@article {13278, title = {Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts.}, journal = {BMC Geriatr}, volume = {23}, year = {2023}, pages = {268}, abstract = {

BACKGROUND: Stroke and heart disease are two major contributors to the global disease burden. We aimed to evaluate and compare the roles of different handgrip strength (HGS) expressions in predicting stroke and heart disease in three nationally representative cohorts.

METHODS: This longitudinal study used data from the Health and Retirement Study (HRS), the Survey of Health, Ageing, and Retirement in Europe (SHARE), and the China Health and Retirement Longitudinal Study (CHARLS). The Cox proportional hazard model was applied to analyze the relationship between HGS and stroke and heart disease, and Harrell{\textquoteright}s C index was used to assess the predictive abilities of different HGS expressions.

RESULTS: A total of 4,407 participants suffered from stroke and 9,509 from heart disease during follow-up. Compared with the highest quartile, participants in the lowest quartile of dominant HGS, absolute HGS and relative HGS possessed a significantly higher risk of new-onset stroke in Europe, America, and China (all P < 0.05). After adding HGS to office-based risk factors, there were minimal or no differences in the increases of Harrell{\textquoteright}s C indexes among three HGS expressions. In contrast, the modest association between HGS and heart disease was only seen in SHARE and HRS, but not in CHARLS.

CONCLUSION: Our findings support that HGS can be used as an independent predictor of stroke in middle-aged and older European, American and Chinese populations, and the predictive ability of HGS may not depend on how it is expressed. The relationship between HGS and heart disease calls for further validation.

}, keywords = {Aged, Hand Strength, Heart Diseases, Humans, Longitudinal Studies, Middle Aged, Prospective Studies, Stroke}, issn = {1471-2318}, doi = {10.1186/s12877-023-03953-8}, author = {Li, Guochen and Lu, Yanqiang and Shao, Liping and Wu, Luying and Qiao, Yanan and Ding, Yi and Ke, Chaofu} } @article {13692, title = {Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults.}, journal = {Neurology}, volume = {101}, year = {2023}, pages = {e2355-e2363}, abstract = {

BACKGROUND AND OBJECTIVES: The role of aging biology as a novel risk factor and biomarker for vascular outcomes in different accessible body tissues such as saliva and blood remain unclear. We aimed to (1) assess the role of aging biology as a risk factor of stroke and heart disease among individuals of same chronologic age and sex and (2) compare aging biology biomarkers measured in different accessible body tissues as novel biomarkers for stroke and heart disease in older adults.

METHODS: This study included individuals who consented for blood and saliva draw in the Venous Blood Substudy and Telomere Length Study of the Health and Retirement Study (HRS). The HRS is a population-based, nationally representative longitudinal survey of individuals aged 50 years and older in the United States. Saliva-based measures included telomere length. Blood-based measures included DNA methylation and physiology biomarkers. Propensity scores-matched analyses and Cox regression models were conducted.

RESULTS: This study included individuals aged 50 years and older, who consented for blood (N = 9,934) and saliva (N = 5,808) draw in the HRS. Blood-based biomarkers of aging biology showed strong associations with incident stroke as follows: compared with the lowest tertile of blood-based biomarkers of aging, biologically older individuals had significantly higher risk of stroke based on DNA methylation Grim Age clock (adjusted hazard ratio [aHR] = 2.64, 95\% CI 1.90-3.66, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.75, 95\% CI 1.27-2.42, < 0.001). In secondary analysis, biologically older individuals had increased risk of heart disease as follows: DNA methylation Grim Age clock (aHR = 1.77, 95\% CI 1.49-2.11, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.61, 95\% CI 1.36-1.90, < 0.001).

DISCUSSION: Compared with saliva-based telomere length, blood-based aging physiology and some DNA methylation biomarkers are strongly associated with vascular disorders including stroke and are more precise and sensitive biomarkers of aging. Saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely represent different aspects of biological aging and accordingly vary in their precision as novel biomarkers for optimal vascular health.

}, keywords = {Aged, Aging, Biology, Biomarkers, DNA Methylation, Heart Diseases, Humans, Middle Aged, Saliva, Stroke, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000207909}, author = {Waziry, Reem and Gu, Yian and Boehme, Amelia K and Williams, Olajide A} } @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 {13022, title = {Cognitive decline among older adults with heart diseases before and during the COVID-19 pandemic: A longitudinal cohort study.}, journal = {Frontiers in Cardiovascular Medicine}, volume = {9}, year = {2022}, pages = {1077800}, abstract = {

BACKGROUND: Little is known about the impact induced by the COVID-19 pandemic on the cognitive function of older adults with heart diseases. This study aimed to examine whether older adults with heart diseases suffered larger cognitive deterioration during the COVID-19 pandemic.

METHODS: This study leveraged longitudinal data from the Health and Retirement Study (HRS), a nationally representative U.S. aging cohort with objective cognitive assessments measured before and during the pandemic. The interval from HRS waves 13 to 14 (April 2016 to June 2019) was defined as the pre-pandemic period to control the pre-existed cognitive difference between participants with and without heart diseases, and the interval from waves 14 to 15 (June 2019 to June 2021) was defined as the pandemic period. The HRS wave 14 survey was considered the baseline. The heart disease status was defined by a self-reported diagnosis. Linear mixed models were performed to evaluate and compare the cognitive differences during different periods.

RESULTS: A total of 9,304 participants (women: 5,655, 60.8\%; mean age: 65.8 {\textpm} 10.8 years) were included, and 2,119 (22.8\%) had heart diseases. During the pre-pandemic period, there was no significant difference (-0.03, 95\% CI: -0.22 to 0.15, = 0.716) in the changes in global cognitive scores between participants with and without heart disease. During the pandemic period, a larger decreased change in the global cognitive score was observed in the heart disease group compared with the non-heart disease group (-0.37, 95\% CI: -0.55 to -0.19, < 0.001). An enlarged difference in global cognitive score was observed during the pandemic period (-0.33, 95\% CI: -0.65 to -0.02, = 0.036).

CONCLUSION: The findings demonstrated that the population with heart diseases suffered more cognitive decline related to the pandemic, underscoring the necessity to provide immediate cognitive monitoring and interventions for the population with heart diseases.

}, keywords = {Cognitive decline, COVID-19 pandemic, Dementia, Heart Diseases}, issn = {2297-055X}, doi = {10.3389/fcvm.2022.1077800}, author = {Hua, Rong and Li, Chenglong and Gao, Darui and Zheng, Fanfan and Xie, Wuxiang} } @article {7695, title = {Health behavior change following chronic illness in middle and later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 May}, pages = {279-88}, publisher = {67B}, abstract = {

OBJECTIVES: Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life.

METHODS: Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease.

RESULTS: Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40\% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors.

DISCUSSION: Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Alcohol Drinking, Chi-Square Distribution, Chronic disease, Diabetes Mellitus, Exercise, Female, Health Behavior, Heart Diseases, Humans, Longitudinal Studies, Lung Diseases, Male, Middle Aged, Neoplasms, Smoking, Stroke, Time Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbr103}, author = {Jason T Newsom and Nathalie Huguet and Michael J. McCarthy and Pamela Ramage-Morin and Mark S Kaplan and Julie Bernier and Bentson McFarland and Jillian Oderkirk} } @article {7739, title = {Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults.}, journal = {Am J Epidemiol}, volume = {176}, year = {2012}, note = {Roberts, Melissa H Mapel, Douglas W United States Am J Epidemiol. 2012 Jul 15;176(2):127-34. Epub 2012 Jun 28.}, month = {2012 Jul 15}, pages = {127-34}, publisher = {176}, abstract = {

The authors examined whether peak expiratory flow (PEF) is a valid measure of health status in older adults. Survey and test data from the 2006 and 2008 cycles of the Health and Retirement Study, a longitudinal study of US adults over age 50 years (with biennial surveys initiated in 1992), were used to develop predicted PEF regression models and to examine relations between low PEF values and other clinical factors. Low PEF (<80\% of predicted value) was prevalent among persons with chronic conditions, including frequent pain, obstructive lung disease, heart disease, diabetes, and psychological distress. Persons with higher physical disability scores had substantially higher adjusted odds of having low PEF, on par with those for conditions known to be associated with poor health (cancer, heart disease, and stroke). In a multivariate regression model for difficulty with mobility, PEF remained an independent factor (odds ratio (OR) = 1.69, 95\% confidence interval (CI): 1.53, 1.86). Persons with low PEF in 2006 were more likely to be hospitalized (OR = 1.26, 95\% CI: 1.10, 1.43) within the subsequent 2 years and to estimate their chances of surviving for 10 or more years at less than 50\% (OR = 1.69, 95\% CI: 1.24, 2.30). PEF is a valid measure of health status in older persons, and low PEF is an independent predictor of hospitalization and poor subjective mortality assessment.

}, keywords = {Activities of Daily Living, Aged, Chronic disease, Cohort Studies, Comorbidity, Diabetes Mellitus, Female, Health Services, Health Status, Heart Diseases, Hospitalization, Humans, Incidence, Logistic Models, Longitudinal Studies, Lung Diseases, Male, Middle Aged, Neoplasms, Odds Ratio, Peak Expiratory Flow Rate, Population Surveillance, Stroke, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwr503}, author = {Melissa H. Roberts and Douglas W Mapel} } @article {7744, title = {Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke.}, journal = {Epidemiology}, volume = {23}, year = {2012}, note = {Nandi, Arijit Glymour, M Maria Kawachi, Ichiro VanderWeele, Tyler J HD060696/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Epidemiology. 2012 Mar;23(2):223-32.}, month = {2012 Mar}, pages = {223-32}, publisher = {23}, abstract = {

BACKGROUND: Early-life socioeconomic status (SES) is associated with adult chronic disease, but it is unclear whether this effect is mediated entirely via adult SES or whether there is a direct effect of adverse early-life SES on adult disease. Major challenges in evaluating these alternatives include imprecise measurement of early-life SES and bias in conventional regression methods to assess mediation. In particular, conventional regression approaches to direct effect estimation are biased when there is time-varying confounding of the association between adult SES and chronic disease by chronic disease risk factors.

METHODS: First-reported heart disease, diabetes, and stroke diagnoses were assessed in a national sample of 9760 Health and Retirement Study participants followed biennially from 1992 through 2006. Early-life and adult SES measures were derived using exploratory and confirmatory factor analysis. Early-life SES was measured by parental education, father{\textquoteright}s occupation, region of birth, and childhood rural residence. Adult SES was measured by respondent{\textquoteright}s education, occupation, labor force status, household income, and household wealth. Using marginal structural models, we estimated the direct effect of early-life SES on chronic disease onset that was not mediated by adult SES. Marginal structural models were estimated with stabilized inverse probability-weighted log-linear models to adjust for risk factors that may have confounded associations between adult SES and chronic disease.

RESULTS: During follow-up, 24\%, 18\%, and 9\% of participants experienced first onset of heart disease, diabetes, and stroke, respectively. Comparing those in the most disadvantaged with the least disadvantaged quartile, early-life SES was associated with coronary heart disease (risk ratio = 1.30 [95\% confidence interval = 1.12-1.51]) and diabetes (1.23 [1.02-1.48]) and marginally associated with stroke via pathways not mediated by adult SES.

CONCLUSIONS: Our results suggest that early-life socioeconomic experiences directly influence adult chronic disease outcomes.

}, keywords = {Age Factors, Age of Onset, Child, Diabetes Mellitus, Educational Status, Female, Heart Diseases, Humans, Income, Linear Models, Male, Middle Aged, Models, Statistical, Risk Factors, Social Class, Social Conditions, Socioeconomic factors, Stroke, United States}, issn = {1531-5487}, doi = {10.1097/EDE.0b013e31824570bd}, author = {Nandi, Arijit and M. Maria Glymour and Ichiro Kawachi and Tyler J VanderWeele} } @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 {7296, title = {Smoking and weight change after new health diagnoses in older adults.}, journal = {Arch Intern Med}, volume = {169}, year = {2009}, month = {2009 Feb 09}, pages = {237-42}, publisher = {169}, abstract = {

BACKGROUND: Smoking and patterns of diet and activity are the 2 leading underlying causes of death in the United States, yet the factors that prompt individuals to adopt healthier habits are not well understood.

METHODS: This study was undertaken to determine whether individuals who have experienced recent adverse health events are more likely to quit smoking or to lose weight than those without recent events using Health and Retirement Study panel survey data for 20 221 overweight or obese individuals younger than 75 years and 7764 smokers from 1992 to 2000.

RESULTS: In multivariate analyses, adults with recent diagnoses of stroke, cancer, lung disease, heart disease, or diabetes mellitus were 3.2 times more likely to quit smoking than were individuals without new diagnoses (P < .001). Among overweight or obese individuals younger than 75 years, those with recent diagnoses of lung disease, heart disease, or diabetes mellitus lost -0.35 U of body mass index (calculated as weight in kilograms divided by height in meters squared) compared with those without these new diagnoses (P < .001). Smokers with multiple new diagnoses were 6 times more likely to quit smoking compared with those with no new diagnoses. The odds of quitting smoking were 5 times greater in individuals with a new diagnosis of heart disease, and body mass index declined by 0.6 U in overweight or obese individuals with a new diagnosis of diabetes mellitus (P < .001).

CONCLUSIONS: Across a range of health conditions, new diagnoses can serve as a window of opportunity that prompts older adults to change health habits, in particular, to quit smoking. Quality improvement efforts targeting secondary as well as primary prevention through the health care system are likely well founded.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Body Mass Index, Diabetes Mellitus, Type 2, Health Behavior, Health Surveys, Heart Diseases, Humans, Longitudinal Studies, Lung Diseases, Middle Aged, Multivariate Analysis, Neoplasms, Overweight, Racial Groups, Smoking, Smoking cessation, Stroke, United States, Weight Loss}, issn = {1538-3679}, doi = {10.1001/archinternmed.2008.557}, author = {Patricia S Keenan} } @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 {7282, title = {Life with and without heart disease among women and men over 50.}, journal = {J Women Aging}, volume = {20}, year = {2008}, month = {2008}, pages = {5-19}, publisher = {20}, abstract = {

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

}, keywords = {Activities of Daily Living, Aged, Female, Health Status, Heart Diseases, Humans, Life Expectancy, Male, Middle Aged, Myocardial Infarction, Patient Education as Topic, Prejudice, Risk Factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {0895-2841}, doi = {10.1300/j074v20n01_02}, author = {Eileen M. Crimmins and Mark D Hayward and Ueda, Hiroshi and Saito, Yasuhiko and Jung K Kim} } @article {7263, title = {Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans.}, journal = {Psychosom Med}, volume = {70}, year = {2008}, month = {2008 Nov}, pages = {993-1004}, publisher = {70}, abstract = {

OBJECTIVE: To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD: Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS: Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS: The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Cohort Studies, Comorbidity, Confounding Factors, Epidemiologic, Culture, depression, Diabetes Mellitus, Educational Status, ethnicity, Factor Analysis, Statistical, Female, Heart Diseases, Humans, Hypertension, Interviews as Topic, Lung Diseases, Male, Self-Assessment, Sex Factors, Stroke, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0b013e31818ce4fa}, author = {Frances Margaret Yang and Richard N Jones} } @article {7152, title = {Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults.}, journal = {Gerontologist}, volume = {47}, year = {2007}, month = {2007 Aug}, pages = {423-37}, publisher = {47}, abstract = {

PURPOSE: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults.

DESIGN AND METHODS: We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiple-morbidity constellations on these expenses. We paid particular attention to the most common disease constellations - hypertension, arthritis, and heart disease.

RESULTS: An increasing prevalence of multiple morbidity (58\% compared with 70\% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-of-pocket expenditures (2,164 dollars in 1998, increasing by 104\% to 3,748 dollars in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41\%, 85\%, and 100\%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations.

IMPLICATIONS: Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders.

}, keywords = {Aged, Arthritis, Chronic disease, Comorbidity, Cost of Illness, Female, Financing, Personal, Health Expenditures, Health Surveys, Heart Diseases, Humans, Hypertension, Interviews as Topic, Male, Middle Aged, United States}, issn = {0016-9013}, doi = {10.1093/geront/47.4.423}, author = {Schoenberg, Nancy E. and Hyungsoo Kim and Edwards, William and Fleming, Steven T.} } @article {7080, title = {The tide to come: elderly health in Latin America and the Caribbean.}, journal = {J Aging Health}, volume = {18}, year = {2006}, note = {Article English}, month = {2006 Apr}, pages = {180-206}, publisher = {18}, abstract = {

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status{\textquoteright} connection to early conditions has some merit.

}, keywords = {Aged, Aged, 80 and over, Caribbean Region, Child, Diabetes Mellitus, Forecasting, Health Status, Heart Diseases, Humans, Latin America, Malnutrition, Middle Aged, Mortality, Nutritional Status, United States}, issn = {0898-2643}, doi = {10.1177/0898264305285664}, author = {Alberto Palloni and Mary McEniry and Rebeca Wong and Pelaez, M.} } @article {6985, title = {Heart disease, comorbidity, and activity limitation in community-dwelling elderly.}, journal = {Eur J Cardiovasc Prev Rehabil}, volume = {11}, year = {2004}, month = {2004 Oct}, pages = {427-34}, publisher = {11}, abstract = {

PURPOSE: The purpose of this study was to describe the impact of self-report heart disease, other chronic comorbidities, and perceived health status on activity limitation among community dwelling persons older than 50 years of age.

METHODS: Odds ratios for activity limitation in activities of daily living, mobility, and other activities were estimated for respondents with self-report heart disease, eight other chronic comorbid conditions, and perceived health status using data generated in two nationally representative cross-sectional surveys, the Health and Retirement Survey (HRS; respondents aged 51 to 60 years) and the Assets and Health Dynamics of the Oldest Old study (AHEAD; respondents aged 70 years and older).

RESULTS: The prevalence of activity limitation increased significantly across the spectrum from activities of daily living to mobility to other activities in both surveys in respondents with and without heart disease. There was a significantly increased likelihood of mobility and other activity limitation among those with heart disease. Among the HRS respondents with heart disease, five or more of the eight comorbid conditions plus poor or fair perceived health were associated with a significantly increased limitation in each activity category. Among the AHEAD respondents with heart disease, three comorbid conditions plus perceived health were associated with a significantly increased limitation in activities of daily living whereas six comorbid conditions plus perceived health were associated with a significantly increased limitation in mobility and in other activities.

CONCLUSIONS: As a prime objective of cardiac rehabilitation is to reduce activity limitation, the strong associations between comorbidity and activity limitation observed in this study among persons older than 50 years with heart disease suggest that the burden of comorbidity-associated is considerable but should not be an automatic exclusion criterion for referral to cardiac rehabilitation. The lack of rigorous scientific information on how these associations may influence clinicians who refer patients to rehabilitation and those who manage these programs strongly reinforces the need for more research to explore the real-world spectrum of comorbidity among persons with heart disease and the impact on activity limitation.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cross-Sectional Studies, Female, Health Status, Heart Diseases, Humans, Male, Middle Aged, Motor Activity, Residence Characteristics, Self Concept, Socioeconomic factors}, issn = {1741-8267}, doi = {10.1097/01.hjr.0000140716.25015.b8}, author = {Oldrige, Neil B. and Timothy E. Stump} }