.

METHOD: Samples used in this research are drawn from wave 11 (2012) of the HRS. Five operationalizations of disability were used: childhood disability (n~=~719), childhood chronic condition (n~=~3070), adult chronic condition (n~=~13,723), functional limitation in adulthood (n~=~4448) and work disability (n~=~5632).

RESULTS: These subsamples are not mutually exclusive. Among respondents that reported having a childhood disability, 87\% also report having at least one chronic disease in adulthood, 50\% report having functional limitations in adulthood and 38\% report interruption in their ability to work due to a disability. Compared to the childhood disability samples, rates of reporting fair/poor health are nearly double among adults with functional limitations or those with work disruptions because of disability.

CONCLUSION: Work disability and functional limitation appeared to be the most viable sub-sample options to consider when using the HRS to study experiences of adults aging with disability. Overall, age at onset is unclear.

}, keywords = {Activities of Daily Living, Adolescent, Age of Onset, Aged, Aged, 80 and over, Aging, Child, Child Health, Chronic disease, Disabled Persons, Female, health, Health Status, Health Surveys, Humans, Male, Middle Aged, Retirement, Self Report, Work}, issn = {1876-7583}, doi = {10.1016/j.dhjo.2016.12.016}, url = {https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1}, author = {Caitlin E. Coyle and Putnam, Michelle} } @article {8492, title = {Successful Aging in the Context of the Disablement Process: Working and Volunteering as Moderators on the Association Between Chronic Conditions and Subsequent Functional Limitations.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Mar 01}, pages = {340-350}, abstract = {

Objectives : This study evaluated the successful aging model by assessing the impact of two forms of productive engagement-working and volunteering-as potential interventions in the process of disablement.

Method : The Health and Retirement Study was used to (a) estimate two-stage selection equations of (i) currently working part time and full time and (ii) currently volunteering less than 100 hours and volunteering 100 hours or more per year (net of chronic health problems) and (b) assess whether, net of selection, working, and volunteering moderate the association between chronic conditions and subsequent functional limitations.

Results : Chronic conditions were associated with elevated levels of subsequent functional limitations, whereas both working and volunteering were associated with lower levels of subsequent functional limitations. Moreover, workers and volunteers of less than 100 hours per year experienced a reduction in the association of chronic conditions on subsequent functional limitations.

Discussion : This research highlights the role of productive engagement as a key element in successful aging. Not only do work and volunteering have direct associations with health outcomes themselves, but they also act as potential interventions in the process of disablement by attenuating the way in which chronic conditions are translated into subsequent functional limitations. This suggests that (a) future research should apply successful aging models to health processes as well as health outcomes and (b) policy makers should support social institutions that foster late-life productive engagement.

}, keywords = {Aged, Aged, 80 and over, Aging, Disabled Persons, Employment, Female, Humans, Male, United States, Volunteers}, issn = {1758-5368}, doi = {10.1093/geronb/gbw060}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27225973}, author = {Ben Lennox Kail and Dawn C Carr} } @article {8502, title = {Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis.}, journal = {Lancet Diabetes Endocrinol}, volume = {4}, year = {2016}, month = {2016 08}, pages = {686-694}, abstract = {

BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years.

METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years.

FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0{\textperiodcentered}8-2{\textperiodcentered}3 year delay in disability across the three metrics (mobility, 63{\textperiodcentered}0 [95\% CI 62{\textperiodcentered}3-63{\textperiodcentered}6] to 64{\textperiodcentered}8 [63{\textperiodcentered}6-65{\textperiodcentered}7], p=0{\textperiodcentered}01; instrumental activities of daily living, 63{\textperiodcentered}5 [63{\textperiodcentered}0-64{\textperiodcentered}0] to 64{\textperiodcentered}3 [63{\textperiodcentered}0-65{\textperiodcentered}3], p=0{\textperiodcentered}24; activities of daily living, 62{\textperiodcentered}7 [62{\textperiodcentered}1-63{\textperiodcentered}3] to 65{\textperiodcentered}0 [63{\textperiodcentered}5-65{\textperiodcentered}9], p<0{\textperiodcentered}0001) and 1{\textperiodcentered}3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2{\textperiodcentered}8 [2{\textperiodcentered}5-3{\textperiodcentered}2] to 1{\textperiodcentered}5 [1{\textperiodcentered}3-1{\textperiodcentered}9]; p<0{\textperiodcentered}0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1{\textperiodcentered}1-2{\textperiodcentered}3 year delay in disability across the three metrics (mobility, 61{\textperiodcentered}3 [95\% CI 60{\textperiodcentered}5-62{\textperiodcentered}1] to 63{\textperiodcentered}2 [61{\textperiodcentered}5-64{\textperiodcentered}5], p=0{\textperiodcentered}0416; instrumental activities of daily living, 63{\textperiodcentered}0 [62{\textperiodcentered}4-63{\textperiodcentered}7] to 64{\textperiodcentered}1 [62{\textperiodcentered}7-65{\textperiodcentered}2], p=0{\textperiodcentered}16; activities of daily living, 62{\textperiodcentered}3 [61{\textperiodcentered}6-63{\textperiodcentered}0] to 64{\textperiodcentered}6 [63{\textperiodcentered}1-65{\textperiodcentered}6], p<0{\textperiodcentered}0001) and 0{\textperiodcentered}8 fewer life-years lost by age 70 years (1{\textperiodcentered}9 [1{\textperiodcentered}7-2{\textperiodcentered}2] to 1{\textperiodcentered}1 [0{\textperiodcentered}9-1{\textperiodcentered}5]; p<0{\textperiodcentered}0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0{\textperiodcentered}0001 for all comparisons).

INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years.

FUNDING: US Department of Health \& Human Services and the US Centers for Disease Control and Prevention.

}, keywords = {Activities of Daily Living, Aged, Diabetes Mellitus, Disabled Persons, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, United States}, issn = {2213-8595}, doi = {10.1016/S2213-8587(16)30090-0}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27298181}, author = {Barbara H. Bardenheier and Ji Lin and Zhuo, Xiaohui and Mohammed K. Ali and Theodore J Thompson and Yiling J. Cheng and Edward W Gregg} } @article {8530, title = {Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life?}, journal = {Gerontologist}, volume = {56}, year = {2016}, month = {2016 06}, pages = {514-24}, abstract = {

PURPOSE OF THE STUDY: In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability.

DESIGN AND METHODS: This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score.

RESULTS: Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability.

IMPLICATIONS: Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Chronic disease, Disability Evaluation, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Middle Aged, Resilience, Psychological, Retirement, Surveys and Questionnaires}, issn = {1758-5341}, doi = {10.1093/geront/gnu068}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25063353}, author = {Lydia K Manning and Dawn C Carr and Ben Lennox Kail} } @article {6501, title = {Life Expectancy With and Without Pain in the U.S. Elderly Population.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {71}, year = {2016}, month = {2016 Sep}, pages = {1171-6}, abstract = {

BACKGROUND: This study contributes to dialogue on quality versus quantity of life by examining years older persons can expect to live in various states of pain.

METHODS: Data from seven waves of the Health and Retirement Study; N = 26,896; age 55+. Estimations using the Interpolative Markov Chain approach apply probability transitions to multistate life table functions. Two estimates are interpreted: (i) population-based, which provide population averages aggregated across baseline states and (ii) status-based, which provide independent estimates by baseline state. Age- and sex-specific years with no pain, milder nonlimiting, and severe or limiting pain are reported as is percent of life in states of pain.

RESULTS: Females have higher life expectancy than males but similar expectations of pain-free life. Total life expectancy varies only slightly by baseline pain states but pain-free life expectancy varies greatly. For example, an 85-year-old female pain-free at baseline expects 7.04 more years, 5.28 being pain-free. An 85-year-old female with severe pain at baseline expects 6.42 years with only 2.66 pain-free. Percent of life with pain decreases by age for those pain-free at baseline and increases for those with pain at baseline.

CONCLUSION: Pain is moderately associated with quantity of or total life but substantially and importantly associated with quality of or pain-free life.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Disabled Persons, Female, Health Status Indicators, Humans, Incidence, Life Expectancy, Life Tables, Male, Middle Aged, pain, Quality of Life, Risk Factors, Surveys and Questionnaires, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glw028}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2016/03/17/gerona.glw028.abstract}, author = {Zachary Zimmer and Rubin, Sara} } @article {8674, title = {Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults.}, journal = {J Urban Health}, volume = {93}, year = {2016}, month = {2016 10}, pages = {840-850}, abstract = {

While Medicare provides health insurance coverage for those over 65~years of age, many still are underinsured, experiencing substantial out-of-pocket costs for covered and non-covered services as a proportion of their income. Using the Health and Retirement Study (HRS), this study found that being underinsured is a significant predictor of entering into Medicaid coverage over a 16-year period. The rate of entering Medicaid was almost twice as high for those who were underinsured and with physical and/or cognitive impairment than those who were not, while supplemental health insurance reduced the rate of entering Medicaid by 30~\%. Providing more comprehensive coverage through the traditional Medicare program, including a ceiling on out-of-pocket expenditures or targeted support for those with physical or cognitive impairment, could postpone becoming covered by Medicaid and yield savings in Medicaid.

}, keywords = {Aged, Cognitive Dysfunction, Delivery of Health Care, Disabled Persons, Eligibility Determination, Female, Financing, Personal, Humans, Insurance Coverage, Insurance, Health, Male, Medicaid, Middle Aged, United States}, issn = {1468-2869}, doi = {10.1007/s11524-016-0078-1}, url = {https://link.springer.com/article/10.1007\%2Fs11524-016-0078-1}, author = {Willink, Amber and Davis, Karen and Schoen, Cathy and Jennifer L. Wolff} } @article {8195, title = {Anchoring vignettes in the Health and Retirement Study: how do medical professionals and disability recipients characterize the severity of work limitations?}, journal = {PLoS One}, volume = {10}, year = {2015}, month = {2015}, pages = {e0126218}, publisher = {10}, abstract = {

PURPOSE: Recent studies report systematic differences in how individuals categorize the severity of identical health and work limitation vignettes. We investigate how health professionals and disability recipients characterize the severity of work limitations and whether their reporting patterns are robust to demographic, education, and health characteristics. We use the results to illustrate the potential impact of reporting heterogeneity on the distribution of work disability estimated from self-reported categorical health and disability data.

METHOD: Nationally representative data on anchoring disability vignettes from the 2004 Health and Retirement Study (HRS) are used to investigate how respondents with an occupation background in health and Social Security disability beneficiaries categorize work limitation vignettes. Using pain, cardiovascular health, and depression vignettes, we estimate generalized ordered probit models (N = 2,660 individuals or 39,681 person-vignette observations) that allow the severity thresholds to vary by respondent characteristics.

RESULTS: We find that health professionals (excluding nurses) and disability recipients tend to classify identical work limitations as more severe compared to non-health professional non-disabled respondents. For disability recipients, the differences are most pronounced and particularly visible in the tails of the work limitations distribution. For health professionals, we observe smaller differences, affecting primarily the classification of mildly and moderately severe work limitations. The patterns for health professionals (excluding nurses) are robust to demographics, education, and health conditions. The greater likelihood of viewing the vignette person as more severely work limited observed among disability recipients is mostly explained by the fact that these respondents also tend to be in poorer health which itself predicts a more inclusive scale.

CONCLUSIONS: Knowledge of reporting scales from health professionals and disabled individuals can benefit researchers in a broad range of applications in health and disability research. They may be useful as reference scales to evaluate disability survey data. Such knowledge may be beneficial when studying disability programs. Given the increasing availability of anchoring vignette data in surveys, this is a promising area for future evaluation research.

}, keywords = {Aged, Cardiovascular Diseases, depression, Disabled Persons, Female, Health Personnel, Humans, Male, Middle Aged, pain, Retirement, Self Report}, issn = {1932-6203}, doi = {10.1371/journal.pone.0126218}, url = {http://dx.doi.org/10.1371 2Fjournal.pone.0126218}, author = {Frank Heiland and Yin, Na} } @article {8174, title = {Cross-National Differences in Disability Among Elders: Transitions in Disability in Mexico and the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {759-68}, publisher = {70}, abstract = {

OBJECTIVES: Little is known about how exposure to a combination of infectious and chronic conditions throughout the lifecourse could impact disability in old age. This paper compares 2 cohorts of adults who have aged under very different country contexts by contrasting disability transitions among elders in Mexico with elders in the United States.

METHODS: Data comes from the Mexican Health and Aging Study (MHAS) and the U.S. Health and Retirement Study (HRS). Estimated probabilities of 2-year transitions among disability states and mortality are presented for adults aged 50 and older.

RESULTS: The levels of disability prevalence and 2 year transitions are consistent with a higher rate of disability for the United States compared to Mexico. In 2-year transitions, the U.S. sample was more likely to transition to a disabled state or increase the number of disabilities than the Mexican counterparts, while Mexicans are more likely to move out of disability or reduce the number of disabilities reported.

DISCUSSION: The findings suggest that the current rate of disability in old age is lower for a less developed country compared with a developed society. We discuss implications, possible explanations, and likely future scenarios.

}, keywords = {Aged, Aged, 80 and over, Aging, Cross-Cultural Comparison, Disabled Persons, Female, Humans, Male, Mexico, Middle Aged, Mortality, Prevalence, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu185}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/28/geronb.gbu185.abstract}, author = {Kerstin Gerst and Rebeca Wong and Alejandra Michaels-Obregon and Alberto Palloni} } @article {8237, title = {Disability Trajectories at the End of Life: A "Countdown" Model.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {745-52}, publisher = {70}, abstract = {

OBJECTIVES: Studies of late-life disablement typically address the role of advancing age as a factor in developing disability, and in some cases have pointed out the importance of time to death (TTD) in understanding changes in functioning. However, few studies have addressed both factors simultaneously, and none have dealt satisfactorily with the problem of missing data on TTD in panel studies.

METHODS: We fit latent-class trajectory models of disablement using data from the Health and Retirement Study. Among survivors (~20\% of the sample), TTD is unknown, producing a missing-data problem. We use an auxiliary regression equation to impute TTD and employ multiple imputation techniques to obtain final parameter estimates and standard errors.

RESULTS: Our best-fitting model has 3 latent classes. In all 3 classes, the probability of having a disability increases with nearness to death; however, in only 2 of the 3 classes is age associated with disability. We find gender, race, and educational differences in class-membership probabilities.

DISCUSSION: The model reveals a complex pattern of age- and time-dependent heterogeneity in late-life disablement. The techniques developed here could be applied to other phenomena known to depend on TTD, such as cognitive change, weight loss, and health care spending.

}, keywords = {Aged, Aged, 80 and over, Aging, Death, Disabled Persons, Female, Humans, Male, Time Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu182}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/23/geronb.gbu182.abstract}, author = {Douglas A. Wolf and Vicki A Freedman and Jan I Ondrich and Christopher L Seplaki and Brenda C Spillman} } @article {8224, title = {Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Oct}, pages = {1413-20}, publisher = {30}, abstract = {

BACKGROUND: As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.

OBJECTIVE: We aimed to examine the relationship between healthcare discrimination and new or worsened disability.

DESIGN: This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.

PARTICIPANTS: Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 \% female, 83.1 \% white) were included in this study.

MAIN MEASURES: Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.

KEY RESULTS: In all, 12.6 \% experienced discrimination infrequently and 5.9 \% frequently. Almost one-third of participants (29 \%) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 \% of those who infrequently and 14.7 \% of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 \% CI 1.16-2.27).

CONCLUSIONS: One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

}, keywords = {Activities of Daily Living, Aged, Ageism, Aging, Disabled Persons, Female, Follow-Up Studies, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Surveys and Questionnaires}, issn = {1525-1497}, doi = {10.1007/s11606-015-3233-6}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff}, author = {Stephanie E Rogers and Angela D Thrasher and Yinghui Miao and W John Boscardin} } @article {8228, title = {Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 1 0 1}, month = {2015 Oct}, pages = {1528-49}, publisher = {50}, abstract = {

OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

DATA SOURCE: 1996-2010 waves of the Health and Retirement Study.

STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Alcohol Drinking, Chronic disease, Disabled Persons, Female, Health Behavior, Health Surveys, Humans, Male, Middle Aged, Mobility Limitation, Obesity, Prevalence, Sex Distribution, Smoking, Socioeconomic factors, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12284}, author = {Chen, Yiqun and Frank A Sloan} } @article {8229, title = {Increase in Disability Prevalence Before Hip Fracture.}, journal = {J Am Geriatr Soc}, volume = {63}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Oct}, pages = {2029-35}, publisher = {63}, abstract = {

OBJECTIVES: To establish the prevalence and correlates of disability during the 2 years before hip fracture.

DESIGN: Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time points in the 2 years before hip fracture. Disability was defined as self-report of the need for assistance in any activity of daily living (walking across the room, eating, bathing, dressing, using the toilet, transferring). Based on the timing between interview and hip fracture, prevalence of disability was calculated in the cohort as a whole over the 2 years before hip fracture and in subgroups defined according to demographic and clinical characteristics.

SETTING: The HRS is a nationally representative longitudinal study (1992-2010).

PARTICIPANTS: HRS participants aged >=65 with hip fracture (mean age at fracture 84, 77\% female).

RESULTS: The adjusted prevalence of disability was 20\% (95\% confidence interval (CI) = 14-25\%) 2 years before hip fracture, with little change until approximately 10 months before fracture, when it started to rise, reaching 44\% (95\% CI = 33-55\%) in the month before hip fracture. The prevalence of disability was highest in the last month before fracture for persons aged 85 and older (53\%) and for those with dementia (60\%).

CONCLUSION: Care models for hip fracture need to consider not only the acute medical and surgical needs, but also the high level of need for supportive care and caregiver assistance that chronically disabled individuals require.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Dementia, Disability Evaluation, Disabled Persons, Educational Status, Female, Health Surveys, Hip Fractures, Humans, Income, Male, Mobility Limitation, Prevalence, United States}, issn = {1532-5415}, doi = {10.1111/jgs.13658}, author = {Irena Cenzer and W John Boscardin and Christine S Ritchie and Margaret Wallhagen and Kenneth E Covinsky} } @article {8663, title = {Lifespan and Healthspan: Past, Present, and Promise.}, journal = {Gerontologist}, volume = {55}, year = {2015}, month = {2015 Dec}, pages = {901-11}, abstract = {

The past century was a period of increasing life expectancy throughout the age range. This resulted in more people living to old age and to spending more years at the older ages. It is likely that increases in life expectancy at older ages will continue, but life expectancy at birth is unlikely to reach levels above 95 unless there is a fundamental change in our ability to delay the aging process. We have yet to experience much compression of morbidity as the age of onset of most health problems has not increased markedly. In recent decades, there have been some reductions in the prevalence of physical disability and dementia. At the same time, the prevalence of disease has increased markedly, in large part due to treatment which extends life for those with disease. Compressing morbidity or increasing the relative healthspan will require "delaying aging" or delaying the physiological change that results in disease and disability. While moving to life expectancies above age 95 and compressing morbidity substantially may require significant scientific breakthroughs; significant improvement in health and increases in life expectancy in the United States could be achieved with behavioral, life style, and policy changes that reduce socioeconomic disparities and allow us to reach the levels of health and life expectancy achieved in peer societies.

}, keywords = {Aged, Aged, 80 and over, Aging, Disabled Persons, Humans, Life Expectancy, Socioeconomic factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnv130}, author = {Eileen M. Crimmins} } @article {8272, title = {Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {661-71}, publisher = {70}, abstract = {

OBJECTIVES: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3\%, 23.5\%, 24.5\%, and 22.6\% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition Disorders, Disabled Persons, Educational Status, Female, Health Status, Humans, Male, Social Class, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu095}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/08/25/geronb.gbu095.abstract}, author = {Xiao Xu and Jersey Liang and Joan M. Bennett and Anda Botoseneanu and Heather G. Allore} } @article {8166, title = {Spouse and Child Availability for Newly Disabled Older Adults: Socioeconomic Differences and Potential Role of Residential Proximity.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 May}, pages = {462-9}, publisher = {70}, abstract = {

OBJECTIVES: To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults.

METHOD: We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics.

RESULTS: Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s.

DISCUSSION: Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

}, keywords = {Activities of Daily Living, Adult children, Aged, Aged, 80 and over, Aging, Disabled Persons, Female, Home Nursing, Humans, Male, Middle Aged, Nursing homes, Residence Characteristics, Social Class, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbu015}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/06/geronb.gbu015.abstract}, author = {Choi, Hwajung and Robert F. Schoeni and Kenneth M. Langa and Michele M Heisler} } @article {7995, title = {The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jul}, pages = {860-70}, publisher = {69}, abstract = {

BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace.

METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace.

RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke.

CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Disabled Persons, Female, Humans, Male, Prospective Studies, Stroke, United States, White People}, issn = {1758-535X}, doi = {10.1093/gerona/glt191}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract}, author = {Benjamin D Capistrant and Nicte I Mejia and Sze Y Liu and Qianyi Wang and M. Maria Glymour} } @article {8105, title = {Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, note = {Times Cited: 0}, month = {2014 Jun}, pages = {606-13}, publisher = {22}, abstract = {

OBJECTIVES: Either dysphoria (sadness) or anhedonia (loss of interest in usually pleasurable activities) is required for a diagnosis of major depression. Although major depression is a known risk factor for disability in older persons, few studies have examined the relationship between the two core symptoms of major depression and disability or mortality. Our objective was to examine the relationship between these two core symptoms and time to disability or death.

METHODS: In a longitudinal cohort study, we used the nationally representative Health and Retirement Study to examine this relationship in 11,353 persons older than 62 years (mean: 73 years) followed for up to 13 years. Dysphoria and anhedonia were assessed with the Short Form Composite International Diagnostic Interview. Our outcome measure was time to either death or increased disability, defined as the new need for help in a basic activity of daily living. We adjusted for a validated disability risk index and other confounders.

RESULTS: Compared with subjects without either dysphoria or anhedonia, the risk for disability or death was not elevated in elders with dysphoria without anhedonia (adjusted hazard ratio [HR]: 1.11; 95\% confidence interval [CI]: 0.91-1.36). The risk was elevated in those with anhedonia without dysphoria (HR: 1.30; 95\% CI: 1.06-1.60) and those with both anhedonia and dysphoria (HR: 1.28; 95\% CI: 1.13-1.46).

CONCLUSION: Our results highlight the need for clinicians to learn whether patients have lost interest in usually pleasurable activities, even if they deny sadness.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Anhedonia, depression, Disabled Persons, Female, Humans, Interview, Psychological, Longitudinal Studies, Male, Middle Aged, Mortality, Risk Factors}, issn = {1545-7214}, doi = {10.1016/j.jagp.2012.12.001}, author = {Kenneth E Covinsky and Irena Cenzer and Kristine Yaffe and Sarah O{\textquoteright}Brien and Dan G. Blazer} } @article {8126, title = {Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke.}, journal = {Circ Cardiovasc Qual Outcomes}, volume = {7}, year = {2014}, note = {Times Cited: 1 0 1}, month = {2014 Nov}, pages = {863-71}, publisher = {7}, abstract = {

BACKGROUND: We assessed the acute and long-term effect of myocardial infarction (MI) and stroke on postevent functional disability and cognition while controlling for survivors{\textquoteright} changes in functioning over the years before the event.

METHODS AND RESULTS: Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we determined within-person changes in functional limitations (basic and instrumental activities of daily living) and cognitive impairment after hospitalization for stroke (n=432) and MI (n=450), controlling for premorbid functioning using fixed-effects regression. In persons without baseline impairments, an acute MI yielded a mean acute increase of 0.41 functional limitations (95\% confidence interval [CI], 0.18-0.63) with a linear increase of 0.14 limitations/year in the following decade. These increases were 0.65 limitations (95\% CI, 0.07-1.23) and 0.27 limitations/year afterward for those with mild-to-moderate impairment at baseline. Stroke resulted in an acute increase of 2.07 (95\% CI, 1.51-2.63) limitations because of the acute event and an increase of 0.15 limitations/year afterward for those unimpaired at baseline. There were 2.65 new limitations (95\% CI, 1.86-3.44) and 0.19/year afterward for those with baseline mild-to-moderate impairment. Stroke hospitalization was associated with greater odds of moderate-to-severe cognitive impairment (odds ratio, 3.86; 95\% CI, 2.10-7.11) at the time of the event, after adjustment for premorbid cognition but MI hospitalization was not.

CONCLUSIONS: In this population-based cohort, most MI and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterward. Survivors of MI and stroke warrant screening for functional disability over the long-term.

}, keywords = {Activities of Daily Living, Cognition, Cognition Disorders, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Hospitalization, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Odds Ratio, Retrospective Studies, Stroke, Time Factors, United States}, issn = {1941-7705}, doi = {10.1161/HCQ.0000000000000008}, author = {Deborah A Levine and Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Mary A M Rogers and Theodore J Iwashyna} } @article {7844, title = {BMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach.}, journal = {J Gen Intern Med}, volume = {28}, year = {2013}, note = {Copyright - Society of General Internal Medicine 2013 Last updated - 2013-09-09 Bowman, Robert L.; DeLucia, Janice L. Accuracy of self-reported weight: A meta-analysis. Behavior Therapy, 23. 4 (1992): 637-655. 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Journal of health and social behavior, 39. 4 (1998): 271-294. American Sociological Association Zamboni, M.; Mazzali, G.; Zoico, E.; Di Francesco, V.; et al. Health consequences of obesity in the elderly: A review of four unresolved questions. International Journal of Obesity, 29. 9 (2005): 1011-1029. Nature Publishing Group}, month = {2013 Sep}, pages = {1150-6}, publisher = {28}, abstract = {

BACKGROUND: Few longitudinal studies have examined associations between body mass index (BMI) changes in adults with diabetes and the development of disability.

OBJECTIVE: To investigate association patterns between BMI and disability in middle-aged adults with diabetes.

DESIGN AND SETTING: Retrospective cohort design with data from the 1992-2006 Health and Retirement Study (HRS). A group-based joint trajectory method identified distinct BMI change trajectories and their link to subsequent disability trajectories.

PARTICIPANTS: U.S. nationally representative adults aged 51-61 who reported a diagnosis of diabetes in the 1992 HRS (N = 1,064).

MEASUREMENTS: BMI and self-reported disability score were the main variables. Sociodemographic, clinical, behavioral, and diabetes-related factors were also examined.

RESULTS: Four distinct weight trajectories (stable normal weight, 28.7~\%; stable overweight, 46.2~\%; loss and regain obese, 18.0~\%; weight cumulating morbidly obese, 7.1~\%) and three disability trajectories (little or low increase, 34.4~\%; moderate increase, 45.4~\%; chronic high increase, 20.2~\%) best characterized the long-term patterns of BMI and disability change in middle-aged adults with diabetes. Adults in stable normal weight had the highest probability of being in the little/low increase disability group; however, one in five adults in that group progressed into chronic high disability, a higher proportion compared to the stable overweight group.

CONCLUSIONS: Although there were various ways in which the two trajectories were linked, the beneficial impacts of optimizing weight in adults with diabetes were supported. In addition, the complexity of diabetes control in those with relatively normal weight was highlighted from this study.

}, keywords = {Activities of Daily Living, Body Mass Index, Diabetes Mellitus, Type 2, Disability Evaluation, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Obesity, Obesity, Morbid, Overweight, Retrospective Studies, United States, Weight Gain, Weight Loss}, issn = {1525-1497}, doi = {10.1007/s11606-013-2399-z}, author = {Chiu, Ching-Ju and Linda A. Wray and Lu, Feng-hwa and Elizabeth A Beverly} } @article {7789, title = {Disability during the last two years of life.}, journal = {JAMA Intern Med}, volume = {173}, year = {2013}, note = {Copyright - Copyright American Medical Association Sep 9, 2013 Last updated - 2013-09-18 SubjectsTermNotLitGenreText - United States--US}, month = {2013 Sep 09}, pages = {1506-13}, publisher = {173}, abstract = {

IMPORTANCE: Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life.

OBJECTIVE: To determine national estimates of disability during the last 2 years of life.

DESIGN: Prospective cohort study.

SETTING: A nationally representative study of older adults in the United States.

PARTICIPANTS: Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex.

MAIN OUTCOMES AND MEASURES: Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet.

RESULTS: There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52\% women). The prevalence of disability increased from 28\% (95\% CI, 24\%-31\%) 2 years before death to 56\% (95\% CI, 52\%-60\%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14\%; 70-79 years, 21\%; 80-89 years, 32\%; 90 years or more, 50\%; P for trend, <.001). Disability was more common in women 2 years before death (32\% [95\% CI, 28\%-36\%]) than men (21\% [95\% CI, 18\%-25\%]; P < .001), even after adjustment for older age at death.

CONCLUSIONS AND RELEVANCE: Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Disabled Persons, Educational Status, Female, Frail Elderly, Humans, Income, Longitudinal Studies, Male, Marital Status, Middle Aged, Prospective Studies, Sex Distribution, Socioeconomic factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2013.8738}, author = {Alexander K Smith and Louise C Walter and Yinghui Miao and W John Boscardin and Kenneth E Covinsky} } @article {7929, title = {Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, month = {2013 Jan}, pages = {96-100}, publisher = {61}, abstract = {

OBJECTIVES: To determine whether falling would be a marker for future difficulty with activities of daily (ADLs) that would vary according to fall frequency and associated injury.

DESIGN: Longitudinal analysis.

SETTING: Community.

PARTICIPANTS: Nationally representative cohort of 2,020 community-living, functionally independent older adults aged 65 to 69 at baseline followed from 1998 to 2008.

MEASUREMENTS: ADL difficulty.

RESULTS: Experiencing one fall with injury (odds ratio (OR) = 1.78, 95\% confidence interval (CI) = 1.29-2.48), at least two falls without injury (OR = 2.36, 95\% CI = 1.80-3.09), or at least two falls with at least one injury (OR = 3.75, 95\% CI = 2.55-5.53) in the prior 2 years was independently associated with higher rates of ADL difficulty after adjustment for sociodemographic, behavioral, and clinical covariates.

CONCLUSION: Falling is an important marker for future ADL difficulty in younger, functionally independent older adults. Individuals who fall frequently or report injury are at highest risk.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aging, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Health Status, Humans, Male, Odds Ratio, Retrospective Studies, Risk Factors, United States, Wounds and Injuries}, issn = {1532-5415}, doi = {10.1111/jgs.12071}, author = {Nishant K. Sekaran and Choi, Hwajung and Rodney A. Hayward and Kenneth M. Langa} } @article {7788, title = {Pain as a risk factor for disability or death.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, note = {Date revised - 2013-05-01 Last updated - 2013-05-31 DOI - 0b2ff290-e53b-4073-a3d7csamfg102v; 17944301; 0002-8614; 1532-5415 SubjectsTermNotLitGenreText - Demography; Mortality; Mobility; Risk factors; Disabilities; Survival; Pain}, month = {2013 Apr}, pages = {583-9}, publisher = {61}, abstract = {

OBJECTIVES: To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.

DESIGN: Prospective cohort study.

SETTING: The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.

PARTICIPANTS: Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.

MEASUREMENTS: Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10~yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).

RESULTS: At baseline, 2,283 (18\%) participants had significant pain. Participants with pain were more likely (all P~<~.001) to be female (65\% vs 54\%), have ADL difficulty (e.g., transferring 12\% vs 2\%, toileting 11\% vs 2\%), have difficulty walking several blocks (60\% vs 21\%), and have difficulty climbing one flight of stairs (40\% vs 12\%). Over 10~years, participants with pain were more likely to develop ADL disability or death (58\% vs 43\%, unadjusted hazard ratio (HR)~=~1.67, 95\% confidence interval~(CI)~=~1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR~=~0.98, 95\% CI~=~0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.

CONCLUSION: Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cohort Studies, Disabled Persons, Female, Geriatric Assessment, Health Status, Humans, Life Style, Male, Middle Aged, pain, Prevalence, Prognosis, Prospective Studies, Severity of Illness Index, Sex Distribution, Sex Factors, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12172}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1356928876?accountid=14667}, author = {James S Andrews and Irena Cenzer and Yelin, Edward and Kenneth E Covinsky} } @article {7814, title = {Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, month = {2013 Jun}, pages = {931-938}, publisher = {61}, abstract = {

OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke.

DESIGN: Prospective, observational study.

SETTING: Community-dwelling Health and Retirement Study (HRS) cohort.

PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441).

MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor{\textquoteright}s diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates.

RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards.

CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.

}, keywords = {Activities of Daily Living, Age of Onset, Aged, Aged, 80 and over, Bayes Theorem, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Humans, Male, Middle Aged, Morbidity, Prospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Stroke, Stroke Rehabilitation, Survival Rate, Survivors, Time Factors, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12270}, author = {Benjamin D Capistrant and Qianyi Wang and Sze Y Liu and M. Maria Glymour} } @article {7819, title = {Trends in late-life activity limitations in the United States: an update from five national surveys.}, journal = {Demography}, volume = {50}, year = {2013}, month = {2013 Apr}, pages = {661-71}, publisher = {50}, abstract = {

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disabled Persons, Female, Health Surveys, Humans, Male, Mobility Limitation, Models, Statistical, United States}, issn = {0070-3370}, doi = {10.1007/s13524-012-0167-z}, author = {Vicki A Freedman and Brenda C Spillman and Patricia Andreski and Jennifer C. Cornman and Eileen M. Crimmins and Kramarow, Ellen and Lubitz, James and Linda G Martin and Sharon S. Merkin and Robert F. Schoeni and Teresa Seeman and Timothy A Waidmann} } @article {7865, title = {Type of high-school credentials and older age ADL and IADL limitations: is the GED credential equivalent to a diploma?}, journal = {Gerontologist}, volume = {53}, year = {2013}, month = {2013 Apr}, pages = {326-33}, publisher = {53}, abstract = {

PURPOSE: Educational attainment is a robust predictor of disability in elderly Americans: older adults with high-school (HS) diplomas have substantially lower disability than individuals who did not complete HS. General Educational Development (GED) diplomas now comprise almost 20\% of new HS credentials issued annually in the United States but it is unknown whether the apparent health advantages of HS diplomas extend to GED credentials. This study examines whether adults older than 50 years with GEDs have higher odds of incident instrumental or basic activities of daily living (IADLs) limitations compared with HS degree holders.

METHODS: We compared odds of incident IADL limitations by HS credential type using discrete-time survival models among 9,426 Health and Retirement Study participants followed from 1998 through 2008.

RESULTS: HS degree holders had lower odds of incident IADLs than GED holders (OR = 0.72, 95\% CI = 0.58, 0.90 and OR = 0.69, 95\% CI = 0.56, 0.86 for ADLs and IADLs, respectively). There was no significant difference in odds of incident IADL limitations between GED holders and respondents without HS credentials (OR = 0.89, 95\% CI = 0.71, 1.11 for ADLs; OR = 0.88, 95\% CI = 0.70, 1.12 for IADLs).

IMPLICATIONS: Although GEDs are widely accepted as equivalent to high school diplomas, they are not associated with comparable health advantages for physical limitations in older age.

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Aging, Disabled Persons, Educational Status, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Socioeconomic factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gns077}, author = {Sze Y Liu and Chavan, Niraj R. and M. Maria Glymour} } @article {7741, title = {Vascular depression: an early warning sign of frailty.}, journal = {Aging Ment Health}, volume = {17}, year = {2013}, month = {2013}, pages = {85-93}, abstract = {

OBJECTIVES: Frailty is a common geriatric disorder associated with activities of daily living (ADL) impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004 ), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis.

METHODS: We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first represented respondents with either high cerebrovascular burden (CVB; at least two cerebrovascular risk factors) or probable depression (score >=3 on the 8-item Center for Epidemiological Studies Depression Scale (CES-D)), and the second represented respondents with both high CVB and probable depression.

RESULTS: At baseline, the prevalence of frailty was 31.5\%. Over four years the incidence of frailty was 31.8\%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004.

DISCUSSION: These findings suggest that vascular depression is a prodrome for frailty.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cerebrovascular Disorders, depression, Disabled Persons, Female, Follow-Up Studies, Frail Elderly, Geriatric Assessment, Health Status, Humans, Incidence, Logistic Models, Male, Prevalence, Psychiatric Status Rating Scales, Risk Factors, Socioeconomic factors, United States}, issn = {1364-6915}, doi = {10.1080/13607863.2012.692767}, author = {Daniel Paulson and Peter A Lichtenberg} } @article {7714, title = {Association of chronic diseases and impairments with disability in older adults: a decade of change?}, journal = {Med Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {501-7}, publisher = {50}, abstract = {

BACKGROUND: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.

OBJECTIVE: To examine how the associations of chronic disease and impairment with specific disability have changed over time.

RESEARCH DESIGN: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.

SUBJECTS: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.

MEASUREMENTS: : Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.

RESULTS: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99\% confidence interval (CI), 1.06-1.46; OR = 1.07; 99\% CI, 0.90-1.27; OR = 1.00; 99\% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99\% CI, 1.13-1.54; OR=0.97; 99\% CI, 0.82-1.14; OR = 0.99; 99\% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99\% CI, 1.01-1.46; OR = 1.37; 99\% CI, 1.15-1.64; OR = 1.52; 99\% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99\% CI, 1.33-2.03; OR = 1.63; 99\% CI, 1.32-2.01; OR = 2.11; 99\% CI, 1.73-2.57).

CONCLUSIONS: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.

}, keywords = {Activities of Daily Living, Aged, Aging, Cardiovascular Diseases, Chronic disease, Cognition Disorders, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Hearing loss, Humans, Hypertension, Male, Mobility Limitation, Residence Characteristics, Respiratory Tract Diseases, Self Care, Socioeconomic factors, United States, Vision Disorders}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a0e0}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7703, title = {Disability and decline in physical function associated with hospital use at end of life.}, journal = {J Gen Intern Med}, volume = {27}, year = {2012}, month = {2012 Jul}, pages = {794-800}, publisher = {27}, abstract = {

BACKGROUND: Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions.

OBJECTIVE: To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use.

DESIGN/PARTICIPANTS: We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000-2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI).

KEY RESULTS: Median hospital days was 7 (range = 0-183). 53\% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47-9.05, depending on category). Dementia was associated with fewer days (-3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27).

CONCLUSIONS: Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Dementia, Disability Evaluation, Disabled Persons, Female, Frail Elderly, Geriatric Assessment, Hospitalization, Humans, Length of Stay, Longitudinal Studies, Male, Medicare, Socioeconomic factors, Terminal Care, United States}, issn = {1525-1497}, doi = {10.1007/s11606-012-2013-9}, author = {Amy Kelley and Susan L Ettner and R Sean Morrison and Qingling Du and Catherine A Sarkisian} } @article {7742, title = {The Disability burden of COPD.}, journal = {COPD}, volume = {9}, year = {2012}, month = {2012 Aug}, pages = {513-21}, abstract = {

Affecting an estimated 12.6 million people and causing over 100,000 deaths per year, chronic obstructive pulmonary disease (COPD) exacts a heavy burden on American society. Despite knowledge of the impact of COPD on morbidity, mortality, and health care costs, little is known about the association of the disease with economic outcomes such as employment and the collection of disability. We quantify the impact of COPD on Americans aged 51 and older-in particular, their employment prospects and their likelihood of collecting federal disability benefits-by conducting longitudinal regression analysis using the Health and Retirement Study. Controlling for initial health status and a variety of sociodemographic factors, we find that COPD is associated with a decrease in the likelihood of employment of 8.6 percentage points (OR = 0.58, 95\% CI 0.50-0.67), from 44\% to 35\%. This association rivals that of stroke and is larger than those of heart disease, cancer, hypertension, and diabetes. Furthermore, COPD is associated with a 3.9 percentage point (OR 2.52, 95\% CI 2.00-3.17) increase in the likelihood of collecting Social Security Disability Insurance (SSDI), from 3.2\% to 7.1\%, as well as a 1.7 percentage point (OR 2.87, 95\% CI 2.02-4.08) increase in the likelihood of collecting Supplemental Security Income (SSI), from 1.0\% to 2.7\%. The associations of COPD with SSDI and SSI are the largest of any of the conditions studied. Our results are consistent with the hypothesis that COPD imposes a substantial burden on American society by inhibiting employment and creating disability.

}, keywords = {Aged, Cost of Illness, Disabled Persons, Employment, Female, Humans, Income, Insurance, Disability, Likelihood Functions, Logistic Models, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Social Security, United States}, issn = {1541-2563}, doi = {10.3109/15412555.2012.696159}, author = {Thornton Snider, Julia and J. A. Romley and Ken S Wong and Zhang, Jie and Eber, Michael and Dana P Goldman} } @article {7681, title = {Effect of obesity on falls, injury, and disability.}, journal = {J Am Geriatr Soc}, volume = {60}, year = {2012}, note = {Himes, Christine L Reynolds, Sandra L United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2012 Jan;60(1):124-9. doi: 10.1111/j.1532-5415.2011.03767.x. Epub 2011 Dec 8.}, month = {2012 Jan}, pages = {124-9}, publisher = {60}, abstract = {

OBJECTIVES: To examine the effect of obesity on the propensity of older adults to fall, sustain a fall-related injury, and develop disability in activities of daily living (ADLs) after a fall.

DESIGN: Longitudinal population-based survey.

SETTING: Five waves of the Health and Retirement Study (HRS), 1998-2006.

PARTICIPANTS: Ten thousand seven hundred fifty-five respondents aged 65 and older in 31,602 person-intervals.

MEASUREMENTS: Falls within any 2-year interval (9,621 falls). Injuries requiring medical attention (3,130 injuries). Increased ADL disability after a fall within any 2-year interval (2,162 events). Underweight and three classes of obesity (body mass index (BMI) 30.0-34.9~kg/m(2) , Class 1) 35.0-39.9~kg/m(2) , Class 2; >=40.0~kg/m(2) , Class 3), calculated from self-reported height and weight. Self-reported presence of lower body limitation, pain, dizziness, or vision problems. Self-reported doctor{\textquoteright}s diagnosis of diabetes mellitus, stroke, or arthritis.

RESULTS: Compared with normal-weight respondents, the odds ratios (OR) for risk of falling were 1.12 (95\% confidence interval (CI)~=~1.01-1.24) for obesity Class 1, 1.26 (95\% CI~=~1.05-1.51) for obesity Class 2, and 1.50 (95\% CI~=~1.21-1.86) for obesity Class 3. Conditional on falling, only obesity Class 3 was related to a lower propensity for a fall-related injury (OR~=~0.62, 95\% CI~=~0.44-0.87). Obesity Classes 1 and 2 were associated with a higher risk of greater ADL disability after a fall than normal-weight respondents (OR~=~1.17, 95\% CI~=~1.02-1.34; OR~=~1.39, 95\% CI~=~1.10-1.75, respectively). Being underweight was not related to risk of falling or to reported injury or greater ADL limitation after a fall. The presence of measured health problems and chronic conditions was associated with greater risk of falling and, of those who fell, greater ADL limitation but not serious injury.

CONCLUSION: Obesity appears to be associated with greater risk of falling in older adults, as well as a higher risk of greater ADL disability after a fall. Obesity (BMI~>=~40~kg/m(2) ) may reduce the risk of injury from a fall. Further investigation of the mechanisms of obesity on falls and related health outcomes is warranted.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Body Mass Index, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Humans, Incidence, Male, Obesity, Odds Ratio, Prevalence, Retrospective Studies, Risk Factors, United States, Wounds and Injuries}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03767.x}, author = {Christine L Himes and Sandra L Reynolds} } @article {7757, title = {Progressive and accelerated disability onset by race/ethnicity and education among late midlife and older adults.}, journal = {J Aging Health}, volume = {24}, year = {2012}, month = {2012 Dec}, pages = {1320-45}, abstract = {

OBJECTIVE: This study explores the pace of severe disability onset with an emphasis on the role of race/ethnicity and education. More specifically, this research examines whether race/ethnicity and educational attainment are independent predictors of progressive and accelerated disability onset.

METHOD: Using the Health and Retirement Study (HRS) Waves 2 to 10 (1994-2010), a series of discrete-time Cox proportional hazards models with multiple competing events were created to ascertain whether respondents developed progressive or accelerated disability in subsequent waves.

RESULTS: Black and Hispanic respondents were at an increased risk of developing progressive disability. Respondents without a high school degree were more likely to experience progressive or accelerated disability.

DISCUSSION: Low educational attainment was a particularly strong predictor of accelerated disability onset and may represent an acute lack of resources over the life course. Race and ethnicity were important predictors of progressive disability onset, which may reflect racial/ethnic variations in the disabling process.

}, keywords = {Black or African American, Disabled Persons, disease progression, Educational Status, Female, Follow-Up Studies, Health Status Disparities, Hispanic or Latino, Humans, Male, Middle Aged, Qualitative Research, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, United States, White People}, issn = {1552-6887}, doi = {10.1177/0898264312459345}, author = {Kenzie Latham} } @article {7751, title = {The relationship between body weight, frailty, and the disablement process.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Sep}, pages = {618-26}, publisher = {67}, abstract = {

OBJECTIVES: To prospectively examine the relationship between body weight, frailty, and the disablement process.

METHOD: Longitudinal data from the Health and Retirement Study (1998-2006) were used to examine the relationship between being underweight, overweight, or obese (compared with normal weight) and the onset and progression of functional limitations and disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) among a nationally representative sample of community-dwelling older adults (aged 50 and older) with characteristics of frailty (n= 11,491). Nonlinear multilevel models additionally adjusted for demographic characteristics and intra-individual changes in body weight, socioeconomic status, health behaviors, and health conditions over the course of 8 years.

RESULTS: Compared with their nonfrail normal weight counterparts, prefrail obese respondents have a 16\% (p <= 0.001) reduction in the expected functional limitations rate and frail overweight and obese respondents have a 10\% (p <= 0.01) and 36\% (p <= 0.001) reduction in the expected functional limitations rate, respectively. In addition, frail obese respondents have a 27\% (p <= 0.05) reduction in the expected ADL disability rate.

DISCUSSION: This study{\textquoteright}s findings suggest that underweight, overweight, and obese status differentially affect the risk for functional limitations and disabilities in IADL and ADL. Among prefrail and frail adults, some excess body weight in later life may be beneficial, reducing the rate of functional limitations and disability.

}, keywords = {Activities of Daily Living, Aged, Body Weight, Cross-Sectional Studies, Disability Evaluation, Disabled Persons, Female, Frail Elderly, Geriatric Assessment, Health Behavior, Health Surveys, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Overweight, Physical Fitness, Prospective Studies, sarcopenia, Socioeconomic factors, Thinness, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbs067}, author = {Mary E Bowen} } @article {7676, title = {Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study.}, journal = {BMC Geriatr}, volume = {12}, year = {2012}, month = {2012 Jul 26}, pages = {39}, publisher = {12}, abstract = {

BACKGROUND: Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders.

METHODS: Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation.

RESULTS: The prevalence of RLS among U.S. elders born before 1947 was 10.6\%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95\% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95\% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46).

CONCLUSIONS: RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cross-Sectional Studies, Disabled Persons, Female, Humans, Male, Middle Aged, Prevalence, Restless Legs Syndrome, Risk Factors, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-12-39}, author = {Dominic J Cirillo and Robert B Wallace} } @article {7712, title = {Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions.}, journal = {Am J Respir Crit Care Med}, volume = {185}, year = {2012}, note = {Iwashyna, Theodore J Netzer, Giora Langa, Kenneth M Cigolle, Christine K08 AG031837/AG/NIA NIH HHS/ K08 HL091249/HL/NHLBI NIH HHS/ K12 RR023250/RR/NCRR NIH HHS/ P30-AG028747/AG/NIA NIH HHS/ P60 DK-20572/DK/NIDDK NIH HHS/ R01 AG030155/AG/NIA NIH HHS/ U01 AG09740/AG/NIA NIH HHS/ UL1RR024986/RR/NCRR NIH HHS/ Am J Respir Crit Care Med. 2012 Apr 15;185(8):835-41. Epub 2012 Feb 9.}, month = {2012 Apr 15}, pages = {835-41}, publisher = {185}, abstract = {

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors{\textquoteright} own pre-sepsis levels assessed before hospitalization, or survivors{\textquoteright} own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients{\textquoteright} pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Chronic pain, Cohort Studies, Comorbidity, Critical Illness, Disabled Persons, disease progression, Female, Geriatric Assessment, Hearing Disorders, Hospitalization, Humans, Incidence, Male, Musculoskeletal Diseases, Prognosis, Retrospective Studies, Risk Assessment, Sepsis, Survival Analysis, Survivors, Thinness, Time, Treatment Outcome, Urinary incontinence, Vision Disorders}, issn = {1535-4970}, doi = {10.1164/rccm.201109-1660OC}, author = {Theodore J Iwashyna and Netzer, Giora and Kenneth M. Langa and Christine T Cigolle} } @article {7600, title = {Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {457-67}, publisher = {66B}, abstract = {

OBJECTIVES: We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities.

METHOD: Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control.

RESULTS: Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe.

DISCUSSION: These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cross-Cultural Comparison, Culture, Disabled Persons, England, Female, Gait, Health Status, Humans, Internal-External Control, Longitudinal Studies, Male, Mobility Limitation, Politics, Social Values, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr054}, author = {Philippa J Clarke and Jacqui Smith} } @article {7548, title = {Chronic diseases and functional limitations among older construction workers in the United States: a 10-year follow-up study.}, journal = {J Occup Environ Med}, volume = {53}, year = {2011}, month = {2011 Apr}, pages = {372-80}, publisher = {53}, abstract = {

OBJECTIVES: To examine the health status of older construction workers in the United States, and how occupation and the aging process affect health in workers{\textquoteright} later years.

METHODS: We analyzed six waves (1998 to 2008) of the Health and Retirement Study, a longitudinal survey of US residents age 50+. The study sample totaled 7200 male workers (510 in construction trades) in the baseline. Multiple logistic regression and paired t tests were conducted to compare health outcomes across occupations and within individuals over time.

RESULTS: Compared with white-collar workers, construction workers had increased odds of arthritis, back problems, chronic lung disease, functional limitations, work disability, and work-related injuries after controlling for possible confounders.

CONCLUSIONS: Safety and health interventions, as well as retirement and pension policy, should meet the needs of older construction workers, who face increasingly chronic health conditions over time.

}, keywords = {Aged, Aging, Arthritis, Chronic disease, Disabled Persons, Facility Design and Construction, Follow-Up Studies, Humans, Lung Diseases, Male, Middle Aged, Occupational Diseases, Occupations, United States}, issn = {1536-5948}, doi = {10.1097/JOM.0b013e3182122286}, author = {Xiuwen S Dong and Wang, Xuanwen and Daw, Christina and Ringen, Knut} } @article {7675, title = {Differences in health between Americans and Western Europeans: Effects on longevity and public finance.}, journal = {Soc Sci Med}, volume = {73}, year = {2011}, month = {2011 Jul}, pages = {254-63}, publisher = {73}, abstract = {

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

}, keywords = {Activities of Daily Living, Adult, Aged, Body Mass Index, Cross-Cultural Comparison, Disabled Persons, Europe, Female, Health Expenditures, health policy, Health Status Disparities, Health Surveys, Humans, Internationality, Life Expectancy, Male, Middle Aged, Models, Economic, Models, Statistical, Mortality, Public Health, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.05.027}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {7579, title = {Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, month = {2011 Aug 16}, pages = {43}, publisher = {11}, abstract = {

BACKGROUND: Most prior studies have focused on short-term (<= 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6\% on ADL abilities, 32.3\% on IADL abilities, and 30.9\% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cohort Studies, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Health Surveys, Humans, Insurance Benefits, Longitudinal Studies, Male, Medicare, Mobility Limitation, Prospective Studies, Time Factors, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-43}, author = {Frederic D Wolinsky and Suzanne E Bentler and Jason Hockenberry and Michael P Jones and Maksym Obrizan and Paula A Weigel and Kaskie, Brian and Robert B Wallace} } @article {7653, title = {Partner caregiving in older cohabiting couples.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, note = {Noel-Miller, Claire M Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 May;66(3):341-53. Epub 2011 Apr 11.}, month = {2011 May}, pages = {341-53}, publisher = {66}, abstract = {

OBJECTIVES: Despite the rapidly increasing prevalence of cohabitation among older adults, the caregiving literature has exclusively focused on formally married individuals. Extending prior work on intra-couple care, this study contrasts frail cohabitors{\textquoteright} patterns of care receipt from a partner to that of frail spouses.

METHODS: Using nationally representative panel data from the Health and Retirement Study (2000, 2002, 2004, and 2006), we estimate random effects cross-sectional times series models predicting frail cohabitors{\textquoteright} likelihood of receiving partner care compared with their married counterparts{\textquoteright}. Conditional on the receipt of intra-couple care, we also examine differences in marital and nonmarital partners{\textquoteright} caregiving hours and caregiving involvement relative to other helpers.

RESULTS: Net of sociodemographic, disability, and comorbidity factors, we find that cohabitors are less likely to receive partner care than married individuals. However, caregiving nonmarital partners provide as many hours of care as spouses while providing a substantially larger share of disabled respondents{\textquoteright} care than marital partners.

DISCUSSION: Cohabitation and marriage have distinct implications for older adults{\textquoteright} patterns of partner care receipt. This study adds weight to a growing body of research emphasizing the importance of accounting for older adults{\textquoteright} nontraditional union forms and of examining the ramifications of cohabitation for older adults{\textquoteright} well-being.

}, keywords = {Aged, Caregivers, Disabled Persons, Family Characteristics, Female, Frail Elderly, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Sex Factors, Single Person, Social Support}, issn = {1758-5368}, doi = {10.1093/geronb/gbr027}, author = {Claire No{\"e}l-Miller} } @article {7576, title = {Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education.}, journal = {Gerontologist}, volume = {51}, year = {2011}, month = {2011 Feb}, pages = {51-63}, publisher = {51}, abstract = {

PURPOSE: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education.

DESIGN AND METHODS: Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50.

RESULTS: Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model.

IMPLICATIONS: This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Educational Status, ethnicity, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Models, Theoretical, Racial Groups, Sex Distribution, Time Factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnq069}, author = {Chiu, Ching-Ju and Linda A. Wray} } @article {7637, title = {Recent trends in chronic disease, impairment and disability among older adults in the United States.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, note = {Hung, William W Ross, Joseph S Boockvar, Kenneth S Siu, Albert L K08 AG032886/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t England BMC geriatrics BMC Geriatr. 2011 Aug 18;11:47.}, month = {2011 Aug 18}, pages = {47}, publisher = {11}, abstract = {

BACKGROUND: To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.

METHODS: We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: The proportion of older adults reporting no chronic disease decreased from 13.1\% (95\% Confidence Interval [CI], 12.4\%-13.8\%) in 1998 to 7.8\% (95\% CI, 7.2\%-8.4\%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9\% (95\% CI, 86.2\%-89.6\%) in 1998 to 92.2\% (95\% CI, 91.6\%-92.8\%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7\% (95\% CI, 11.0\%-12.4\%) in 1998 to 17.4\% (95\% CI, 16.6\%-18.2\%) in 2008. The proportion of older adults reporting no impairments was 47.3\% (95\% CI, 46.3\%-48.4\%) in 1998 and 44.4\% (95\% CI, 43.3\%-45.5\%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2\% (95\% CI, 6.7\%-7.7\%) in 1998 and 7.3\% (95\% CI, 6.8\%-7.9\%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3\% (95\% CI, 25.4\%-27.2\%) in 1998 and 25.4\% (95\% CI, 24.5\%-26.3\%) in 2008.

CONCLUSIONS: Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Disabled Persons, Female, Health Surveys, Humans, Longitudinal Studies, Male, United States, Visually Impaired Persons}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-47}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7596, title = {Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Apr}, pages = {1236-48}, publisher = {72}, abstract = {

A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings \& Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.

}, keywords = {Age Factors, Black or African American, Disability Evaluation, Disabled Persons, Female, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Male, Middle Aged, Models, Statistical, Models, Theoretical, Sex Factors, Social Class, United States, White People}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.02.034}, author = {David F Warner and Tyson H Brown} } @article {7453, title = {Childhood socioeconomic position and disability in later life: results of the health and retirement study.}, journal = {Am J Public Health}, volume = {100 Suppl 1}, year = {2010}, month = {2010 Apr 01}, pages = {S197-203}, publisher = {100}, abstract = {

OBJECTIVES: We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life.

METHODS: We used longitudinal data from the nationally representative Health and Retirement Study (1998-2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities.

CONCLUSIONS: Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life.

}, keywords = {Activities of Daily Living, Cohort Studies, Disabled Persons, Female, Humans, Male, Michigan, Middle Aged, Prospective Studies, Retirement, Risk Assessment, Social Class}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.160986}, author = {Mary E Bowen and Hector M Gonz{\'a}lez} } @article {7493, title = {Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults.}, journal = {Soc Sci Med}, volume = {71}, year = {2010}, note = {Using Smart Source Parsing pp. Jul Elsevier Science, Amsterdam The Netherlands}, month = {2010 Jul}, pages = {405-413}, publisher = {71}, abstract = {

In this paper, we study the impact of obesity on labor market decisions of older working age adults in USA. Labor market outcomes are defined as any one of three: working; not working due to a disability; or not working due to an early retirement. Based on existing medical literature, we deduce that obesity can largely impact labor market decisions directly through impairment of bodily functions and indirectly by being a risk factor for various diseases like hypertension, arthritis, etc. We use data from the US Health and Retirement Study on older adults who were no more than 64 years of age in 2002. In our modeling effort, we employ two estimation strategies. We first estimate a model in which employment outcome in 2002 is a function of weight status in 1992. In the second strategy, controlling for time-invariant individual heterogeneity, we first consider the impact of obesity on bodily impairments and chronic illnesses; then, we consider the impact of such impairments and illnesses on labor market outcomes. Our results indicate that, for men, obesity class 2 and 3 increases both the probability of taking an early retirement and the incidence of disability by 1.5 percentage points. For women, we find that obesity class 2 and 3 increases the probability of taking an early retirement by 2.5 percentage points and the incidence of disability by 1.7 percentage points.

}, keywords = {Chronic disease, Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Obesity, Retirement, Risk Factors, Sex Factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.03.038}, author = {F. Renna and Thakur, Nidhi} } @article {7406, title = {Ethnicity and changing functional health in middle and late life: a person-centered approach.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {470-81}, publisher = {65}, abstract = {

OBJECTIVES: Following a person-centered approach, this research aims to depict distinct courses of disability and to ascertain how the probabilities of experiencing these trajectories vary across Black, Hispanic, and White middle-aged and older Americans.

METHODS: Data came from the 1995-2006 Health and Retirement Study, which involved a national sample of 18,486 Americans older than 50 years of age. Group-based semiparametric mixture models (Proc Traj) were used for data analysis.

RESULTS: Five trajectories were identified: (a) excellent functional health (61\%), (b) good functional health with small increasing disability (25\%), (c) accelerated increase in disability (7\%), (d) high but stable disability (4\%), and (e) persistent severe impairment (3\%). However, when time-varying covariates (e.g., martial status and health conditions) were controlled, only 3 trajectories emerged: (a) healthy functioning (53\%), moderate functional decrement (40\%), and (c) large functional decrement (8\%). Black and Hispanic Americans had significantly higher probabilities than White Americans in experiencing poor functional health trajectories, with Blacks at greater risks than Hispanics.

CONCLUSIONS: Parallel to the concepts of successful aging, usual aging, and pathological aging, there exist distinct courses of changing functional health over time. The mechanisms underlying changes in disability may vary between Black and Hispanic Americans.

}, keywords = {Age Factors, Aged, Black or African American, Disabled Persons, disease progression, ethnicity, Female, Health Status, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Likelihood Functions, Male, Marital Status, Middle Aged, Time Factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbp114}, author = {Jersey Liang and Xiao Xu and Joan M. Bennett and Wen Ye and Ana R Qui{\~n}ones} } @article {7477, title = {Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference?}, journal = {Soc Sci Med}, volume = {70}, year = {2010}, month = {2010 Apr}, pages = {1050-8}, publisher = {70}, abstract = {

This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (>or=70 years old) covering the period 1993-2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.

}, keywords = {Activities of Daily Living, Aged, Cognition, Community Health Services, depression, Disabled Persons, Female, Home Care Services, Humans, Logistic Models, Male, Mental Health, Multilevel Analysis, Risk Factors, Social Support, Spouses, State Government, Stress, Psychological, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2009.12.005}, author = {Muramatsu, Naoko and yin, Hongjun and Hedeker, Donald} } @article {7506, title = {Longitudinal changes in disabled husbands{\textquoteright} and wives{\textquoteright} receipt of care.}, journal = {Gerontologist}, volume = {50}, year = {2010}, month = {2010 Oct}, pages = {681-93}, publisher = {50}, abstract = {

PURPOSE OF THE STUDY: This study contrasts 2-year adjustments in disabled husbands{\textquoteright} and wives{\textquoteright} amount of received care following both worsening and recovery in personal (activities of daily living [ADLs]) and routine care (instrumental activities of daily living [IADLs]) disability.

DESIGN AND METHODS: Using longitudinal data on 789 husbands and 778 wives from the Health and Retirement Study (2000 and 2002), changes in marital partners{\textquoteright} monthly hours of spousal and nonspousal care were jointly modeled using bivariate Tobit models. In addition, asymmetry in the magnitude of responses to worsening and improvement of function was examined.

RESULTS: Disabled husbands receive more hours of spousal and nonspousal care following worsening in ADL function than wives. Conversely, disabled wives lose more spousal and nonspousal care hours following improvements in ADL disability than husbands. Moreover, wives recovering in ADL function lose more hours of spousal care than they receive following worsening in personal care disability. There is no evidence of corresponding gender differences in the dynamics of assistance received following changes in IADL function.

IMPLICATIONS: Compared with husbands, disabled wives are disadvantaged in the adjustment of their personal care hours. Although disabled married community residents receive more hours of care than their unmarried counterparts, there are important gender differences in the advantages offered by marriage.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Disabled Persons, Female, Humans, Long-term Care, Longitudinal Studies, Male, Marriage, Middle Aged, Models, Theoretical, Sex Factors, Social Support, Socioeconomic factors, Spouses, Surveys and Questionnaires, Time Factors}, issn = {1758-5341}, doi = {10.1093/geront/gnq028}, author = {Claire No{\"e}l-Miller} } @article {7528, title = {Long-term cognitive impairment and functional disability among survivors of severe sepsis.}, journal = {JAMA}, volume = {304}, year = {2010}, month = {2010 Oct 27}, pages = {1787-94}, publisher = {304}, abstract = {

CONTEXT: Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients{\textquoteright} long-term cognitive and functional limitations after sepsis is unknown.

OBJECTIVE: To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their presepsis functioning.

DESIGN, SETTING, AND PATIENTS: A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis.

MAIN OUTCOME MEASURES: Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance.

RESULTS: Survivors{\textquoteright} mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 (95\% confidence interval [CI], 1.53-7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis: in those with no limits before sepsis, a mean 1.57 new limitations (95\% CI, 0.99-2.15); and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations (95\% CI, 0.87-2.12). In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15; 95\% CI, 0.80-1.67; P for difference vs sepsis = .01) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48; 95\% CI, 0.39-0.57; P for difference vs sepsis <.001 and mean among those with mild to moderate limits, 0.43; 95\% CI, 0.23-0.63; P for difference = .001). The declines in cognitive and physical function persisted for at least 8 years.

CONCLUSIONS: Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients{\textquoteright} ability to live independently.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Case-Control Studies, Cognition Disorders, Disabled Persons, Female, Health Status, Hospitalization, Humans, Male, Prospective Studies, Sepsis, Severity of Illness Index, Survivors, United States}, issn = {1538-3598}, doi = {10.1001/jama.2010.1553}, url = {http://jama.ama-assn.org/content/304/16/1787.abstract}, author = {Theodore J Iwashyna and E Wesley Ely and Dylan M Smith and Kenneth M. Langa} } @article {12659, title = {Neighborhood disadvantage and self-assessed health, disability, and depressive symptoms: longitudinal results from the health and retirement study.}, journal = {Ann Epidemiol}, volume = {20}, year = {2010}, month = {2010 Nov}, pages = {856-61}, abstract = {

PURPOSE: By using a longitudinal cohort, we assessed the association between neighborhood disadvantage and incidence of poor health and function in three domains.

METHODS: More than 4,000 enrollees aged 55 to 65 years in the national Health and Retirement Study were assessed biennially from 1998 through 2006 for incidence of fair/poor self-rated health, elevated depressive symptoms, and limitations in six basic activities of daily living (disability). Each analysis was restricted to subjects without that condition in 1994 or 1996. Neighborhoods (census tracts, time-updated for moves), were considered disadvantaged if they fell below the 25th percentile in an index comprising six socioeconomic status indicators. Repeated measures logistic regressions, inverse probability weighted to account for individual confounders, selective survival, and loss to follow-up were used to estimate odds ratios (ORs) for incidence of each outcome in the wave after exposure to disadvantaged neighborhood.

RESULTS: After covariate adjustment, neighborhood disadvantage predicted onset of fair/poor SRH (OR, 1.36; 95\% confidence interval, 1.15-1.59) but not disability (OR, 0.97; 0.81-1.16) or elevated depressive symptoms (OR, 0.97; 0.81-1.16).

CONCLUSIONS: Results confirmed previous findings that neighborhood disadvantage predicts self-rated health in a longitudinal context but did not support an association between neighborhood disadvantage and onset of disability or elevated depressive symptoms.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Confidence Intervals, depression, Disabled Persons, Female, Health Status Disparities, Humans, Incidence, Logistic Models, Longitudinal Studies, Male, Middle Aged, Odds Ratio, Poverty, Residence Characteristics, Risk, Self-Assessment, Socioeconomic factors, Time Factors}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2010.08.003}, author = {M. Maria Glymour and Mujahid, Mahasin and Wu, Qiong and White, Kellee and Tchetgen Tchetgen, Eric J} } @article {7342, title = {Childhood socioeconomic status and racial differences in disability: evidence from the Health and Retirement Study (1998-2006).}, journal = {Soc Sci Med}, volume = {69}, year = {2009}, note = {PMID: 19541400}, month = {2009 Aug}, pages = {433-41}, publisher = {69}, abstract = {

This study used a life course approach to examine the ways in which childhood socioeconomic status (SES) may account for some of the racial differences in disability in later life. Eight years (5 waves) of longitudinal data from the US Health and Retirement Study (HRS; 1998-2006), a nationally representative sample of community-dwelling Black and White Americans over age 50 (N=14,588), were used in nonlinear multilevel models. Parental education and father{\textquoteright}s occupation were used to predict racial differences in activities of daily living (ADL) and instrumental activities of daily living (IADL). The role of adult SES (education, income, and wealth) and health behaviors (smoking, drinking alcohol, exercising, and being obese) were also examined and models were adjusted for health conditions (heart problems, diabetes, stroke, hypertension, cancer, lung disease, and arthritis). With the inclusion of childhood SES indicators, racial differences in ADL and IADL disability were reduced. Adult SES and health behaviors mediated some of the relationship between low childhood SES and disability, though low childhood SES continued to be associated with disability net of these. In support of a life course approach, these findings suggest that socioeconomic conditions in early life may have implications for racial differences in disability between older Black and older White adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Disabled Persons, Female, Health Behavior, Humans, Male, Middle Aged, Models, Statistical, Prejudice, Prospective Studies, Racial Groups, Social Justice, Socioeconomic factors, Statistics as Topic, United States, White People}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2009.06.006}, author = {Mary E Bowen} } @article {7341, title = {Fall risk in older adults: roles of self-rated vision, home modifications, and limb function.}, journal = {J Aging Health}, volume = {21}, year = {2009}, month = {2009 Aug}, pages = {655-76}, publisher = {21}, abstract = {

Objective. To assess direct effects of self-rated vision, home modifications, and limb functioning, and moderating effects of self-rated vision on change in functioning of upper and lower limbs on fall risk in older adults. Method. Logistic regression was used to analyze 2004 and 2006 waves of the Health and Retirement Study. Results. Effects of self-rated vision and home modifications in predicting falls decreased after controlling functioning in upper and lower extremities. Declines/gains in functioning across short periods of time superseded self-rated vision in predicting falls. No evidence was found for a moderating effect of vision status on limb functioning. Discussion. Poor self-rated vision may not be a good indicator of fall risk in older adults. Thus, for older adults with visual impairments, preserving residual limb functioning through exercise and activity has the important potential to reduce fall risk in addition to improving muscle and bone strength as well as improving balance and gait.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Disabled Persons, Educational Status, Female, Health Status, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Musculoskeletal Physiological Phenomena, Risk, Risk Factors, Self-Assessment, Self-Help Devices, Surveys and Questionnaires, Vision, Low, Visual Acuity, White People}, issn = {0898-2643}, doi = {10.1177/0898264309338295}, author = {Bernard A Steinman and Pynoos, Jon and Anna Q D Nguyen} } @article {7409, title = {Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Mar}, pages = {540-8}, publisher = {99}, abstract = {

OBJECTIVES: We compared the health of older US, English, and other European adults, stratified by wealth.

METHODS: Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n = 17,481), England (n = 6527), and the United States (n = 9940). We calculated prevalence rates of 6 chronic diseases and functional limitations.

RESULTS: American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12\% of English and 11\% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95\% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95\% CI = 1.73, 2.62) in England, and 1.38 (95\% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations.

CONCLUSIONS: American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

}, keywords = {Age Factors, Aged, Chronic disease, Confidence Intervals, Disabled Persons, Europe, Female, Health Status Disparities, Heart Diseases, Humans, Male, Middle Aged, Odds Ratio, Poverty, Prevalence, Risk Factors, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.139469}, author = {Mauricio Avendano and M. Maria Glymour and James Banks and Johan P Mackenbach} } @article {7400, title = {Medicare savings programs: analyzing options for expanding eligibility.}, journal = {Inquiry}, volume = {46}, year = {2009}, note = {Journal Article}, month = {2009-2010 Winter}, pages = {391-404}, publisher = {46}, abstract = {

The Medicare Savings Programs (MSPs) are designed to provide financial assistance to Medicare beneficiaries who do not qualify for full Medicaid coverage. This paper considers changes in eligibility that would better align MSP program rules with those related to receiving low-income subsidies for the Medicare Part D drug benefit. These changes would make more people eligible for the MSPs and could encourage greater participation; similar changes were incorporated in recently passed legislation. Our analysis, based on 2006 data from the Health and Retirement Study, shows there is a trade-off between making larger numbers of beneficiaries eligible by eliminating resource requirements and better targeting of individuals with greater health care needs by expanding income standards.

}, keywords = {Aged, Demography, Disabled Persons, Eligibility Determination, Female, Health Status, Humans, Income, Male, Medical Assistance, Medicare, Medicare Part D, Public Policy, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_46.4.391}, url = {URL:http://www.inquiryjournal.org Publisher{\textquoteright}s URL}, author = {Zuckerman, Stephen and Shang, Baoping and Timothy A Waidmann} } @article {7214, title = {Declines in late-life disability: the role of early- and mid-life factors.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Apr}, pages = {1588-602}, publisher = {66}, abstract = {

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2\% in 1995 to 26.0\% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother{\textquoteright}s education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Chronic disease, Cross-Sectional Studies, Disabled Persons, Female, Frail Elderly, Health Behavior, Health Status, Health Surveys, Humans, Life Style, Logistic Models, Male, Morbidity, Population Surveillance, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.11.037}, author = {Vicki A Freedman and Linda G Martin and Robert F. Schoeni and Jennifer C. Cornman} } @article {7198, title = {Degree of disability and patterns of caregiving among older Americans with congestive heart failure.}, journal = {J Gen Intern Med}, volume = {23}, year = {2008}, month = {2008 Jan}, pages = {70-6}, publisher = {23}, abstract = {

OBJECTIVES: Although congestive heart failure (CHF) is a common condition, the extent of disability and caregiving needs for those with CHF are unclear. We sought to determine: (1) prevalence of physical disability and geriatric conditions, (2) whether CHF is independently associated with disability, (3) rates of nursing home admission, and (4) formal and informal in-home care received in the older CHF population.

METHODS: We used cross-sectional data from the 2000 wave of the Health and Retirement Study. We compared outcomes among three categories of older adults: (1) no coronary heart disease (CHD), (2) CHD, without CHF, and (3) CHF. Compared to those without CHF, respondents reporting CHF were more likely to be disabled (P < 0.001) and to have geriatric conditions (P < 0.001). Respondents reporting CHF were more likely to have been admitted to a nursing home (P < 0.05). CHF respondents were more functionally impaired than respondents without CHF.

RESULTS: The adjusted average weekly informal care hours for respondents reporting CHF was higher than for those reporting CHD but without CHF and those reporting no CHD (6.7 vs 4.1 vs 5.1, respectively; P < 0.05). Average weekly formal caregiving hours also differed among the three groups (1.3 CHF vs 0.9 CHD without CHF vs 0.7 no CHD; P > 0.05).

CONCLUSIONS: CHF imposes a significant burden on patients, families, and the long-term care system. Older adults with CHF have higher rates of disability, geriatric conditions, and nursing home admission.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Coronary Disease, Cross-Sectional Studies, Disabled Persons, Female, Health Surveys, Heart Failure, Hospitalization, Humans, Male, Nursing homes, United States}, issn = {1525-1497}, doi = {10.1007/s11606-007-0456-1}, author = {Tanya R Gure and Mohammed U Kabeto and Caroline S Blaum and Kenneth M. Langa} } @article {7238, title = {Divergent pathways? Racial/ethnic differences in older women{\textquoteright}s labor force withdrawal.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 May}, pages = {S122-34}, publisher = {63B}, abstract = {

OBJECTIVES: The purpose of this study was to investigate how women{\textquoteright}s labor force withdrawal behavior varies across race/ethnicity and to identify life course factors that generate these differences.

METHODS: Using a sample of 7,235 women from the 1992-2004 Health and Retirement Study, we estimated cross-sectional multinomial logit models to explore racial/ethnic differences in labor force status at first interview. We then examined the prospective risk of exiting the labor force via retirement, work disability, or death using discrete-time hazard models.

RESULTS: Black and Hispanic women had twice the odds of Whites of being work-disabled at first interview. Whereas younger minorities had lower odds of being retired at first interview, older minorities had higher odds. The prospective results showed that both Blacks and Hispanics had higher risks of work disability but not of retirement or of dying in the labor force. Overall, racial/ethnic differences in mid- and later life work behavior stemmed primarily from disparities in life course capital.

DISCUSSION: This study shows that substantial racial/ethnic disparities in labor force exit behavior have already emerged by midlife. It is important to note that distinguishing between alternative pathways out of the labor force demonstrates that work disability is a more common experience for Black and Hispanic women than for Whites.

}, keywords = {Aged, Black People, Demography, Disability Evaluation, Disabled Persons, Employment, ethnicity, Hispanic or Latino, Humans, Middle Aged, Retirement, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.3.s122}, author = {Tyson H Brown and David F Warner} } @article {7228, title = {Dynamics of work disability and pain.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 Mar}, pages = {496-509}, publisher = {27}, abstract = {

This paper investigates the role of pain dynamics in subsequently affecting dynamics in self-reported work disability and the dynamics of employment patterns of older workers in the US. Not only is pain prevalence quite high, there also are many transitions in and out of pain at these ages. We investigate pain and its relationship to health (work disability) and work in a dynamic panel data model, using six biennial waves from the Health and Retirement Study. We find that the dynamics of the presence of pain are central to understanding the dynamics of self-reported work disability and through this pathway, pain dynamics are also a significant factor in the dynamic patterns of employment.

}, keywords = {Aged, Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Models, Statistical, pain, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2007.05.002}, author = {Arie Kapteyn and James P Smith and Arthur H.O. vanSoest} } @article {7252, title = {Gender differences in functional status in middle and older age: are there any age variations?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Sep}, pages = {S282-92}, publisher = {63B}, abstract = {

OBJECTIVES: The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups.

METHODS: Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women.

RESULTS: As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups.

DISCUSSION: A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women{\textquoteright}s socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Disabled Persons, Female, Health Status, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Sex Factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.5.s282}, author = {Jersey Liang and Joan M. Bennett and Benjamin A Shaw and Ana R Qui{\~n}ones and Wen Ye and Xiao Xu and Mary Beth Ofstedal} } @article {7217, title = {Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Jun}, pages = {367-84}, publisher = {20}, abstract = {

OBJECTIVE: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms.

METHODS: The sample included a prospective cohort of 53 to 63 year olds (n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later.

RESULTS: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions.

DISCUSSION: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

}, keywords = {Activities of Daily Living, Age Factors, Arthritis, Comorbidity, depression, Depressive Disorder, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Heart Diseases, Humans, Hypertension, Lung Diseases, Male, Mental Disorders, Middle Aged, Neoplasms, Obesity, Risk Factors, Sex Factors, Stroke, United States, Weight Gain}, issn = {0898-2643}, doi = {10.1177/0898264308315851}, author = {Valerie L Forman-Hoffman and Kelly K Richardson and Jon W. Yankey and Stephen L Hillis and Robert B Wallace and Frederic D Wolinsky} } @article {7218, title = {Neighborhoods and disability in later life.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Jun}, pages = {2253-67}, publisher = {66}, abstract = {

This paper uses the US Health and Retirement Study to explore linkages between neighborhood conditions and stages of the disablement process among adults aged 55 years and older in the United States. We consider multiple dimensions of the neighborhood including the built environment as well as social and economic conditions. In doing so, we use factor analysis to reduce indicators into eight neighborhood scales, which we incorporate into two-level logistic regression models along with controls for individual-level factors. We find evidence that economic conditions and the built environment, but not social conditions, matter. Neighborhood economic advantage is associated with a reduced risk of lower body limitations for both men and women. We also find for men that neighborhood economic disadvantage is linked to increased chances of reporting personal care limitations, particularly for those aged 55-64 years, and that high connectivity of the built environment is associated with reduced risk of limitations in instrumental activities. Our findings highlight the distinctive benefits of neighborhood economic advantage early in the disablement process. In addition, findings underscore the need for attention in the design and evaluation of disability-prevention efforts to the benefits that accrue from more physically connected communities and to the potential harm that may arise in later life from living in economically disadvantaged areas.

}, keywords = {Aging, Disabled Persons, Factor Analysis, Statistical, Female, Health Status Disparities, Humans, Male, Middle Aged, Residence Characteristics, Social Conditions, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2008.01.013}, author = {Vicki A Freedman and Irina B Grafova and Robert F. Schoeni and Jeannette Rogowski} } @article {7276, title = {Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers.}, journal = {Arch Phys Med Rehabil}, volume = {89}, year = {2008}, month = {2008 Jul}, pages = {1262-6}, publisher = {89}, abstract = {

OBJECTIVE: To compare incident disability patterns across racial and ethnic groups.

DESIGN: Prospective cohort study with 6-year follow-up (1998-2004).

SETTING: National probability sample.

PARTICIPANTS: A 1998 Health and Retirement Study sample of 12,288 non-Hispanic whites, 1952 African Americans, 575 Hispanics interviewed in Spanish (Hispanic-Spanish), and 518 Hispanics interviewed in English (Hispanic-English), older than 51 years, and free of disability at baseline.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Disability in activities of daily living (ADL) tasks (walking, dressing, transferring, bathing, toileting, feeding).

RESULTS: Hispanic-Spanish reported disproportionately lower rates of walking disability (standardized rates, 4.31\% vs Hispanic-English [8.57\%], black [7.54\%], white [7.20\%]) despite higher reported Hispanic-Spanish frequencies of lower-extremity dysfunction than other racial and ethnic groups. Across the 6 ADL tasks, the development of walking disability was most frequent among Hispanic-English subjects, African Americans, and whites. In contrast, Hispanic-Spanish subjects reported dressing as the most frequent ADL task disability, whereas walking ranked fourth.

CONCLUSIONS: Aggregating all Hispanics, regardless of interview language, may be inappropriate. Future research on linguistic group differences in self-reported health outcomes is necessary to ensure that health status measures will be appropriate for use in diverse racial and ethnic groups.

}, keywords = {Acculturation, Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Disabled Persons, Female, Geriatric Assessment, Health Status Indicators, Hispanic or Latino, Humans, Male, Middle Aged}, issn = {1532-821X}, doi = {10.1016/j.apmr.2007.11.042}, author = {Manasi A. Tirodkar and Song, Jing and Rowland W Chang and Dorothy D Dunlop and Huan J. Chang} } @article {7256, title = {Racial/ethnic differences in the relationship between the use of health care services and functional disability: the health and retirement study (1992-2004).}, journal = {Gerontologist}, volume = {48}, year = {2008}, month = {2008 Oct}, pages = {659-67}, publisher = {48}, abstract = {

PURPOSE: The purpose of this study was to examine racial/ethnic differences in the relationship between functional disability and the use of health care services in a nationally representative sample of older adults by using the Andersen behavioral model of health services utilization.

DESIGN AND METHODS: The study used 12 years of longitudinal data from the Health and Retirement Study (1992-2004), a nationally representative sample of community-dwelling adults older than 50 in 1992 (N = 8,947). Nonlinear multilevel models used self-reported health care service utilization (physician visits and hospital admissions) to predict racial/ethnic differences in disability (activities of daily living and mobility limitations). The models also evaluated the roles of other predisposing (age and gender), health need (medical conditions and self-rated health), and enabling factors (health insurance, education, income, and wealth).

RESULTS: Blacks and Latinos utilizing physician visits and hospital admissions were associated with significantly more activity of daily living disability than Whites (p <.001). Blacks utilizing physician visits (p <.001) and hospital admissions (p <.05) and Latinos utilizing hospital admissions (p <.05) were associated with more mobility disability than Whites. Other predisposing, health need, and enabling factors did not account for these racial/ethnic differences.

IMPLICATIONS: Nationally, health care use for Blacks and Latinos was associated with more disabilities than for Whites after we accounted for predisposing, health need, and enabling factors. The findings suggest that improving health care quality for all Americans may supersede equal access to health care for reducing ethnic and racial disparities in functional health.

}, keywords = {Activities of Daily Living, Disabled Persons, ethnicity, Female, Health Services, Health Status Disparities, Healthcare Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Racial Groups, Retirement}, issn = {0016-9013}, doi = {10.1093/geront/48.5.659}, author = {Mary E Bowen and Hector M Gonz{\'a}lez} } @article {7151, title = {Age group differences in depressive symptoms among older adults with functional impairments.}, journal = {Health Soc Work}, volume = {32}, year = {2007}, month = {2007 Aug}, pages = {177-88}, publisher = {32}, abstract = {

This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years or older who had at least one activities of daily living (ADL) or instrumental activities of daily living (IADL) limitation. Depression was defined as scoring three points or higher on the eight-point Center for Epidemiological Studies Depression Scale. The results show that respondents age 75 years or older with one ADL/IADL impairment or more were significantly less likely to be depressed than were those between ages 55 and 64 with the same degree of functional impairment. It is recommended that doctors, social workers, and other health care and social services providers pay special attention to younger old adults with health problems and functional limitations because they have a greater risk of being depressed.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Demography, depression, Disabled Persons, Female, Health Status, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, United States}, issn = {0360-7283}, doi = {10.1093/hsw/32.3.177}, author = {Namkee G Choi and Kim, Johnny S.} } @article {7123, title = {The long-term effects of poor childhood health: an assessment and application of retrospective reports.}, journal = {Demography}, volume = {44}, year = {2007}, month = {2007 Feb}, pages = {113-35}, publisher = {44}, abstract = {

This study assesses retrospective childhood health reports and examines childhood health as a predictor of adult health. The results suggest that such reports are of reasonable reliability as to warrant their judicious use in population research. They also demonstrate a large positive relationship between childhood and adult health. Compared with excellent, very good, or good childhood health, poor childhood health is associated with more than three times greater odds of having poor adult self-rated health and twice the risk of a work-limiting disability or a chronic health condition. These associations are independent of childhood and current socioeconomic position and health-related risk behaviors.

}, keywords = {Adolescent, Adult, Age Factors, Aged, Child, Child Welfare, Child, Preschool, Chronic disease, Disabled Persons, Female, Health Status, Humans, Infant, Infant, Newborn, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Time, United States}, issn = {0070-3370}, doi = {10.1353/dem.2007.0003}, author = {Steven A Haas} } @article {7175, title = {Racial/ethnic differences in the development of disability among older adults.}, journal = {Am J Public Health}, volume = {97}, year = {2007}, month = {2007 Dec}, pages = {2209-15}, publisher = {97}, abstract = {

OBJECTIVES: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.

METHODS: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.

RESULTS: The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95\% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95\% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95\% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2).

CONCLUSIONS: Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Disabled Persons, Female, Health Behavior, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Male, Prevalence, Proportional Hazards Models, Prospective Studies, Risk, Socioeconomic factors, Survival Analysis, United States, White People}, issn = {1541-0048}, doi = {10.2105/AJPH.2006.106047}, author = {Dorothy D Dunlop and Song, Jing and Larry M Manheim and Daviglus, Martha L. and Rowland W Chang} } @article {7114, title = {Functional impairment, race, and family expectations of death.}, journal = {J Am Geriatr Soc}, volume = {54}, year = {2006}, month = {2006 Nov}, pages = {1682-7}, publisher = {54}, abstract = {

OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race.

DESIGN: Cross-sectional.

SETTING: Community based.

PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older.

MEASUREMENTS: Families were interviewed within 2 years of the HRS participant{\textquoteright}s death. The primary outcome was whether death was expected. The primary predictors were the decedent{\textquoteright}s functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent{\textquoteright}s race.

RESULTS: Overall, 58\% of families reported that their family member{\textquoteright}s death was expected. Expecting death was strongly associated with functional impairment; 71\% of families of decedents with ADL disability expected death, compared with 24\% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60\%) than African Americans (49\%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95\% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95\% CI = 0.46-0.86).

CONCLUSION: Family members of older adults expected death only 58\% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.

}, keywords = {Activities of Daily Living, Aged, Attitude to Death, Black or African American, Cross-Sectional Studies, Disabled Persons, Family, Female, Hispanic or Latino, Humans, Male, White People}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2006.00941.x}, author = {Brie A Williams and Lindquist, Karla and Sandra Y. Moody-Ayers and Louise C Walter and Kenneth E Covinsky} } @article {7043, title = {Longitudinal analysis of the reciprocal effects of self-assessed global health and depressive symptoms.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Nov}, pages = {P296-P303}, publisher = {60}, abstract = {

This study examined whether a reciprocal relationship exists between measures of self-assessed global health and depressive symptoms, net of covariates that included chronic illness, functional disability, education, income, gender, race, and age. Analyses of five waves of data from the Rand version of the Health and Retirement Survey (N=7,475), using an autoregressive, cross-lagged panel design, indicated that self-assessed overall health had a modest but statistically significant and consistent effect on depressive symptoms. In contrast, the level of depressive symptoms had a statistically nonsignificant effect on self-assessed health. There has been growing interest in identifying the factors that inform self-assessments of overall health. The present findings indicate that self-assessed global health is not simply a manifestation of depressed affect.

}, keywords = {Aged, Analysis of Variance, Attitude to Health, Chronic disease, depression, Disabled Persons, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Personality Inventory, Psychometrics, Reproducibility of Results, Self-Assessment, Statistics as Topic}, issn = {1079-5014}, doi = {10.1093/geronb/60.6.p296}, author = {Karl Kosloski and Stull, Donald E. and Kercher, Kyle and VanDussen, Daniel J.} } @article {6912, title = {The impact of diabetes on workforce participation: results from a national household sample.}, journal = {Health Serv Res}, volume = {39}, year = {2004}, note = {Social Security Administration/Michigan Retirement Research Center Grant UM01-11}, month = {2004 Dec}, pages = {1653-69}, publisher = {39}, abstract = {

OBJECTIVE: Diabetes is a highly prevalent condition that results in substantial morbidity and premature mortality. We investigated how diabetes-associated mortality, disability, early retirement, and work absenteeism impacts workforce participation.

DATA SOURCE: We used the Health and Retirement Study (HRS), a national household sample of adults aged 51-61 in 1992, as a data source.

STUDY DESIGN: We conducted cross-sectional analyses on the baseline HRS data, and longitudinal analyses using data from eight years of follow-up. We used two-part regression models to estimate the adjusted impact of diabetes on workforce participation, and then estimated the economic impact of diabetes-related losses in productivity.

PRINCIPAL FINDINGS: Diabetes is a significant predictor of lost productivity. The incremental lost income due to diabetes by 1992 was 60.0 billion US dollars over an average diabetes duration of 9.7 years. From 1992 to 2000, diabetes was responsible for 4.4 billion US dollars in lost income due to early retirement, 0.5 billion US dollars due to increased sick days, 31.7 billion US dollars due to disability, and 22.0 US dollars billion in lost income due to premature mortality, for a total of 58.6 billion dollars in lost productivity, or 7.3 billion US dollars per year.

CONCLUSIONS: In the U.S. population of adults born between 1931 and 1941, diabetes is associated with a profound negative impact on economic productivity. By 1992, an estimated 60 billion US dollars in lost productivity was associated with diabetes; additional annual losses averaged 7.3 billion US dollars over the next eight years, totaling about 120 billion US dollars by the year 2000. Given the rising prevalence of diabetes, these costs are likely to increase substantially unless countered by better public health or medical interventions.

}, keywords = {Chronic disease, Cohort Studies, Cost of Illness, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Efficiency, Employment, Female, Health Services Research, Health Status Indicators, Humans, Longitudinal Studies, Male, Middle Aged, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2004.00311.x}, author = {Sandeep Vijan and Rodney A. Hayward and Kenneth M. Langa} } @article {6917, title = {Increasing obesity rates and disability trends.}, journal = {Health Aff (Millwood)}, volume = {23}, year = {2004}, month = {2004 Mar-Apr}, pages = {199-205}, publisher = {23}, abstract = {

Are older Americans becoming more or less disabled? Unhealthy body weight has increased dramatically, but other data show that disability rates have declined. We use data from the Health and Retirement Study to estimate the association between obesity and disability, and we combine these data with trend estimates of obesity rates from the Behavioral Risk Factor Surveillance Survey. If current trends in obesity continue, disability rates will increase by 1 percent per year more in the 50-69 age group than if there were no further weight gain.

}, keywords = {Aged, Disabled Persons, Female, Humans, Male, Middle Aged, Obesity, Population Surveillance, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.23.2.199}, author = {Sturm, Roland and Ringel, Jeanne S. and Andreyeva, Tatiana} } @article {6915, title = {Obesity{\textquoteright}s effects on the onset of functional impairment among older adults.}, journal = {Gerontologist}, volume = {44}, year = {2004}, month = {2004 Apr}, pages = {206-16}, publisher = {44}, abstract = {

PURPOSE: This study has two purposes. First, it determines if there is a relationship between body weight and the onset of functional impairment across time among this sample of older adults. More specifically, it examines if obese older adults are more likely to experience the onset of functional impairment. Second, it explores how health behaviors and health conditions may explain the relationship between body weight and the onset of functional impairment.

DESIGN AND METHODS: With the use of longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, logistic regression models on the onset of functional impairment over two time points are estimated for older adults.

RESULTS: Results indicate that body weight (more specifically being overweight or obese) makes one more likely to experience the onset of functional impairment across various domains of impairment. Outside of health behaviors and health conditions, obesity has an independent effect on the onset of impairment in strength, lower body mobility, and activities of daily living.

IMPLICATIONS: Study findings support the active treatment of weight problems in older adults. Future directions for research in this area should address effective weight management interventions targeting issues related to older individuals.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Body Weight, Chronic disease, Disabled Persons, Exercise, Female, Humans, Longitudinal Studies, Male, Motor Activity, Movement, Obesity, Risk-Taking, United States}, issn = {0016-9013}, doi = {10.1093/geront/44.2.206}, author = {Kristi Rahrig Jenkins} } @article {6944, title = {Resolving inconsistencies in trends in old-age disability: report from a technical working group.}, journal = {Demography}, volume = {41}, year = {2004}, month = {2004 Aug}, pages = {417-41}, publisher = {41}, abstract = {

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1\%-2.5\% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic disease, Disabled Persons, Female, Health Surveys, Homemaker Services, Humans, Male, Models, Statistical, Self-Help Devices, United States}, issn = {0070-3370}, doi = {10.1353/dem.2004.0022}, author = {Vicki A Freedman and Eileen M. Crimmins and Robert F. Schoeni and Brenda C Spillman and Aykan, Hakan and Kramarow, Ellen and Land, Kenneth and Lubitz, James and Kenneth G. Manton and Linda G Martin and Shinberg, Diane and Timothy A Waidmann} } @article {6926, title = {Retirement transitions and spouse disability: effects on depressive symptoms.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {59}, year = {2004}, month = {2004 Nov}, pages = {S333-42}, publisher = {59B}, abstract = {

OBJECTIVES: The purpose of this study was to investigate the effects of type of retirement (forced, early, abrupt) and spouse{\textquoteright}s disability on longitudinal change in depressive symptoms.

METHODS: The analyses rely on Waves 1-4 of the Health and Retirement Survey (N = 2,649). Generalized estimating equations models with bootstrapped standard errors and adjustment for survey design and non-independence of dyad members estimate effects of retirement, type of retirement, and spouse{\textquoteright}s disability on depressive symptoms, controlling for relevant covariates.

RESULTS: The results suggest that depressive symptoms increase when retirement is abrupt and perceived as too early or forced. Women retirees who stopped employment and were either forced into retirement or perceived their retirement as too early report significantly more depressive symptoms with increasing spouse activities of daily living (ADLs) limitations. There is no similar effect for men. In contrast, for working retirees who retired on time, depressive symptoms decrease with increasing spouse ADLs.

DISCUSSION: These results highlight the importance of retirement context on postretirement well-being. They suggest that both type of retirement transition and marital contexts such as spouse{\textquoteright}s disability influence postretirement well-being, and these effects differ by gender.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aged, Caregivers, Demography, depression, Disabled Persons, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retirement, Spouses, Surveys and Questionnaires}, issn = {1079-5014}, doi = {10.1093/geronb/59.6.s333}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {6989, title = {Workplace characteristics and work disability onset for men and women.}, journal = {Soz Praventivmed}, volume = {49}, year = {2004}, month = {2004}, pages = {122-31}, publisher = {49}, abstract = {

OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits.

METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview.

RESULTS: Women{\textquoteright}s disability onset and health problems appear less related to job characteristics than men{\textquoteright}s. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions.

CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.

}, keywords = {Disabled Persons, Female, Humans, Logistic Models, Male, Middle Aged, Occupational Diseases, Proportional Hazards Models, Retirement, Risk, Sex Factors, Sick Leave, Stress, Psychological, United States, Workers{\textquoteright} compensation, Workload, Workplace}, issn = {0303-8408}, doi = {10.1007/s00038-004-3105-z}, author = {Eileen M. Crimmins and Mark D Hayward} } @article {6890, title = {Determinants of stability and changes in self-reported work disability among older working-age populations.}, journal = {J Aging Soc Policy}, volume = {15}, year = {2003}, month = {2003}, pages = {11-31}, publisher = {15}, abstract = {

Data from the Health and Retirement Study, 1992-1994, were used to analyze (1) the prevalence and incidence of self-reported work disability among older working-age populations over a two-year period, and (2) the effect of the stability/changes in physical and functional health conditions, controlling for socioeconomic and occupational characteristics, on the stability/changes in self-reported work ability/disability. Findings show a high rate of transitions into and out of work-disabled status over the two-year period. Findings also show that, although objective physical and functional health problems and low self-ratings of health at wave 1 were significant determinants of self-reported work disability at wave 1, most subsequent changes in objective physical and functional health conditions over the two-year period were not significantly associated with the changes in self-report of work disability between wave 1 and wave 2. Especially, improved health conditions were not significantly associated with regained work ability between the two waves. Of the demographic variables, female gender significantly increased the likelihood of reporting work disability at wave 2, and being Black or Hispanic significantly decreased the likelihood of reporting regained work ability at wave 2. Research and policy implications of the findings are discussed.

}, keywords = {Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Self Disclosure, Surveys and Questionnaires}, issn = {0895-9420}, doi = {10.1300/J031v15n01_02}, author = {Namkee G Choi} } @article {6827, title = {Body-mass index and 4-year change in health-related quality of life.}, journal = {J Aging Health}, volume = {14}, year = {2002}, month = {2002 May}, pages = {195-210}, publisher = {14}, abstract = {

OBJECTIVE: To determine the effect of body-mass index (BMI) categories (a proxy for adiposity) on 4-year changes in health-related quality of life (HRQL) independent of baseline disease severity.

DESIGN: Secondary analyses of a prospective, longitudinal study.

PARTICIPANTS: Data on 7,895 adults ages 51 to 61 years who responded to the Health and Retirement Surveys in 1992, 1994, and 1996 were included.

RESULTS: Estimates of the effect of BMI on changes in HRQL were adjusted by disease severity. Each BMI category was associated with an increasing risk of decline in perceived health, with the highest risk in the higher categories. A BMI of between 30 and 35 was associated with a risk of decline in mobility.

CONCLUSIONS: The findings suggest a significant impact of BMI on changes in HRQL that is independent of disease severity and baseline HRQL.

}, keywords = {Body Mass Index, Disabled Persons, Female, Health Status, Humans, Male, Middle Aged, Obesity, Quality of Life, United States}, issn = {0898-2643}, doi = {10.1177/089826430201400202}, url = {http://reviews.bmn.com/medline/search/record?uid=MDLN.21990701andrefer=scirus}, author = {Damush, T.M. and Timothy E. Stump and Daniel O. Clark} } @article {6790, title = {Informal caregiving for diabetes and diabetic complications among elderly americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {57}, year = {2002}, month = {2002 May}, pages = {S177-86}, publisher = {57B}, abstract = {

OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care.

METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM.

RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM.

DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cost of Illness, Costs and Cost Analysis, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Humans, Hypoglycemic Agents, Insulin, Male, Time Factors}, issn = {1079-5014}, doi = {10.1093/geronb/57.3.s177}, author = {Kenneth M. Langa and Sandeep Vijan and Rodney A. Hayward and M.E. Chernew and Caroline S Blaum and Mohammed U Kabeto and David R Weir and Steven J. Katz and Robert J. Willis and A. Mark Fendrick} } @article {6737, title = {Predictors of transitions in disease and disability in pre- and early-retirement populations.}, journal = {J Aging Health}, volume = {13}, year = {2001}, month = {2001 Aug}, pages = {379-409}, publisher = {13}, abstract = {

OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period.

METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses.

RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes.

DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Chronic disease, Disabled Persons, Female, Health Status, Hispanic or Latino, Humans, Male, Middle Aged, Retirement, Risk Factors, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0898-2643}, doi = {10.1177/089826430101300304}, author = {Namkee G Choi and Schlichting-Ray, L.} } @article {6699, title = {Gender disparities in the receipt of home care for elderly people with disability in the United States.}, journal = {JAMA}, volume = {284}, year = {2000}, month = {2000 Dec 20}, pages = {3022-7}, publisher = {284}, abstract = {

CONTEXT: Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources.

OBJECTIVE: To address gender differences in receipt of informal and formal home care.

DESIGN, SETTING, AND PARTICIPANTS: Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older.

MAIN OUTCOME MEASURE: Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors.

RESULTS: Compared with disabled men, disabled women were much more likely to be living alone (45.4\% vs 16.8\%, P<.001) and much less likely to be living with a spouse (27.8\% vs 73.6\%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95\% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95\% CI, 19. 7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95\% CI, 13.7-15.8 vs 26.2 hours; 95\% CI, 24.6-27.9). Children (>80\% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95\% CI, 2.5-3.1 vs 2.1 hours for men; 95\% CI, 1.7-2.4).

CONCLUSION: Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.

}, keywords = {Activities of Daily Living, Aged, Disabled Persons, Family, Female, Geriatrics, Home Care Services, Home Nursing, Humans, Male, Regression Analysis, Sex Distribution, United States}, issn = {0098-7484}, doi = {10.1001/jama.284.23.3022}, author = {Steven J. Katz and Mohammed U Kabeto and Kenneth M. Langa} } @article {6715, title = {The prevalence and impact of accommodations on the employment of persons 51-61 years of age with musculoskeletal conditions.}, journal = {Arthritis Care Res}, volume = {13}, year = {2000}, month = {2000 Jun}, pages = {168-76}, publisher = {13}, abstract = {

OBJECTIVE: To provide estimates of the frequency with which persons 51 to 61 years of age with musculoskeletal conditions receive workplace accommodations from their employers and to determine if the receipt of such accommodations is associated with higher rates of employment two years later.

METHODS: The estimates derive from the Health and Retirement Survey, a national probability sample of 8,781 respondents who were interviewed both in 1992 and 1994 and who were between the ages of 51 and 61 years, of whom 5,495 reported one or more musculoskeletal conditions. We tabulated the frequency of accommodations provided in 1992 and then estimated the impact of accommodations and demographic and medical characteristics on 1994 employment status, using logistic regression.

RESULTS: In 1992, about 14.40 million persons aged 51-61 years reported a musculoskeletal condition. Of these, 1.32 million (9.2\%) reported a disability and were employed, the target population for accommodations. Overall, fewer than 1 in 5 persons with musculoskeletal conditions who had a disability and were employed indicated that they had received any form of accommodation on their current jobs. Although no form of accommodation was reported with great frequency, the most commonly used ones included getting someone to help do one{\textquoteright}s job (12.1\%), scheduling more breaks during the work day (9.5\%), changing the time that the work day started and stopped (6.3\%), having a shorter work day (5.6\%), getting special equipment (5.3\%), and changing the work tasks (5.3\%). Persons with one or more accommodations in 1992, however, were no more likely to be working in 1994 than those with none. Only one specific accommodation--getting someone to help do one{\textquoteright}s job--was associated with a higher rate of employment in 1994.

CONCLUSIONS: Receipt of employment accommodations occurred infrequently, and was not generally associated with an improvement in the employment rate of persons with musculoskeletal conditions and disabilities.

}, keywords = {Disabled Persons, Employment, Supported, Female, Health Status, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Morbidity, Musculoskeletal Diseases, Personnel Turnover, Program Evaluation, Surveys and Questionnaires, United States, Workload, Workplace}, issn = {0893-7524}, doi = {10.1002/1529-0131(200006)13:3<168::aid-anr6>3.0.co;2-r}, author = {Yelin, Edward and Sonneborn, Dean and Laura S. Trupin} } @article {6702, title = {Race and ethnic variation in the disablement process.}, journal = {J Aging Health}, volume = {12}, year = {2000}, month = {2000 May}, pages = {229-49}, publisher = {12}, abstract = {

OBJECTIVES: This analysis examines ethnoracial group differences in the transition from health to disability.

METHODS: Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability.

RESULTS: Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences.

DISCUSSION: The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

}, keywords = {Activities of Daily Living, Black or African American, Cognition Disorders, Disabled Persons, Hispanic or Latino, Humans, Socioeconomic factors, White People}, issn = {0898-2643}, doi = {10.1177/089826430001200205}, author = {Zsembik, Barbara A. and M. Kristen Peek and Chuck W Peek} } @article {6697, title = {The racial crossover in comorbidity, disability, and mortality.}, journal = {Demography}, volume = {37}, year = {2000}, note = {RDA 2002-016}, month = {2000 Aug}, pages = {267-83}, publisher = {37}, abstract = {

This study analyzed one respondent per household who was age 70 or more at the time of the household{\textquoteright}s inclusion in Wave 1 (1993-1994) and whose survival status was determinable at Wave 2 (1995-1996) of the Survey on Asset and Health Dynamics Among the Oldest Old (AHEAD Survey). At age 76 at Wave 1, there was a racial crossover in the cumulative number of six potentially fatal diagnoses (chronic lung disease, cancer, heart disease, hypertension, diabetes, and stroke) from a higher cumulative average number for blacks to a higher average number for whites. Also, there was a racial crossover at age 86 in the cumulative average number of disabilities in the Advanced Activities of Daily Living (AADLs), from a higher average for blacks to a higher average for whites. Between Waves 1 and 2, there was a racial crossover in the odds of mortality from higher odds for blacks to higher odds for whites; this occurred at about age 81. The results are consistent with the interpretation that the racial crossover in comorbidity (but not the crossover in AADL disability) propelled the racial crossover in mortality.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Birth Certificates, Black People, Chronic disease, Comorbidity, Cross-Over Studies, Death Certificates, Disabled Persons, Female, Humans, Male, United States, White People}, issn = {0070-3370}, author = {Nan E. Johnson} } @article {6671, title = {Measuring disability with parsimony.}, journal = {Disabil Rehabil}, volume = {21}, year = {1999}, month = {1999 May-Jun}, pages = {295-306}, publisher = {21}, abstract = {

PRIMARY OBJECTIVE: Health surveys, especially those for older persons, include numerous detailed items about disability. There has been little effort to develop a global disability item, that is, one question that covers the concept of disability briefly but well. This article discusses how parsimony can be achieved through a single item, or less desirably by reductions of detailed items.

MAIN OUTCOME AND RESULTS: Results of three analyses on the issue of compact disability indicators, using public-use data sets (AHEAD, HRS, BRFSS), are presented. The analyses study relationships of global disability to both detailed disability items and global health. Overall, the results show that a global disability item has good coverage of specific disabilities and is distinct from self-rated health.

CONCLUSIONS: Routine inclusion of a global disability item in surveys is recommended, and specific suggestions are made to aid its design.

}, keywords = {Activities of Daily Living, Disability Evaluation, Disabled Persons, Health Status Indicators, Health Surveys, Humans, Surveys and Questionnaires}, issn = {0963-8288}, doi = {10.1080/096382899297729}, url = {https://pubmed.ncbi.nlm.nih.gov/10381242}, author = {Verbrugge, Lois M. and Merrill, Susan S. and Xian Li} } @article {6666, title = {Transitions in employment, morbidity, and disability among persons ages 51-61 with musculoskeletal and non-musculoskeletal conditions in the US, 1992-1994.}, journal = {Arthritis Rheum}, volume = {42}, year = {1999}, month = {1999 Apr}, pages = {769-79}, publisher = {42}, abstract = {

OBJECTIVE: To provide estimates of the prevalence of musculoskeletal conditions in a sample of persons ages 51-61 living in the community in the US in 1992, to indicate the incidence of such conditions between 1992 and 1994, and to describe the proportion of individuals with these conditions who developed or recovered from disability and who left and entered employment during this time.

METHODS: The estimates were derived from the Health and Retirement Survey, consisting of data on a national probability sample of 8,739 persons, ages 51-61, who were interviewed in the community in 1992 and reinterviewed in 1994.

RESULTS: In 1992, 62.4\% of persons (14.4 million) between the ages of 51 and 61 years reported at least 1 musculoskeletal condition; the rate increased to 70.5\% by 1994. More than 40\% of persons with musculoskeletal conditions reported disability, which was almost 90\% of all persons with disability in this age group. Persons with musculoskeletal conditions had lower employment rates, were less likely to enter employment, and were more likely to leave employment compared with persons without these conditions. High rates of disability account for much of these differences.

CONCLUSION: Musculoskeletal conditions affected more than two-thirds of persons ages 51-61 and accounted for all but 10\% of those with disabilities. The prevention of disability among such persons should improve their employment prospects.

}, keywords = {Chronic disease, Disability Evaluation, Disabled Persons, Employment, Female, Humans, Incidence, Male, Middle Aged, Morbidity, Musculoskeletal Diseases, Prevalence, Retirement, United States}, issn = {0004-3591}, doi = {10.1002/1529-0131(199904)42:4<769::AID-ANR22>3.0.CO;2-M}, author = {Yelin, Edward and Laura S. Trupin and Sebesta, D.S.} } @article {6613, title = {Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994.}, journal = {Am J Public Health}, volume = {88}, year = {1998}, month = {1998 Nov}, pages = {1691-5}, publisher = {88}, abstract = {

OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries.

METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers.

RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95\% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios.

CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.

}, keywords = {Accidents, Occupational, Age Distribution, Aged, Aged, 80 and over, Analysis of Variance, Cross-Sectional Studies, Disabled Persons, Female, Health Surveys, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Prospective Studies, Retirement, Risk Factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.88.11.1691}, url = {https://pubmed.ncbi.nlm.nih.gov/9807538/}, author = {Zwerling, Craig and Nancy L. Sprince and Charles S. Davis and Paul S. Whitten and Robert B Wallace and Steven G Heeringa} } @article {6622, title = {Occupational injuries among older workers with visual, auditory, and other impairments. A validation study.}, journal = {J Occup Environ Med}, volume = {40}, year = {1998}, month = {1998 Aug}, pages = {720-3}, publisher = {40}, abstract = {

This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.

}, keywords = {Accidents, Occupational, Aged, Cohort Studies, Disabled Persons, Female, Health Surveys, Humans, Logistic Models, Male, Middle Aged, Persons With Hearing Impairments, Risk Factors, Visually Impaired Persons}, issn = {1076-2752}, doi = {10.1097/00043764-199808000-00010}, url = {https://pubmed.ncbi.nlm.nih.gov/9729756/}, author = {Zwerling, Craig and Paul S. Whitten and Charles S. Davis and Nancy L. Sprince} } @article {6566, title = {Demographic and economic correlates of health in old age.}, journal = {Demography}, volume = {34}, year = {1997}, note = {ProCite field 3 : RAND; UCLA and RAND}, month = {1997 Feb}, pages = {159-70}, publisher = {34}, abstract = {

In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (1) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, Demography, Disabled Persons, ethnicity, Female, Health Status, Humans, Income, Male, Models, Econometric, Racial Groups, Socioeconomic factors, United States}, issn = {0070-3370}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9074837}, author = {James P Smith and Raynard Kington} } @article {6581, title = {The earnings, income, and assets of persons aged 51-61 with and without musculoskeletal conditions.}, journal = {J Rheumatol}, volume = {24}, year = {1997}, month = {1997 Oct}, pages = {2024-30}, publisher = {24}, abstract = {

OBJECTIVE: To describe the personal and family earnings, income, and assets of persons with musculoskeletal conditions.

METHODS: This study uses the Health and Retirement Survey, a national, community based probability sample of persons 51-61 years of age and their spouses in 1992 to estimate earnings, income, and assets (by kind) in the years immediately prior to the normal age of retirement.

RESULTS: Fifty-nine percent of persons 51-61 years of age (13.76 million) report one or more musculoskeletal condition; of these 38\% (8.74 million) also report at least one comorbid condition and 21\% (5.02 million) report no such comorbidity. Persons with musculoskeletal conditions and comorbidity report 18\% lower family earnings, 15\% lower family income, and 35\% fewer assets than the average among all persons these ages. Persons with musculoskeletal conditions and no comorbidity have earnings, incomes, and assets closer to the average among their peers.

CONCLUSION: Persons with musculoskeletal conditions and comorbidity have lower earnings and incomes now and fewer assets with which to face the future than the remainder of their peers.

}, keywords = {Comorbidity, Data collection, Disabled Persons, Economics, Female, Health Services Research, Humans, Income, Male, Middle Aged, Musculoskeletal Diseases, Retirement}, issn = {0315-162X}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9330948}, author = {Yelin, Edward} } @article {6569, title = {Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {52}, year = {1997}, month = {1997 Mar}, pages = {M97-105}, publisher = {52A}, abstract = {

BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites.

METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups.

RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group.

CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Chronic disease, Cohort Studies, Disabled Persons, Disease, Female, Health Behavior, Humans, Male, Memory Disorders, Mexican Americans, Middle Aged, Prevalence, Risk Factors, Socioeconomic factors, White People}, issn = {1079-5006}, doi = {10.1093/gerona/52a.2.m97}, url = {http://biomed.gerontologyjournals.org/contents-by-date.0.shtml}, author = {Daniel O. Clark and Mungai, S.M. and Timothy E. Stump and Frederic D Wolinsky} } @article {6545, title = {Disentangling the effects of disability status and gender on the labor supply of Anglo, black, and Latino older workers.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {299-310}, publisher = {36}, abstract = {

Utilizing data from the 1991 Health and Retirement Study Early Release File, this article examines the effects of disability status on labor force participation and earnings of preretirement workers aged 50 to 64. Results from our hierarchical regression models suggest that poor health and the presence of a work disability significantly reduced the labor force participation and earnings of older men and women. These analyses also suggest that economic well-being was constrained by the costs associated with additional "minority statuses." For example, the odds of being employed were reduced by approximately 46\% for black men with disabilities. Further, the earnings of black men were 17\% lower than the earnings of their nondisabled counterparts.

}, keywords = {Black or African American, Disabled Persons, Employment, Female, Hispanic or Latino, Humans, Male, Middle Aged, Models, Theoretical, Multivariate Analysis, Sex Factors, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/36.3.299}, author = {Santiago, A.M. and Clara G. Muschkin} } @article {6551, title = {The role of ethnicity in the disability and work experience of preretirement-age Americans.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {287-98}, publisher = {36}, abstract = {

Using the 1992 HRS, this study examines the effects of social and demographic risk factors, including ethnicity, as well as health and job characteristics on disability and work status among 8,701 preretirement-age Americans with work history. Analytic results indicated that non-Anglo ethnicity was not a significant predictor of disability status but that being African American was a strong significant predictor of being a past versus current worker. The primary predictors of disability and work status were health behaviors, effects of health conditions, job characteristics, and workplace adaptations, factors that lend themselves to policy manipulation.

}, keywords = {Activities of Daily Living, Analysis of Variance, Disabled Persons, Employment, ethnicity, Female, Humans, Male, Middle Aged, Odds Ratio, Regression Analysis, Risk Factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.287}, author = {Linda A. Wray} }