@article {10.1093/geroni/igae021, title = {Can Retrospective Reports Provide Accurate Job History Information? A Comparison with Concurrent Reports in a National Prospective Study of Older Adults}, journal = {Innovation in Aging}, year = {Forthcoming}, abstract = {Growing interest in the impact of lifetime occupational exposures on later life health underscores the need to expand and evaluate the quality of data resources. The present study took advantage of a retrospective life history survey fielded within context of the Health and Retirement Study (HRS) to assess the accuracy of retrospectively obtained information on job history. We evaluated hypotheses related to job history and respondent characteristics to understand more about factors associated with recall accuracy.We used data from the Life History Mail Survey (LHMS), a self-administered survey conducted in 2015 and 2017. We compared the match rate of work status collected in the LHMS questionnaire with data collected concurrently during HRS core face-to-face or phone interviews from 1992 through 2016 with respect to jobs held at the time of interview. We also conducted a limit set of comparisons of occupation and industry match.The sample was 61.79\% female, 82.12\% white, and 8.57 percent Hispanic with a mean age of 74.70 years. The overall work status match rate was 83 percent. Jobs held longer ago were recalled with less accuracy. Jobs held for longer durations and that were full-time rather than part-time were recalled with greater accuracy. More complex job histories that involved a larger number of jobs were also associated with a lower match rate. Higher levels of conscientiousness and cognitive functioning were both associated with a higher match between the two sources of work status information. The occupation match rate was 69 percent, and the industry match rate was 77 percent.A self-administered, paper-and-pencil questionnaire attempting to measure decades-long histories of autobiographically important dimensions of life can provide reasonably accurate historical employment information. Several factors are likely to influence the relative accuracy of recalled information.}, keywords = {employment history, Life History Mail Survey, recall accuracy}, issn = {2399-5300}, doi = {10.1093/geroni/igae021}, author = {Sonnega, Amanda and Al-Hinai, Maymona and Chen, Qize and Helppie-McFall, Brooke and Smith, Jacqui} } @article {13651, title = {Chronic Pain Among Middle-Aged and Older Adults in the United States: The Role of Everyday Discrimination and Racial/Ethnic Identity.}, journal = {The Journal of Pain}, year = {Forthcoming}, abstract = {

Chronic pain disproportionately affects middle-aged and older adults in the United States. Everyday discrimination is associated with worse pain outcomes and is more prevalent among adults from racial/ethnic minoritized groups. Yet, there is limited evidence on relationships between everyday discrimination and chronic pain among middle-aged and older adults, as well as how discrimination and racial/ethnic identity may interact to influence this relationship. We used the 2018 Health and Retirement study to evaluate associations between exposure to everyday discrimination and odds to experience any, severe, and high-impact chronic pain among 5,314 Hispanic, non-Hispanic Black, and non-Hispanic White adults over the age of 50. Logistic regression was used to evaluate the main and interaction effects of everyday discrimination on the odds of chronic pain (any, severe, and high-impact) across racial/ethnic groups. Results showed that Hispanic and non-Hispanic Black middle-aged and older adults had a higher, unadjusted prevalence of severe and high-impact chronic pain and reported more exposure to everyday discrimination compared to non-Hispanic White middle-aged and older adults. In fully adjusted models, exposure to everyday discrimination predicted higher odds to experience each type of chronic pain. In addition, study findings showed that exposure to everyday discrimination significantly raised pain risk among Hispanic and non-Hispanic White, but not non-Hispanic Black, middle-aged, and older adults. Findings underscore the influential role of everyday discrimination on the chronic pain experiences of middle-aged and older adults, as well as differential effects across racial/ethnic groups. PERSPECTIVE: Using national data, we examined associations between discrimination and chronic pain among middle-aged and older adults, including interactions between discrimination and race/ethnicity. Exposure to discrimination predicted a higher chronic pain burden, overall. Differential effects within racial/ethnic groups underscored a need for more nuanced investigations into pain disparities among this population.

}, keywords = {Chronic pain, everyday discrimination, high impact chronic pain}, issn = {1528-8447}, doi = {10.1016/j.jpain.2023.11.022}, author = {Spector, Antoinette L and Quinn, Katherine G and Cruz-Almeida, Yenisel and Fillingim, Roger B} } @article {13880, title = {Correlates of SuperAging in Two Population-Based Samples of Hispanic Older Adults.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, year = {Forthcoming}, abstract = {

OBJECTIVES: {\textquoteright}SuperAgers{\textquoteright} are generally defined as people 80+ years old with episodic memory performance comparable to those 20 years younger. Limited knowledge exists to describe characteristics of SuperAgers, with even less known about Hispanic SuperAgers.

METHODS: We examined indicators of cognitive, physical, and psychological resilience in relation to the likelihood of being a SuperAger using data from two population-based studies of Hispanic older adults [Puerto Rican Elder: Health Conditions (PREHCO) study; Health and Retirement Study (HRS)]. SuperAgers were defined as 1) >=80 years old, 2) recall scores >= the median for Hispanic respondents aged 55-64, and 3) no cognitive impairment during the observation period. Overall, 640 PREHCO participants and 180 HRS participants were eligible, of whom 45 (7\%) and 31 (17\%) met SuperAging criteria.

RESULTS: Logistic regressions controlling for age and sex demonstrated that higher education (PREHCO: odds ratio[OR]=1.20, p<.001; HRS: OR=1.14, p=.044) and fewer instrumental activities of daily living (IADL) limitations (PREHCO: OR=0.79, p=.019; HRS: OR=0.58, p=.077) (cognitive resilience), fewer activities of daily living (ADL) limitations (PREHCO: OR=0.72, p=.031; HRS: OR=0.67, p=.068) (physical resilience), and fewer depressive symptoms (PREHCO: OR=0.84, p=.015; HRS: OR=0.69, p=.007) (psychological resilience) were associated with SuperAging, although not all results reached threshold for statistical significance, presumably due to low statistical power. Additionally, known indicators of physical health (e.g., chronic conditions, self-rated health) did not relate to SuperAging.

DISCUSSION: Increasing access to education and recognizing/treating depressive symptoms represent potential pathways to preserve episodic memory among older Hispanic adults.

}, keywords = {Cognitive Reserve, Minority aging, Puerto Rico, SuperAgers, Superior memory}, issn = {1758-5368}, doi = {10.1093/geronb/gbae058}, author = {Doyle, Cassidy and Andel, Ross and Saenz, Joseph and Crowe, Michael} } @article {13610, title = {Couples{\textquoteright} Cognition, Intimacy, and Activity Engagement: An Actor-Partner Interdependence Model Analysis.}, journal = {Clinical gerontologist}, year = {Forthcoming}, pages = {1-13}, abstract = {

OBJECTIVES: This study examines the actor and partner effects of cognition on activity engagement and the potential mediating role of intimate relationship in older couple dyadic context.

METHODS: Data for this study were obtained from heterosexual couples who participated in the 2020 wave of the Health and Retirement Study. Constructing a dyadic model of couples{\textquoteright} cognitions, activity engagement, and intimacy using structural equation modeling to analyze the relationship between variables and mediating effects.

RESULTS: At the actor level, cognition was positively correlated with their activity participation. At the partner level, wives{\textquoteright} cognition and husbands{\textquoteright} activity engagement were positively correlated. Husband{\textquoteright}s cognitive score affect wife{\textquoteright}s subjective feelings about intimacy. The mediation effect of Wife{\textquoteright}s intimacy on the relationship between husband{\textquoteright}s cognition and wife{\textquoteright}s activity engagement was significant.

CONCLUSIONS: In older couples, cognition influences activity engagement at a binary level, and this association is influenced by the level of intimacy. Improving intimacy can help increase activity engagement in older couples, which in turn promotes health. Clinical Implications Maintaining cognition helps older people enjoy good marriage and participation in activities. For women, the closer the partnership, the higher the frequency of participating in various activities.

}, keywords = {Activity engagement, Cognition, dyadic analysis, spouse relationship}, issn = {1545-2301}, doi = {10.1080/07317115.2023.2274524}, author = {Su, Fan and Chao, Jianqian and Zhang, Bowen and Zhang, Na and Luo, Zongyu and Han, Jiaying} } @article {10.1093/geroni/igae033, title = {Cognitive Decline after Divorce and Widowhood: Is Marital Loss Always a Loss?}, journal = {Innovation in Aging}, year = {2024}, month = {03}, pages = {igae033}, abstract = {We used longitudinal data to determine whether the type of marital loss is associated with the rate of cognitive change before and after divorce or widowhood. Previous research found that relationship status was associated with older adults{\textquoteright} cognitive performance: married persons performed better on memory assessments and had lower dementia risk than unmarried-cohabitating, never-married, divorced, and widowed persons. However, the end of a marriage may cause distress or reduce distress because a stressor disappears. Questions thus remain about the mechanisms by which marital change affects cognitive outcomes and, specifically, whether termination of marriage can improve cognitive performance for some.Using data from the 1998{\textendash}2016 waves of the Health and Retirement Study (HRS; N = 23,393), we conducted two analyses. First, we used trajectory analysis to create clusters of participants with similar cognitive trajectories and tested the association between participants{\textquoteright} cluster membership and marital loss type. Second, we used multi-level modeling (MLM) to analyze the relationship between participants{\textquoteright} cognitive scores while married and following divorce or widowhood and linked these to marital features.Participants who divorced showed no difference in trajectory distribution; widowed participants were more likely to be in the lower-performing and more quickly declining groups. Participants had lower rates of decline following divorce (β = 0.136, p \< 0.001), while widowed participants had accelerated decline following spousal death (β = -0.183, p \< 0.001) and an immediate decline following spousal death (β = -0.11}, keywords = {Alzheimer{\textquoteright}s disease, Dementia, Marriage}, issn = {2399-5300}, doi = {10.1093/geroni/igae033}, author = {Hanes, Douglas William and Clouston, Sean A P} } @article {13816, title = {Cognitive Functioning is Higher among Older Adults in Walkable Neighborhoods that Have Low Economic Disadvantage}, year = {2024}, institution = {Syracuse University}, address = {Syracuse}, keywords = {cognitive, economic disadvantage, Older Adults, walkable neighborhoods}, url = {https://surface.syr.edu/cgi/viewcontent.cgi?article=1244\&context=lerner}, author = {Tse-Chuan Yang and Seulki Kim and Seung-won Emily Choi and Shannon Halloway and Uchechi A. Mitchell and Benjamin A. Shaw} } @article {13817, title = {Cognitive Functioning is Higher among Older Adults in Walkable Neighborhoods that Have Low Economic Disadvantage}, year = {2024}, institution = {Syracuse University}, address = {Syracuse}, keywords = {cognitive, economic disadvantage, Older Adults, walkable neighborhoods}, url = {https://surface.syr.edu/cgi/viewcontent.cgi?article=1244\&context=lerner}, author = {Tse-Chuan Yang and Seulki Kim and Seung-won Emily Choi and Shannon Halloway and Uchechi A. Mitchell and Benjamin A. Shaw} } @article {13748, title = {Cost of care for Alzheimer{\textquoteright}s disease and related dementias in the United States: 2016 to 2060.}, journal = {NPJ Aging}, volume = {10}, year = {2024}, pages = {13}, abstract = {

Medical and long-term care for Alzheimer{\textquoteright}s disease and related dementias (ADRDs) can impose a large economic burden on individuals and societies. We estimated the per capita cost of ADRDs care in the in the United States in 2016 and projected future aggregate care costs during 2020-2060. Based on a previously published methodology, we used U.S. Health and Retirement Survey (2010-2016) longitudinal data to estimate formal and informal care costs. In 2016, the estimated per patient cost of formal care was $28,078 (95\% confidence interval [CI]: $25,893-$30,433), and informal care cost valued in terms of replacement cost and forgone wages was $36,667 ($34,025-$39,473) and $15,792 ($12,980-$18,713), respectively. Aggregate formal care cost and formal plus informal care cost using replacement cost and forgone wage methods were $196 billion (95\% uncertainty range [UR]: $179-$213 billion), $450 billion ($424-$478 billion), and $305 billion ($278-$333 billion), respectively, in 2020. These were projected to increase to $1.4 trillion ($837 billion-$2.2 trillion), $3.3 trillion ($1.9-$5.1 trillion), and $2.2 trillion ($1.3-$3.5 trillion), respectively, in 2060.

}, keywords = {Alzheimer, cost, Dementia, Health Care, health policy}, issn = {2731-6068}, doi = {10.1038/s41514-024-00136-6}, author = {Nandi, Arindam and Counts, Nathaniel and Br{\"o}ker, Janina and Malik, Sabrina and Chen, Simiao and Han, Rachael and Klusty, Jessica and Seligman, Benjamin and Tortorice, Daniel and Vigo, Daniel and Bloom, David E} } @article {13217, title = {Cardiovascular disease and type 2 diabetes in older adults: a combined protocol for an individual participant data analysis for risk prediction and a network meta-analysis of novel anti-diabetic drugs.}, journal = {medRxiv}, year = {2023}, abstract = {

INTRODUCTION: Older and multimorbid adults with type 2 diabetes (T2D) are at high risk of cardiovascular disease (CVD) and chronic kidney disease (CKD). Estimating risk and preventing CVD is a challenge in this population notably because it is underrepresented in clinical trials. Our study aims to (1) assess if T2D and haemoglobin A1c (HbA1c) are associated with the risk of CVD events and mortality in older adults, (2) develop a risk score for CVD events and mortality for older adults with T2D, (3) evaluate the comparative efficacy and safety of novel antidiabetics.

METHODS AND ANALYSIS: For Aim 1, we will analyse individual participant data on individuals aged >=65 years from five cohort studies: the Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People study; the Cohorte Lausannoise study; the Health, Aging and Body Composition study; the Health and Retirement Study; and the Survey of Health, Ageing and Retirement in Europe. We will fit flexible parametric survival models (FPSM) to assess the association of T2D and HbA1c with CVD events and mortality. For Aim 2, we will use data on individuals aged >=65 years with T2D from the same cohorts to develop risk prediction models for CVD events and mortality using FPSM. We will assess model performance, perform internal-external cross validation, and derive a point-based risk score. For Aim 3, we will systematically search randomized controlled trials of novel antidiabetics. Network meta-analysis will be used to determine comparative efficacy in terms of CVD, CKD, and retinopathy outcomes, and safety of these drugs. Confidence in results will be judged using the CINeMA tool.

ETHICS AND DISSEMINATION: Aims 1 and 2 were approved by the local ethics committee (Kantonale Ethikkommission Bern); no approval is required for Aim 3. Results will be published in peer-reviewed journals and presented in scientific conferences.

STRENGTHS AND LIMITATIONS: We will analyse individual participant data from multiple cohort studies of older adults who are often not well represented in large clinical trials.By using flexible survival parametric models, we will be able to capture the potentially complex shapes of the baseline hazard functions of cardiovascular disease (CVD) and mortality.Our network meta-analysis will include recently published randomised controlled trials on novel anti-diabetic drugs that have not been included in previous network meta-analysis and results will be stratified by age and baseline HbA1cAlthough we plan to use several international cohorts, the external validity of our findings and particularly of our prediction model will need to be assessed in independent studiesOur study will help guide CVD risk estimation and prevention among older adults with type 2 diabetes.

}, keywords = {anti-diabetic drugs, Cardiovascular disease, Diabetes, risk prediction}, doi = {10.1101/2023.03.13.23287105}, author = {Aponte Ribero, Valerie and Alwan, Heba and Efthimiou, Orestis and Abolhassani, Nazanin and Bauer, Douglas C and Henrard, S{\'e}verine and Christiaens, Antoine and Waeber, G{\'e}rard and Rodondi, Nicolas and Gencer, Baris and Del Giovane, Cinzia} } @article {article, title = {Change of productivity loss due to presenteeism among the ageing workforce: Role of work support, workplace discrimination, and the work-nonwork interface}, journal = {Human Resource Management Journal}, volume = {33}, year = {2023}, abstract = {Presenteeism behaviour (working while one is ill or experiencing cognitive or emotional difficulties) and the consequent productivity loss are attracting growing attention. Without proper support, employees who are under stress or ill are prone to presenteeism, which incurs invisible burdens on organizations. In this study, we focussed on productivity loss due to presenteeism (PRE) among the ageing workforce, because this group may be more vulnerable to productivity loss due to age-related deteriorating cognitive functions and physical abilities. We established a longitudinal latent difference score model over a two-wave period so we could examine whether and how the work{\textendash}nonwork interface mediates the effects of work support and workplace discrimination (DIS) on PRE. The results showed that the work{\textendash}nonwork interface fully mediated the positive influence of DIS on PRE as well as the negative influence of supervisor support.}, keywords = {ageing workforce, cognitive functions, Presenteeism, productivity decline}, doi = {10.1111/1748-8583.12475}, author = {Yang, Tianan and Liu, Yexin and Chen, Zhenjiao and Deng, Jianwei} } @article {13354, title = {Changes in childhood caregiving impressions among middle-aged and older adults}, year = {2023}, abstract = {Childhood experiences and impressions are important for individuals{\textquoteright} health and well-being{\textemdash}they often set the stage for how people approach relationships across the lifespan and how they make sense of their relational worlds. However, impressions of these experiences are likely not static and can change over time, even years after these experiences happened. The current study examined how impressions of parental relationships in childhood changed over time, and predictors of these changes, among middle-aged and older adults followed over a 4-year period (N = 2692; Mage = 66.67, SD = 9.15; 64.1\% women). Childhood impressions of parental care were mostly stable over time, with 53.5\%{\textendash}65.0\% of participants reporting consistent impressions. Becoming divorced/separated as an adult was associated with more negative impressions about relationships with fathers in the past. Having a mother pass away was associated with more positive impressions of mothers{\textquoteright} caregiving when participants were children. Higher depressive symptoms at follow-up were associated with darker perceptions of the past{\textemdash} more negative impressions of mothers and fathers as caregivers. The current study is one of the most comprehensive studies of late-life changes in childhood impressions to date, suggesting future directions for studying the organization of relational experiences and recollection over time.}, keywords = {caregiving impressions, divorce/separation, Health and Retirement Study, life span development, reminiscence bump}, doi = { 10.1111/pere.12499}, author = {William J. Chopik and Jeewon Oh and Sneha R. Challa and Hannah L. Hua and Julia M. Maahs and Jacqui Smith} } @article {13017, title = {Changes in social lives and loneliness during COVID-19 among older adults: a closer look at the sociodemographic differences.}, journal = {International Psychogeriatrics}, volume = {35}, year = {2023}, pages = {305-317}, abstract = {

OBJECTIVES: The COVID-19 pandemic greatly impacted the social lives of older adults across several areas, leading to concern about an increase in loneliness. This study examines the associations of structural, functional, and quality aspects of social connection with increased loneliness during COVID-19 and how these associations vary by sociodemographic factors.

DESIGN: Secondary data analyses on a nationally representative survey of older US adults.

SETTING: The 2020 Health and Retirement Study (HRS) COVID-19 module.

PARTICIPANTS: The study sample includes 3,804 adults aged 54 or older.

MEASUREMENTS: Increased loneliness was based on respondents{\textquoteright} self-report on whether they felt lonelier than before the COVID-19 outbreak.

RESULTS: While 29\% felt lonelier after COVID-19, middle-aged adults, women, non-Hispanic Whites, and the most educated were more likely to report increased loneliness. Not having enough in-person contact with people outside the household was associated with increased loneliness (OR = 10.07, < .001). Receiving emotional support less frequently (OR = 2.28, < .05) or more frequently (OR = 2.00, < .001) than before was associated with increased loneliness. Worse quality of family relationships (OR = 1.85, < .05) and worse friend/neighbor relationships (OR = 1.77, < .01) were related to feeling lonelier. Significant interactions indicated stronger effects on loneliness of poor-quality family relationships for women and insufficient in-person contact with non-household people for the middle-aged group and non-Hispanic Whites.

CONCLUSIONS: Our findings show an increase in loneliness during COVID-19 that was partly due to social mitigation efforts, and also uncover how sociodemographic groups were impacted differently, providing implications for recovery and support.

}, keywords = {COVID-19, Diversity, Pandemic, Psychosocial, social isolation}, issn = {1741-203X}, doi = {10.1017/S1041610222001107}, author = {Choi, Eun Young and Farina, Mateo P and Zhao, Erfei and Jennifer A Ailshire} } @article {13159, title = {Childhood Family Environment and Osteoporosis in a Population-Based Cohort Study of Middle-to Older-Age Americans.}, journal = {JBMR Plus}, volume = {7}, year = {2023}, month = {2023 May}, pages = {e10735}, abstract = {

Demographic and early-life socioeconomic and parental investment factors may influence later-life health and development of chronic and progressive diseases, including osteoporosis, a costly condition common among women. The "long arm of childhood" literature links negative early-life exposures to lower socioeconomic attainment and worse adult health. We build on a small literature linking childhood socioeconomic status (SES) and bone health, providing evidence of whether associations exist between lower childhood SES and maternal investment and higher risk of osteoporosis diagnosis. We further examine whether persons identifying with non-White racial/ethnic groups experience underdiagnosis. Data from the nationally representative, population-based cohort Health and Retirement Study (~=~5,490-11,819) were analyzed for participants ages 50-90 to assess these relationships. Using a machine learning algorithm, we estimated seven survey-weighted logit models. Greater maternal investment was linked to lower odds of osteoporosis diagnosis (odds ratio [OR]~=~0.80, 95\% confidence interval [CI]~=~0.69, 0.92), but childhood SES was not (OR~=~1.03, 95\% CI~=~0.94, 1.13). Identifying as Black/African American (OR~=~0.56, 95\% CI~=~0.40, 0.80) was associated with lower odds, and identifying as female (OR~=~7.22, 95\% CI~=~5.54, 9.40) produced higher odds of diagnosis. There were differences in diagnosis across intersectional racial/ethnic and sex identities, after accounting for having a bone density scan, and a model predicting bone density scan receipt demonstrated unequal screening across groups. Greater maternal investment was linked to lower odds of osteoporosis diagnosis, likely reflecting links to life-course accumulation of human capital and childhood nutrition. There is some evidence of underdiagnosis related to bone density scan access. Yet results demonstrated a limited role for the long arm of childhood in later-life osteoporosis diagnosis. Findings suggest that (1) clinicians should consider life-course context when assessing osteoporosis risk and (2) diversity, equity, and inclusivity training for clinicians could improve health equity. {\textcopyright} 2023 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

}, keywords = {americans, Childhood, middle-age, older-age, Osteoporosis}, issn = {2473-4039}, doi = {10.1002/jbm4.10735}, author = {Courtney, Margaret Gough and Roberts, Josephine and Quintero, Yadira and Godde, K} } @article {13132, title = {Childhood health conditions and insomnia among adults in mid-life.}, journal = {Aging Health Res}, volume = {3}, year = {2023}, month = {2023 Mar}, abstract = {

BACKGROUND: Little is known regarding the influence of childhood health broadly and childhood health conditions specifically on insomnia throughout adulthood.

METHODS: Health and Retirement Study (HRS) Baby Boomers born 1954-1965 were investigated. We fitted regression models predicting self-reported insomnia based on twenty-three retrospectively reported specific childhood health conditions (e.g., measles) and general childhood health measures and adjusted for demographics, childhood socioeconomic status, and adult socioeconomic status.

RESULTS: Nearly all the measures of childhood health significantly increased insomnia symptoms in adulthood. In a model where all measures were included, we found that respiratory disorders, headaches, stomach problems, and concussions were particularly strong predictors of insomnia.

CONCLUSIONS: Our findings extend past work illustrating the "long arm" of childhood conditions for health, showing that specific health conditions in childhood may indelibly imprint insomnia risk.

}, issn = {2667-0321}, doi = {10.1016/j.ahr.2023.100124}, author = {Sheehan, Connor and Cantu, Phillip and Powell, Danielle and Tran, Sydney} } @article {13503, title = {CogDrisk, ANU-ADRI, CAIDE, and LIBRA Risk Scores for Estimating Dementia Risk.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, month = {2023 Aug 01}, pages = {e2331460}, abstract = {

IMPORTANCE: While the Australian National University-Alzheimer Disease Risk Index (ANU-ADRI), Cardiovascular Risk Factors, Aging, and Dementia (CAIDE), and Lifestyle for Brain Health (LIBRA) dementia risk tools have been widely used, a large body of new evidence has emerged since their publication. Recently, Cognitive Health and Dementia Risk Index (CogDrisk) and CogDrisk for Alzheimer disease (CogDrisk-AD) risk tools have been developed for the assessment of dementia and AD risk, respectively, using contemporary evidence; comparison of the relative performance of these risk tools is limited.

OBJECTIVE: To evaluate the performance of CogDrisk, ANU-ADRI, CAIDE, LIBRA, and modified LIBRA (LIBRA with age and sex estimates from ANU-ADRI) in estimating dementia and AD risks (with CogDrisk-AD and ANU-ADRI).

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study obtained data from the Rush Memory and Aging Project (MAP), the Cardiovascular Health Study Cognition Study (CHS-CS), and the Health and Retirement Study-Aging, Demographics and Memory Study (HRS-ADAMS). Participants who were free of dementia at baseline were included. The factors were component variables in the risk tools that included self-reported baseline demographics, medical risk factors, and lifestyle habits. The study was conducted between November 2021 and March 2023, and statistical analysis was performed from January to June 2023.

MAIN OUTCOMES AND MEASURES: Risk scores were calculated based on available factors in each of these cohorts. Area under the receiver operating characteristic curve (AUC) was calculated to measure the performance of each risk score. Multiple imputation was used to assess whether missing data may have affected estimates for dementia risk.

RESULTS: Among the 6107 participants in 3 validation cohorts included for this study, 2184 participants without dementia at baseline were available from MAP (mean [SD] age, 80.0 [7.6] years; 1606 [73.5\%] female), 548 participants without dementia at baseline were available from HRS-ADAMS (mean [SD] age, 79.5 [6.3] years; 288 [52.5\%] female), and 3375 participants without dementia at baseline were available from CHS-CS (mean [SD] age, 74.8 [4.9] years; 1994 [59.1\%] female). In all 3 cohorts, a similar AUC for dementia was obtained using CogDrisk, ANU-ADRI, and modified LIBRA (MAP cohort: CogDrisk AUC, 0.65 [95\% CI, 0.61-0.69]; ANU-ADRI AUC, 0.65 [95\% CI, 0.61-0.69]; modified LIBRA AUC, 0.65 [95\% CI, 0.61-0.69]; HRS-ADAMS cohort: CogDrisk AUC, 0.75 [95\% CI, 0.71-0.79]; ANU-ADRI AUC, 0.74 [95\% CI, 0.70-0.78]; modified LIBRA AUC, 0.75 [95\% CI, 0.71-0.79]; CHS-CS cohort: CogDrisk AUC, 0.70 [95\% CI, 0.67-0.72]; ANU-ADRI AUC, 0.69 [95\% CI, 0.66-0.72]; modified LIBRA AUC, 0.70 [95\% CI, 0.68-0.73]). The CAIDE and LIBRA also provided similar but lower AUCs than the 3 aforementioned tools (eg, MAP cohort: CAIDE AUC, 0.50 [95\% CI, 0.46-0.54]; LIBRA AUC, 0.53 [95\% CI, 0.48-0.57]). The performance of CogDrisk-AD and ANU-ADRI in estimating AD risks was also similar.

CONCLUSIONS AND RELEVANCE: CogDrisk and CogDrisk-AD performed similarly to ANU-ADRI in estimating dementia and AD risks. These results suggest that CogDrisk and CogDrisk-AD, with a greater range of modifiable risk factors compared with other risk tools in this study, may be more informative for risk reduction.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Australia, Cohort Studies, Female, Heart Disease Risk Factors, Humans, Male, Risk Factors}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.31460}, author = {Huque, Md Hamidul and Kootar, Scherazad and Eramudugolla, Ranmalee and Han, S Duke and Carlson, Michelle C and Lopez, Oscar L and Bennett, David A and Peters, Ruth and Anstey, Kaarin J} } @article {12962, title = {Cognitive Aging in Same- and Different-Sex Relationships: Comparing Age of Diagnosis and Rate of Cognitive Decline in the Health and Retirement Study.}, journal = {Gerontology}, volume = {69}, year = {2023}, pages = {356-369}, abstract = {

INTRODUCTION: The ongoing marginalization of lesbian, gay, and bisexual people has been hypothesized to produce poorer late-in-life cognitive outcomes, according to mechanisms posited by minority stress and allostatic load theories. Yet the existence of those outcomes remains understudied, and results of existing studies have been contradictory. Using a population-based longitudinal aging study, this paper will compare age at diagnosis of Alzheimer{\textquoteright}s disease (AD) or a related dementia and rates of cognitive decline between participants in same-sex relationships (SSRs) and different-sex relationships (DSRs).

METHODS: The study used longitudinal cognitive-health data from the Health and Retirement Study (HRS; 1998-2018; N = 26,344) to analyze the onset of cognitive impairment and AD/dementia and the rates of cognitive change between participants in SSRs and those in DSRs. We hypothesized that SSR participants would have worse overall cognitive functioning in old age and would experience earlier onset of cognitive impairment. Using multiple regression, we compared the ages at which participants in SSRs and DSRs first reported AD or dementia diagnoses and the ages at which they first scored below cutoffs for cognitive impairment, not dementia (CIND) and possible dementia as determined using the cognitive assessment. The study then compared rates of cognitive decline over time across the SSR and DSR groups, including stratified analyses by education, race/ethnicity, wealth, and sex/gender.

RESULTS: Participants in SSRs reported dementia diagnoses (β = -12.346; p = 0.001), crossed the threshold into CIND (β = -8.815; p < 0.001) and possible dementia (β = -13.388; p < 0.001) at a younger age than participants in DSRs. When adjusted for covariates, participants in SSRs also had lower cognition at baseline (β = 0.745; p = 0.003), though having slower rates of cognitive decline when SSR was interacted with time (β = 0.066; p = 0.003). In separate analyses, cognitive differences for SSR participants were only found in participants without undergraduate degrees, with below-median household incomes, and women.

CONCLUSION: Our findings support theories suggesting that marginalization and stigma cause premature cognitive impairment. Findings also suggest that higher education might mitigate the adverse effects of sexuality-minority status on cognitive aging. Results do not support these theories{\textquoteright} claims of more rapid cognitive decline; the lower slopes of cognitive decline with time are compatible with the possibility of slower rates of decline for aging individuals in SSRs.

}, keywords = {Alzheimer disease, bisexual, Cognition, cognitive aging, Cognitive Dysfunction, Gay, Lesbian, Retirement, same-sex relationship, sexual orientation}, issn = {1423-0003}, doi = {10.1159/000526922}, author = {Hanes, Douglas William and Clouston, Sean A P} } @article {13510, title = {Cohabitation as a determinant of adaptive and innate immune cell profiles: Findings from the Health and Retirement Study.}, journal = {Brain, Behavior, and Immunity - Health}, volume = {33}, year = {2023}, pages = {100676}, abstract = {

INTRODUCTION: Non-genetic factors are important but poorly understood determinants of immune profiles. Age and Cytomegalovirus (CMV) infection remain two well documented non-genetic determinants of the immune profile. Recently, one study identified cohabitation in the same household as an important determinant of immune profiles.

METHODS: We used immunophenotyping data from the Health and Retirement Study (HRS) to evaluate the association between cohabitation and the adaptive (subsets of T-cells, B-cells) and innate immune profiles (subsets of monocytes, natural killer cells and neutrophils). We compared adaptive and innate immune cell profiles using immunophenotyping data from 1184 same-household pairs (cohabitating partners) to 1184 non-household pairs to evaluate the association between cohabitation and adaptive immune cell profiles. We used data from 1737 same-household pairs and 1737 non-household pairs to evaluate the association between cohabitation and innate cell profiles. Household and non-household pairs were matched on age ({\textpm}2years), educational background and race/ethnicity to minimize confounding due to these factors. The adaptive immune cells and innate immune cell profiles were compressed to two coordinates using multidimensional scaling (MDS). The Euclidean distances between same-household pairs were compared to the distances between non-household pairs for the adaptive and innate cell profiles separately using two sample independent t-tests. We also performed additional adjustment for age and BMI differences, CMV serostatus and smoking concordance/discordance status among household members.

RESULTS: For adaptive immune cell profiles, the mean Euclidean distance between same-household pairs was 4\% lower than the non-household pairs (p~=~0.03). When stratified by concordance for CMV serostatus among household pairs, the Euclidean distance was significantly lower by 8\% in the same-household pairs as compared to non-household pairs among those who were discordant for CMV serostatus (p~=~0.01) and among same-household pairs who were CMV seronegative (p~=~0.02) after covariate adjustment. The mean Euclidian distance between same-household pairs was also 8\% lower than non-household pairs for the innate immune cell profiles (p-value <0.0001) and this difference remained consistent across all strata of CMV infection.

DISCUSSION: This study confirms that cohabitation is associated with similarity in immune cell profiles. The differential effects of cohabitation on the adaptive and innate immune profiles suggest that further studies into the common environmental factors that influence individual immune cell subsets need to be evaluated in greater detail.

}, keywords = {cohabition, Immune System}, issn = {2666-3546}, doi = {10.1016/j.bbih.2023.100676}, author = {Ramasubramanian, Ramya and Kim, Jae Won and Guan, Weihua and Meier, Helen C S and Crimmins, Eileen and Jessica Faul and Bharat Thyagarajan} } @article {13299, title = {Communication Modalities, Personality Traits, and Change in Perceived Control Over Social Life Following Onset of the COVID-19 Pandemic Among Older Americans.}, journal = {Res Aging}, year = {2023}, pages = {1640275231178809}, abstract = {

We examined associations between change in social contact communication modalities and change in perceived control over social life (PCOSL) following onset of the COVID-19 pandemic among older Americans and evaluated the extent to which associations were moderated by personality. Data were from the 2016 and 2020 waves of the Health and Retirement Study. Multivariate ordinary least squares regression analyses were computed adjusting for baseline PCOSL, sociodemographic, health, and psychosocial factors. Multiple moderation analyses revealed that extraversion moderated the association between change in social media communication and change in PCOSL before to during COVID-19. As levels of engagement in social media communication increased, those with high extraversion experienced increases in PCOSL, whereas those with low extraversion experienced decreases in PCOSL. Findings suggest that social interventions targeting perceived control and communication modality may be useful for older adults during global health events and that personality characteristics can help to inform intervention choices.

}, issn = {1552-7573}, doi = {10.1177/01640275231178809}, author = {Choi, Shinae L and Hill, Kyrsten C and Parmelee, Patricia A} } @article {13513, title = {Cross-National and Cross-Generational Evidence That Educational Attainment May Slow the Pace of Aging in European-Descent Individuals.}, journal = {The Journal of Gerontology, Series B }, volume = {78}, year = {2023}, pages = {1375-1385}, abstract = {

OBJECTIVES: Individuals with more education are at lower risk of developing multiple, different age-related diseases than their less-educated peers. A reason for this might be that individuals with more education age slower. There are 2 complications in testing this hypothesis. First, there exists no definitive measure of biological aging. Second, shared genetic factors contribute toward both lower educational attainment and the development of age-related diseases. Here, we tested whether the protective effect of educational attainment was associated with the pace of aging after accounting for genetic factors.

METHODS: We examined data from 5 studies together totaling almost 17,000 individuals with European ancestry born in different countries during different historical periods, ranging in age from 16 to 98 years old. To assess the pace of aging, we used DunedinPACE, a DNA methylation algorithm that reflects an individual{\textquoteright}s rate of aging and predicts age-related decline and Alzheimer{\textquoteright}s disease and related disorders. To assess genetic factors related to education, we created a polygenic score based on the results of a genome-wide association study of educational attainment.

RESULTS: Across the 5 studies, and across the life span, higher educational attainment was associated with a slower pace of aging even after accounting for genetic factors (meta-analysis effect size = -0.20; 95\% confidence interval [CI]: -0.30 to -0.10; p = .006). Further, this effect persisted after taking into account tobacco smoking (meta-analysis effect size = -0.13; 95\% CI: -0.21 to -0.05; p = .01).

DISCUSSION: These results indicate that higher levels of education have positive effects on the pace of aging, and that the benefits can be realized irrespective of individuals{\textquoteright} genetics.

}, keywords = {Academic Success, Educational Status, Genome-Wide Association Study}, issn = {1758-5368}, doi = {10.1093/geronb/gbad056}, author = {Sugden, Karen and Moffitt, Terrie E and Arpawong, Thalida Em and Arseneault, Louise and Belsky, Daniel W and Corcoran, David L and Crimmins, Eileen M and Hannon, Eilis and Houts, Renate and Mill, Jonathan S and Poulton, Richie and Ramrakha, Sandhya and Wertz, Jasmin and Williams, Benjamin S and Caspi, Avshalom} } @article {13445, title = {Cumulative exposure to extreme heat and trajectories of cognitive decline among older adults in the USA.}, journal = {J Epidemiol Community Health}, year = {2023}, abstract = {

BACKGROUND: The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status.

METHODS: Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older.

RESULTS: We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods.

CONCLUSION: Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.

}, keywords = {Aging, Climate Change, Cognition, Cohort Studies}, issn = {1470-2738}, doi = {10.1136/jech-2023-220675}, author = {Choi, Eun Young and Lee, Haena and Chang, Virginia W} } @article {11845, title = {Changes in the Hierarchy of Functional Impairment from Middle Age to Older Age.}, journal = {The Journals of Gerontology, Series A }, volume = {77}, year = {2022}, pages = {1577-1584}, abstract = {

BACKGROUND: Understanding the hierarchy of functional impairment in older adults has helped illuminate mechanisms of impairment and inform interventions, but little is known about whether hierarchies vary by age. We compared the pattern of new-onset impairments in activities of daily living (ADLs) and instrumental ADLs (IADLs) from middle age through older age.

METHODS: We conducted a cohort study using nationally representative data from 32486 individuals enrolled in the Health and Retirement Study. The outcomes were new-onset impairment in each ADL and IADL, defined as self-reported difficulty performing each task, assessed yearly for 9 years. We used multi-state models and competing risks survival analysis to estimate the cumulative incidence of impairment in each task by age group (ages 50-64, 65-74, 75-84, and 85 or older).

RESULTS: The pattern of incident ADL impairments differed by age group. Among individuals ages 50-64 and 65-74 who were independent at baseline, over 9 years{\textquoteright} follow-up, difficulties dressing and transferring were the most common impairments to develop. In individuals ages 75-84 and 85 or older who were independent at baseline, difficulties bathing, dressing, and walking were most common. For IADLs, the pattern of impairments was similar across age groups; difficulty shopping was most common followed by difficulty managing money and preparing meals. Complementary analyses demonstrated a similar pattern.

CONCLUSIONS: These findings suggest that the hierarchy of ADL impairment differs by age. These findings have implications for the development of age-specific interventions to prevent or delay functional impairment.

}, keywords = {Activities of Daily Living, functional impairment}, issn = {1758-535X}, doi = {10.1093/gerona/glab250}, author = {Brown, Rebecca T and L Grisell Diaz-Ramirez and W John Boscardin and Anne Cappola and Lee, Sei J and Michael A Steinman} } @article {12678, title = {Childhood adversity and cognitive impairment in later life.}, journal = {Frontiers in Psychology}, volume = {13}, year = {2022}, pages = {935254}, abstract = {

Objectives: This study examined the association between childhood adversity and cognitive impairment in later life and explored the potential moderation effect of gender and race.

Methods: The study sample included 15,133 participants of the Health and Retirement Study (1998-2016 surveys) who had complete data on key study measures and were more than 50. The outcome variable is a dichotomous indicator of cognitive impairment as assessed by the Telephone Interview for Cognitive Status for self-respondents and the 16-item Informant Questionnaire on Cognitive Decline in the Elderly for proxies. A total of six childhood adversity indicators included grade retention, parental substance abuse, physical abuse, trouble with the police, moving due to financial hardship, and receipt of help due to financial hardship in early life. The estimation of the association between childhood adversity and cognitive impairment involved Cox proportional hazards regression. Results: Grade retention had the largest effect on incident cognitive impairment (HR = 1.3, 95\% CI = 1.23-1.38, < 0.001), followed by physical abuse by a parent (HR = 1.10, 95\% CI = 1.00-1.20, = 0.001). The impact of grade retention was more detrimental to women than men (interaction term HR = 0.89, 95\% CI = 0.80-1.00, = 0.048, female as the reference). Parental substance abuse was associated with a lower risk of incident cognitive impairment for most racial groups (HR = 0.89, 95\% CI = 0.83-0.95, = 0.001), but this association was reversed in "non-Hispanic other" race, consisting mainly of Asians (HR = 1.54, 95\% CI = 1.05-2.26, = 0.025).

Discussion: Some aspects of childhood adversity continue to harm cognitive functioning in later life, while some events may have the opposite effect, with evidence of heterogeneity across gender and race.

}, keywords = {ACE, Adverse childhood events, Childhood adversity, cognitive impairment, Dementia, life course}, issn = {1664-1078}, doi = {10.3389/fpsyg.2022.935254}, author = {Xiang, Xiaoling and Cho, Joonyoung and Sun, Yihang and Wang, Xiafei} } @article {12519, title = {Cognitive Decline, Limited Awareness, Imperfect Agency, and Financial Well-being}, number = {29634}, year = {2022}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Cognitive decline may lead older Americans to make poor financial decisions. Preventing poor decisions may require timely transfer of financial control to a reliable agent. Cognitive decline, however, can develop unnoticed, creating the possibility of suboptimal timing of the transfer of control. This paper presents survey-based evidence that wealthholders regard suboptimal timing of the transfer of control, in particular delay due to unnoticed cognitive decline, as a substantial risk to financial well-being. This paper provides a theoretical framework to model such a lack of awareness and the resulting welfare loss.}, keywords = {Cognitive decline, Financial well-being}, doi = {10.3386/w29634}, author = {Ameriks, John and Caplin, Andrew and Lee, Minjoon and Matthew D. Shapiro and Tonetti, Christopher} } @article {12601, title = {A computational solution for bolstering reliability of epigenetic clocks: implications for clinical trials and longitudinal tracking}, journal = {Nature Aging}, volume = {2}, year = {2022}, pages = {644{\textendash}661}, abstract = {Epigenetic clocks are widely used aging biomarkers calculated from DNA methylation data, but this data can be surprisingly unreliable. Here we show that technical noise produces deviations up to 9 years between replicates for six prominent epigenetic clocks, limiting their utility. We present a computational solution to bolster reliability, calculating principal components (PCs) from CpG-level data as input for biological age prediction. Our retrained PC versions of six clocks show agreement between most replicates within 1.5 years, improved detection of clock associations and intervention effects, and reliable longitudinal trajectories in vivo and in vitro. This method entails only one additional step compared to traditional clocks, requires no replicates or previous knowledge of CpG reliabilities for training, and can be applied to any existing or future epigenetic biomarker. The high reliability of PC-based clocks is critical for applications to personalized medicine, longitudinal tracking, in vitro studies and clinical trials of aging interventions.}, keywords = {Aging, Bioinformatics, computational models, DNA Methylation, predictive markers}, doi = {10.1038/s43587-022-00248-2}, author = {Higgins-Chen, Albert T. and Thrush, Kyra L. and Wang, Yunzhang and Minteer, Christopher J. and Kuo, Pei-Lun and Wang, Meng and Niimi, Peter and Sturm, Gabriel and Lin, Jue and Ann Zenobia Moore and Bandinelli, Stefania and Vinkers, Christiaan H. and Vermetten, Eric and Rutten, Bart P. F. and Geuze, Elbert and Okhuijsen-Pfeifer, Cynthia and van der Horst, Marte and Schreiter, Stefanie and Gutwinski, Stefan and Luykx, Jurjen J. and Picard, Martin and Ferrucci, Luigi and Eileen M. Crimmins and Boks, Marco P. and H{\"a}gg, Sara and Hu-Seliger, Tina T. and Morgan E. Levine} } @article {12632, title = {Cost-utility and cost-benefit analysis of TAVR availability in the US severe symptomatic aortic stenosis patient population.}, journal = {Journal of Medical Economics}, volume = {25}, year = {2022}, pages = {1051-1060}, abstract = {

AIMS: We evaluated the availability of transcatheter aortic valve replacement (TAVR) to determine its value across all severe symptomatic aortic stenosis (SSAS) patients, especially those untreated because of concerns regarding invasive surgical AVR (SAVR) and its impact on active aging.

METHODS: We performed payer perspective cost-utility analysis (CUA) and societal perspective cost-benefit analysis (CBA). The CBA{\textquoteright}s benefit measure is active time: salaried labor, unpaid work, and active leisure. The study population is a cohort of US elderly SSAS patients. We compared a "TAVR available" scenario in which SSAS patients distribute themselves across TAVR, SAVR, and medical management (MM); and a "TAVR not available" scenario with only SAVR and MM. We structured each scenario with a decision-tree model of SSAS patient treatment allocation. We measured the association between health and active time in the US Health and Retirement Study and used this association to impute active time to SSAS patients given their health.

RESULTS: The incremental cost-effectiveness ratio (ICER) and rate of return (RoR) of TAVR availability were $8,533 and 395\%, respectively. CUA net monetary benefits (NMB) were $212,199 per patient and $43.4 billion population-wide. CBA NMB were $50,530 per patient and $10.3 billion population-wide.

LIMITATIONS: Among study limitations were scarcity of evidence regarding key parameters and the lack of long-term survival, health utility, and treatment cost data. Our analysis did not account for TAVR durability, retreatments, and valve-in-valve treatments.

CONCLUSION: Across risk-, age-, and treatment-eligibility groups, TAVR is the economically optimal treatment choice. It represents strong value-for-money per patient and population-wide. The vast majority of TAVR value involves raising treatment uptake among the untreated.

}, keywords = {Aortic Valve, Aortic Valve Stenosis, Cost-Benefit Analysis, Health Care Costs, Heart Valve Prosthesis Implantation, Risk Factors, Transcatheter Aortic Valve Replacement, Treatment Outcome}, issn = {1941-837X}, doi = {10.1080/13696998.2022.2112442}, author = {Sevilla, J P and Klusty, Jessica M and Song, Younghwan and Russo, Mark J and Thompson, Christin A and Jiao, Xiayu and Clancy, Seth J and Bloom, David E} } @article {12676, title = {Could Correcting Your Vision Lower Your Alzheimer{\textquoteright}s Risk?}, year = {2022}, publisher = {AARP}, keywords = {Alzheimer{\textquoteright}s, Dementia, vision functioning}, url = {https://www.aarp.org/health/conditions-treatments/info-2022/vision-loss-and-dementia.html}, author = {Crouch, Michelle} } @article {12516, title = {Creating a Public Resource: O*NET Job Characteristics Data Set for Use with the Health and Retirement Study and Other Surveys}, number = {UM22-Q1}, year = {2022}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {Creating a public resource of historical occupational information from the O*NET database linked with survey data in the HRS will allow researchers to better inform policy makers about the impact of long-term exposure to different types of tasks or work environments on the ability and willingness of older adults to work longer. This is relevant to informing potential behavioral responses and other effects of potential SSA policy changes such as increasing the age of eligibility for OASI. With a growing need to understand how individuals within the same work environments experience different outcomes, particularly among those from under-represented groups (e.g., racial and ethnic minorities), pairing O*NET data with HRS data has important implications for scientific advances that can promote more equitable work environments. This project will complete the documentation report of the data set linking 2019 O*NET measures to the 2010 Census occupation code frame; link 2019 O*NET-Census 2010 data set to HRS occupations from 2010 forward; write documentation report of the data set linking 2019 O*NET measures to the HRS occupation data from 2010 forward for the HRS website; and conduct validation and quality control analyses.}, keywords = {O*NET, occupational information, Older workers, Social Security Administration, work environments}, url = {https://mrdrc.isr.umich.edu/projects/creating-a-public-resource-onet-job-characteristics-data-set-for-use-with-the-health-and-retirement-study-and-other-surveys/}, author = {Helppie-McFall, Brooke and Carr, Dawn C and Amanda Sonnega} } @article {11930, title = {Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors.}, journal = {Cancer Causes \& Control}, volume = {33}, year = {2022}, pages = {81-90}, abstract = {

PURPOSE: The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia.

METHODS: Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters.

RESULTS: CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95\% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95\% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95\% CI [6.1, 56.1]).

CONCLUSION: The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.

}, keywords = {Cancer survivor, CMV Seropositivity, Dementia, Inflammation}, issn = {1573-7225}, doi = {https://doi.org/10.1007/s10552-021-01504-3}, author = {Vivek, Sithara and Heather Hammond Nelson and Anna Prizment and Jessica Faul and Eileen M. Crimmins and Bharat Thyagarajan} } @article {13050, title = {CROSS-NATIONAL COMPARISONS OF STRESS AND WELL-BEING IN THE INTERNATIONAL FAMILY OF HEALTH AND RETIREMENT STUDIES}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, month = {12/2022}, type = {Journal Article}, chapter = {729}, abstract = {Strong evidence demonstrates the long-term influence of stress and well-being on psychological, social, and physical health outcomes across the lifespan. Because of this, stress and well-being measures have been added to nearly all of the International Family of Health and Retirement Studies. However, this newly available data has not been compared cross-nationally or within-country to unpack how culture influences these important predictors of healthy aging. Using the Gateway to Global Aging Data, which provides harmonized data from the Health and Retirement Study and its sibling nationally representative studies, levels of self-reported stress (e.g. job stress, discrimination, loneliness) and well-being (e.g. quality of life, life satisfaction) are compared across 30 countries. Data come from the following studies: HRS, ELSA, SHARE, TILDA, CHARLS, KLoSA, MHAS, and JSTAR. We used data from the latest study wave for which the relevant survey was implemented. Average age of participants across studies is 67 and 55\% are women. Initial analyses show stressor specific findings such as participants in Korea reported greater work stress than participants in Japan, England, the United States, and across Europe, and the United States reported higher loneliness than China and England, but not higher than Ireland. Reporting cross-national and within-country variation in these measures will be generative in pointing to new research directions for understanding how culture influences health and aging trajectories.}, keywords = {Stress, Well-being}, doi = {10.1093/geroni/igac059.2656}, author = {Yoobin Park and Alexandra Crosswell and Drystan Phillips} } @article {12585, title = {Cumulative loneliness associated with accelerated memory aging in older adults}, year = {2022}, publisher = {Michigan News, University of Michigan}, address = {Ann Arbor, MI}, keywords = {Loneliness, memory decline}, url = {https://news.umich.edu/cumulative-loneliness-associated-with-accelerated-memory-aging-in-older-adults/}, author = {Cook, Destiny} } @article {11752, title = {Cardiometabolic Risk Trajectory among Older Americans: Findings from the Health and Retirement Study.}, journal = {The Journals of Gerontology, Series A}, volume = {76}, year = {2021}, pages = {2265-2274}, abstract = {

BACKGROUND: Cardiometabolic risk (CMR) is a key indicator of physiological decline with age; but age-related declines in a nationally representative older U.S. population have not been previously examined.

METHODS: We examined the trajectory of cardiometabolic risk (CMR) over 8 years of aging, from 2006/2008 to 2014/2016, among 3,528 people over age 50 in the Health and Retirement Study. We used growth curve models to examine change in total CMR as well as in individual cardiometabolic biomarkers to understand how baseline differences and rates of change vary across sociodemographic characteristics, by smoking status, and medication use.

RESULTS: Total CMR did not change among respondents who survived over 8 years. Despite significant differences in CMR across demographic and education groups at baseline, the pace of change with age did not differ by these characteristics. Among individual biomarkers, risk levels of diastolic blood pressure, resting heart rate, and total cholesterol decreased over 8 years while glycosylated hemoglobin, waist circumference, and pulse pressure increased over that time. Both the statistical significance levels and the magnitudes of the reduction over time with age in diastolic blood pressure, resting heart rate, and total cholesterol in models adjusted for age, race/ethnicity, gender, smoking, and education were reduced after controlling for blood pressure and cholesterol medication.

CONCLUSIONS: The relatively constant total CMR level over 8 years occurred because some indicators improved with age while some deteriorated in this period. Medication use contributed to the improvement in blood pressure, resting heart rate, and total cholesterol.

}, keywords = {cardiovascular, Change with age, Medication, Metabolism}, issn = {1758-535X}, doi = {10.1093/gerona/glab205}, author = {Wu, Qiao and Jennifer A Ailshire and Jung K Kim and Eileen M. Crimmins} } @article {11379, title = {Change in Mobility: Consistency of Estimates and Predictors Across Studies of Older Adults.}, journal = {The Journals of Gerontology, Series B }, volume = {76}, year = {2021}, pages = {209-218}, abstract = {

OBJECTIVES: This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.

METHODS: Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.

RESULTS: Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.

DISCUSSION: To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.

}, keywords = {Decline, Measures, physical functioning, Recovery, Risk Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbz091}, author = {Jennifer C. Cornman and Dana A Glei and Weinstein, Maxine} } @article {su13042361, title = {Cognitive Functioning: An Underlying Mechanism of Age and Gender Differences in Self-Assessed Risk Tolerance among an Aging Population}, journal = {Sustainability}, volume = {13}, year = {2021}, pages = {2361}, abstract = {Attitude toward risk plays a vital role in an individual{\textquoteright}s financial decision-making and well-being. Past studies have found significant association of age and gender with risk tolerance. However, studies on the factors affecting the underlying mechanism are scant. The purpose of this research is to test whether cognitive functioning mediates the association between age, gender, and self-assessed risk tolerance. Using the 2014 wave of the Health and Retirement Study, path analysis was conducted to test the hypothesized model. Results revealed a negative direct association between age and risk tolerance. Moreover, the study also found a lower level of risk tolerance in women. A bootstrap-based confidence interval revealed that a significant portion of the relationship between age and risk tolerance was mediated by cognition. However, the gender difference in risk tolerance was not explained by cognition. Financial planning practitioners and policymakers should understand the contribution of cognitive functioning toward the difference in risk tolerance in older populations and implement strategies to reinforce cognitive functioning to mitigate the adversity of a low level of risk tolerance.}, keywords = {Age, Cognition, gender, mediation, Risk tolerance}, issn = {2071-1050}, doi = {10.3390/su13042361}, author = {Sharma, Muna and Chatterjee, Swarn} } @article {11426, title = {Cognitive Impairment and Prevalence of Memory-Related Diagnoses among U.S. Older Adults}, number = {No 777}, year = {2021}, institution = { Global Labor Organization}, address = {Essen, Germany}, abstract = {Cognitive impairment creates significant challenges to health and well-being of the fast-growing aging population. Early recognition of cognitive impairment may confer important advantages, allowing for diagnosis and appropriate treatment, education, psychosocial support, and improved decision-making regarding life planning, health care, and financial matters. Yet the prevalence of memory-related diagnoses among older adults with early symptoms of cognitive impairment is unknown. Using 2000-2014 Health and Retirement Survey - Medicare linked data, we leveraged within-individual variation in a longitudinal cohort design to examine the relationship between incident cognitive impairment and receipt of diagnosis among American older adults. Receipt of a memory-related diagnosis was determined by ICD-9-CM codes. Incident cognitive impairment was assessed using the modified Telephone Interview of Cognitive Status (TICS). We found overall low prevalence of early memory-related diagnosis, or high rate of underdiagnosis, among older adults showing symptoms of cognitive impairment, especially among non-whites and socioeconomically disadvantaged subgroups. Our findings call for targeted interventions to improve the rate of early diagnosis, especially among vulnerable populations. }, keywords = {cognitive aging, cognitive impairment, Dementia, Medicare, memory-related diagnosis}, url = {https://www.econstor.eu/bitstream/10419/229436/1/GLO-DP-0777.pdf}, author = {Qian, Yuting and Chen, Xi and Tang, Diwen and Amy Kelley and Li, Jing} } @mastersthesis {11727, title = {Comparison of Functional and Cognitive Capacity Among Cancer Survivors and Cancer-free Individuals in an Older US population}, year = {2021}, school = {Johns Hopkins University}, address = {Baltimore, MD}, abstract = {Background The global population is aging rapidly, and cancer is one of the major health concerns of an aging population. Older cancer survivors can be challenged by the toxicities associated with cancer and its treatment in addition to the normal declines in functional and cognitive capacities due to aging. However, we only have limited data on whether older cancer survivors have worse functional and cognitive capacity profiles than their cancer-free counterparts. Method For this study, 7,459 participants from Health and Retirement Study (HRS) and completed functional capacity questionnaire between Feb 2016 to April 2018 were included, among which 1,238 are cancer survivors, and the rest are cancer-free. Answers from biennial HRS questionnaires were used for exposure and outcome ascertainment. Poisson regression models with robust variance were used to estimate the risk ratio (RR) for the association between cancer history and prevalence of functional and cognitive limitation. Stratified analysis by race/ethnicity was performed to explore potential race/ethnic group differences. Sensitivity analyses excluding demented participants were performed to evaluate the reliability of the primary analyses. Results A significant positive association was observed between cancer history and any disability in basic ADLs (adjusted Risk Ratio = 1.09, 95\% CI (1.01, 1.18). A significant positive association was observed between cancer history and any disability in IADLs (adjusted Risk Ratio = 1.11 (1.02, 1.22). Cognitive capacity did not differ significantly between cancer survivors and cancer-free participants. Low educational level, depressive symptoms within 12-month, and dementia history may also contribute to poor functional and cognitive capacities. Stratified analyses showed that non-Hispanic white has similar results to the analytic population. Because of group size, other race/ethnic groups do not show statistically significant associations, but the point estimate directions are similar to the analytic population except for gender. Sensitivity analysis results were similar to that of the primary analysis. Conclusion Older U.S. individuals with cancer history have reduced functional capacities but not cognitive capacity compared to older U.S. individuals without cancer history. More research is needed to study these differences and how to improve older cancer survivors{\textquoteright} functional capacity, therefore optimizing health in elderly cancer survivors.}, keywords = {Cancer Survivors, cancer-free, Cognition}, url = {http://jhir.library.jhu.edu/handle/1774.2/64163}, author = {Chen, Xueyu} } @article {11398, title = {The Consequences of Current Benefit Adjustments for Early and Delayed Claiming}, number = {WP$\#$2021-3}, year = {2021}, institution = {Center for Retirement Research at Boston College}, address = {Boston, MA}, abstract = {Workers have the option of claiming Social Security retirement benefits at any age between 62 and 70, with later claiming resulting in higher monthly benefits. These higher monthly benefits reflect an actuarial adjustment designed to keep lifetime benefits equal, for an individual with average life expectancy, regardless of when benefits are claimed. The actuarial adjustments, however, are decades old. Since then, interest rates have declined; life expectancy has increased; and longevity improvements have been much greater for high earners than low earners. This paper explores how changes in longevity and interest rates have affected the fairness of the actuarial adjustment over time and how the disparity in life expectancy affects the equity across the income distribution. It also looks at the impact of these developments on the costs of the program and the progressivity of benefits.}, keywords = {interest rates, Life Expectancy, Social Security claiming}, url = {https://crr.bc.edu/working-papers/the-consequences-of-current-benefit-adjustments-for-early-and-delayed-claiming/}, author = {Andrew G. Biggs and Anqi Chen and Alicia H. Munnell} } @article {11265, title = {Cross-country differences in age trends in alcohol consumption among older adults: a cross-sectional study of individuals aged 50~years and older in 22 countries.}, journal = {Addiction}, volume = {116}, year = {2021}, pages = {1399-1412}, abstract = {

BACKGROUND AND AIMS: Age-related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross-national variation in the quantity and patterns of drinking throughout older age, and to investigate country-level variables explaining cross-national variation in consumption for individuals aged 50~years and older.

DESIGN: Cross-sectional observational study using previously harmonized survey data.

SETTING: Twenty-two countries surveyed in 2010 or the closest available year.

PARTICIPANTS: A total of 106 180 adults aged 50~years and over.

MEASUREMENTS: Cross-national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country-level variables moderating age-related declines in drinking.

FINDINGS: Alcohol consumption was negatively associated with age (risk ratio~=~0.98; 95\% confidence interval~=~0.97, 0.99; P-value~<~0.001), but there was substantial cross-country variation in the age-related differences in alcohol consumption [likelihood ratio (LR) test P-value <~0.001], even after adjusting for the composition of populations. Countries{\textquoteright} development level and alcohol prices explained 31\% of cross-country variability in SDUs (LR test P-value~<~0.001) but did not explain cross-country variability in the prevalence of heavy drinkers.

CONCLUSIONS: Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country-specific composition of populations and country-level contextual factors such as development level and alcohol prices.

}, keywords = {alcohol, cross-cultural, development, drink, global, Mixed model, multi-level}, issn = {1360-0443}, doi = {10.1111/add.15292}, author = {Calvo, Esteban and Allel, Kasim and Ursula M. Staudinger and Castillo-Carniglia, Alvaro and Medina, Jos{\'e} T and Katherine M Keyes} } @article {11495, title = {Cross-sectional and prospective association between personality traits and IADL/ADL limitations.}, journal = {Psychology and Aging}, volume = {36}, year = {2021}, pages = {309-321}, abstract = {

Prior research has shown that personality traits are associated with activities of daily living (ADLs) and instrumental ADLs (IADLs). To advance research on the psychological factors related to aging-related functional limitations, this study examined the relation between personality traits and both concurrent and incident functional limitations, tested whether these associations are similar across IADLs and ADLs, and tested potential mediators of these associations. Participants were drawn from eight longitudinal samples from the U.S., England, and Japan. Participants provided data on demographic variables, the five major personality traits, and on the Katz ADL-scale and Lawton IADL-scales. IADL/ADL limitations were assessed again 3-18 years later. A consistent pattern of associations was found between personality traits and functional limitations, with associations slightly stronger for IADLs than ADLs, and robust across samples that used different measures and from different cultural contexts. The meta-analysis indicated that higher neuroticism was related to a higher likelihood of concurrent and incident IADL/ADL limitations, and higher conscientiousness, extraversion, and openness were associated with lower risk. Higher agreeableness was associated with lower risk of concurrent IADL/ADL, but unrelated to incident limitations. Physical activity, disease burden, depressive symptoms, self-rated health, handgrip strength, falls, and smoking status mediated the relation between personality traits and incident IADL/ADL limitations. The present study indicates that personality traits are risk factors for both IADL and ADL limitations across multiple national cohorts, identifies potential mediators, and informs conceptual models on psychological risk factors for functional decline. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

}, keywords = {ADL disability, ELSA, IADLS, Personality Traits}, issn = {1939-1498}, doi = {10.1037/pag0000502}, author = {Canada, Brice and Yannick Stephan and Fundenberger, Herv{\'e} and Angelina R Sutin and Antonio Terracciano} } @article {11295, title = {Cardiometabolic Risk and Biomarker Trajectories Among Older Adults: Findings From the Health and Retirement Study}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {429 }, abstract = {The deterioration of the cardiovascular system is a process associated with aging. Most of the prior works have examined changes in cardiometabolic risk (CMR) while aging at the population level using cross-sectional data, but we study within-person changes for total CMR and separate risk factors, including pulse pressure, resting heart rate, C-reactive protein, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, total cholesterol, waist circumference, and obesity. We examine 8-year changes (from 2006 to 2014) among respondents from the Health and Retirement Study biomarker sample (n=19,776). We use growth curve models to identify differences at baseline and the changes while aging, by age, gender, race/ethnicity, and education. Blacks, the old-old, the less educated, and current smokers have higher baseline CMR. The total CMR increases while people age over 8 years. HbA1c, waist circumference, and pulse pressure increase significantly with age. A reduction in total cholesterol can be observed and is likely due to medication. The CMR increase is no longer significant after accounting for socioeconomic status. The next step of this study is to focus on the disparity of risk distribution, in order to identify the individuals that are most in need of specific care and support.}, keywords = {biomarker trajectories, cardiometabolic risk}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa057.1386}, author = {Wu, Qiao and Eileen M. Crimmins and Jennifer A Ailshire and Jung K Kim and Zhao, Erfei} } @proceedings {10699, title = {Cardiovascular Disease and Cumulative Incidence of Cognitive Impairment: Longitudinal Findings from The Health and Retirement Study}, journal = {Conference of American-College-of-Cardiology (ACC) / World Congress of Cardiology (WCC)}, volume = {75}, year = {2020}, pages = {726}, publisher = {Journal of the American College of Cardiology}, edition = {11}, address = {Chicago, IL}, url = {https://apps.webofknowledge.com/InboundService.do?product=WOS\&Func=Frame\&DestFail=http\%3A\%2F\%2Fwww.webofknowledge.com\&SrcApp=search\&SrcAuth=Alerting\&SID=7EI254HJQZJyroHmyfS\&customersID=Alerting\&mode=FullRecord\&IsProductCode=Yes\&AlertId=2547ce2d-b446-4503-}, author = {Covello, Allyson and Horwitz, Leora and Singhal, Shreya and Caroline S Blaum and John A. Dodson} } @article {11258, title = {Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data}, journal = {Jamia Open}, year = {2020}, abstract = {Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks.This is a retrospective cohort study of older patients with type 2 diabetes using EHR from New York University Langone Health ambulatory care (NYULH-EHR, years 2009{\textendash}2017) and from the Health and Retirement Survey (HRS, 1995{\textendash}2014) to study subsequent cardiovascular disease (CVD) risks. We used the same eligibility criteria, outcome definitions, and demographic covariates/biomarkers in both datasets. We compared subsequent CVD incidence rates, hazard ratios (HRs) of risk factors, and discrimination/calibration performances of CVD risk scores.The estimated subsequent total CVD incidence rate was 37.5 and 90.6 per 1000 person-years since T2DM onset in HRS and NYULH-EHR respectively. HR estimates were comparable between the datasets for most demographic covariates/biomarkers. Common CVD risk scores underestimated observed total CVD risks in NYULH-EHR.EHR-estimated HRs of demographic and major clinical risk factors for CVD were mostly consistent with the estimates from a national cohort, despite high incidences and absolute risks of total CVD outcome in the EHR samples.}, keywords = {Cardiovascular disease, type 2 diabetes}, isbn = {2574-2531}, doi = {https://doi.org/10.1093/jamiaopen/ooaa059}, author = {Szymonifka, Jackie and Conderino, Sarah and Christine T Cigolle and Ha, Jinkyung and Mohammed U Kabeto and Yu, Jaehong and John A. Dodson and Thorpe, Lorna and Caroline S Blaum and Zhong, Judy} } @article {Cobian2020e200731, title = {Changes in Health Insurance Coverage Over Time by Immigration Status Among US Older Adults, 1992-2016}, journal = {JAMA network open}, volume = {3}, year = {2020}, note = {cited By 0}, type = {Journal}, chapter = {e200731}, abstract = {Importance: Disparities in health insurance coverage by immigration status are well documented; however, there are few data comparing long-term changes in insurance coverage between immigrant and nonimmigrant adults as they age into older adulthood. Objective: To compare longitudinal changes in insurance coverage over 24 years of follow-up between recent immigrant, early immigrant, and nonimmigrant adults in the US. Design, Setting, and Participants: This population-based cohort study used data from the nationally representative Health and Retirement Study. Data were collected biennially from 1992 to 2016. The population included community-dwelling US adults born between 1931 and 1941 and aged 51 to 61 years at baseline. Statistical analysis was performed from February 3, 2017, to January 10, 2020. Exposures: Participants were categorized as nonimmigrants (born in the US), early immigrants (immigrated to the US before the age of 18 years), and recent immigrants (immigrated to the US from the age of 18 years onward). Main Outcomes and Measures: Self-reported data on public, employer, long-term care, and other private insurance were used to define any insurance coverage. Longitudinal changes in insurance coverage were examined over time by immigration status using generalized estimating equations accounting for inverse probability of attrition weights. The association between immigration status and continuous insurance coverage was also evaluated. Results: A total of 9691 participants were included (mean [SD] age, 56.0 [3.2] years; 5111 [52.6\%] female). Nonimmigrants composed 90\% (n = 8649) of the cohort; early immigrants, 2\% (n = 201); and recent immigrants, 8\% (n = 841). Insurance coverage increased from 68\%, 83\%, and 86\% of recent immigrant, early immigrant, and nonimmigrant older adults, respectively, in 1992 to 97\%, 100\%, and 99\% in 2016. After accounting for selective attrition, recent immigrants were 15\% less likely than nonimmigrants to have any insurance at baseline (risk ratio, 0.85; 95\% CI, 0.82-0.88), driven by lower rates of private insurance. However, disparities in insurance decreased incrementally over time and were eliminated, such that insurance coverage rates were similar between groups as participants attained Medicare age eligibility. Furthermore, recent immigrants were less likely than nonimmigrants to be continuously insured (risk ratio, 0.89; 95\% CI, 0.85-0.94). Conclusions and Relevance: Among community-dwelling adults who were not age eligible for Medicare, recent immigrants had lower rates of health insurance, but this disparity was eliminated over the 24-year follow-up period because of uptake of public insurance among all participants. Future studies should evaluate policies and health care reforms aimed at reducing disparities among vulnerable populations such as recent immigrants who are not age eligible for Medicare.}, keywords = {Emigrants and Immigrants, health, Immigrant population}, issn = {25743805}, doi = {10.1001/jamanetworkopen.2020.0731}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081691720\&doi=10.1001\%2fjamanetworkopen.2020.0731\&partnerID=40\&md5=9a3c12cf98521d4455f3c49d64c60fc8}, author = {Cobian, J. and Maynor G Gonz{\'a}lez and Ying Jessica Cao and Xu, Huiwen and Li, R. and Mendis, M. and Noyes, K. and Becerra, A.Z.} } @article {10986, title = {Changes in optimism and pessimism in response to life events: Evidence from three large panel studies}, journal = {Journal of Research in Personality}, volume = {88}, year = {2020}, abstract = {Although individuals vary in how optimistic they are about the future, one assumption that researchers make is that optimism is sensitive to changes in life events and circumstances. We examined how optimism and pessimism changed across the lifespan and in response to life events in three large panel studies (combined N = 74,886). In the American and Dutch samples, we found that optimism increased across younger adulthood, plateaued in midlife, and then decreased in older adulthood. In the German sample, there were inconsistent results with respect to age differences and mean level changes in optimism. Associations between life events and changes in optimism/pessimism were inconsistent across samples. We discuss our results in the context of life events and lifespan development.}, keywords = {Adult personality development, Aging, Life events, Lifespan development, Optimism, Time perspective}, isbn = {0092-6566}, doi = {10.1016/j.jrp.2020.103985}, author = {William J. Chopik and Oh, Jeewon and Eric S Kim and Schwaba, Ted and Kr{\"a}mer, Michael D. and Richter, David and Jacqui Smith} } @article {11222, title = {Changes in physical and mental health of Black, Hispanic, and White caregivers and non-caregivers associated with onset of spousal dementia.}, journal = {Alzheimer{\textquoteright}s \& Dementia}, volume = {6}, year = {2020}, pages = {e12082}, abstract = {

Introduction: We aim to determine whether racial/ethnic health disparities are a consequence of caregiving for persons with dementia and/or health status before becoming a caregiver.

Methods: Longitudinal data from the Health and Retirement Study (1998-2012) on 7859 Black, Hispanic, and White couples were analyzed for changes in physical and mental health with incident dementia of a spouse.

Results: Blacks and Hispanics, but not Whites, had poorer health before becoming caregivers for a spouse with dementia, than those who did not become caregivers. Spouse{\textquoteright}s dementia onset was associated with caregiver{\textquoteright}s higher odds of depressive disorder, with no racial/ethnic variation. Racial disparities in caregiver{\textquoteright}s health were attributed to health differences before caregiving, not differential health changes due to caregiving.

Discussion: Older Blacks and Hispanics with poor health are at increased risk of caregiving for a spouse with dementia. Protecting the health of persons supporting spouses with dementia requires understanding socioeconomic and cultural factors driving care provision.

}, keywords = {Caregiving, Dementia, depression, Racial Disparities}, issn = {2352-8737}, doi = {10.1002/trc2.12082}, author = {Chen, Cynthia and Thunell, Johanna and Julie M Zissimopoulos} } @article {11183, title = {Changes in Self-Rated Health After Sepsis in Older Adults: A Retrospective Cohort Study.}, journal = {Chest}, volume = {S0012-3692}, year = {2020}, month = {2020 Nov}, pages = {31732-3}, abstract = {

BACKGROUND: As more individuals survive sepsis, there is an urgent need to understand its effects on patient-reported outcomes.

RESEARCH QUESTION: What is the effect of sepsis on self-rated health, and what role, if any, does functional disability play in mediating this effect?

STUDY DESIGN AND METHODS: We conducted a survey- and administrative claims-based retrospective cohort study using the US Health and Retirement Study, a nationally representative cohort-based survey of older adults in the United States, from 2000 through 2016. We matched Medicare beneficiaries hospitalized with sepsis in 2000 to 2008 to nonhospitalized individuals. Self-rated health and functional disability were tracked biannually for 8 years. Differences in self-rated health between the cohorts were measured using mixed models with and without controlling for changes in functional disability.

RESULTS: Seven hundred fifty-eight individuals with sepsis were matched 1:1 to 758 nonhospitalized individuals, all aged 65 years and older. Among survivors, sepsis was associated with worse self-rated health in years 2 and 4 (adjusted absolute difference in self-rated health on a 5-point scale in year 2: -0.24 [95\%~CI, -0.38 to -0.10] and year 4: -0.17 [95\%~CI, -0.33 to -0.02]) but not in years 6 or 8. After accounting for changes in functional status, the association between sepsis and self-rated health was still present but reduced in year 2 (adjusted absolute difference in self-rated health, -0.18 [95\%~CI, -0.31 to -0.05]) and was not present in years 4, 6, or~8.

INTERPRETATION: Self-rated health worsened initially after sepsis but returned to the level of that of nonhospitalized control subjects by year 6. Mitigating sepsis-related functional disability may play a key role in improving self-rated health after sepsis.

}, keywords = {Aging, health-related quality of life, Quality of Life, Sepsis}, issn = {1931-3543}, doi = {10.1016/j.chest.2020.05.606}, author = {Carey, Matthew R and Hallie C Prescott and Theodore J Iwashyna and Wilson, Michael E and Angela Fagerlin and Valley, Thomas S} } @article {10899, title = {Childhood Circumstances and Health Inequality in Old Age: Comparative Evidence from China and the United States}, number = {13460}, year = {2020}, note = {ISSN: 2365-9793}, institution = {IZA Institute of Labor Economics}, address = {Bonn, Germany}, abstract = {This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015 with the newly released 2014 Life History Survey (LHS), and two waves of the Health and Retirement Study (HRS) in 2014 and 2016 with the newly released 2015 Life History Mail Survey (LHMS) in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7-16 percent and 14-30 percent of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/ urban status contribute more to health inequality in China, while family socioeconomic status (SES) contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity.}, keywords = {childhood circumstances, Frailty, inequality of opportunity, life course approach, Mental Health, Self-rated health}, url = {http://ftp.iza.org/dp13460.pdf}, author = {Chen, Xi and Yan, Binjian and Thomas M Gill} } @article {10920, title = {Childhood Circumstances and Health Inequality in Old Age: Comparative Evidence from China and the USA}, journal = {Social Indicators Research }, year = {2020}, abstract = {This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study in 2013 and 2015 with the newly released 2014 Life History Survey, and two waves of the Health and Retirement Study in 2014 and 2016 with the newly released 2015 Life History Mail Survey in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7{\textendash}16 and 14{\textendash}30\% of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/urban status contribute more to health inequality in China, while family socioeconomic status contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity.}, keywords = {childhood circumstances, Frailty, inequality of opportunity, life course approach, Mental Health, Self-rated health}, isbn = {1573-0921}, doi = {10.1007/s11205-020-02436-2}, author = {Chen, Xi and Yan, Binjian and Thomas M Gill} } @article {11008, title = {Cognitive Function and Cardiometabolic-Inflammatory Risk Factors Among Older Indians and Americans.}, journal = {Journal of the American Geriatrics Society}, volume = {68 }, year = {2020}, pages = {S36-S44}, abstract = {

OBJECTIVES: To investigate how cardiometabolic-inflammatory risk factors are related to cognition among older adults in India and the United States.

DESIGN: The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS-HCAP) in the United States conducted an in-depth assessment of cognition, using protocols designed for international comparison.

SETTING: Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States.

PARTICIPANTS: Respondents aged 60 years and older from LASI-DAD (N = 1,865) and respondents aged 65 years and older from HRS-HCAP (N = 2,111) who provided venous blood specimen.

MEASUREMENTS: We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro-B-type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C-reactive protein, albumin, and uric acid (only in India).

RESULTS: The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P < .001) in India and -2.4 (P < .001) in the United States for one percentage increase in absolute HbA1c value.

CONCLUSION: Cardiometabolic-inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. J Am Geriatr Soc 68:S36-S44, 2020.

}, keywords = {cardiometabolic risk, Cognition, HCAP, LASI-DAD}, issn = {1532-5415}, doi = {10.1111/jgs.16734}, author = {Hu, Peifeng and Jinkook Lee and Beaumaster, Sidney and Jung K Kim and Dey, Sharmistha and David R Weir and Eileen M. Crimmins} } @article {COTESERGENT2020326, title = {Comparing the education gradient in health deterioration among the elderly in six OECD countries}, journal = {Health Policy}, volume = {124}, year = {2020}, pages = {326 - 335}, abstract = {Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems.}, keywords = {Education, Health deterioration, Older ages}, issn = {0168-8510}, doi = {https://doi.org/10.1016/j.healthpol.2019.12.015}, url = {http://www.sciencedirect.com/science/article/pii/S0168851018302537}, author = {Aurelie C{\^o}t{\'e}-Sergent and Raquel Fonseca and Erin Strumpf} } @article {10884, title = {Comparison of Cox proportional hazards regression and generalized Cox regression models applied in dementia risk prediction}, journal = {Alzheimer{\textquoteright}s \& Dementia: Translational Research \& Clinical Interventions}, volume = {6}, year = {2020}, abstract = {Abstract Introduction The frequently used Cox regression applies two critical assumptions, which might not hold for all predictors. In this study, the results from a Cox regression model (CM) and a generalized Cox regression model (GCM) are compared. Methods Data are from the Survey of Health, Ageing and Retirement in Europe (SHARE), which includes approximately 140,000 individuals aged 50 or older followed over seven waves. CMs and GCMs are used to estimate dementia risk. The results are internally and externally validated. Results None of the predictors included in the analyses fulfilled the assumptions of Cox regression. Both models predict dementia moderately well (10-year risk: 0.737; 95\% confidence interval [CI]: 0.699, 0.773; CM and 0.746; 95\% CI: 0.710, 0.785; GCM). Discussion The GCM performs significantly better than the CM when comparing pseudo-R2 and the log-likelihood. GCMs enable researcher to test the assumptions used by Cox regression independently and relax these assumptions if necessary.}, keywords = {ADAMS, Cox proportional hazards regression, Dementia, dementia risk model, Prediction, SHARE, splines}, doi = {10.1002/trc2.12041}, author = {Goerdten, Jantje and Carri{\`e}re, Isabelle and Muniz-Terrera, Graciela} } @article {10901, title = {Comparison of Health Outcomes Among High- and Low-Income Adults Aged 55 to 64 Years in the US vs England}, journal = {JAMA Intern Med}, year = {2020}, month = {2020}, abstract = {Socioeconomic differences in life expectancy, health, and disability have been found in European countries as well as in the US. Identifying the extent and pattern of health disparities, both within and across the US and England, may be important for informing public health and public policy aimed at reducing these disparities.To compare the health of US adults aged 55 to 64 years with the health of their peers in England across the high and low ranges of income in each country.Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for 2008-2016, a pooled cross-sectional analysis of comparably measured health outcomes, with adjustment for demographic characteristics and socioeconomic status, was conducted. The analysis sample included community-dwelling adults aged 55 to 64 years from the HRS and ELSA, resulting in 46 887 person-years of observations. Data analysis was conducted from September 17, 2019, to May 12, 2020.Residence in the US or England and yearly income.Sixteen health outcomes were compared, including 5 self-assessed outcomes, 3 directly measured outcomes, and 8 self-reported physician-diagnosed health conditions.This cross-sectional study included 12 879 individuals and 31 928 person-years from HRS (mean [SD] age, 59.2 [2.8] years; 51.9\% women) and 5693 individuals and 14 959 person-years from ELSA (mean [SD] age, 59.3 [2.9] years; 51.0\% women). After adjusting for individual-level demographic characteristics and socioeconomic status, a substantial health gap between lower-income and higher-income adults was found in both countries, but the health gap between the bottom 20\% and the top 20\% of the income distribution was significantly greater in the US than England on 13 of 16 measures. The adjusted US-England difference in the prevalence gap between the bottom 20\% and the top 20\% ranged from 3.6 percentage points (95\% CI, 2.0-5.2 percentage points) in stroke to 9.7 percentage points (95\% CI, 5.4-13.9 percentage points) for functional limitation. Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6\% (95\% CI, 6.0\%-9.3\%) vs 3.8\% (95\% CI, 2.6\%-4.9\%) for stroke to 75.7\% (95\% CI, 72.7\%-78.8\%) vs 59.5\% (95\% CI, 56.3\%-62.7\%) for functional limitation. Among individuals in the highest income group, those in the US group vs England group had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9\% (95\% CI, 33.4\%-40.4\%) vs 30.0\% (95\% CI, 27.2\%-32.7\%) for hypertension to 35.4\% (95\% CI, 32.0\%-38.7\%) vs 22.5\% (95\% CI, 19.9\%-25.1\%) for arthritis.For most health outcomes examined in this cross-sectional study, the health gap between adults with low vs high income appeared to be larger in the US than in England, and the health disadvantages in the US compared with England are apparently more pronounced among individuals with low income. Public policy and public health interventions aimed at improving the health of adults with lower income should be a priority in the US.}, keywords = {Demographics, ELSA, Income, socioeconomic status}, isbn = {2168-6106}, doi = {10.1001/jamainternmed.2020.2802}, author = {Choi, Hwajung and Andrew Steptoe and Michele M Heisler and Philippa J Clarke and Robert F. Schoeni and Jivraj, Stephen and Cho, Tsai-Chin and Kenneth M. Langa} } @article {Chao2020, title = {Composite diagnostic criteria are problematic for linking potentially distinct populations: the case of frailty}, journal = {Scientific Reports}, volume = {10}, year = {2020}, note = {cited By 0}, type = {Article}, abstract = {{Composite diagnostic criteria are common in frailty research. We worry distinct populations may be linked to each other due to complicated criteria. We aim to investigate whether distinct populations might be considered similar based on frailty diagnostic criteria. The Functional Domains Model for frailty diagnosis included four domains: physical, nutritive, cognitive and sensory functioning. Health and Retirement Study participants with two or more deficiencies in the domains were diagnosed frail. The survival distributions were analyzed using discrete-time survival analysis. The distributions of the demographic characteristics and survival across the groups diagnosed with frailty were significantly different (p < 0.05). A deficiency in cognitive functioning was associated with the worst survival pattern compared with a deficiency in the other domains (adjusted p < 0.05). The associations of the domains with mortality were cumulative without interactions. Cognitive functioning had the largest effect size for mortality prediction (Odds ratios}, keywords = {Frail Elderly, Frailty Phenotype, Residence Characteristics}, issn = {20452322}, doi = {10.1038/s41598-020-58782-1}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85079339704\&doi=10.1038\%2fs41598-020-58782-1\&partnerID=40\&md5=ba7c890ffb416ce5b17f819b2c21936a}, author = {Yi-Sheng Chao and Chao-Jung Wu and Hsing-Chien Wu and Hui-Ting Hsu and Tsao, L.-C. and Cheng, Y.-P. and Lai, Y.-C. and Wei-Chih Chen} } @article {10817, title = {Comprehensive review of ICD-9 code accuracies to measure multimorbidity in administrative data}, journal = {BMC Health Services Research}, volume = {20}, year = {2020}, chapter = {489}, abstract = {Background Quantifying the burden of multimorbidity for healthcare research using administrative data has been constrained. Existing measures incompletely capture chronic conditions of relevance and are narrowly focused on risk-adjustment for mortality, healthcare cost or utilization. Moreover, the measures have not undergone a rigorous review for how accurately the components, specifically the International Classification of Diseases, Ninth Revision (ICD-9) codes, represent the chronic conditions that comprise the measures. We performed a comprehensive, structured literature review of research studies on the accuracy of ICD-9 codes validated using external sources across an inventory of 81 chronic conditions. The conditions as a weighted measure set have previously been demonstrated to impact not only mortality but also physical and mental health-related quality of life. Methods For each of 81 conditions we performed a structured literature search with the goal to identify 1) studies that externally validate ICD-9 codes mapped to each chronic condition against an external source of data, and 2) the accuracy of ICD-9 codes reported in the identified validation studies. The primary measure of accuracy was the positive predictive value (PPV). We also reported negative predictive value (NPV), sensitivity, specificity, and kappa statistics when available. We searched PubMed and Google Scholar for studies published before June 2019. Results We identified studies with validation statistics of ICD-9 codes for 51 (64\%) of 81 conditions. Most of the studies (47/51 or 92\%) used medical chart review as the external reference standard. Of the validated using medical chart review, the median (range) of mean PPVs was 85\% (39{\textendash}100\%) and NPVs was 91\% (41{\textendash}100\%). Most conditions had at least one validation study reporting PPV >=70\%. Conclusions To help facilitate the use of patient-centered measures of multimorbidity in administrative data, this review provides the accuracy of ICD-9 codes for chronic conditions that impact a universally valued patient-centered outcome: health-related quality of life. These findings will assist health services studies that measure chronic disease burden and risk-adjust for comorbidity and multimorbidity using patient-centered outcomes in administrative data.}, keywords = {ICD-9, Literature Review, multimorbidity, Validation}, isbn = {1472-6963}, doi = {10.1186/s12913-020-05207-4}, author = {Melissa Y Wei and Jamie E Luster and Chan, Chiao-Li and Lillian C. Min} } @article {9502, title = {Change in cardiometabolic risk among blacks, whites and Hispanics: findings from the Health and Retirement Study}, journal = {The Journals of Gerontology: Series A}, volume = {74}, year = {2019}, pages = {240-246}, abstract = {Background Blacks experience greater multi-system physiological dysregulation, or cumulative biological risk, which is associated with poor cardiometabolic health and mortality. In this study, we assess race differences in change in risk over four years among older whites, blacks and Hispanics. Method We examined race differences in 4-year change in individual biomarkers and a cumulative measure of risk{\textemdash}cardiometabolic risk (CMR){\textemdash}using data for each respondent from two waves of the Health and Retirement Study{\textquoteright}s biomarker assessment (n=5,512). CMR is a count of high-risk cardiovascular and metabolic biomarkers. We estimated mean CMR at baseline and follow-up by race/ethnicity, and used logistic regression to determine whether race differences exist in 4-year transitions between high- and low-risk states for individual biomarkers. Results Blacks had higher baseline CMR than whites and Hispanics and experienced an increase in risk over four years; conversely, CMR decreased among whites and Hispanics. Blacks were more likely to develop high-risk pulse pressure and high-risk hemoglobin A1c, which contributed to increases in CMR. Whites and Hispanics were more likely to become low-risk on C-reactive protein and HDL cholesterol which contributed to declines in CMR. Race differences in transitions between risk states remained after controlling for social, behavioral and health care related factors. However, the racial patterning of these differences was influenced by disease diagnosis and medication use. Conclusions We show that the cardiometabolic health of older blacks worsens as they age both absolutely and relative to that of whites and Hispanics because of poor blood pressure control and diabetes prevention.}, keywords = {Biomarkers, C-reactive protein, Cardiovascular health, Racial/ethnic differences, Risk Factors}, issn = {1079-5006}, doi = {10.1093/gerona/gly026}, url = {https://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/gly026/4857183http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/gly026/23921802/gly026.pdf}, author = {Uchechi A Mitchell and Jennifer A Ailshire and Eileen M. Crimmins} } @article {9980, title = {Change in leisure participation among older adults after falling}, journal = {Leisure Sciences}, year = {2019}, type = {Journal}, abstract = {Falls among older adults can lead to severe physical and psychological consequences. However, whether leisure participation changes after falling is not clear. We investigated whether falls resulted in reduced leisure participation in terms of duration, number, and intensity among older adults. Secondary data from the Health and Retirement Study and the Consumption and Activities Mail Survey (n = 1163) were analyzed. The results showed falls did not predict future leisure participation. Female, white, higher education, fewer functional limitations, and good balance were significant predictors of leisure participation at follow-up. Being white also predicted a significant decline in total number of leisure activities from baseline to follow-up, whereas higher education protected older adults from a significant reduction in total intensity of leisure activity. Our findings suggest falls may not directly affect leisure participation, but its risk factors, such as demographics, functional limitations, and balance, have a direct impact on leisure participation.}, keywords = {Disabilities, Falls, Older Adults, Participation}, issn = {0149-0400}, doi = {10.1080/01490400.2018.1536568}, url = {https://www.tandfonline.com/doi/full/10.1080/01490400.2018.1536568?scroll=top\&needAccess=true}, author = {Tuo-Yu Chen and Megan C Janke} } @article {10.1093/gerona/glz075, title = {Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study}, journal = {The Journals of Gerontology: Series A}, volume = {74}, year = {2019}, month = {11}, pages = {S21-S26}, abstract = {This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study.We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years.The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke.While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive.}, keywords = {disease incidence, disease prevalence, Mortality}, issn = {1079-5006}, doi = {10.1093/gerona/glz075}, url = {https://doi.org/10.1093/gerona/glz075}, author = {Eileen M. Crimmins and Yuan S Zhang and Jung K Kim and Morgan E. Levine} } @article {10104, title = {Changing impact of obesity on active life expectancy of older Americans.}, journal = {Journals of Gerontology Series A: Biological Sciences \& Medical Sciences}, year = {2019}, month = {11/2019}, abstract = {

BACKGROUND: The rise in the number and earlier age of onset of obese persons has raised critical concerns about consequences of obesity; however, recent evidence suggests that the impact of obesity on health outcomes may have changed. This study aims to assess the change of the impact of obesity on active life expectancy among Americans 70 years and older over almost two decades, 1993-1998 to 2010-2014.

METHODS: For each period, we use three waves of data from the Health and Retirement Study to estimate age-specific transition probabilities between health states. The average number of years active and disabled are calculated with Interpolated Markov Chain software based on estimated transition probabilities.

RESULTS: Overall obesity and severe obesity increased markedly over time yet active life expectancy expanded for all individuals and the increases are greater among the obese and women. Increases in total and active life expectancy occurred because of the changing association of obesity with disability and mortality.

CONCLUSION: Individuals at age 70 in the later period in each weight group could expect to live a smaller proportion of remaining life with ADL disability than those in the earlier period. High levels of obesity continue to have significant adverse effects on the quality of life. The increasing prevalence of severe obesity and the growing number of older persons may result in substantial additional health care needs and costs. Continued effort to improve cardiovascular health is required to control the burden of obesity in later life in an era of rising obesity.

}, keywords = {Health Trajectories, Longevity, Obesity}, issn = {1758-535X}, doi = {10.1093/gerona/glz133}, author = {Yuan S Zhang and Saito, Yasuhiko and Eileen M. Crimmins} } @conference {10402, title = {The changing nature of work and public pension coverage: Evidence from the US and Europe}, booktitle = {World Social Security Forum}, year = {2019}, publisher = {International Social Security Association}, organization = {International Social Security Association}, address = {Brussels, Belgium}, abstract = {We examine nonstandard work and its impact on pension coverage via a case study of the United States, the United Kingdom, and Germany. We define nonstandard work broadly to include alternative work, contingent work, and self-employment. We discuss how nonstandard work may affect public pension coverage, as both the pension rules and the level of actual and reported earnings of workers engaged in nonstandard work can differ from those of workers engaged in standard work. Current nonstandard workers receive essentially symmetric treatment from the pension systems in both the U.S. and U.K., but this is not the case in Germany and is a recent development in the U.K. We find that the share of workers engaged in nonstandard work has changed only modestly over time in these three countries, despite the popular perception that a more significant transformation in the nature of work may be underway. We also find that workers who spent much of their career in self-employment (one type of nonstandard work) have higher levels of financial distress in retirement and rely more on financial assets outside the public pension system. }, keywords = {International, Pension Coverage, Pensions, Social Security}, url = {https://ww1.issa.int/sites/default/files/documents/events/2-TCResearch-WSSF2019-report2\%20changing\%20nature\%20of\%20work-full-263559.pdf}, author = {Axel Borsch-Supan and Courtney Coile and Jonathan Cribb and Carl Emmerson and Yuri Pettinicchi} } @article {8672, title = {Chronic Stress and Negative Marital Quality Among Older Couples: Associations With Waist Circumference.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {74}, year = {2019}, month = {2019 01 10}, pages = {318-328}, abstract = {

Objective: More than a third of the U.S. population of older adults is obese. The present study tests the Dyadic Biopsychosocial Model of Marriage and Health, which hypothesizes that, among married couples, individual and partner chronic stress predicts increased waist circumference and these links are exacerbated in negative quality marriages.

Method: Participants were from the nationally representative longitudinal Health and Retirement Study (HRS). A total of 2,042 married individuals (in 1,098 married couples) completed psychosocial and waist circumference assessments in 2006 and 2010. Analyses examined whether negative marital quality and chronic stress in Wave 1 (2006) were associated with changes in waist circumference over time.

Results: Actor-partner interdependence models revealed that greater partner stress, rather than individuals{\textquoteright} own reports of stress, was associated with increased waist circumference over time. Higher perceived negative marital quality among husbands and lower negative marital quality among wives exacerbated the positive link between partner stress and waist circumference.

Discussion: Consistent with the Dyadic Biopsychosocial Model of Marriage and Health, partner stress has direct associations with waist circumference among couples and this link is moderated by negative marital quality. Thus, dyadic perceptions of stress and negative marital quality are important to consider for understanding marriage and obesity.

}, keywords = {Family Conflict, Female, Humans, Interviews as Topic, Longitudinal Studies, Male, Marriage, Middle Aged, Obesity, Stress, Psychological, Surveys and Questionnaires, Waist Circumference}, issn = {1758-5368}, doi = {10.1093/geronb/gbw112}, author = {Kira S. Birditt and Nicky J Newton and James A. Cranford and Noah J Webster} } @article {STEPHAN2019187, title = {Cigarette smoking and personality change across adulthood: Findings from five longitudinal samples}, journal = {Journal of Research in Personality}, volume = {81}, year = {2019}, pages = {187 - 194}, type = {Journal}, abstract = {Personality traits are related to cigarette smoking. However, little is known about the link between smoking and change in personality. Therefore, the present study examined whether current cigarette smoking and smoking cessation are associated with personality change across adulthood. Participants (n = 15,572) aged from 20 to 92 years were drawn from five longitudinal cohorts with follow-ups that ranged from 4 to 20 years. Compared to non-smokers, current smokers were more likely to increase on neuroticism and to decline on extraversion, openness, agreeableness and conscientiousness over time. Compared to the persistent smokers, those who quit had a steeper decline in agreeableness. Cigarette smoking is related to detrimental personality changes across adulthood, and the pattern was not improved by smoking cessation.}, keywords = {Cigarette smoking, longitudinal study, Personality change}, issn = {0092-6566}, doi = {doi.org/10.1016/j.jrp.2019.06.006}, url = {http://www.sciencedirect.com/science/article/pii/S0092656618300825}, author = {Yannick Stephan and Angelina R Sutin and Martina Luchetti and Pauline Caille and Antonio Terracciano} } @article {doi:10.1111/jgs.16163, title = {Cognitive Performance Among Older Persons in Japan and the United States}, journal = {Journal of the American Geriatrics Society}, year = {2019}, abstract = {OBJECTIVE To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance. DESIGN Nationally representative studies with harmonized collection of data on cognitive functioning. SETTING Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study. PARTICIPANTS A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older. MEASUREMENTS Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s. RESULTS Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20-point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5-point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years. CONCLUSION Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition.}, keywords = {cognitive performance, Education, Japan, Nihon University Japanese Longitudinal Study of Aging, United States}, doi = {10.1111/jgs.16163}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16163}, author = {Saito, Yasuhiko and Jung K Kim and Davarian, Shieva and Hagedorn, Aaron and Eileen M. Crimmins} } @article {12564, title = {Cohort Profile: The Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project.}, journal = {International Journal of Epidemiology}, volume = {48}, year = {2019}, pages = {1052-1053i}, keywords = {Female, Global Health, Health Behavior, Health Status, Longitudinal Studies, Male, Mental Health, Physical Functional Performance, Social Environment, Socioeconomic factors}, issn = {1464-3685}, doi = {10.1093/ije/dyz077}, author = {Sanchez-Niubo, Albert and Egea-Cort{\'e}s, Laia and Olaya, Beatriz and Caballero, Francisco F{\'e}lix and Ayuso-Mateos, Jose L and Prina, Matthew and Bobak, Martin and Arndt, Holger and Tobiasz-Adamczyk, Beata and Paj{\k a}k, Andrzej and Leonardi, Matilde and Koupil, Ilona and Panagiotakos, Demosthenes and Tamosiunas, Abdonas and Scherbov, Sergei and Sanderson, Warren and Koskinen, Seppo and Chatterji, Somnath and Haro, Josep Maria} } @article {9798, title = {Cohort Trends in the Gender Distribution of Household Tasks in the United States and the Implications for Understanding Disability}, journal = {Journal of Aging and Health}, year = {2019}, abstract = {Objectives: Measures of disability depend on health and social roles in a given environment. Yet, social roles can change over time as they have by gender. We document how engagement in Instrumental Activities of Daily Living (IADLs) is shifting by gender and birth cohort among older adults, and the challenges these shifts can create for population-level estimates of disability. Method: We used the Health and Retirement Study (N = 25,047) and multinomial logistic regression models with an interaction term between gender and birth cohort to predict limitation and nonperformance relative to no difficulty conducting IADLs. Results: Nonperformance of IADLs have significantly decreased among younger cohorts. Women in younger cohorts were more likely to use a map, whereas men in younger cohorts were more likely to prepare meals and shop. Discussion: Failing to account for gender and cohort changes in IADL, performance may lead to systematic bias in estimates of population-level disability.}, keywords = {Cohort Studies, Disabilities, Gender Differences, Household, Women and Minorities}, issn = {0898-2643}, doi = {10.1177/0898264318793469}, author = {Connor M Sheehan and Benjamin W Domingue and Eileen M. Crimmins} } @article {10426, title = {COMBINED EFFECT OF CMV SEROPOSITIVITY AND SYSTEMIC INFLAMMATION ON DEMENTIA PREVALENCE IN CANCER SURVIVORS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, pages = {S461-S461}, abstract = {Though cancer patients treated with multi-modal therapies demonstrate higher levels of systemic inflammation, which is associated with dementia, cancer survivors have not shown a consistent association with dementia. Since several studies reported an independent association between cytomegalovirus (CMV) infection, inflammation and dementia in non-cancer populations, we have evaluated whether CMV infection and systemic inflammation were associated with increased prevalence of dementia in cancer survivors in Health and Retirement Study (HRS). We evaluated prevalence of dementia (using score <=7 on the 27-point scale) among 1607 cancer survivors, in whom we measured CMV seropositivity and two biomarkers of systemic inflammation: C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR). The prevalence of CMV seropositivity was 68.26\% (n=1097), while prevalence of increased systemic inflammation [CRP \>5mg/L and NLR \>4] was 4.23\% (n=68). Using survey logistic regression, adjusted for age, race, gender, BMI (Body Mass Index) and sampling design, cancer survivors who were both CMV seropositive and had increased systemic inflammation had the highest odds of dementia compared to those who were CMV seronegative and had low levels of systemic inflammation (OR=6.59; 95\% CI [2.81, 15.44]; p\<.0001). Cancer survivors who were CMV seropositive without evidence of systemic inflammation had a lower but increased odds of dementia (OR=2.02; 95\% CI [1.17, 3.47]; p=0.01). Odds of dementia among those who were CMV seronegative with elevated systemic inflammation was not significant (p=0.09). Our study demonstrates a possible role for ongoing CMV induced inflammation in determining dementia prevalence among cancer survivors that needs further confirmation.}, keywords = {Cancer, cnv, Dementia, Inflammation, seropositivity}, issn = {2399-5300}, doi = {10.1093/geroni/igz038.1724}, author = {Vivek, Sithara and Bharat Thyagarajan and Heather Hammond Nelson and Anna Prizment and Eileen M. Crimmins and Jessica Faul} } @article {12140, title = {Combined linkage and association analysis identifies rare and low frequency variants for blood pressure at 1q31.}, journal = {European Journal of Human Genetics}, volume = {27}, year = {2019}, pages = {269-277}, abstract = {

High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD) and is more prevalent in African Americans as compared to other US groups. Although large, population-based genome-wide association studies (GWAS) have identified over 300 common polymorphisms modulating inter-individual BP variation, largely in European ancestry subjects, most of them do not localize to regions previously identified through family-based linkage studies. This discrepancy has remained unexplained despite the statistical power differences between current GWAS and prior linkage studies. To address this issue, we performed genome-wide linkage analysis of BP traits in African-American families from the Family Blood Pressure Program (FBPP) and genotyped on the Illumina Human Exome BeadChip v1.1. We identified a genomic region on chromosome 1q31 with LOD score 3.8 for pulse pressure (PP), a region we previously implicated in DBP studies of European ancestry families. Although no reported GWAS variants map to this region, combined linkage and association analysis of PP identified 81 rare and low frequency exonic variants accounting for the linkage evidence. Replication analysis in eight independent African ancestry cohorts (N = 16,968) supports this specific association with PP (P = 0.0509). Additional association and network analyses identified multiple potential candidate genes in this region expressed in multiple tissues and with a strong biological support for a role in BP. In conclusion, multiple genes and rare variants on 1q31 contribute to PP variation. Beyond producing new insights into PP, we demonstrate how family-based linkage and association studies can implicate specific rare and low frequency variants for complex traits.

}, keywords = {African Americans, Chromosomes, Human, Pair 1, Gene Frequency, Genome-Wide Association Study, Humans, Hypertension, Linkage Disequilibrium, Polymorphism, Single Nucleotide}, issn = {1476-5438}, doi = {10.1038/s41431-018-0277-1}, author = {Wang, Heming and Nandakumar, Priyanka and Tekola-Ayele, Fasil and Bamidele O Tayo and Erin B Ware and Gu, C Charles and Lu, Yingchang and Yao, Jie and Zhao, Wei and Smith, Jennifer A and Hellwege, Jacklyn N and Guo, Xiuqing and Edwards, Todd L and Ruth J F Loos and Donna K Arnett and Myriam Fornage and Charles N Rotimi and Sharon L R Kardia and Cooper, Richard S and Rao, D C and Georg B Ehret and Chakravarti, Aravinda and Zhu, Xiaofeng} } @article {10049, title = {Comparing the utility of mitochondrial and nuclear DNA to adjust for genetic ancestry in association studies.}, journal = {Cells}, volume = {8}, year = {2019}, abstract = {Mitochondrial genome-wide association studies identify mitochondrial single nucleotide polymorphisms (mtSNPs) that associate with disease or disease-related phenotypes. Most mitochondrial and nuclear genome-wide association studies adjust for genetic ancestry by including principal components derived from nuclear DNA, but not from mitochondrial DNA, as covariates in statistical regression analyses. Furthermore, there is no standard when controlling for genetic ancestry during mitochondrial and nuclear genetic interaction association scans, especially across ethnicities with substantial mitochondrial genetic heterogeneity. The purpose of this study is to (1) compare the degree of ethnic variation captured by principal components calculated from microarray-defined nuclear and mitochondrial DNA and (2) assess the utility of mitochondrial principal components for association studies. Analytic techniques used in this study include a principal component analysis for genetic ancestry, decision-tree classification for self-reported ethnicity, and linear regression for association tests. Data from the Health and Retirement Study, which includes self-reported White, Black, and Hispanic Americans, was used for all analyses. We report that (1) mitochondrial principal component analysis (PCA) captures ethnic variation to a similar or slightly greater degree than nuclear PCA in Blacks and Hispanics, (2) nuclear and mitochondrial DNA classify self-reported ethnicity to a high degree but with a similar level of error, and 3) mitochondrial principal components can be used as covariates to adjust for population stratification in association studies with complex traits, as demonstrated by our analysis of height-a phenotype with a high heritability. Overall, genetic association studies might reveal true and robust mtSNP associations when including mitochondrial principal components as regression covariates.}, keywords = {Genetics, GWAS, Survey Methodology}, issn = {2073-4409}, doi = {10.3390/cells8040306}, author = {Miller, Brendan and Thalida E. Arpawong and Jiao, Henry and Kim, Su-Jeong and Yen, Kelvin and Hemal H Mehta and Wan, Junxiang and John Carpten and Cohen, Pinchas} } @article {10092, title = {Complex multimorbidity and breast cancer screening among midlife and older women: The role of perceived need}, journal = {The Gerontologist}, volume = {59}, year = {2019}, pages = {S77 - S87}, abstract = {Background and Objectives There is minimal survival benefit to cancer screening for those with poor clinical presentation (complex multimorbidity) or at advanced ages. The current screening mammography guidelines consider these objective indicators. There has been less attention, however, to women{\textquoteright}s subjective assessment of screening need. This study examines the interplay between complex multimorbidity, age, and subjective assessments of health and longevity for screening mammography receipt. Research Design and Method This cross-sectional study uses self-reported data from 8,938 women over the age of 52 in the 2012 Health and Retirement Study. Logistic regression models estimated the association between women{\textquoteright}s complex multimorbidity (co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes), subjective health and longevity assessments, age, and screening mammography in the 2 years before the interview. These associations were evaluated adjusting for sociodemographic and behavioral factors. Results Both age and complex multimorbidity were negatively associated with screening mammography. However, women{\textquoteright}s perceived need for screening moderated these effects. Most significantly, women optimistic about their chances of living another 10{\textendash}15 years were more likely to have had screening mammography regardless of their health conditions or advanced age. Discussion and Implications Women with more favorable self-assessed health and perceived life expectancy were more likely to receive screening mammography even if they have poor clinical presentation or advanced age. This is contrary to current cancer screening guidelines and suggests an opportunity to engage women{\textquoteright}s subjective health and longevity assessments for cancer screening decision making in both for screening policy and in individual clinician recommendations.}, keywords = {Cancer screenings, Comorbidity, Decision making, Women and Minorities}, issn = {0016-9013}, doi = {10.1093/geront/gny180}, url = {https://academic.oup.com/gerontologist/article/59/Supplement_1/S77/5491135http://academic.oup.com/gerontologist/article-pdf/59/Supplement_1/S77/28667857/gny180.pdf}, author = {David F Warner and Siran M Koroukian and Nicholas K Schiltz and Kathleen A Smyth and Cooper, Gregory S and Owusu, Cynthia and Kurt C Stange and Nathan A. Berger} } @article {10005, title = {Computer usage and cognitive capability of older adults: Analysis of data from the Health and Retirement Study}, journal = {Educational Gerontology}, volume = {45}, year = {2019}, pages = {22-23}, abstract = {As America{\textquoteright}s older population continues to grow, more individuals are experiencing cognitive decline in the United States. At the same time, we live in an age where technology has increasingly become an integral part of our daily lives. Although numerous studies have examined cognitive functions of older adults from a diverse range of perspectives, research on the relationship between the technology adoption and adult cognitive capacity has been limited. Using nationally representative data (n = 5,259) from the Health and Retirement Study (HRS), this study analyzed the effect of computer usage on the cognitive capabilities of individuals aged 50 and older in the United States. Findings show that computer use in older adults declines with age but rises for those with higher levels of education. Results also indicate that an increased use of computers is significantly associated with improved cognitive capability, when controlling for age, gender, and years of education. Further research is needed to better understand the patterns of technology adoption among older adults and assess its effects on their cognitive abilities.}, keywords = {Cognitive Ability, Education, Technology}, issn = {0360-1277}, doi = {10.1080/03601277.2019.1575026}, url = {https://www.tandfonline.com/doi/full/10.1080/03601277.2019.1575026https://www.tandfonline.com/doi/pdf/10.1080/03601277.2019.1575026}, author = {Denise Calhoun and Lee, Seung Bok} } @article {10074, title = {Consolidated measures of activity among older adults: results of a three data set comparison.}, journal = {Journal of Gerontological Social Work}, year = {2019}, abstract = {This study explores the potential to consolidate a broad range of activity items to create more manageable measures that could be used in statistical modeling of multi-activity engagement. We utilized three datasets in the United States: Panel Study of Income Dynamics, Health and Retirement Study, and Midlife in the United States. After identifying activity items, exploratory and confirmatory factor analysis were used to empirically explore composite activity measures. Findings suggest that discrete activity items can be consolidated into activity domains; however, activity domains differ across datasets depending on availability of activity items. Implications for research and practice are further discussed.}, keywords = {Physical activity}, issn = {1540-4048}, doi = {10.1080/01634372.2019.1582123}, author = {Lee, Yung Soo and Putnam, Michelle and Morrow-Howell, Nancy and Inoue, Megumi and Jennifer C. Greenfield and Chen, Huajuan} } @article {10454, title = {CROSS-COUNTRY COMPARISON OF INTERNET USE AND DEPRESSION BY GENDER: THE ROLE OF INTERGENERATIONAL FACTORS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, month = {2019/11/08}, pages = {S330 - S331}, abstract = {Technology may offer one approach to reducing depression as it provides medium to maintain connections (Cotton et al., 2014). Yet, depression, internet use, gender roles, and expectation of intergenerational interaction all differ across countries. Using nationally representative data from the U.S (Health and Retirement Study: HRS) and South Korea (Living Profiles of Older People Survey: LPOPS), the study examines 1) association between internet use and depressive symptoms by gender in two countries; 2) and whether intergenerational factors moderated this association. In the U.S., more than half of men and women aged 65+ used the internet, while approximately 30\% of women and 47\% of men used the internet in Korea. Using the internet was associated with lower depression for those living far from the closest child for women in the U.S., and for men in Korea. The findings indicate that the association of internet use on depressive symptoms can be influenced by intergenerational factors that may differentially affect men and women depending on the sociohistorical contexts.}, keywords = {depression, gender, Intergenerational ties, International}, isbn = {2399-5300}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840073/}, author = {Shim, Hyunju and Jennifer A Ailshire and Eileen M. Crimmins} } @article {10116, title = {Crowded nests: Parent-adult child coresidence transitions and parental mental health following the Great Recession.}, journal = {Journal of Health and Social Behavior}, volume = {60}, year = {2019}, pages = {204-221}, abstract = {Although many studies have examined contemporary increases in parent-adult child coresidence, questions about what this demographic shift means for the well-being of parents remain. This article draws on insights from the life course perspective to investigate the relationship between parent-adult child coresidence and parental mental health among U.S. adults ages 50+, distinguishing between parents stably living with and without adult children and those who transitioned into or out of coresidence with an adult child. Based on analyses of the 2008 to 2012 waves of the Health and Retirement Study ( = 11,277), parents with a newly coresidential adult child experienced an increase in depressive symptoms relative to their peers without coresidential adult children. Further analyses suggest that transitions to coresidence that occurred in the southern United States or involved out-of-work children were particularly depressing for parents. These findings highlight the significance of evolving intergenerational living arrangements for the well-being of older adults.}, keywords = {Adult children, Depressive symptoms, Great Recession, Parents}, issn = {2150-6000}, doi = {10.1177/0022146519849113}, author = {Caputo, Jennifer} } @article {9570, title = {Cliches about only being as old as you feel are starting to have scientific backing}, journal = {The Washington Post}, year = {2018}, address = {Washington, D.C.}, keywords = {News, Optimism}, url = {https://www.washingtonpost.com/national/health-science/cliches-about-only-being-as-old-as-you-feel-are-starting-to-have-scientific-backing/2018/04/13/4ccd9c4a-3125-11e8-8abc-22a366b72f2d_story.html?utm_term=.2ebefb4f43f0}, author = {Cimons, Marlene} } @article {9461, title = {Comfort Eating and All-Cause Mortality in the US Health and Retirement Study.}, journal = {International Journal of Behavioral Medicine}, volume = {25}, year = {2018}, pages = {473-478}, abstract = {

PURPOSE: Comfort eating is a prevalent behavior. Prior research shows that comfort eating is associated with reduced stress responses and increased metabolic risk across adolescence, young adulthood, and middle adulthood. The purpose of the current research was to test if comfort eating prospectively predicted all-cause mortality in older adulthood.

METHOD: The US Health and Retirement Study is an ongoing, nationally representative, longitudinal study of older adults. The final sample for the present study (N = 1445) included participants randomly selected to report how often they comfort ate. Comfort eating data were collected in 2008 and all-cause mortality data were collected in 2014. Participants also reported how often they consumed high-fat/sugar food as well as their height and weight in 2008.

RESULTS: For each 1-unit increase in comfort eating, the expected odds of all-cause mortality (n = 255 deceased) decreased by 14\%, OR = 0.86, p = 0.048, 95\% CI [0.74, 0.99]. This analysis statistically accounted for other predictors of mortality in the sample including age, biological sex, race, highest educational degree attained, moderate and vigorous exercise, smoking, and cumulative illness. High-fat/sugar intake did not mediate (or diminish) the association but body mass index did.

CONCLUSION: Comfort eating-irrespective of consuming high-fat/sugar food-may be associated with reduced mortality in older adults because it may promote greater body mass, and greater body mass is associated with lower risk of mortality in nationally representative samples. Interventionists might consider both beneficial and detrimental aspects of comfort eating across the lifespan.

}, keywords = {BMI, Depressive symptoms, Health Conditions and Status, Mortality}, issn = {1532-7558}, doi = {10.1007/s12529-017-9706-8}, author = {Jenna R. Cummings and Ashley E Mason and Puterman, Eli and A Janet Tomiyama} } @article {9628, title = {A Common DIO2 Polymorphism and Alzheimer Disease Dementia in African and European Americans}, journal = {Journal of Endocrinology \& Metabolism}, volume = {103}, year = {2018}, month = {05/2018}, pages = {118-1826}, chapter = {1818}, abstract = {Context A common single nucleotide polymorphism in DIO2, Thr92AlaD2, has been associated with a transcriptome typically found in neurodegenerative diseases in postmortem human brain tissue. Objective To determine whether Thr92AlaD2 is associated with incident Alzheimer disease (AD). Design Population-based study; human brain tissue microarray. Setting Community-based cohorts from Chicago and northeastern Illinois and religious clergymen from across the United States constituted the primary population. A representative sample of the U.S. population was used for secondary analyses. Participants 3054 African Americans (AAs) and 9304 European Americans (EAs). Main Outcome Measure Incident AD. Results In the primary population, AAs with Thr92AlaD2 had 1.3 times [95\% confidence interval (CI), 1.02 to 1.68; P = 0.048] greater odds of developing AD. AAs from a second population with Thr92AlaD2 showed a trend toward increased odds of dementia (odds ratio, 1.33; 95\% CI, 0.99 to 1.78; P = 0.06) and 1.35 times greater odds of developing cognitive impairment not demented (CIND; 95\% CI, 1.09 to 1.67; P = 0.006). Meta-analysis showed that AAs with Thr92AlaD2 had 1.3 times increased odds of developing AD/dementia (95\% CI, 1.07 to 1.58; P = 0.008). In EAs, no association was found between Thr92AlaD2 and AD, dementia, or CIND. Microarray of AA brain tissue identified transcriptional patterns linked to AD pathogenesis. Conclusions Thr92AlaD2 was associated with molecular markers known to underlie AD pathogenesis in AAs, translating to an observed phenotype of increased odds of developing AD/dementia in AAs in these populations. Thr92AlaD2 might represent one factor contributing to racial discrepancies in incident AD.}, keywords = {Alzheimer{\textquoteright}s disease, Cognitive Ability, Genome}, issn = {0021-972X}, url = {https://academic.oup.com/jcem/article/103/5/1818/4893706}, author = {Elizabeth A. McAninch and Rajan, Kumar B and Sungro Jo and Layal Chaker and et al.} } @article {9856, title = {A Comprehensive Measure of the Costs of Caring for a Parent: Differences According to Functional Status}, journal = {Journal of the American Geriatrics Society}, volume = {66}, year = {2018}, month = {Jan-10-2018}, pages = {2003 - 2008}, abstract = {Approximately 34 million family and friends provided unpaid care to individuals aged 50 and older in 2015. It is difficult to place a value on that time, because no payment is made to the caregiver, and multiplying caregiving hours by a wage does not account for the value of lost leisure time, implications for future employability and wages, or any intrinsic benefits accrued to the care provider. This study used a dynamic discrete choice model to estimate the costs of informal care provided by a daughter to her mother, including these other costs and benefits not typically accounted for, and compared these cost estimates for 4 categories of the mother{\textquoteright}s functional status: doctor-diagnosed memory-related disease, limitations in activities of daily living (ADLs), combination of both, cannot be left alone for 1 hour or more. We studied women aged 40 to 70 with a living mother at the start of the sample period (N=3,427 adult daughters) using data from the Health and Retirement Study (1998{\textendash}2012). The primary outcome was the monetized change in well-being due to caregiving, what economists call {\textquotedblleft}welfare costs.{\textquotedblright} We estimate that the median cost to the daughter{\textquoteright}s well-being of providing care to an elderly mother ranged from $144,302 to $201,896 over 2 years, depending on the mother{\textquoteright}s functional status. These estimates suggest that informal care cost $277 billion in 2011, 20\% more than estimates that account only for current foregone wages. {\textcopyright} 2018, Copyright the Author Journal compilation {\textcopyright} 2018, The American Geriatrics Society }, keywords = {Caregiving, Informal care, Well-being}, doi = {10.1111/jgs.15552}, url = {https://pubmed.ncbi.nlm.nih.gov/30222183/}, author = {Norma B Coe and Meghan M. Skira and Eric B Larson} } @article {9395, title = {Cross-Country Comparisons of Disability and Morbidity: Evidence from the Gateway to Global Aging Data}, journal = {The Journals of Gerontology: Series A}, volume = {73}, year = {2018}, pages = {1519-1524}, abstract = {Background International comparisons of disease prevalence have been useful in understanding what proportion of disease might be preventable and in informing potential policy interventions in different cultural and economic contexts. Using newly available, harmonized data from 20 countries, we compare disability and morbidity of older adults between the ages of 55 and 74. Methods The Gateway to Global Aging Data, a data and information portal, provides access to easy-to-use individual-level longitudinal data from 10 surveys covering over 30 countries. Exploiting harmonized measures available from the Gateway, we descriptively examine how disability and morbidity differ across countries. Results Significant cross-country differences are observed for several health indicators. Comparing countries with the highest and lowest prevalence rates, we observe that hypertension rates vary twofold and stroke rates vary threefold, while disability and arthritis rates vary more than fivefold. Among women, higher gross domestic product and life expectancy are related to lower diabetes, heart disease, and better functioning. Among men, national indicators of economic conditions are not significantly associated with reported disease prevalence. Conclusions We document substantial heterogeneity in disability and morbidity across countries, separately for men and women and after controlling for population age composition and education. Rich data from various surveys across the world offers remarkable opportunities for cross-country analyses, calling for further investigation of what drives observed differences. The Gateway to Global Aging Data provides easy-to-use harmonized data files and tools to facilitate this type of research.}, keywords = {Cross-National, Disabilities, Disease, Gateway to Global Aging}, issn = {1079-5006}, doi = {10.1093/gerona/glx224}, url = {http://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/glx224/4683782http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/glx224/22474170/glx224.pdf}, author = {Jinkook Lee and Drystan F. Phillips and Wilkens, Jenny and Chien, Sandy and Lin, Yu-Chen and Marco Angrisani and Eileen M. Crimmins} } @article {8936, title = {Clinical Trials Targeting Aging and Age-Related Multimorbidity}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {72}, year = {2017}, pages = {355-361}, abstract = {Background: There is growing interest in identifying interventions that may increase health span by targeting biological processes underlying aging. The design of efficient and rigorous clinical trials to assess these interventions requires careful consideration of eligibility criteria, outcomes, sample size, and monitoring plans. Methods: Experienced geriatrics researchers and clinical trialists collaborated to provide advice on clinical trial design. Results: Outcomes based on the accumulation and incidence of age-related chronic diseases are attractive for clinical trials targeting aging. Accumulation and incidence rates of multimorbidity outcomes were developed by selecting at-risk subsets of individuals from three large cohort studies of older individuals. These provide representative benchmark data for decisions on eligibility, duration, and assessment protocols. Monitoring rules should be sensitive to targeting aging-related, rather than disease-specific, outcomes. Conclusions: Clinical trials targeting aging are feasible, but require careful design consideration and monitoring rules.}, keywords = {Chronic disease, Clinical trials, Older Adults}, issn = {1079-5006}, doi = {10.1093/gerona/glw220}, url = {https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glw220https://academic.oup.com/biomedgerontology/article/2328606/Clinical-Trials-Targeting-Aging-and-AgeRelated}, author = {Mark A. Espeland and Eileen M. Crimmins and Brandon R. Grossardt and Jill P. Crandall and Jonathan A. L. Gelfond and Tamara B Harris and Stephen B Kritchevsky and JoAnn E Manson and Jennifer G Robinson and Walter A Rocca and Temprosa, Marinella and Thomas, Fridtjof and Robert B Wallace and Barzilai, Nir} } @article {9332, title = {Comparing 2SLS vs 2SRI for Binary Outcomes and Binary Exposures}, number = {Working Paper No. 23840}, year = {2017}, month = {09/2017}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {This study uses Monte Carlo simulations to examine the ability of the two-stage least-squares (2SLS) estimator and two-stage residual inclusion (2SRI) estimators with varying forms of residuals to estimate the local average and population average treatment effect parameters in models with binary outcome, endogenous binary treatment, and single binary instrument. The rarity of the outcome and the treatment are varied across simulation scenarios. Results show that 2SLS generated consistent estimates of the LATE and biased estimates of the ATE across all scenarios. 2SRI approaches, in general, produce biased estimates of both LATE and ATE under all scenarios. 2SRI using generalized residuals minimizes the bias in ATE estimates. Use of 2SLS and 2SRI is illustrated in an empirical application estimating the effects of long-term care insurance on a variety of binary healthcare utilization outcomes among the near-elderly using the Health and Retirement Study.}, keywords = {Economics, Health Services Utilization, Long-term Care}, doi = {10.3386/w23840}, url = {http://www.nber.org/papers/w23840.pdf}, author = {Basu, Anirban and Norma B Coe and Cole G. Chapman} } @article {8813, title = {A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012.}, journal = {JAMA Intern Med}, volume = {177}, year = {2017}, month = {2017 01 01}, pages = {51-58}, abstract = {

Importance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results: The study cohorts had an average age of 75.0 years (95\% CI, 74.8-75.2 years) in 2000 and 74.8 years (95\% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4\% (95\% CI, 57.3\%-59.4\%) of the 2000 cohort was female compared with 56.3\% (95\% CI, 55.5\%-57.0\%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6\% (95\% CI, 10.7\%-12.7\%) in 2000 to 8.8\% (95\% CI, 8.2\%-9.4\%) (8.6\% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95\% CI, 11.6-11.9 years] to 12.7 years [95\% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

}, keywords = {Aged, Dementia, Female, Humans, Male, Prevalence, Risk Factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2016.6807}, url = {http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084}, author = {Kenneth M. Langa and Eric B Larson and Eileen M. Crimmins and Jessica Faul and Deborah A Levine and Mohammed U Kabeto and David R Weir} } @article {9172, title = {The complex genetics of gait speed: genome-wide meta-analysis approach.}, journal = {Aging (Albany NY)}, volume = {9}, year = {2017}, pages = {209-246}, abstract = {Emerging evidence suggests that the basis for variation in late-life mobility is attributable, in part, to genetic factors, which may become increasingly important with age. Our objective was to systematically assess the contribution of genetic variation to gait speed in older individuals. We conducted a meta-analysis of gait speed GWASs in 31,478 older adults from 17 cohorts of the CHARGE consortium, and validated our results in 2,588 older adults from 4 independent studies. We followed our initial discoveries with network and eQTL analysis of candidate signals in tissues. The meta-analysis resulted in a list of 536 suggestive genome wide significant SNPs in or near 69 genes. Further interrogation with Pathway Analysis placed gait speed as a polygenic complex trait in five major networks. Subsequent eQTL analysis revealed several SNPs significantly associated with the expression of PRSS16, WDSUB1 and PTPRT, which in addition to the meta-analysis and pathway suggested that genetic effects on gait speed may occur through synaptic function and neuronal development pathways. No genome-wide significant signals for gait speed were identified from this moderately large sample of older adults, suggesting that more refined physical function phenotypes will be needed to identify the genetic basis of gait speed in aging.}, keywords = {Genetics, GWAS}, issn = {1945-4589}, doi = {10.18632/aging.101151}, author = {Ben-Avraham, Dan and Karasik, David and Joe Verghese and Kathryn L Lunetta and John D Eicher and Vered, Rotem and Deelen, Joris and Alice M. Arnold and Aron S Buchman and Toshiko Tanaka and Jessica Faul and Nethander, Maria and Myriam Fornage and Hieab H Adams and Amy M Matteini and Michele L Callisaya and Albert Vernon Smith and Lei Yu and Philip L de Jager and Denis A Evans and Gudnason, Vilmundur and Hofman, Albert and Pattie, Alison and Corley, Janie and Lenore J Launer and David S Knopman and Parimi, Neeta and Stephen T Turner and Bandinelli, Stefania and Beekman, Marian and Gutman, Danielle and Sharvit, Lital and Simon P Mooijaart and David C Liewald and Jeanine J Houwing-Duistermaat and Ohlsson, Claes and Moed, Matthijs and Vincent J Verlinden and Mellstr{\"o}m, Dan and Jos N van der Geest and Karlsson, Magnus and Dena G Hernandez and McWhirter, Rebekah and Yongmei Liu and Thomson, Russell and Tranah, Gregory J and Andr{\'e} G Uitterlinden and David R Weir and Wei Zhao and John M Starr and Mohammed Arfan Ikram and David A Bennett and Steven R Cummings and Ian J Deary and Tamara B Harris and Sharon L R Kardia and Thomas H Mosley and Velandai K Srikanth and Beverly G Windham and Anne B Newman and Jeremy D Walston and Gail Davies and Daniel S Evans and Eline P Slagboom and Luigi Ferrucci and Douglas P Kiel and Joanne M Murabito and Atzmon, Gil} } @article {9129, title = {Consumer decision-making abilities and long-term care insurance purchase.}, journal = {Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, year = {2017}, month = {9999}, abstract = {

Objectives: To determine the impact of consumer decision-making abilities on making a long-term care insurance (LTCi) purchasing decision that is consistent with normative economic predictions regarding policy ownership.

Method: Using data from the Health and Retirement Study, multivariate analyses are implemented to estimate the effect of decision-making ability factors on owning LTCi. Stratified multivariate analyses are used to examine the effect of decision-making abilities on the likelihood of adhering to economic predictions of LTCi ownership.

Results: In the full sample, better cognitive capacity was found to significantly increase the odds of ownership. When the sample was stratified based on expected LTCi ownership status, cognitive capacity was positively associated with ownership among those predicted to own and negatively associated with ownership among those predicted not to own who could likely afford a policy.

Discussion: Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and private insuring mechanisms.

}, keywords = {Decision making, Long-term Care}, issn = {1758-5368}, doi = {10.1093/geronb/gbx059}, author = {Brian E McGarry and Tempkin-Greener, Helena and David C Grabowski and Chapman, Benjamin P and Li, Yue} } @article {9326, title = {Contemporaneous Social Environment and the Architecture of Late-Life Gene Expression Profiles.}, journal = {American Journal of Epidemiology}, volume = {186}, year = {2017}, pages = {503-509}, abstract = {Environmental or social challenges can stimulate a cascade of coordinated physiological changes in stress response systems. Unfortunately, chronic activation of these adaptations under conditions such as low socioeconomic status (SES) can have negative consequences for long-term health. While there is substantial evidence tying low SES to increased disease risk and reduced life expectancy, the underlying biology remains poorly understood. Using pilot data on 120 older adults from the Health and Retirement Study (United States, 2002-2010), we examined the associations between SES and gene expression levels in adulthood, with particular focus on a gene expression program known as the conserved transcriptional response to adversity. We also used a bioinformatics-based approach to assess the activity of specific gene regulation pathways involved in inflammation, antiviral responses, and stress-related neuroendocrine signaling. We found that low SES was related to increased expression of conserved transcriptional response to adversity genes and distinct patterns of proinflammatory, antiviral, and stress signaling (e.g., sympathetic nervous system and hypothalamic-pituitary-adrenal axis) transcription factor activation.}, keywords = {Genetics, Socioeconomic factors}, issn = {1476-6256}, doi = {10.1093/aje/kwx147}, author = {Morgan E. Levine and Eileen M. Crimmins and David R Weir and Steven W. Cole} } @article {10009, title = {The credit card debt puzzle and noncognitive ability}, journal = {Review of Finance}, volume = {22}, year = {2017}, pages = {2109-2137}, abstract = {Many households concurrently hold low-yield liquid assets while incurring costly credit card debt. In our sample, more than 80\% of households with credit card debt also have low-yield liquid assets. Using data from the Health and Retirement Study (N=30,517), we examine the role of noncognitive skills as well as the economic, financial, and demographic factors that affect the likelihood of co-holding. We find that the "Big Five" personality traits have a statistically significant and economically important effect: households with a more agreeable, introvert, and less conscientious head of household are more likely to co-hold. We also examine the role of intra-household dynamics.}, keywords = {Cognitive Ability, Financial literacy, Personality}, issn = {1572-3097}, doi = {10.1093/rof/rfx020}, url = {https://academic.oup.com/rof/article/22/6/2109/3970879http://academic.oup.com/rof/article-pdf/22/6/2109/26172467/rfx020.pdf}, author = {Choi, Hwan-sik and Laschever, Ron A.} } @article {9375, title = {Cultural and emotional determinants of cervical cancer screening among older Hispanic women}, journal = {Health Care for Women International}, volume = {38}, year = {2017}, pages = {1289-1312}, abstract = {Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics{\textquoteright} cervical cancer screening behaviors.}, keywords = {Cancer screenings, Depressive symptoms, Hispanics, Women and Minorities}, issn = {0739-9332}, doi = {10.1080/07399332.2017.1364740}, url = {https://www.tandfonline.com/doi/full/10.1080/07399332.2017.1364740https://www.tandfonline.com/doi/pdf/10.1080/07399332.2017.1364740}, author = {Tamara J. Cadet and Shanna Lynn Burke and Stewart, Kathleen and Howard, Tenial and Schonberg, Mara} } @article {8902, title = {Cut points for clinical muscle weakness among older Americans.}, journal = {American Journal of Preventative Medicine}, volume = {53}, year = {2017}, pages = {63-69}, abstract = {

INTRODUCTION: Muscle weakness is an important indicator of disability, chronic disease, and early mortality. Grip strength is a simple, cost-effective measure of overall muscle strength. The Foundation of the National Institutes of Health recently proposed sex-specific grip strength cut points for clinical muscle weakness. However, these criteria were established using non-nationally representative data. This study used nationally representative data on Americans aged >=65 years to identify race- and sex-specific cut points for clinical muscle weakness and quantify prevalence among older blacks and whites by sex.

METHODS: Classification and Regression Tree models were used to identify cut points based on individual-level grip strength associated with slow gait speed (<0.8 m/second) among 7,688 individuals (57\% female; 8\% black; mean age, 74.6 [SD=6.79] years) from the 2010/2012 Health and Retirement Study during January-April 2016. Identified cut points were then used to quantify the prevalence of weakness by race/sex subgroup.

RESULTS: Fifty-five percent of men (maximum grip strength <39 kg) and 47\% of women (maximum grip strength <22 kg) were classified as weak. Higher cut points were identified for black men (maximum grip strength <40 kg) and women (maximum grip strength <31 kg), and the prevalence of weakness (57\% and 88\%, respectively) was higher compared with whites. Fifty-five percent of individuals had slow gait speed (<0.8 m/second).

CONCLUSIONS: Prevalence of weakness was substantially higher than previous reports, underscoring the importance of using population-level data to identify individuals at greatest risk for adverse health outcomes. This is the first study to establish cut points for muscle weakness in a nationally representative sample by race and sex.

}, keywords = {Cut points, Gender Differences, Grip strength, Muscle Weakness, Older Adults, Racial/ethnic differences}, issn = {1873-2607}, doi = {10.1016/j.amepre.2016.12.022}, author = {Kate A Duchowny and Mark D Peterson and Philippa J Clarke} } @article {8400, title = {Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 Feb}, pages = {129-135.e3}, publisher = {26}, abstract = {

PURPOSE: The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities.

METHODS: Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents >= 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups.

RESULTS: Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95\% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95\% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95\% CI = (-8.2, -22.6), P = .035].

CONCLUSIONS: Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.

}, keywords = {Aged, Aged, 80 and over, depression, Health Status Disparities, Humans, Korean War, Male, Public Policy, Residence Characteristics, Risk Factors, Socioeconomic factors, Veterans}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2015.12.003}, url = {http://www.sciencedirect.com/science/article/pii/S1047279715300107}, author = {Anusha M Vable and Canning, David and M. Maria Glymour and Ichiro Kawachi and Marcia P Jimenez and S. V. Subramanian} } @article {8810, title = {Change in Cognitively Healthy and Cognitively Impaired Life Expectancy in the United States: 2000-2010.}, journal = {SSM Popul Health}, volume = {2}, year = {2016}, month = {2016 Dec}, pages = {793-797}, abstract = {

OBJECTIVE: To determine how cognitively healthy and cognitively impaired life expectancy have changed from 2000 to 2010 among American men and women 65 years of age and over.

METHODS: The prevalence of dementia, cognitive impairment without dementia (CIND), and normal cognition is determined from the nationally representative data from the U.S. Health and Retirement Study (HRS). Mortality rates are from U.S. Decennial Life Table for 2000 and the U.S. annual life table for 2010. Life expectancy by cognitive status is estimated using the Sullivan method.

RESULTS: Most of the increase in life expectancy has been concentrated in cognitively healthy years in this 10 year period. The increase in expected years cognitively intact at age 65, which exceeded that in total life expectancy, was 1.8 for men and 1.6 for women.

CONCLUSION: This study provides evidence suggesting that there has been a compression of cognitive morbidity.

}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2016.10.007}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2352827316301148http://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/xml}, author = {Eileen M. Crimmins and Saito, Yasuhiko and Jung K Kim} } @article {6514, title = {Changes in Visual Function in the Elderly Population in the United States: 1995-2010.}, journal = {Ophthalmic Epidemiol}, volume = {23}, year = {2016}, month = {2016 Jun}, pages = {137-44}, chapter = {1}, abstract = {

PURPOSE: To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes).

METHODS: Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent).

RESULTS: Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma.

CONCLUSION: Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Chronic disease, Cross-Sectional Studies, Female, Humans, Male, Medicare Part B, Prevalence, Self Report, Socioeconomic factors, United States, Visual Acuity, Visually Impaired Persons}, issn = {1744-5086}, doi = {10.3109/09286586.2015.1057603}, url = {http://dx.doi.org/10.3109/09286586.2015.1057603}, author = {Chen, Yiqun and Hahn, Paul and Frank A Sloan} } @article {8389, title = {Cohort Effects in the Genetic Influence on Smoking.}, journal = {Behav Genet}, volume = {46}, year = {2016}, note = {Export Date: 9 September 2015 Article in Press}, month = {2016 Jan}, pages = {31-42}, publisher = {46}, abstract = {

We examine the hypothesis that the heritability of smoking has varied over the course of recent history as a function of associated changes in the composition of the smoking and non-smoking populations. Classical twin-based heritability analysis has suggested that genetic basis of smoking has increased as the information about the harms of tobacco has become more prevalent-particularly after the issuance of the 1964 Surgeon General{\textquoteright}s Report. In the present paper we deploy alternative methods to test this claim. We use data from the Health and Retirement Study to estimate cohort differences in the genetic influence on smoking using both genomic-relatedness-matrix restricted maximum likelihood and a modified DeFries-Fulker approach. We perform a similar exercise deploying a polygenic score for smoking using results generated by the Tobacco and Genetics consortium. The results support earlier claims that the genetic influence in smoking behavior has increased over time. Emphasizing historical periods and birth cohorts as environmental factors has benefits over existing GxE research. Our results provide additional support for the idea that anti-smoking policies of the 1980s may not be as effective because of the increasingly important role of genotype as a determinant of smoking status.

}, keywords = {Aged, Cohort Effect, Female, Gene Frequency, Genetic Predisposition to Disease, Genotype, Humans, Male, Middle Aged, Multifactorial Inheritance, Smoking, Twins}, issn = {1573-3297}, doi = {10.1007/s10519-015-9731-9}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84938496073andpartnerID=40andmd5=76a4f2cefad88fc22ebca2e435b4323e}, author = {Benjamin W Domingue and Dalton C Conley and Jason M. Fletcher and Jason D Boardman} } @article {8682, title = {A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 10}, pages = {1256-78}, abstract = {

OBJECTIVE: This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.

METHOD: This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.

RESULTS: Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.

DISCUSSION: Japan{\textquoteright}s compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Cause of Death, Cross-Cultural Comparison, Educational Status, Employment, Family Characteristics, Female, Health Status, Health Surveys, Healthy Lifestyle, Humans, Japan, Life Expectancy, Life Tables, Longitudinal Studies, Male, Middle Aged, Regression Analysis, Retirement, Sex Distribution, United States}, issn = {1552-6887}, doi = {10.1177/0898264316656505}, author = {Chi-Tsun Chiu and Mark D Hayward and Saito, Yasuhiko} } @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 {8537, title = {Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights.}, journal = {Int Psychogeriatr}, volume = {28}, year = {2016}, month = {2016 Apr}, pages = {557-76}, abstract = {

BACKGROUND: Older persons are particularly vulnerable to loneliness because of common age-related changes and losses. This paper reviews predictors of loneliness in the older population as described in the current literature and a small qualitative study.

METHODS: Peer-reviewed journal articles were identified from psycINFO, MEDLINE, and Google Scholar from 2000-2012. Overall, 38 articles were reviewed. Two focus groups were conducted asking older participants about the causes of loneliness.

RESULTS: Variables significantly associated with loneliness in older adults were: female gender, non-married status, older age, poor income, lower educational level, living alone, low quality of social relationships, poor self-reported health, and poor functional status. Psychological attributes associated with loneliness included poor mental health, low self-efficacy beliefs, negative life events, and cognitive deficits. These associations were mainly studied in cross-sectional studies. In the focus groups, participants mentioned environmental barriers, unsafe neighborhoods, migration patterns, inaccessible housing, and inadequate resources for socializing. Other issues raised in the focus groups were the relationship between loneliness and boredom and inactivity, the role of recent losses of family and friends, as well as mental health issues, such as shame and fear.

CONCLUSIONS: Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.

}, keywords = {Aged, Aged, 80 and over, Aging, Cross-Sectional Studies, Female, Focus Groups, Humans, Loneliness, Male, Marital Status, Motor Activity, Qualitative Research, Quality of Life, Residence Characteristics, Sex Factors, Social Environment, social isolation, Socioeconomic factors}, issn = {1741-203X}, doi = {10.1017/S1041610215001532}, url = {http://www.journals.cambridge.org/abstract_S1041610215001532}, author = {Cohen-Mansfield, Jiska and Hazan, Haim and Lerman, Yaffa and Shalom, Vera} } @article {8330, title = {Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults.}, journal = {J Am Heart Assoc}, volume = {4}, year = {2015}, month = {2015 May 13}, publisher = {4}, abstract = {

BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.

METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors{\textquoteright} diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was >=3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (>=65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95\% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95\% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95\% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95\% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95\% CI 0.98 to 5.67).

CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.

}, keywords = {Adult, Aged, Aged, 80 and over, Aging, depression, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Sex Factors, Stroke, Time Factors}, issn = {2047-9980}, doi = {10.1161/JAHA.115.001923}, author = {Stefan Walter and Eric J. Tchetgen Tchetgen and Kristen K Patton and J Robin Moon and Benjamin D Capistrant and Jessica R Marden and Laura D Kubzansky and Paola Gilsanz and Ichiro Kawachi and M. Maria Glymour} } @article {8911, title = {Changes in Optimism Are Associated with Changes in Health Over Time Among Older Adults.}, journal = {Social Psychological and Personality Science}, volume = {6}, year = {2015}, month = {2015 Sep}, pages = {814-822}, abstract = {

Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a four-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a four-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being.

}, keywords = {Health Changes, Health Conditions and Status, Older Adults, Optimism}, issn = {1948-5506}, doi = {10.1177/1948550615590199}, author = {William J. Chopik and Eric S Kim and Jacqui Smith} } @article {8314, title = {Childhood and later life stressors and increased inflammatory gene expression at older ages.}, journal = {Soc Sci Med}, volume = {130}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {16-22}, publisher = {130}, abstract = {

Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists.

}, keywords = {Adolescent, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Continental Population Groups, Cyclooxygenase 2, Female, Health Status, Health Surveys, Humans, Interleukin-1beta, Interleukin-8, Life Change Events, Male, Middle Aged, Obesity, RNA, Sex Factors, Smoking, Socioeconomic factors, Stress, Psychological}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2015.01.030}, author = {Morgan E. Levine and Steven W. Cole and David R Weir and Eileen M. Crimmins} } @article {8627, title = {Comparing Retirement Wealth Trajectories on Both Sides of the Pond }, number = {Research Brief 33}, year = {2015}, institution = {Institute for Social Research}, type = {Brief}, address = {Ann Arbor}, keywords = {Cross-National, Income, Older Adults, Retirement Planning and Satisfaction}, url = {http://www.mrrc.isr.umich.edu/publications/briefs/pdf/rb333.pdf}, author = {Richard Blundell and Crawford, Rowena and Eric French and Tetlow, Gemma} } @article {9063, title = {Comparison of self-reported and Medicare claims-identified acute myocardial infarction.}, journal = {Circulation}, volume = {131}, year = {2015}, month = {2015 Apr 28}, pages = {1477-85; discussion 1485}, abstract = {

BACKGROUND: Cardiovascular disease is often studied through patient self-report and administrative data. However, these 2 sources provide different information, and few studies have compared them.

METHODS AND RESULTS: We compared data from a longitudinal, nationally representative survey of older Americans with matched Medicare claims. Self-reported heart attack in the previous 2 years was compared with claims-identified acute myocardial infarction (AMI) and acute coronary syndrome. Among the 3.1\% of respondents with self-reported heart attack, 32.8\% had claims-identified AMI, 16.5\% had non-AMI acute coronary syndrome, and 25.8\% had other cardiac claims; 17.3\% had no inpatient visits in the previous 2.5 years. Claims-identified AMIs were found in 1.4\% of respondents; of these, 67.8\% reported a heart attack. Self-reports were less likely among respondents >75 years of age (62.7\% versus 74.6\%; P=0.006), with less than high school education (61.6\% versus 71.4\%; P=0.015), with at least 1 limitation in activities of daily living (59.6\% versus 74.7\%; P=0.001), or below the 25th percentile of a word recall memory test (60.7\% versus 71.3\%; P=0.019). Both self-reported and claims-identified cardiac events were associated with increased mortality; the highest mortality was observed among those with claims-identified AMI who did not self-report (odds ratio, 2.8; 95\% confidence interval, 1.5-5.1) and among those with self-reported heart attack and claims-identified AMI (odds ratio, 2.5; 95\% confidence interval, 1.7-3.6) or non-AMI acute coronary syndrome (odds ratio, 2.7; 95\% confidence interval, 1.8-4.1).

CONCLUSIONS: There is considerable disagreement between self-reported and claims-identified events. Although self-reported heart attack may be inaccurate, it indicates increased risk of death, regardless of whether the self-report is confirmed by Medicare claims.

}, keywords = {Heart disease, Medicare linkage, Medicare/Medicaid/Health Insurance, Self-reported health}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.114.013829}, author = {Laura Yasaitis and Lisa F Berkman and Chandra, Amitabh} } @article {8617, title = {Comprehensive gene- and pathway-based analysis of depressive symptoms in older adults.}, journal = {J Alzheimers Dis}, volume = {45}, year = {2015}, month = {2015}, pages = {1197-206}, abstract = {

Depressive symptoms are common in older adults and are particularly prevalent in those with or at elevated risk for dementia. Although the heritability of depression is estimated to be substantial, single nucleotide polymorphism-based genome-wide association studies of depressive symptoms have had limited success. In this study, we performed genome-wide gene- and pathway-based analyses of depressive symptom burden. Study participants included non-Hispanic Caucasian subjects (n = 6,884) from three independent cohorts, the Alzheimer{\textquoteright}s Disease Neuroimaging Initiative (ADNI), the Health and Retirement Study (HRS), and the Indiana Memory and Aging Study (IMAS). Gene-based meta-analysis identified genome-wide significant associations (ANGPT4 and FAM110A, q-value = 0.026; GRM7-AS3 and LRFN5, q-value = 0.042). Pathway analysis revealed enrichment of association in 105 pathways, including multiple pathways related to ERK/MAPK signaling, GSK3 signaling in bipolar disorder, cell development, and immune activation and inflammation. GRM7, ANGPT4, and LRFN5 have been previously implicated in psychiatric disorders, including the GRM7 region displaying association with major depressive disorder. The ERK/MAPK signaling pathway is a known target of antidepressant drugs and has important roles in neuronal plasticity, and GSK3 signaling has been previously implicated in Alzheimer{\textquoteright}s disease and as a promising therapeutic target for depression. Our results warrant further investigation in independent and larger cohorts and add to the growing understanding of the genetics and pathobiology of depressive symptoms in aging and neurodegenerative disorders. In particular, the genes and pathways demonstrating association with depressive symptoms may be potential therapeutic targets for these symptoms in older adults.

}, keywords = {Aged, Cohort Studies, depression, European Continental Ancestry Group, Female, Genotyping Techniques, Humans, Male, Psychiatric Status Rating Scales}, issn = {1875-8908}, doi = {10.3233/JAD-148009}, author = {Nho, Kwangsik and Vijay K Ramanan and Horgusluoglu, Emrin and Sungeun Kim and Mark H Inlow and Shannon L Risacher and Brenna C McDonald and Martin R Farlow and Tatiana Foroud and Gao, Sujuan and Christopher M. Callahan and Hugh C Hendrie and Alexander B Niculescu and Andrew J Saykin} } @article {12129, title = {Contribution of common non-synonymous variants in PCSK1 to body mass index variation and risk of obesity: a systematic review and meta-analysis with evidence from up to 331 175 individuals.}, journal = {Human Molecular Genetics}, volume = {24}, year = {2015}, pages = {3582-3594}, abstract = {

Polymorphisms rs6232 and rs6234/rs6235 in PCSK1 have been associated with extreme obesity [e.g. body mass index (BMI) >= 40 kg/m(2)], but their contribution to common obesity (BMI >= 30 kg/m(2)) and BMI variation in a multi-ethnic context is unclear. To fill this gap, we collected phenotypic and genetic data in up to 331 175 individuals from diverse ethnic groups. This process involved a systematic review of the literature in PubMed, Web of Science, Embase and the NIH GWAS catalog complemented by data extraction from pre-existing GWAS or custom-arrays in consortia and single studies. We employed recently developed global meta-analytic random-effects methods to calculate summary odds ratios (OR) and 95\% confidence intervals (CIs) or beta estimates and standard errors (SE) for the obesity status and BMI analyses, respectively. Significant associations were found with binary obesity status for rs6232 (OR = 1.15, 95\% CI 1.06-1.24, P = 6.08 {\texttimes} 10(-6)) and rs6234/rs6235 (OR = 1.07, 95\% CI 1.04-1.10, P = 3.00 {\texttimes} 10(-7)). Similarly, significant associations were found with continuous BMI for rs6232 (β = 0.03, 95\% CI 0.00-0.07; P = 0.047) and rs6234/rs6235 (β = 0.02, 95\% CI 0.00-0.03; P = 5.57 {\texttimes} 10(-4)). Ethnicity, age and study ascertainment significantly modulated the association of PCSK1 polymorphisms with obesity. In summary, we demonstrate evidence that common gene variation in PCSK1 contributes to BMI variation and susceptibility to common obesity in the largest known meta-analysis published to date in genetic epidemiology.

}, keywords = {Alleles, Body Mass Index, Genetic Predisposition to Disease, Genetic Variation, Humans, Obesity, Odds Ratio, Polymorphism, Single Nucleotide, Proprotein Convertase 1}, issn = {1460-2083}, doi = {10.1093/hmg/ddv097}, author = {Nead, Kevin T and Li, Aihua and Wehner, Mackenzie R and Neupane, Binod and Gustafsson, Stefan and Adam S Butterworth and Engert, James C and Davis, A Darlene and Hegele, Robert A and Miller, Ruby and den Hoed, Marcel and Khaw, Kay-Tee and Kilpel{\"a}inen, Tuomas O and Wareham, Nick and Edwards, Todd L and Hallmans, G{\"o}ran and Varga, Tibor V and Sharon L R Kardia and Smith, Jennifer A and Zhao, Wei and Jessica Faul and David R Weir and Mi, Jie and Xi, Bo and Quinteros, Samuel Canizales and Cooper, Cyrus and Sayer, Avan Aihie and Jameson, Karen and Gr{\o}ntved, Anders and Myriam Fornage and Stephen Sidney and Hanis, Craig L and Highland, Heather M and H{\"a}ring, Hans-Ulrich and Heni, Martin and Lasky-Su, Jessica and Weiss, Scott T and Gerhard, Glenn S and Still, Christopher and Melka, Melkaey M and Pausova, Zdenka and Paus, Tom{\'a}{\v s} and Grant, Struan F A and Hakonarson, Hakon and Price, R Arlen and Wang, Kai and Scherag, Andre and Hebebrand, Johannes and Hinney, Anke and Franks, Paul W and Timothy M Frayling and McCarthy, Mark I and Hirschhorn, Joel N and Ruth J F Loos and Ingelsson, Erik and Gerstein, Hertzel C and Yusuf, Salim and Beyene, Joseph and Anand, Sonia S and Meyre, David} } @article {8052, title = {Changes in Memory before and after Stroke Differ by Age and Sex, but Not by Race}, journal = {Cerebrovascular Diseases}, volume = {37}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, pages = {235-243}, publisher = {37}, abstract = {Background: Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race. Methods: Health and Retirement Study participants aged 50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age ( 70 vs. 70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change. Results: Older ( 70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p 0.001 for both interactions), and among stroke survivors, larger memory decrements (-0.64 vs. -0.26 points, p 0.001) at stroke and faster memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p 0.001). However, no sex differences were seen for other contrasts. Although whites had higher post-stroke memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory. Conclusions: Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease. 2014 S. Karger AG, Basel.}, keywords = {Health Conditions and Status, Methodology}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84897121425andpartnerID=40andmd5=22785f81bf8b09c85697670c6a2e2382}, author = {Qianyi Wang and Mej{\'\i}a-Guevara, Iv{\'a}n and Pamela M. Rist and Stefan Walter and Benjamin D Capistrant and M. Maria Glymour} } @article {8124, title = {Chronic obstructive pulmonary disease, cognitive impairment, and development of disability: the health and retirement study}, journal = {Annals of the American Thoracic Society}, volume = {11}, year = {2014}, note = {Times Cited: 0 0}, pages = {1362-70}, publisher = {11}, abstract = {RATIONALE: The relationship between chronic obstructive pulmonary disease (COPD) and cognitive impairment in leading to disability has not been characterized. OBJECTIVES: We aimed to investigate the prevalence and cumulative incidence of disability among adults with and without COPD and the association of COPD and cognitive impairment with disability. METHODS: We analyzed 2006-2008 waves of the Health and Retirement Study, a nationally representative longitudinal health survey. COPD was self-reported. Prevalent disability was defined as baseline dependency in one or more activities of daily living (ADLs) and incident disability as one or more additional ADL dependencies. We used a validated performance-based measure of cognition to identify dementia and mild cognitive impairment. Covariates included seven chronic diseases, four geriatric syndromes, and sociodemographics. We used logistic regression to test associations between COPD, cognitive status, and prevalent/incident disability. MEASUREMENTS AND MAIN RESULTS: Of 17,535 participants at least 53 years of age in wave 2006 (representing 77.7 million Americans), 9.5 reported COPD and 13.5 mild cognitive impairment; 17.5 of those with COPD had mild cognitive impairment. Prevalent disability for COPD was 12.8 (5.2 for no-COPD, P 0.001). An additional 9.2 with COPD developed incident disability at 2 years (4.0 for no-COPD, P 0.001). In adjusted models, COPD was associated with baseline (odds ratio, 2.0) and incident disability (odds ratio, 2.1; adjusted for baseline disability). Cognitive impairment had an additive effect to COPD. The COPD-disability association, prevalent/incident, was of similar or greater magnitude than that of other chronic diseases (e.g., stroke, diabetes). The associations were maintained in sensitivity analyses using alternative definitions of disability (dependency in two or more ADLs, dependency in instrumental ADLs), and in analysis excluding respondents with dementia. CONCLUSIONS: Both COPD and mild cognitive impairment increase the risk of disability. The risk conferred by COPD is significant and similar or higher than other chronic diseases.}, keywords = {Disabilities, Health Conditions and Status, Healthcare}, doi = {10.1513/AnnalsATS.201405-187OC}, author = {Martinez, Carlos H. and Richardson, Caroline R. and Han, MeiLan K. and Christine T Cigolle} } @article {10656, title = {Common genetic variants associated with cognitive performance identified using the proxy-phenotype method.}, journal = {Proc Natl Acad Sci U S A}, volume = {111}, year = {2014}, month = {2014 Sep 23}, pages = {13790-4}, abstract = {

We identify common genetic variants associated with cognitive performance using a two-stage approach, which we call the proxy-phenotype method. First, we conduct a genome-wide association study of educational attainment in a large sample (n = 106,736), which produces a set of 69 education-associated SNPs. Second, using independent samples (n = 24,189), we measure the association of these education-associated SNPs with cognitive performance. Three SNPs (rs1487441, rs7923609, and rs2721173) are significantly associated with cognitive performance after correction for multiple hypothesis testing. In an independent sample of older Americans (n = 8,652), we also show that a polygenic score derived from the education-associated SNPs is associated with memory and absence of dementia. Convergent evidence from a set of bioinformatics analyses implicates four specific genes (KNCMA1, NRXN1, POU2F3, and SCRT). All of these genes are associated with a particular neurotransmitter pathway involved in synaptic plasticity, the main cellular mechanism for learning and memory.

}, keywords = {Cell Adhesion Molecules, Neuronal, Cognition, Female, Humans, Learning, Male, Memory, Multifactorial Inheritance, Nerve Tissue Proteins, Neuronal Plasticity, Octamer Transcription Factors, Polymorphism, Single Nucleotide, Synaptic Transmission}, issn = {1091-6490}, doi = {10.1073/pnas.1404623111}, author = {Cornelius A Rietveld and T{\~o}nu Esko and Gail Davies and Pers, Tune H and Turley, Patrick and Benyamin, Beben and Chabris, Christopher F and Emilsson, Valur and Andrew D Johnson and Lee, James J and Christiaan de Leeuw and Riccardo E Marioni and Sarah E Medland and Michael B Miller and Rostapshova, Olga and Sven J van der Lee and Anna A E Vinkhuyzen and Amin, Najaf and Dalton C Conley and Derringer, Jaime and Cornelia M van Duijn and Fehrmann, Rudolf and Lude L Franke and Edward L Glaeser and Narelle K Hansell and Caroline Hayward and Iacono, William G and Carla A Ibrahim-Verbaas and Vincent Jaddoe and Karjalainen, Juha and David I Laibson and Paul Lichtenstein and David C Liewald and Patrik K E Magnusson and Nicholas G Martin and McGue, Matt and McMahon, George and Nancy L Pedersen and Pinker, Steven and David J Porteous and Posthuma, Danielle and Fernando Rivadeneira and Smith, Blair H and John M Starr and Henning Tiemeier and Nicholas J Timpson and Trzaskowski, Maciej and Andr{\'e} G Uitterlinden and Verhulst, Frank C and Mary E Ward and Margaret J Wright and George Davey Smith and Ian J Deary and Johannesson, Magnus and Plomin, Robert and Peter M Visscher and Daniel J. Benjamin and Cesarini, David and Philipp D Koellinger} } @article {6471, title = {Contribution of Leisure-Time Physical Activity on Psychological Benefits Among Elderly Immigrants}, journal = {Applied Research in Quality of Life}, volume = {11}, year = {2014}, note = {Export Date: 20 January 2015 Article in Press}, pages = {461-470}, chapter = {461}, abstract = {Research provides evidence that leisure-time physical activity engagement promotes health and well-being among older adults. In this study, using data released from the Health and Retirement Study (HRS) in 2008, we focused on the exploration of the relationship between leisure-time physical activity and psychological benefits such as positive affect, optimism, psychological well-being, and life satisfaction among elderly immigrants. The results of this study demonstrated that leisure-time physical activities play an important role in gaining psychological benefits. This finding provided further evidence that leisure-time physical activities provides rich opportunities for elderly immigrants to experience psychological benefits, which may contribute to quality of life and successful aging.}, keywords = {Demographics, Health Conditions and Status, Retirement Planning and Satisfaction}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84910072781andpartnerID=40andmd5=41857df2ae7e029ce6a69f2190475ba5}, author = {Kim, Junhyoung and Sanghee Chun and Jinmoo Heo and Lee, Sunwoo and Areum Han} } @article {7861, title = {THE CARE SPAN Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay}, journal = {Health Affairs}, volume = {32}, year = {2013}, note = {Times Cited: 2}, pages = {552-561}, publisher = {32}, abstract = {Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-08, and individual Medicare claims, and overcoming limitations of previous work, we found 2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: 2,650, 5,040, and 6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit.}, keywords = {Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance}, doi = {10.1377/hlthaff.2012.0851}, author = {Amy Kelley and Deb, Partha and Qingling Du and Carlson, Melissa D. Aldridge and R Sean Morrison} } @article {7922, title = {Causal effects of retirement timing on subjective physical and emotional health}, journal = {The journals of gerontology. Series B, Psychological sciences and social sciences}, volume = {68}, year = {2013}, pages = {73}, publisher = {68}, abstract = {This article explores the effects of the timing of retirement on subjective physical and emotional health. Using panel data from the Health and Retirement Study (HRS), we test 4 theory-based hypotheses about these effects-that retirements maximize health when they happen earlier, later, anytime, or on time. We employ fixed and random effects regression models with instrumental variables to estimate the short- and long-term causal effects of retirement timing on self-reported health and depressive symptoms. Early retirements--those occurring prior to traditional and legal retirement age--dampen health. Workers who begin their retirement transition before cultural and institutional timetables experience the worst health outcomes; this finding offers partial support to the psychosocial-materialist approach that emphasizes the benefits of retiring later. Continued employment after traditionally expected retirement age, however, offers no health benefits. In combination, these findings offer some support for the cultural-institutional approach but suggest that we need to modify our understanding of how cultural-institutional forces operate. Retiring too early can be problematic but no disadvantages are associated with late retirements. Raising the retirement age, therefore, could potentially reduce subjective health of retirees by expanding the group of those whose retirements would be considered early.}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, author = {Calvo, Esteban and Sarkisian, Natalia and Tamborini, Christopher R.} } @article {7845, title = {Concordance of Physical Activity Trajectories Among Middle-Aged and Older Married Couples: Impact of Diseases and Functional Difficulties}, journal = {The Journals of Gerontology}, volume = {68}, year = {2013}, note = {Copyright - Copyright Oxford University Press, UK Sep 2013 Last updated - 2013-08-16}, pages = {794}, publisher = {68}, abstract = {This study examined spousal concordance of physical activity trajectories among middle-aged and older married couples and the influences of recent diseases and functional difficulties on individuals{\textquoteright} trajectories and those of their spouses{\textquoteright}. Participants included 5,074 married couples aged 50 or older in the Health and Retirement Study in 2004-2010. Participants were categorized into 4 physical activity trajectories (i.e., stable active, adopters, relapsers, and stable sedentary) using confirmatory latent class growth analysis. Individuals{\textquoteright} trajectory memberships were predicted by their spouses{\textquoteright} memberships, together with recent diseases and functional difficulties of both couple members. In the main, corresponding husbands{\textquoteright} trajectories predicted wives{\textquoteright} trajectories and vice versa. More functional difficulties predicted higher likelihoods of unfavorable trajectories among individuals but not of their spouses{\textquoteright}. Among wives, more recent diseases predicted slightly more physical activity in subsequent data waves but not trajectory memberships. Results supported spousal concordance in physical activity trajectories. The negative impact of functional difficulties was considerably contained within individuals. Increases in physical activity after acquiring diseases among wives were small and short lived. More research is needed to understand the underlying processes, which can be used to improve the design of future physical activity interventions directed toward women, men, and couples.}, keywords = {Adult children, Demographics, Health Conditions and Status, Healthcare}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1424402869?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Apqrlandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articleandr}, author = {Li, Kin-Kit and Cardinal, Bradley J. and Acock, Alan C.} } @article {7775, title = {Clinical complexity and mortality in middle-aged and older adults with diabetes.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Dec}, pages = {1313-20}, publisher = {67}, abstract = {

BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8\%; Self-Management Difficulty Group, 79.4\%; and Uncertain Benefit Group, 52.5\%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50\%.

CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Diabetes Complications, Diabetes Mellitus, Female, Health Status, Humans, Male, Middle Aged, Proportional Hazards Models, Self Care}, issn = {1758-535X}, doi = {10.1093/gerona/gls095}, author = {Christine T Cigolle and Mohammed U Kabeto and Pearl G. Lee and Caroline S Blaum} } @article {10933, title = {A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults.}, journal = {Medical Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {534-9}, abstract = {

BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs.

OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data.

METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model.

RESULTS: At 2-year follow-up, 8.0\% and 7.3\% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness.

CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data.

}, keywords = {Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Body Mass Index, Chronic disease, Female, Humans, Male, Mobility Limitation, Models, Statistical, Risk Assessment, Sex Factors}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a50c}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller} } @article {7625, title = {Current and long-term spousal caregiving and onset of cardiovascular disease.}, journal = {J Epidemiol Community Health}, volume = {66}, year = {2012}, month = {2012 Oct}, pages = {951-6}, abstract = {

BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans.

METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living >=14 h/week according to the care recipients{\textquoteright} report in the most recent prior biennial survey; we define providing >=14 h/week of care at two consecutive biennial surveys as {\textquoteright}long-term caregiving{\textquoteright}. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD.

RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95\% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95\% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95\% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95\% CI 0.06 to 1.28).

CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Caregivers, Female, Follow-Up Studies, Humans, Incidence, Interviews as Topic, Long-term Care, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Self Report, Socioeconomic factors, Spouses, Stress, Psychological, United States}, issn = {1470-2738}, doi = {10.1136/jech-2011-200040}, author = {Benjamin D Capistrant and J Robin Moon and Lisa F Berkman and M. Maria Glymour} } @article {7630, title = {A comparison of response rates in the English Longitudinal Study of Ageing and the Health and Retirement Study.}, journal = {Longit Life Course Stud}, volume = {2}, year = {2011}, month = {2011 May 01}, pages = {127-144}, publisher = {2}, abstract = {

Survey response rates are an important measure of the quality of a survey; this is true for both longitudinal and cross-sectional surveys. However, the concept of a response rate in the context of a panel survey is more complex than is the case for a cross-sectional survey. There are typically many different response rates that can be calculated for a panel survey, each of which may be relevant for a specific purpose. The main objective of our paper is to document and compare response rates for two long-term panel studies of ageing, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) in the United States. To guide our selection and calculation of response rates for the two studies, we use a framework that was developed by Peter Lynn (2005) and present several different types of longitudinal response rates for the two surveys. We discuss similarities and differences in the study designs and protocols and how some of the differences affect comparisons of response rates across the two studies.

}, issn = {1757-9597}, doi = {10.14301/llcs.v2i2.118}, author = {Hayley Cheshire and Mary Beth Ofstedal and Shaun Scholes and Mathis Schroeder} } @article {8744, title = {Conducting High-Value Secondary Dataset Analysis: An Introductory Guide and Resources}, journal = {Journal of General Internal Medicine}, volume = {26}, year = {2011}, pages = {920-929}, abstract = {Secondary analyses of large datasets provide a mechanism for researchers to address high impact questions that would otherwise be prohibitively expensive and time-consuming to study. This paper presents a guide to assist investigators interested in conducting secondary data analysis, including advice on the process of successful secondary data analysis as well as a brief summary of high-value datasets and online resources for researchers, including the SGIM dataset compendium (www.sgim.org/go/datasets). The same basic research principles that apply to primary data analysis apply to secondary data analysis, including the development of a clear and clinically relevant research question, study sample, appropriate measures, and a thoughtful analytic approach. A real-world case description illustrates key steps: (1) define your research topic and question; (2) select a dataset; (3) get to know your dataset; and (4) structure your analysis and presentation of findings in a way that is clinically meaningful. Secondary dataset analysis is a well-established methodology. Secondary analysis is particularly valuable for junior investigators, who have limited time and resources to demonstrate expertise and productivity.}, keywords = {Datasets, Meta-analyses, Survey Methodology}, issn = {0884-8734}, doi = {10.1007/s11606-010-1621-5}, author = {John Z. Ayanian and Kenneth E Covinsky and Landon, Bruce E. and Ellen P McCarthy and Wee, Christina C. and Michael A Steinman} } @article {7614, title = {Consumer Financial Protection.}, journal = {J Econ Perspect}, volume = {25}, year = {2011}, month = {2011 Winter}, pages = {91-114}, publisher = {25}, issn = {0895-3309}, doi = {10.1257/jep.25.1.91}, author = {Campbell, John Y. and Howell E. Jackson and Brigitte C. Madrian and Peter Tufano} } @mastersthesis {6240, title = {Conversations on death: Cost implications of end-of-life preparations}, volume = {M.P.P}, year = {2011}, note = {ISBN 9781124597539}, month = {2011}, pages = {43}, school = {Georgetown University}, type = {Dissertation}, abstract = {The end of a person{\textquoteright}s life is important. Sacred, even. But, more and more the end of life is also expensive--very expensive--for patients and for the taxpayer. According to the Dartmouth Atlas of Health Care, "patients with chronic illness in their last two years of life account for about 32\% of total Medicare spending." As a result, there is a critical need to better understand effective solutions for reducing those costs. This paper focuses on the effect of living wills on total medical expenditures and utilization of heroic medical interventions at end-of-life. Using data pooled from the 2002-2008 exit surveys of the Health and Retirement Study, this paper uses logistic, regression and simulation models to evaluate the cost and care effects of three different types of living wills--those that call for comfort care only, those that call for limited care in certain situations, and those that call for receiving all care possible at end of life. The findings of this analysis indicate that patient preferences as expressed through living wills do, in fact, influence end-of-life medical expenditures as well as utilization of certain types of heroic end-of-life care. Of those patients who faced health care decisions in the final days of life, individuals who had living wills to limit care in some way had significantly lower total medical expenditures in the last two years of life, ranging from $2,730 (7\%) (limited care or withheld treatments) to $8,285 (21\%) (comfort care only) lower than their counterparts who did not have a living will. Conversely, those with living wills to receive all care possible had drastically ($24,171) (60\%) higher end-of-life costs, as well as a 37 percent higher probability of utilizing life support, compared with those who had no living will.}, keywords = {Healthcare, Public Policy, Retirement Planning and Satisfaction}, author = {Cable, Heather M} } @article {7661, title = {Cytomegalovirus antibodies in dried blood spots: a minimally invasive method for assessing stress, immune function, and aging.}, journal = {Immun Ageing}, volume = {8}, year = {2011}, month = {2011 Jan 13}, pages = {3}, publisher = {8}, abstract = {

BACKGROUND: Cytomegalovirus (CMV) is a prevalent herpesvirus with links to both stress and aging. This paper describes and validates a minimally invasive method for assessing antibodies against CMV in finger stick whole blood spot samples for use as an indirect marker of an aspect of cell-mediated immunity.

RESULTS: Analysis of CMV in dried blood spot samples (DBS) was based on modifications of a commercially available protocol for quantifying CMV antibodies in serum or plasma. The method was evaluated through analysis of precision, reliability, linearity, and correlation between matched serum and DBS samples collected from 75 volunteers. Correlation between DBS and plasma values was linear and high (Pearson correlation R = .96), and precision, reliability, and linearity of the DBS assay were within acceptable ranges.

CONCLUSIONS: The validity of a DBS assay for CMV antibodies will enable its inclusion in population-based surveys and other studies collecting DBS samples in non-clinical settings, increasing scientific understanding of the interaction of social and biological stress and immune function.

}, issn = {1742-4933}, doi = {10.1186/1742-4933-8-3}, author = {Jennifer B Dowd and Allison E Aiello and Laura Chyu and Yuan-Yen Huang and Thomas W McDade} } @article {7512, title = {Causes and consequences of early-life health.}, journal = {Demography}, volume = {47 Suppl}, year = {2010}, month = {2010}, pages = {S65-85}, publisher = {47}, abstract = {

We examine the consequences of child health for economic and health outcomes in adulthood, using height as a marker of childhood health. After reviewing previous evidence, we present a conceptual framework that highlights data limitations and methodological problems that complicate the study of this topic. We then present estimates of the associations between height and a range of outcomes--including schooling, employment, earnings, health, and cognitive ability--measured in five data sets from early to late adulthood. These results indicate that, on average, taller individuals attain higher levels of education. Height is also positively associated with better economic, health, and cognitive outcomes. These associations are only partially explained by the higher average educational attainment of taller individuals. We then use data from the National Longitudinal Survey of Youth 1979 Children and Young Adults survey to document the associations between health, cognitive development, and growth in childhood. Even among children with the same mother, taller siblings score better on cognitive tests and progress through school more quickly. Part of the differences found between siblings arises from differences in their birth weights and lengths attributable to mother{\textquoteright}s behaviors while pregnant. Taken together, these results support the hypothesis that childhood health influences health and economic status throughout adulthood.

}, keywords = {Adolescent, Adult, Aged, Body Height, Child, Child Development, Child, Preschool, Educational Status, Employment, Family Characteristics, Female, Health Status, Humans, Income, Infant, Infant, Newborn, Longitudinal Studies, Male, Middle Aged, Pregnancy, Prenatal Exposure Delayed Effects, Regression Analysis, Socioeconomic factors, United Kingdom}, issn = {0070-3370}, doi = {10.1353/dem.2010.0007}, author = {Case, Anne and Paxson, Christina} } @article {7436, title = {Characteristics of physical measurement consent in a population-based survey of older adults.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Jan}, pages = {64-71}, publisher = {48}, abstract = {

BACKGROUND: Collecting physical measurements in population-based health surveys has increased in recent years, yet little is known about the characteristics of those who consent to these measurements.

OBJECTIVE: To examine the characteristics of persons who consent to physical measurements across several domains, including one{\textquoteright}s demographic background, health status, resistance behavior toward the survey interview, and interviewer characteristics.

RESEARCH DESIGN, SUBJECTS, AND MEASURES: We conducted a secondary data analysis of the 2006 Health and Retirement Study, a nationally-representative panel survey of older adults aged 51 and older. We performed multilevel logistic regressions on a sample of 7457 respondents who were eligible for physical measurements. The primary outcome measure was consent to all physical measurements.

RESULTS: Seventy-nine percent (unweighted) of eligible respondents consented to all physical measurements. In weighted multilevel logistic regressions controlling for respondent demographics, current health status, survey resistance indicators, and interviewer characteristics, the propensity to consent was significantly greater among Hispanic respondents matched with bilingual Hispanic interviewers, patients with diabetes, and those who visited a doctor in the past 2 years. The propensity to consent was significantly lower among younger respondents, those who have several Nagi functional limitations and infrequently participate in "mildly vigorous" activities, and those interviewed by black interviewers. Survey resistance indicators, such as number of contact attempts and interviewer observations of resistant behavior in prior wave iterations of the Health and Retirement Study were also negatively associated with physical measurement consent. The propensity to consent was unrelated to prior medical diagnoses, including high blood pressure, cancer (excluding skin), lung disease, heart abnormalities, stroke, and arthritis, and matching of interviewer and respondent on race and gender.

CONCLUSIONS: Physical measurement consent is not strongly associated with one{\textquoteright}s health status, though the findings are somewhat mixed. We recommend that physical measurement results be adjusted for characteristics associated with the likelihood of consent, particularly functional limitations, to reduce potential bias. Otherwise, health researchers should exercise caution when generalizing physical measurement results to the population at large, including persons with functional limitations that may affect their participation.

}, keywords = {Age Factors, Aged, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Physical Examination, Socioeconomic factors}, issn = {1537-1948}, doi = {10.1097/mlr.0b013e3181adcbd3}, author = {Joseph W Sakshaug and Mick P. Couper and Mary Beth Ofstedal} } @article {10772, title = {Children and Household Utility: Evidence from Kids Flying the Coop}, number = {WP$\#$2010-16}, year = {2010}, institution = {Center for Retirement Research at Boston College}, abstract = {Using consumption and wealth data from the Health and Retirement Study (HRS), this paper explores the impact of children leaving home on household consumption. We find that households maintain their household-level consumption, despite the fact that the number of individuals in the household has decreased, increasing per-capita consumption. Further, we find no evidence of increases in total net wealth, or any of its components, after children leave the household. These findings suggest that households do not dramatically change their savings or consumption patterns when their children fly the coop. Those households who are already behind in their retirement preparations will remain at risk of entering retirement with insufficient wealth to maintain their pre-retirement standard of living.}, keywords = {children}, url = {https://crr.bc.edu/working-papers/children-and-household-utility-evidence-from-kids-flying-the-coop-ii/}, author = {Norma B Coe and Anthony Webb} } @article {7452, title = {Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Apr}, pages = {327-34}, publisher = {48}, abstract = {

BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions.

OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics.

DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey.

SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million).

MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c.

RESULTS: Nearly 22\% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10\% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6\% vs. 7.3\%, P < 0.04.).

CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.

}, keywords = {Aged, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, Type 2, Female, Glycemic Index, Health Status, Health Surveys, Humans, Male, Middle Aged, Quality of Health Care, Self Care, Severity of Illness Index, Treatment Failure, United States}, issn = {1537-1948}, doi = {10.1097/mlr.0b013e3181ca4035}, author = {Caroline S Blaum and Christine T Cigolle and Cynthia Boyd and Jennifer L. Wolff and Zhiyi Tian and Kenneth M. Langa and David R Weir} } @article {7443, title = {Continuity of care with a primary care physician and mortality in older adults.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Apr}, pages = {421-8}, publisher = {65A}, abstract = {

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54\%) participants died during the follow-up period. Using the cumulative exposure measure, 27\% never had continuity of care, whereas 31\%, 20\%, 14\%, and 8\%, respectively, had continuity for 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

}, keywords = {Aged, Continuity of Patient Care, Female, Health Services for the Aged, Humans, Male, Mortality, Physicians, Family}, issn = {1758-535X}, doi = {10.1093/gerona/glp188}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and John F Geweke and Elizabeth A Cook and Maksym Obrizan and Elizabeth A Chrischilles and Kara B Wright and Michael P Jones and Gary E Rosenthal and Robert L. Ohsfeldt and Robert B Wallace} } @article {7502, title = {Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US.}, journal = {Eur J Epidemiol}, volume = {25}, year = {2010}, month = {2010 Jul}, pages = {471-80}, publisher = {25}, abstract = {

The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.

}, keywords = {Aged, Aged, 80 and over, Denmark, Disability Evaluation, Female, Health Status, Humans, Japan, Male, Middle Aged, Mortality, Sex Distribution, United States}, issn = {1573-7284}, doi = {10.1007/s10654-010-9460-6}, author = {Oksuzyan, Anna and Eileen M. Crimmins and Saito, Yasuhiko and Angela M O{\textquoteright}Rand and James W Vaupel and Christensen, Kaare} } @article {7338, title = {Comparing models of frailty: the Health and Retirement Study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 May}, pages = {830-9}, publisher = {57}, abstract = {

OBJECTIVES: To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model).

DESIGN: Cross-sectional analysis.

SETTING: 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States.

MEASUREMENTS: The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics.

RESULTS: Almost one-third (30.2\%) of respondents were frail according to at least one model; 3.1\% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1\% of those classified as frail according to the Biologic Syndrome model and 72.1\% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95\% confidence interval (CI)=6.1-18.5), female sex (OR=1.7, 95\% CI=1.2-2.5), and African-American ethnicity (OR=2.1, \% CI=1.0-4.4).

CONCLUSION: Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cross-Sectional Studies, Demography, Disability Evaluation, Frail Elderly, Geriatric Assessment, Health Surveys, Humans, Interviews as Topic, Logistic Models, Models, Theoretical, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02225.x}, author = {Christine T Cigolle and Mary Beth Ofstedal and Zhiyi Tian and Caroline S Blaum} } @article {7330, title = {The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Mar}, pages = {511-6}, publisher = {57}, abstract = {

OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.

DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).

SETTING: Nationally representative health interview survey.

PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older.

MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).

RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58\% were female, 8\% were African American, and 4\% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23\% had two or more. Of respondents with one condition, 20\% to 55\% (depending on the index condition) had two or more additional conditions.

CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Angina Pectoris, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Geriatric Assessment, Health Surveys, Heart Failure, Humans, Male, Myocardial Infarction, Sick Role, Syndrome, United States, Urinary incontinence}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2008.02150.x}, author = {Pearl G. Lee and Christine T Cigolle and Caroline S Blaum} } @article {7315, title = {Correlates of improvement in walking ability in older persons in the United States.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Mar}, pages = {533-9}, publisher = {99}, abstract = {

OBJECTIVES: We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study.

METHODS: We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors.

RESULTS: Among the 25\% of the study population with baseline walking limitations, 29\% experienced improved walking ability, 40\% experienced no change in walking ability, and 31\% experienced deteriorated walking ability or died. In a multivariate analysis, we found positive associations between walking improvement and more recent onset and more severe walking difficulty, being overweight, and engaging in vigorous physical activity. A history of diabetes, having any difficulty with activities of daily living, and being a current smoker were all negatively associated with improvement in walking ability. After we controlled for baseline health, improvement in walking ability was equally likely among racial and ethnic minorities and those with lower socioeconomic status.

CONCLUSIONS: Interventions to reduce smoking and to increase physical activity may help improve walking ability in older Americans.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Confidence Intervals, Female, Health Promotion, Humans, Male, Middle Aged, Motor Activity, Multivariate Analysis, Odds Ratio, Overweight, Smoking Prevention, Social Marketing, Socioeconomic factors, United States, Walking}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.142927}, author = {Joseph Feinglass and Song, Jing and Larry M Manheim and Semanik, Pamela and Rowland W Chang and Dorothy D Dunlop} } @mastersthesis {6249, title = {Childlessness and Psychological Well-Being Across the Life Course as Manifested in Significant Life Events}, volume = {Doctoral Dissertation}, year = {2008}, month = {2008}, school = {University of Southern California}, type = {3311070}, address = {United States -- California}, abstract = {The childless population in the United States is growing fast, accounting for approximately one fifth of population aged 65 and older. The combination of longevity, marital status changes, and childlessness has led to the projection that about 25\% of the population aged 70 to 85 in 2030 will not have a living spouse or a living child. Surprisingly, there is relatively little documentation about the lives of childless elders. Childless people have been conspicuously ignored in social sciences, even in very pertinent fields such as adult development, aging, the life course, and the family. Among previous studies, two common shortcomings make results on childlessness and old-age well-being inconclusive: (a) treating childlessness as a static status and not considering possible changes in its meaning and impact felt in significant life events, and (b) focusing on negative aspect of childlessness at the exclusion of possible positive rewards. This dissertation added contextual variables and measured both negative and positive affects of psychological well-being. It adopts stress process model as a framework to study the effects of childlessness on psychological well-being in the events of caregiving in middle age, retirement in young-old age, and disability in advanced old age. This dissertation uses data from Health and Retirement Study. The findings indicate that childlessness by itself does not pose a negative threat to psychological well-being. The lack of a negative effect of childlessness on psychological well-being does not mean that children are not beneficial to parents. Rather, it suggests that taking the "deviant" path of childlessness, whether voluntarily or not, does not necessarily render childless persons at a greater disadvantage than parents in old age. However, one natural outcome of childlessness is the lack of biological grandchildren the benefits associated with grandparenthood. In this dissertation, grandchildren are found to have a positive influence on grandparents{\textquoteright}, and in particular grandfathers{\textquoteright}, transitions to retirement. The effects of childlessness were teased out from the impact of marital status. Possible interaction of gender, parental status, and marital status were tested. Childlessness and singlehood interacts in some cases. Childlessness poses different implications for men and women.}, keywords = {Adult children, Health Conditions and Status, Healthcare, Methodology}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1564020811\&Fmt=7\&clientId=17822\&RQT=309\&VName=PQD}, author = {Chang, Echo Win-Hu} } @article {7232, title = {Chronic conditions and mortality among the oldest old.}, journal = {Am J Public Health}, volume = {98}, year = {2008}, note = {PMID 18511714}, month = {2008 Jul}, pages = {1209-14}, publisher = {98}, abstract = {

OBJECTIVES: We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.

METHODS: Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.

RESULTS: As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).

CONCLUSIONS: The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Female, Health Behavior, Health Status, Humans, Male, Middle Aged, Models, Statistical, Predictive Value of Tests, Proportional Hazards Models, Reproducibility of Results, Risk Adjustment, Severity of Illness Index, Socioeconomic factors, Survival Analysis, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2007.130955}, author = {Sei J. Lee and Alan S Go and Lindquist, Karla and Bertenthal, Daniel and Kenneth E Covinsky} } @article {7215, title = {Credit Constraints and Human Capital Investment in College Education}, journal = {Journal of Family and Economic Issues}, volume = {29}, year = {2008}, pages = {41-54}, publisher = {29}, abstract = {Using data from the Health and Retirement Study 2001 Human Capital Investment Survey, this article examines the impact of credit market constraints on investment in college education. The effect of family income on college attendance may not be as big as perceived in some previous studies. The interest rates faced by children from middle families are the lowest in the credit market. The research suggests that various government programs aiming to help children from poor families may be effective, but only at the extensive margin--by improving their access to college education. For those who get into college, underinvestment by students from poor families remains a significant problem.}, keywords = {Demographics, Income, Net Worth and Assets}, author = {Cao, Honggao} } @article {7165, title = {Childhood social and economic well-being and health in older age.}, journal = {Am J Epidemiol}, volume = {166}, year = {2007}, month = {2007 Nov 01}, pages = {1059-67}, publisher = {166}, abstract = {

Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants{\textquoteright} mean age was 67 years; 57\% were women. By race/ethnicity, 76\% were White, 14\% were Black, and 8\% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95\% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95\% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95\% CI: 1.21, 1.47) and Black (AOR = 1.37, 95\% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Child, Confidence Intervals, Educational Status, Female, Frail Elderly, Health Status, Health Status Indicators, Hispanic or Latino, Humans, Male, Middle Aged, Mobility Limitation, Odds Ratio, Poverty, Retrospective Studies, Sampling Studies, San Francisco, Socioeconomic factors, Surveys and Questionnaires, White People}, issn = {0002-9262}, doi = {10.1093/aje/kwm185}, author = {Sandra Y. Moody-Ayers and Lindquist, Karla and Sen, Saunak and Kenneth E Covinsky} } @inbook {5183, title = {Consequences of Educational Change for the Burden of Chronic Health Problems in the Population}, booktitle = {Allocating Public and Private Resources across Generations}, number = {3}, year = {2006}, note = {ProCite field 8 : eds.}, pages = {227-242}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {Oxford, UK}, abstract = {Changes in the public and individual burden of chronic health problems have significant implications for the allocation of public and private resources across generations. Preston (1984) noted almost two decades ago that population ageing in the United States was accompanied by the rapid expansion of public programs benefiting the health of elderswhile public programs benefiting children{\textquoteright}s education contracted. Health care is the principal public service provided to the elderly while education is the counterpart for children. Within a historical time period, political choices about the funding of age-targeted service programs have an urgency that oftentimes sweeps aside the fact that investments in children{\textquoteright}s well-being pay substantial dividends decades later when children become the elders of a population. In large part, this reflects a lack of attention both by policy makers and by demographers of these long-run associations. Here, we provide new insights into the longrun consequences of investments in children for the burden of chronic health problems by conducting a thought experiment in which we simulate how sweeping historical changes in a population{\textquoteright}s educational achievement potentially alters active life expectancy and the prevalence of functioning problems in the population.}, keywords = {Educational attainment, Educational Change, Functional Limitation, Functional Problem, Life Table}, isbn = {978-1-4020-4480-9}, doi = {https://doi.org/10.1007/978-1-4020-4481-6_9}, author = {Mark D Hayward and Eileen M. Crimmins and Zhang, Zhenmei}, editor = {Gauthier, Anne H. and Chu, Cyrus and Tuljapurkar, Shripad} } @article {5623, title = {Changes in Wealth for Americans Reaching or Just Past Normal Retirement Age}, year = {2005}, institution = {Employee Benefit Research Institute, EBRI Issue Brief No. 277}, abstract = {This Issue Brief provides a first step in determining how retirees now starting to retire those first to be affected by the shift to lump-sum payments and 401(k) asset accumulation.are managing their wealth. Americans born from 1931 1941 are the focus of this study, since these Americans ranged in age from 51 61 in 1992 (at the beginning of the study period) and had reached age 61 71 by 2002 (the end of the study period). These Americans have been affected by fundamental changes in the employment-based retirement plan market, as fewer people are covered by defined benefit pension plans and more people are covered by defined contribution plans, principally the 401(k) plan. This shift has led to tremendous growth in IRA assets, as workers used these tax-favored savings vehicles to roll over their defined contribution and/or defined benefit assets upon job change or retirement.}, keywords = {Net Worth and Assets, Retirement Planning and Satisfaction}, url = {http://www.ebri.org/ibs/}, author = {Copeland, Craig} } @inbook {8630, title = {Changing the Retirement Paradigm}, booktitle = {Reinventing the Retirement Paradigm}, year = {2005}, pages = {3-13}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {Oxford, UK}, author = {Robert Clark and Olivia S. Mitchell} } @article {6851, title = {The Costs of Arthritis}, journal = {Arthritis and Rheumatism}, volume = {49}, year = {2003}, pages = {101-113}, publisher = {49}, abstract = {Arthritis and rheumatic conditions (i.e., arthritis) are responsible for major health care expenditures and disability burdens. The impact of arthritis is not restrained by national boundaries. It is one of the most prevalent chronic conditions and is a leading cause of disability in Australia (1), Canada (2,3), Europe (4), the United Kingdom (5), and the United States (6,7), affecting an estimated 3 million Australians, 6 million Canadians, 8 million in the UK, almost 43 million people in the US, and 103 million across Europe. With the aging of the baby boomers, these numbers and the associated disabilities will quickly escalate. By 2020 in the US alone, arthritis is projected to affect 60 million people, and the activities of 12 million people may be limited by arthritis (6). The growing magnitude of people affected by arthritis motivates the need to review what is known about its national costs to identify areas where current information is lacking. In addition, it is important to determine targets for public health efforts that will reduce the costs of and burden from arthritis. This knowledge will facilitate planning research agendas that support informed public policy decisions.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.1002/art.10913}, author = {Dorothy D Dunlop and Larry M Manheim and Yelin, Edward and Song, Jing and Rowland W Chang} } @article {6824, title = {Changes in Self-Assessment of Health: Comparison of Self-Perception and Self-Ratings Score Measures Among Young-Old Persons}, journal = {Journal of Gerontological Social Work}, volume = {37}, year = {2002}, note = {ProCite field 18 : ProCite field 34 :}, pages = {65-88}, publisher = {37}, abstract = {Most geriatric screening devices include the self-ratings of health scale as a useful collateral source of information on elders{\textquoteright} health status and their need for social and health services. In this study, I reviewed extant research findings on subjective assessment of health and then compared the congruence and discrepancy between the commonly used self-ratings scale and the less frequently used self-perception scale as measures of longitudinal stability or changes in health status among the young-old. Analysis of data from the 1992 and 1994 waves of the Health and Retirement Study (HRS) shows that the restricted range of the self-ratings scale poses a limitation when the scale is used to measure changes in health status over time. It was also found that the self-ratings scale may reflect a more horizontal, social-comparison dimension and that the self-perception measure may reflect a more vertical, temporal-comparison dimension in subjective assessment of longitudinal changes in health status. Social workers need to be aware of the strengths and limitations of both measures when they use them. Reprinted by permission of the publisher.}, keywords = {Health Conditions and Status}, doi = {https://doi.org/10.1300/J083v37n01_05}, author = {Namkee G Choi} } @article {6833, title = {Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People}, journal = {Journal of the American Geriatrics Society}, volume = {50}, year = {2002}, pages = {1045-1050}, publisher = {50}, abstract = {OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort. DESIGN: Prospective cohort study. SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old. PARTICIPANTS: Five thousand six hundred ninety-seven participants (mean age 77, 64 women, 86 white) followed from 1993 to 1995. MEASUREMENTS: Cognitive impairment and dpressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity. CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.}, keywords = {Health Conditions and Status}, author = {Kala M. Mehta and Kristine Yaffe and Kenneth E Covinsky} } @article {6646, title = {Conjugal loss and syndromal depression in a sample of elders aged 70 years or older.}, journal = {Am J Psychiatry}, volume = {156}, year = {1999}, month = {1999 Oct}, pages = {1596-601}, publisher = {156}, abstract = {

OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse{\textquoteright}s death predicted bereavement-related depression.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Bereavement, Cohort Studies, depression, Depressive Disorder, Female, Humans, Logistic Models, Longitudinal Studies, Male, Marital Status, Odds Ratio, Psychiatric Status Rating Scales, Risk Factors, Sex Factors, Widowhood}, issn = {0002-953X}, doi = {10.1176/ajp.156.10.1596}, author = {Carolyn L. Turvey and Carney, C. and Arndt, Stephan and Robert B Wallace and A. Regula Herzog} } @inbook {5163, title = {Consumption and Saving Balances of the Elderly: Experimental Evidence on Survey Response Bias}, booktitle = {Frontiers in the Economics of Aging}, year = {1998}, note = {ProCite field 8 : ed.}, pages = {353-387}, publisher = {Univ. of Chicago Press}, organization = {Univ. of Chicago Press}, address = {Chicago}, abstract = {A prerequisite for understanding the economic behavior of the elderly, and the impacts of public policy on their health and well-being, is accurate data on key economic variables such as income, consumption, and assets, as well as on expectations regarding future economic and demographic events such as major health costs, disabilities, and death. Standard practice is to elicit such information in economic surveys, relying on respondents{\textquoteright} statements regarding the variables in question. Economists are generally aware that stated responses are noisy. Item nonresponse is a common problem, and carefully done surveys are designed to minimize it. Well-designed analyses of economic survey data are careful about detecting implausible outliers, imputing missing values, and correcting for selection caused by dropping missing observations. Circumstances are recognized that tend to produce systematic biases in response, such as telescoping in recall of past events that arises from the psychophysical perception of time intervals, or overstatement of charitable contributions that arises from the incentive to project a positive self-image. Nevertheless, economic studies are often too sanguine about the reliability of subjects{\textquoteright} statements regarding objective economic data.}, keywords = {Consumption and Savings, Methodology}, url = {https://www.nber.org/chapters/c7306}, author = {Michael D Hurd and Daniel McFadden and Chand, Harish and Gan, Li and Merrill, Angela and Michael Ewing Roberts}, editor = {David A Wise} } @article {5338, title = {The Competitive Performance of Life Insurance Firms in the Retirement Asset Market}, year = {1997}, institution = {University of Pennsylvania}, abstract = {This paper summarizes the findings of the joint Wharton Financial Institutions Center and KPMG study of the retirement assets market and the role of life insurance companies within it. The study began with the following goals: Investigate how people save for retirement and whether this is adequate. Determine the primary products and institutions of the retirement asset market and observe how these have changed through time. Key findings: For most, asset accumulation is less than adequate for a comfortable retirement. The average worker exhibits little of the needed financial understanding to adequately plan for retirement. Upon retirement, households do not spend down their assets optimally. The retirement asset market is rapidly expanding. Products in retirement portfolios have shifted with time. The market share of mutual funds has exploded, mostly at the expense of depository institutions. Life insurance companies maintain a large, but slipping share.}, keywords = {Insurance}, url = {https://www.researchgate.net/publication/23739464_The_Competitive_Performance_of_Life_Insurance_Firms_in_the_Retirement_Asset_Market}, author = {Chorney, Harris R. and Goldman, Jill and Olivia S. Mitchell and Santomero, Anthony M.} }