@article {13553, title = {Declines in Wealth Among US Older Adults at Risk of Dementia.}, journal = {JAMA Neurology}, year = {Forthcoming}, abstract = {Dementia is a set of neurocognitive conditions marked by a gradual deterioration of cognitive capacity that interferes with daily life, with Alzheimer disease being the most common.1 This process may adversely affect household wealth, a key social determinant of health, due to negative outcomes of financial decision capacity2 and need for expensive medical and long-term care services.3,4 We compared trajectories in household wealth for older adults (aged >=65 years) who developed probable dementia with those of a control cohort without dementia. }, keywords = {Dementia, medical cost, Wealth}, issn = {2168-6157}, doi = {10.1001/jamaneurol.2023.3216}, author = {Li, Jing and Skinner, Jonathan S and Kathleen McGarry and Nicholas, Lauren Hersch and Wang, Shao-Pang and Bollens-Lund, Evan and Kelley, Amy S} } @article {13772, title = {Depressive symptom trajectory of older adults with diabetes: exploring the role of physical activities using latent growth modeling.}, journal = {Aging \& mental health}, year = {Forthcoming}, pages = {1-9}, abstract = {

OBJECTIVES: The literature highlights the role of physical activities in reducing depression, primarily in clinical samples and international longitudinal studies on older adults with diabetes. Based on Andersen{\textquoteright}s Behavioral Model, this study aims to describe the trajectory of depressive symptoms in this population and examine whether physical activities are associated with this trajectory.

METHODS: This study used a longitudinal survey design, utilizing three waves of data from the Health and Retirement Study. The respondents were adults aged 50 or older ( = 4,278) with diabetes. After conducting descriptive analyses, latent growth modeling was performed including unconditional and conditional models.

RESULTS: The overall trajectory of depressive symptoms in adults with diabetes decreased over a 4-year period. Physical activities were significantly associated with the variance in the intercept of the trajectory (~.05), but not associated with the variance in the slope (~>~.05). Additionally, this study identified factors significantly associated with the variance in the intercept (e.g. age, gender, race, marriage, education, income, self-reported health) or the slope (e.g. race, marriage, education, self-reported health) of the depressive symptom trajectory (~.05).

CONCLUSION: The findings underscore the importance of implementing targeted interventions to encourage and promote physical activities among older adults with diabetes, recognizing the potential benefits for managing their mental health.

}, keywords = {Depressive symptoms, Diabetes, Mental Health, Older Adults, physical activities}, issn = {1364-6915}, doi = {10.1080/13607863.2024.2313722}, author = {Yoon, Young Ji} } @article {11904, title = {Depressive symptoms in older adults with and without a history of incarceration: A matched pairs comparison.}, journal = {Aging \& Mental Health}, year = {Forthcoming}, abstract = {

OBJECTIVES: Previous research has found that many incarcerated individuals have mental health conditions and that incarcerated women may be at elevated risk. These individuals have been shown to experience mental health concerns shortly after their release, but little is known about their mental health later in life. This study compared depressive symptoms in older adults with and without a history of incarceration and examined the impact of gender on this relationship.

METHOD: Data from 160 pairs of adults aged 65 or older (82.5\% male, mean age = 73.4 years) who participated in the 2012 wave of the Health and Retirement Study (HRS) was utilized. Older adults with a history of incarceration were matched to those without based on age, gender, race, and education level. Depressive symptoms (CES-D) of older adults with and without a history of incarceration were compared using a repeated-measures ANOVA.

RESULTS: The main effect of incarceration history (=.001, =.07) and the interaction between incarceration history and gender (=.01, =.04) were significant. Follow-up analyses revealed that the difference between depressive symptoms for older women with and without a history of incarceration was significant (=.02, = 0.69), whereas the difference for older men was not significant (=.19, = 0.16).

CONCLUSIONS: Findings suggest older adults with a history of incarceration report more depressive symptoms than those without and that the effect is seen among older women. Negative effects of incarceration on mental health may therefore persist into later life, highlighting the importance of pre- and post-release mental health services.

}, keywords = {depression, former inmates, incarceration}, issn = {1364-6915}, doi = {10.1080/13607863.2021.1984392}, author = {Steigerwald, Victoria L and Rozek, David C and Daniel Paulson} } @article {13660, title = {Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia.}, journal = {JAMA Internal Medicine}, year = {Forthcoming}, abstract = {

IMPORTANCE: Most older adults living with dementia ultimately need nursing home level of care (NHLOC).

OBJECTIVE: To develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023.

EXPOSURES: Candidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions.

MAIN OUTCOMES AND MEASURES: The primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots).

RESULTS: Of 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70\%) were female. At the end of follow-up, 2107 participants (63.3\%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95\% CI, 0.70-0.75) in the proxy model and 0.64 (95\% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95\% CI, 0.61-0.70) and 0.64 (95\% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk.

CONCLUSIONS AND RELEVANCE: This prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.

}, keywords = {Community-dwelling, Dementia, home care, Nursing}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2023.6548}, author = {Deardorff, W James and Jeon, Sun Y and Barnes, Deborah E and Boscardin, W John and Kenneth M. Langa and Covinsky, Kenneth E and Mitchell, Susan L and Lee, Sei J and Smith, Alexander K} } @article {12909, title = {Disentangling the Longitudinal Relationship between Loneliness and Depressive Symptoms in U.S. Adults Over 50.}, journal = {Clinical Gerontology}, year = {Forthcoming}, abstract = {

OBJECTIVES: A seminal study on loneliness and depression suggested that loneliness influences depression more than the reverse. However, the study{\textquoteright}s analytic method has since been criticized for failing to account for the trait-like nature of variables. This study aimed to examine the longitudinal relationship between loneliness and depressive symptoms while accounting for the trait-like nature of both variables.

METHODS: Data (n~=~16,478) came from the Health and Retirement Study (2006-2016). Measures included the Hughes Loneliness Scale and a modified Center for Epidemiologic Studies Depression scale (loneliness item omitted). Analyses consisted of random intercepts cross-lagged panel models (three time-points evenly spaced across eight years).

RESULTS: There was evidence that loneliness and depressive symptoms are trait-like and these trait-like components are strongly associated. There was not evidence of cross-lagged effects between loneliness and depressive symptoms.

CONCLUSIONS: A tendency toward loneliness corresponded with a tendency toward depressive symptoms. However, deviations in one{\textquoteright}s typical level of loneliness did not predict deviations in one{\textquoteright}s typical level of depressive symptoms or vice-versa. These findings do not support past assertions that loneliness shapes subsequent depression more than the reverse.

CLINICAL IMPLICATIONS: By middle to late adulthood, loneliness and depressive symptoms are trait-like phenomena that are strongly associated.

}, keywords = {Depressive symptoms, Loneliness, path analysis, RI-CLPM}, issn = {1545-2301}, doi = {10.1080/07317115.2022.2147115}, author = {Griffin, Sarah C and Blakey, Shannon M and Brant, Taylor R and Eshera, Yasmine M and Calhoun, Patrick S} } @article {13742, title = {Does the revised LDCT lung cancer screening guideline bridge the racial disparities gap: Results from the health and retirement study.}, journal = {Journal of the National Medical Association}, year = {Forthcoming}, abstract = {

PURPOSE: This study examined racial/ethnic disparities in lung cancer screening eligibility rates using 2013 US Preventive Services Task Force (USPSTF) guidelines for lung cancer with low-dose computed tomography (LDCT) and the revised 2021 guidelines.

METHODS: The study utilized a retrospective and cross-sectional research design by analyzing data from the Health and Retirement Study (HRS). N = 2,823 respondents aged 50-80 who self-reported current smoking were included in the analyses. Binary logistic regression analysis was conducted to examine the changed status of LDCT screening eligibility based on the revised 2021 guidelines by race/ethnicity after adjusting for respondent demographics.

RESULTS: Our study found substantial increases in screening eligibility rates across racial and ethnic groups when comparing the original and revised guidelines. The largest increase was observed among Black people (174\%), Hispanics (152\%), those in the other category (118\%), and Whites who smoke (80.8\%). When comparing original screening guidelines to revised guidelines, Whites who smoke had the highest percentage of changes from "not eligible" to "eligible" (28.3\%), followed by individuals in the "other" category (28.1\%), Black people (23.2\%) and Hispanics who smoke (18.3\%) (p < 0.001). Binary logistic regression results further showed that Black people who smoke (OR = 0.71, p = 0.001), as well as Hispanics who smoke (OR=0.54, p < 0.001), were less likely to change from not eligible to eligible for screening compared to Whites who smoke after adopting the revised screening guidelines. Based on the absolute differences in screening eligibility rates between Whites and other racial/ethnic groups, the disparities may have widened under the new guidelines, particularly with larger absolute differences observed between Whites, Black people, and Hispanics.

CONCLUSIONS: Our study highlights racial/ethnic disparities in LDCT screening eligibility among people who currently smoke. While the revised USPSTF guidelines increased screening eligibility for racial and ethnic minorities, they did not eliminate these disparities and may have widened under the new guidelines. Targeted interventions and policies are necessary to address barriers faced by underrepresented populations and promote equitable access to lung cancer screening.

}, keywords = {Disparities, Lung cancer screening, Race/ethnicity, Uscreening guidelines}, issn = {1943-4693}, doi = {10.1016/j.jnma.2024.01.008}, author = {Li, Chien-Ching and Manella, Jason and Kefi, Safa El and Matthews, Alicia K} } @article {13618, title = {Drivers of Community-Entry Home Health Care Utilization Among Older Adults.}, journal = {Journal of the American Medical Directors Association}, year = {Forthcoming}, abstract = {

OBJECTIVES: A growing proportion of Medicare home health (HH) patients are "community-entry," meaning referred to HH without a preceding hospitalization. We sought to identify factors that predict community-entry HH use among older adults to provide foundational information regarding care needs and circumstances that may prompt community-entry HH referral.

DESIGN: Nationally representative cohort study.

SETTING AND PARTICIPANTS: Health and Retirement Study (HRS) respondents who were aged >=65 years, community-living, and enrolled in Medicare between 2012 and 2018 (n~= 11,425 unique individuals providing 27,026 two-year observation periods).

METHODS: HRS data were linked with standardized HH patient assessments. Community-entry HH utilization was defined as incurring one or more HH episode with no preceding hospitalization or institutional post-acute care stay (determined via assessment item indicating institutional care within 14~days of HH admission) within 2~years of HRS interview. Weighted, multivariable logistic regression was used to model community-entry HH use as a function of individual, social support, and community characteristics.

RESULTS: The overall rate of community-entry HH utilization across observation periods was 13.4\%. Older adults had higher odds of community-entry HH use if they were Medicaid enrolled [adjusted odds ratio (aOR)~= 1.49, P~= .001], had fair or poor overall health (aOR~= 1.48, P < .001), 3+ activities of daily living limitations (aOR~= 1.47, P~= .007), and had fallen in the past 2 years (aOR~= 1.43, P < .001). Compared with those receiving no caregiver help, individuals were more likely to use community-entry HH if~they~received family or unpaid help only (aOR~= 1.81, P < .001), both family and paid help (aOR~= 2.79, P < .001), or paid help only (aOR: 3.46, P < .001).

CONCLUSIONS AND IMPLICATIONS: Findings indicate that community-entry HH serves a population with long-term care needs and coexisting clinical complexity, making this an important setting to provide skilled care and prevent avoidable health care utilization. Results highlight the need for ongoing monitoring of community-entry HH accessibility as this service is a key component of home-based care for a high-need subpopulation.

}, keywords = {community health care, home care, home care agencies, home health care services, Medicare}, issn = {1538-9375}, doi = {10.1016/j.jamda.2023.09.031}, author = {Burgdorf, Julia G and Ritchie, Christine S and Reckrey, Jennifer M and Liu, Bian and McDonough, Catherine and Ornstein, Katherine A} } @article {13644, title = {Dyadic loneliness, age, and cognitive functioning among midlife and older Black couples.}, journal = {Aging \& mental health}, year = {Forthcoming}, pages = {1-9}, abstract = {

Within marriages, loneliness has been linked with individuals{\textquoteright} own their partners{\textquoteright} cognitive health. Yet little research has situated Black older adults within a relational, dyadic context. This study analyzed longitudinal dyadic data from the Health and Retirement Study (2010-2016; = 1270 participants from 635 couples) from partners in opposite-sex midlife and older couples where at least one partner reported being Black or African American.: Results indicated (1) husbands{\textquoteright} loneliness was associated with worse cognitive functioning 4 years later for wives who had high baseline cognitive functioning themselves; (2) wives{\textquoteright} loneliness was associated with worse cognitive functioning 4 years later only for oldest-old husbands; and (3) wives{\textquoteright} cognitive functioning was associated with slower increases to husbands{\textquoteright} loneliness 4 years later. Findings indicate that loneliness has dyadic consequences for cognitive functioning among older Black couples, but that context is crucial for determining who is at greatest risk of harmful repercussions from a partner{\textquoteright}s loneliness.

}, keywords = {cognitive functioning, Loneliness, quantitative methods and statistics, Stress}, issn = {1364-6915}, doi = {10.1080/13607863.2023.2288862}, author = {Stokes, Jeffrey E and Farmer, Heather} } @article {13696, title = {Development of a diverse osteoporosis screening tool for older US adults from the health and retirement study.}, journal = {Heliyon}, volume = {10}, year = {2024}, pages = {e23806}, abstract = {

Existing osteoporosis screening tools have limitations, including using race as a predictor, and development on homogeneous samples. This biases risk assessment of osteoporosis in diverse populations and increases health inequities. We develop a tool that relies on variables easily learned during point-of-care, known by individuals, and with negligible racial bias. Data from the 2012-2016 waves of the population-based cohort Health and Retirement Study (HRS) were used to build a predictive model of osteoporosis diagnosis on a 75~\% training sample of adults ages 50-90. The model was validated on a 25~\% holdout sample and a cross-sectional sample of American individuals ages 50-80 from the National Health and Nutrition Examination Survey (NHANES). Sensitivity and specificity were compared across sex and race/ethnicity. The model has high sensitivity in the HRS holdout sample (89.9~\%), which holds for those identifying as female and across racial/ethnic groups. Specificity is 57.9~\%, and area under the curve (AUC) is approximately 0.81. Validation in the NHANES sample using empirically measured osteoporosis produced relatively good values of sensitivity, specificity, and consistency across groups. The model was used to create a publicly-available, open-source tool called the Osteoporosis Health Equality (\& Equity) Evaluation (OsteoHEE). The model provided high sensitivity for osteoporosis diagnosis, with consistently high results for those identifying as female, and across racial/ethnic groups. Use of this tool is expected to improve equity in screening and increase access to bone density scans for those at risk of osteoporosis. Validation on alternative samples is encouraged.

}, keywords = {Bone density, disease screening, Equity}, issn = {2405-8440}, doi = {10.1016/j.heliyon.2023.e23806}, author = {Gough Courtney, Margaret and Roberts, Josephine and Godde, K} } @article {13768, title = {Dried blood spot based biomarkers in the Health and Retirement Study: 2006 to 2016.}, journal = {American Journal of Human Biology}, volume = {36}, year = {2024}, pages = {e23997}, abstract = {

INTRODUCTION: The Health and Retirement Study (HRS) has collected biomarker data over multiple waves. Such data can help improve our understanding of health changes in individuals and the causal pathways related to health. There are, however, technical challenges to using the HRS dried blood spots (DBS) biomarker data due to changes over time in assay protocols, platforms, and laboratories. We provide technical and summary information on biological indicators collected as part of the HRS from 2006 to 2016 that should be helpful to users of the data.

METHODS: We describe the opportunities and challenges provided by the HRS DBS data as well as insights provided by the data. The HRS collected DBS from its nationally representative sample of respondents 51 years of age or older from 2006 to 2016. DBS-based biomarkers were collected from half the sample in 2006, 2010, and 2014, and from the other half of the sample in 2008, 2012, and 2016. These DBS specimens were used to assay total and HDL cholesterol, glycosylated hemoglobin, C-reactive protein, and cystatin C from 2006 to 2016, and Interleukin 6 was added in 2014/2016. Samples included approximately 6000 individuals at each wave, and completion rates ranged from 81\% to 90\%. HRS transformed DBS values into venous blood equivalents to make them more comparable to those of the whole blood-based assays collected in most other studies and to facilitate longitudinal analysis.

RESULTS: Distribution of changes over time by age shows that total cholesterol levels decreased for each age, while HbA1c levels increased. Cystatin C shows a clear age gradient, but a number of other markers do not. Non-Hispanic Black persons and Hispanic respondents have a higher incidence of risk levels of each biomarker except for CRP among non-Hispanic Black older persons.

CONCLUSION: These public-use DBS data provide analysis opportunities that can be used to improve our understanding of health change with age in both populations and among individuals.

}, keywords = {Biomarkers, C-reactive protein, Cystatin C, Dried Blood Spot Testing, Retirement}, issn = {1520-6300}, doi = {10.1002/ajhb.23997}, author = {Jung K Kim and Faul, Jessica and Weir, David R and Crimmins, Eileen M} } @mastersthesis {13341, title = {Debt and the Medicare Eligibility Discontinuity: Disparate Effects across Households}, year = {2023}, school = {University of Richmond}, type = {Honors}, address = {Richmond, Virginia}, abstract = {Public health insurance programs like Medicare and Medicaid have been shown to help reduce household debt caused by healthcare costs. The impact of health insurance literacy makes the relationship between public health programs and debt more ambiguous. The increasing complexity of Medicare raises the question of whether cost savings associated with enrollment might be mitigated by the complexity of choosing the ideal plan for those with low health insurance literacy. In this study, I utilize the Medicare eligibility cutoff at age 65 to implement a regression discontinuity design that analyzes the impact of Medicare eligibility on household debt and out of-pocket medical costs after experiencing a negative health shock. Controlling for factors that are strong predictors of health insurance literacy, such as race, ethnicity, income, and education, I tentatively find that, among individuals who experience a stroke between ages 60-70, those eligible for Medicare have lower out-of-pocket medical costs at age 75. However, further research is necessary to isolate the impacts of Medicare eligibility and health insurance literacy on household debt and out-of-pocket medical costs more precisely.}, url = {https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=2656\&context=honors-theses}, author = {Olivia Falck} } @article {13588, title = {Decision Making for Patients With Severe Dementia Versus Normal Cognition Near the End of Life.}, journal = {Innovation in Aging}, volume = {7}, year = {2023}, pages = {igad081}, abstract = {

BACKGROUND AND OBJECTIVES: The clinical progression of severe dementia frequently leads to situations where surrogate decision makers must quickly make choices about potentially burdensome treatments that offer limited clinical benefit. We examined whether the number of decision makers and their access to advance directives were related to treatment choice for patients with severe dementia in comparison to those with normal cognition.

RESEARCH DESIGN AND METHODS: We retrospectively linked survey responses about end-of-life treatment decisions to Medicare claims for Health and Retirement Study respondents dying between 2002 and 2015 whose next-of-kin reported a need for surrogate decision making. We estimated multivariable logistic regression models to study measures of aggressive care in the last 6 months of life; in-hospital death, burdensome transfers, and burdensome treatments.

RESULTS: Compared to patients who were cognitively normal near the end of life ( = 1 198), patients with severe dementia ( = 722) were less likely to experience burdensome treatments (18\% [95\% confidence interval {CI} 14-21] vs 32\% [95\% CI 29-35]), burdensome transfers (20\% [95\% CI 17-24] vs 30\% [95\% CI 27-33]), and in-hospital death (24\% [95\% CI 20-28] vs 30\% [95\% CI 26-33]) when surrogates were involved. Rates of burdensome treatments, transfers, or in-hospital death for decedents with severe dementia did not vary with single versus multiple decision makers or when decision makers were informed by advance directives. However, among decedents with normal cognition, a single decision maker informed by an advance directive was associated with the lowest rates of burdensome treatments and in-hospital death.

DISCUSSION AND IMPLICATIONS: Surrogate decision makers made similar choices around end-of-life care for patients with severe dementia regardless of the number of decision makers and availability of advance directives. However, both advance directives and single decision makers were associated with less aggressive care for cognitively normal decedents.

}, keywords = {Advance care planning, cognitive impairment, family caregivers}, issn = {2399-5300}, doi = {10.1093/geroni/igad081}, author = {Nicholas, Lauren Hersch and Halpern, Scott D and David R Weir and Baum, Micah Y and Nolan, Marie and Gallo, Joseph and Kenneth M. Langa} } @article {13310, title = {Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study}, year = {2023}, abstract = {Background and objectives: Elevated circulating cystatin C is associated with cognitive impairment in non-Hispanic Whites, but its role in racial disparities in dementia is understudied. In a nationally representative sample of older non-Hispanic White, non-Hispanic Black, and Hispanic adults in the United States, we use mediation-interaction analysis to understand how racial disparities in the cystatin C physiological pathway may contribute to racial disparities in prevalent dementia. Results: Overall, elevated cystatin C was associated with dementia (prevalence ratio [PR] = 1.4; 95\%CI: 1.2, 1.8). Among non-Hispanic Black relative to non-Hispanic White participants, the relative excess risk due to interaction was 1.7 (95\% CI: -0.2, 3.7), the attributable proportion was 0.2 (95\%CI: 0.0, 0.5), and the synergy index was 1.4 (95\% CI: 1.0, 2.0) in a fully-adjusted model. Elevated cystatin C was estimated to account for 2\% (95\% CI: -0\%, 4\%) for the racial disparity in prevalent dementia, and the interaction accounted for 9\% (95\% CI: -4\%, 23\%). Analyses for Hispanic relative to non-White participants suggested moderation by race/ethnicity, but not mediation. Discussion: Elevated cystatin C was associated with dementia prevalence. Our mediation-interaction decomposition analysis suggested that the effect of elevated cystatin C on the racial disparity might be moderated by race/ethnicity, which indicates that the racialization process affects not only the distribution of circulating cystatin C across minoritized racial groups, but also the strength of association between the biomarker and dementia prevalence. These results provide evidence that cystatin C is associated with adverse brain health and this effect is larger than expected for individuals racialized as minorities had they been racialized and treated as non-Hispanic White.}, doi = {10.3389/fnhum.2023.1052435}, author = {Higgins Tejera, C{\'e}sar and Ware, Erin B and Lindsay C Kobayashi and Fu, Mingzhou and Hicken, Margaret} } @article {13304, title = {Decoupling genetics from attainments: The role of social environments.}, journal = {Econ Hum Biol}, volume = {50}, year = {2023}, pages = {101259}, abstract = {

This paper examines the extent to which growing up in a socially mobile environment might decouple genetic endowments related to educational attainment with actual attainments. Many models of intergenerational transmission of advantage contain both a transmission channel through endowments (i.e. genetics) from parents to children as well as from parental investments and "luck". Indeed, many scholars consider the intergenerational links due to the transmission of genetically-based advantage to place a lower bound on plausible levels of social mobility-genetics may be able to "lock in" advantage across generations. This paper explores this idea by using genetic measurements in the Health and Retirement Study to examine potential interactions between social environments and genetics related to attainments. The results suggest evidence of gene environment interactions: children born in high mobility states have lower genetic penetrance-the interaction between state-level mobility and the polygenic score for education is negative. These results suggest a need to incorporate gene-environment interactions in models of attainment and mobility and to pursue the mechanisms behind the interactions.

}, issn = {1873-6130}, doi = {10.1016/j.ehb.2023.101259}, author = {Fletcher, Jason} } @article {13686, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy} } @article {13684, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy and Harrati, Amal and Jim{\'e}nez Vel{\'a}zquez, Ivonne Z and Liu, Mao-Mei and Guerra, Jorge J Llibre and Rodriguez, Juan de Jes{\'u}s Llibre and Dow, William H} } @article {12928, title = {Dementia only causes about 41\% of cognitive decline: Study identifies other predictors}, year = {2023}, publisher = {Medical News Today}, keywords = {Cognitive decline, Dementia, predictors}, url = {https://www.medicalnewstoday.com/articles/cognitive-decline-predictors-besides-dementia}, author = {Pelc, Corrie and Beake, Jessica} } @article {13140, title = {Dementia{\textquoteright}s Unique Burden: Function and Health Care in the Last 4 Years of Life.}, journal = {J Gerontol A Biol Sci Med Sci}, year = {2023}, month = {2023 Feb 06}, abstract = {

BACKGROUND: Dementia is a terminal illness marked by progressive cognitive decline. This study characterized trajectories of functional status and health care use for people with and without dementia at the end of their life.

METHODS: We used the Health and Retirement Study linked with Medicare claims to generate a series of generalized linear models. Models predicted functional status and health care use for decedents with and without dementia during each month in the last 4 years of life (48 months).

RESULTS: People with dementia have high, sustained functional impairments during the entire last 4 years of life. People with dementia have the same predicted average activities of daily living score (1.92) at 17 months before death (95\% confidence interval [CI]: 1.857, 1.989) as individuals without dementia at 6 months before death (95\% CI: 1.842, 1.991). Dementia was associated with significantly less hospice during the final 3 months of life, with a 12.5\% (95\% CI: 11.046, 13.906) likelihood of hospice in the last month of life with dementia versus 17.3\% (95\% CI: 15.573, 18.982) without dementia. Dementia was also associated with less durable medical equipment (p < .001), less home health care (p < .005), and fewer office visits (p < .001). There were not significant differences in likelihood of hospitalization in the last 48 months with or without dementia.

CONCLUSIONS: People with dementia can functionally appear to be at end of life (EOL) for years before their death. Simultaneously, they receive less health care, particularly home health and hospice, in their last months. Models of care that target people with dementia should consider the unique and sustained burden of dementia at EOL.

}, keywords = {Dementia, function, Health Care}, issn = {1758-535X}, doi = {10.1093/gerona/glad003}, author = {Broyles, Ila Hughes and Li, Qinghua and Palmer, Lauren Martin and DiBello, Michael and Dey, Judith and Oliveira, Iara and Lamont, Helen} } @article {13231, title = {Depression trajectories, genetic risk, and cognitive performance in older adults: multilevel model with a 10-year longitudinal cohort.}, journal = {Gerontology}, year = {2023}, abstract = {

BACKGROUND: Cognitive performance in older ages is strongly affected by individuals{\textquoteright} genetic predispositions. We investigated whether depression trajectories were associated with subsequent cognitive performance independent of participants{\textquoteright} genetic predispositions.

METHODS: Participants from the Health and Retirement Study with European ancestry and aged over 50 were included in the analysis. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale, and the 6-year trajectories were fitted using latent class linear mixed models. Linear multilevel regression was applied to model the associations between depression trajectory and subsequent cognitive performance. Stratified analyses were performed to investigate these associations in participants with different genetic predispositions of cognitive performance and APOE ε4 allelic status.

RESULTS: A total of 5942 eligible participants were included in the study. Four depression trajectories were identified. Compared with the non-depression trajectory, all other depression trajectories were associated with worse cognitive performance (β [95\% CI]: mild-depression trajectory: -0.20 [-0.56, -0.06], p = 0.007; worsening-depression trajectory: -0.29 [-0.47, -0.12], p = 0.001; persistent-depression trajectory: -0.32 [-0.53, -0.13], p = 0.001). Although these associations were independent of participants{\textquoteright} inherent genetic risk, the participants with a low polygenetic score for cognitive performance were more likely to have an enhanced association between depression trajectories and cognitive decline. Similar relationships were also found in APOE ε4 noncarriers.

CONCLUSION: Among older participants with European ancestry, even a mild-depression trajectory was associated with worse cognitive performance. Early intervention in participants with any degree of depression might benefit regarding preventing cognitive performance decline.

}, keywords = {depression, genetic risk, Older Adults}, issn = {1423-0003}, doi = {10.1159/000530200}, author = {Liu, Zheran and Su, Yonglin and Huang, Rendong and Li, Ruidan and Wei, Zhigong and He, Ling and Pei, Yiyan and Min, Yu and Hu, Xiaolin and Peng, Xingchen} } @article {12841, title = {Depressive Multimorbidity and Trajectories of Functional Status among Older Americans: Differences by Racial/Ethnic Group.}, journal = {JAMDA}, volume = {24}, year = {2023}, pages = {250-257}, abstract = {

OBJECTIVE: This study aims to evaluate the impact of depressive multimorbidity (ie, including depressive symptoms) on the long-term development of activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations according to racial/ethnic group in a representative sample of US older adults.

DESIGN: Prospective, observational, population-based 16-year follow-up study of nationally representative sample.

SETTING AND PARTICIPANTS: Sample of older non-Hispanic Black, Hispanic, and nonHispanic White Americans from the Health and Retirement Study (2000-2016, N~= 16,364, community-dwelling adults >=65 years of age).

METHODS: Data from 9 biennial assessments were used to evaluate the accumulation of ADL-IADL limitations (range 0-11) among participants with depressive (8-item Center for Epidemiologic Studies Depression score>=4) vs somatic (ie, physical conditions only) multimorbidity vs those without multimorbidity (no or 1 condition). Generalized estimating equations included race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White), baseline age, sex, body mass index, education, partnered, and net worth.

RESULTS: Depressive and somatic multimorbidity were associated with 5.18 and 2.95 times greater accumulation of functional limitations, respectively, relative to no disease [incidence rate ratio (IRR)~= 5.18, 95\% confidence interval, CI (4.38,6.13), IRR~= 2.95, 95\% CI (2.51,3.48)]. Hispanic and Black respondents experienced greater accumulation of ADL-IADL limitations than White respondents [IRR~= 1.27, 95\% CI (1.14, 1.41), IRR~= 1.31, 95\% CI (1.20, 1.43), respectively].

CONCLUSIONS AND IMPLICATIONS: Combinations of somatic diseases and high depressive symptoms are associated with greatest accumulation of functional limitations over time in adults ages 65 and older. There is a more rapid growth in functional limitations among individuals from racial/ethnic minority groups. Given the high prevalence of multimorbidity and depressive symptomatology among older adults and the availability of treatment options for depression, these results highlight the importance of screening/treatment for depression, particularly among older adults with socioeconomic vulnerabilities, to slow the progression of functional decline in later life.

}, keywords = {Depressive symptoms, Functional limitations, Health Disparities, multimorbidity, Race/ethnicity}, issn = {1538-9375}, doi = {10.1016/j.jamda.2022.11.015}, author = {Botoseneanu, Anda and Elman, Miriam R and Allore, Heather G and Dorr, David A and Newsom, Jason T and Nagel, Corey L and Qui{\~n}ones, Ana R} } @article {12721, title = {Depressive Symptom Trajectories and Cognition Among Older American Couples: A Dyadic Perspective.}, journal = {Journal of Aging and Health}, year = {2023}, abstract = {

OBJECTIVES: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse{\textquoteright}s memory.

METHODS: Longitudinal data from the Health and Retirement Study (2004-2016) were used ( = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory.

RESULTS: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives{\textquoteright} depressive symptom trajectories was significantly associated with husbands{\textquoteright} memory ( > .05), husbands{\textquoteright} decreasing trajectory was linked to wives{\textquoteright} better memory (β = 0.498, 95\% CI = 0.106, 0.890).

DISCUSSION: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses{\textquoteright} memory.

}, keywords = {Couples, depressive symptom trajectory, dyadic data, latent class growth analysis, Memory}, issn = {1552-6887}, doi = {10.1177/08982643221125838}, author = {Kong, Dexia and Lu, Peiyi and Solomon, Phyllis and Woo, Jean and Shelley, Mack} } @article {13457, title = {Depressive Symptoms Longitudinally Mediate the Effect of Hyperglycemia on Memory Decline in Type 2 Diabetes.}, journal = {Diabetes Care}, year = {2023}, abstract = {

OBJECTIVE: We sought to examine the mediating role of changes in depressive symptoms in the association between chronic hyperglycemia and longitudinal cognition in a sample of older adults with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS: We conducted a longitudinal mediation analysis using structural equation modeling of observational data collected over 6 years from 2,155 participants with T2D (aged >=51 years) in the U.S.-wide Health and Retirement Study. T2D was defined using self-reported diagnosis, and HbA1c was assessed at study baseline. Self-reported depressive symptoms were assessed at two time points 4 years apart. Episodic memory was measured using a list-learning test administered at three time points over 6 years. We adjusted for sociodemographics, chronic health comorbidities, medication adherence, study enrollment year, and prior years{\textquoteright} depressive symptoms and memory scores.

RESULTS: At baseline, participants{\textquoteright} mean age was 69.4 (SD = 9.1), mean HbA1c was 7.2\% (SD = 1.4\%), 55.0\% were women, 19.3\% were non-Latina/o Black, and 14.0\% were Latina/o. Higher baseline levels of HbA1c were associated with increases in depressive symptoms over 4 years, which, in turn, were associated with poorer memory 2 years later. Depressive symptoms accounted for 19\% of the longitudinal effect of HbA1c on memory over the 6-year period. Sensitivity analyses ruled out alternative directions of associations.

CONCLUSIONS: Incident elevations in depressive symptoms mediated the longitudinal association between hyperglycemia and 6-year episodic memory scores. For older adults with T2D, interventions to prevent HbA1c-related incident depressive symptoms may be beneficial in reducing the neurotoxic effects of chronic hyperglycemia on cognition.

}, issn = {1935-5548}, doi = {10.2337/dc23-0656}, author = {Kraal, A Zarina and Ellingrod, Vicki L and Zahodne, Laura B} } @article {doi:10.1080/02703181.2023.2198559, title = {Depressive Symptoms Mediate Associations between Subjective Memory Complaints, Cognitive Ability, and Instrumental Activities of Daily Living}, journal = {Physical \& Occupational Therapy In Geriatrics}, year = {2023}, pages = {1-20}, abstract = {Objectives: Cognitive ability (CA) and instrumental activities of daily living (IADL) performance are essential for productive aging. Therefore, it is important to understand if other common issues such as subjective memory complaints (SMCs) and depressive symptoms are related to CA and IADLs, and explore the nature of those relationships. This study aims to explore 1) the associations between SMCs, depressive symptoms, CA, and IADL performance and 2) the role of depressive symptoms in these associations. Method: The study sample included 1,621 community-dwelling oldest-old from the Health and Retirement Study. Results: SMCs were significantly and positively associated with cognitive decline and limitations in IADL performance. Additionally, depressive symptoms mediated the associations between SMCs and cognitive decline and between SMCs and limitations in IADL performance. Conclusion: Depressive symptoms associated with SMCs negatively affect CA and IADL performance. Therefore, healthcare providers should consider and assess SMCs and depressive symptoms in the oldest-old.}, doi = {10.1080/02703181.2023.2198559}, author = {Chang Dae Lee and Erin R. Foster and Yael Goverover} } @article {12418, title = {Depressive Symptoms Partially Mediate the Association of Frailty Phenotype Symptoms and Cognition for Females but Not Males.}, journal = {Journal of Aging and Health}, year = {2023}, abstract = {

OBJECTIVES: We aimed to evaluate whether depressive symptoms mediated the relationship between frailty phenotype and cognitive function by sex.

METHODS: Data came from the Health and Retirement Study from 2012-2016. The outcome was measured by Fried{\textquoteright}s frailty criteria, our outcome was continuous global cognition, and mediator was depressive symptoms. We used mediation analysis, stratified by sex, to estimate the direct and indirect effects of frailty symptoms on cognition mediated by depressive symptoms.

RESULTS: Males had a larger total effect (β= -0.43; 95\% CI: -0.66, -0.02) for lower cognitive score for each increase in frailty symptom compared to females (β= -0.28; 95\% CI: -0.47, -0.08). A significant indirect effect from frailty phenotype to cognition was found through depressive symptoms for females but not males.

CONCLUSION: These results highlight the importance of identifying individuals with frailty and depressive symptoms to monitor and provide interventions to preserve cognitive function.

}, keywords = {Cognitive decline, depression, Frailty}, issn = {1552-6887}, doi = {10.1177/08982643221100688}, author = {Resciniti, Nicholas V and Farina, Mateo P and Merchant, Anwar T and Lohman, Matthew C} } @article {13517, title = {Determinants of Hispanic and non-Hispanic Workers{\textquoteright} Intent to Work Past Age 65: An Analysis From the Life Course Perspective.}, journal = {Int J Aging Hum Dev}, year = {2023}, pages = {914150231196095}, abstract = {

The average retirement age in the United States (U.S.) has increased over the past few decades. However, the rate of increase for Hispanics is lower than that for non-Hispanics. For Hispanics, the decision to retire later may be more influenced by their migration history and context rather than health or finances. This study aims to explore the differences in the determinants of intentions to delay retirement (i.e., work beyond the age of 65) between Hispanics and non-Hispanic Whites in the U.S. A pooled sample was generated from all waves of the Health and Retirement Study (1992-2014), including a unique record for each non-institutionalized individual aged 55-61 who was employed. All eligible Hispanics ( = 3,663) were included, while a random sample of non-Hispanic Whites ( = 3,663) was selected. Logistic mixed models were conducted for each group, and a Two-fold Oaxaca-Blinder decomposition analysis was used to explore differences between the groups. The results indicate that non-Hispanic Whites are more likely to plan to postpone retirement. Furthermore, significant differences were found between Hispanics and non-Hispanic Whites regarding their intentions to delay retirement, specifically related to socioeconomic indicators such as individual earnings, amount of debt, level of education, and parents{\textquoteright} level of education. The differences between the groups were primarily influenced by the amount of debt, having a defined benefit plan, and parents{\textquoteright} level of education, reflecting the cumulative disadvantage experienced by Hispanics over their life course. Most existing research on the topic has focused on middle-class Whites, while few studies have examined race or ethnicity as the primary focus or explored the extent to which commonly identified predictors of delayed retirement apply to different ethno-racial groups. This is significant because Hispanics and other disadvantaged groups tend to experience financial insecurity during retirement, which directly impacts their health and well-being.

}, keywords = {Hispanics retirement intentions; decomposition analysis; delayed retirement; life course theory; retirement timing}, issn = {1541-3535}, doi = {10.1177/00914150231196095}, author = {Diaz-Valdes, Antonia and Matz-Costa, Christina and Rutledge, Mathew S and Calvo, Esteban} } @article {12851, title = {Development and validation of novel multimorbidity indices for older adults.}, journal = {Journal of the American Geriatrics Society}, volume = {71}, year = {2023}, pages = {121-135}, abstract = {

BACKGROUND: Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes.

METHODS: Health conditions were assessed using Medicare inpatient and outpatient claims from subjects age 67 and older in the Health and Retirement Study. Separate indices were developed for ADL decline, IADL decline, hospitalization, and death, each over 2 years of follow-up. We validated these indices using data from Medicare claims linked to the National Health and Aging Trends Study.

RESULTS: The development cohort included 5012 subjects with median age 76 years; 58\% were female. Claims-based markers of disease severity and disease-disease interactions yielded minimal gains in predictive power and were not included in the final indices. In the validation cohort, after adjusting for age and sex, c-statistics for the new multimorbidity indices were 0.72 for ADL decline, 0.69 for IADL decline, 0.72 for hospitalization, and 0.77 for death. These c-statistics were 0.02-0.03 higher than c-statistics from Charlson and Elixhauser indices for predicting ADL decline, IADL decline, and hospitalization, and <0.01 higher for death (p < 0.05 for each outcome except death), and were similar to those from the CMS-HCC model. On decision curve analysis, the new indices provided minimal benefit compared with legacy approaches. C-statistics for both new and legacy indices varied substantially across derivation and validation cohorts.

CONCLUSIONS: A new series of claims-based multimorbidity measures were modestly better at predicting hospitalization and functional decline than several legacy indices, and no better at predicting death. There may be limited opportunity in claims data to measure multimorbidity better than older methods.

}, keywords = {claims data, functional impairment, multimorbidity, prognostic models}, issn = {1532-5415}, doi = {10.1111/jgs.18052}, author = {Steinman, Michael A and Jing, Bocheng and Shah, Sachin J and Rizzo, Anael and Lee, Sei J and Covinsky, Kenneth E and Ritchie, Christine S and Boscardin, W John} } @article {13287, title = {Development of a latent dementia index in the aging, demographics, and memory study: Validation and measurement invariance by sex.}, journal = {Alzheimers Dement (Amst)}, volume = {15}, year = {2023}, pages = {e12433}, abstract = {

Latent variable models can create a latent dementia index (LDI) using cognitive and functional ability to approximate dementia likelihood. The LDI approach has been applied across diverse cohorts. It is unclear whether sex affects its measurement properties. We use Wave A (2001-2003) of the Aging, Demographics, and Memory Study (~=~856). Multiple group confirmatory factor analysis (CFA) was used to test measurement invariance (MI) using informant-reported functional ability and cognitive performance tasks, which we group into verbal, nonverbal, and memory. Partial scalar invariance was found, allowing for testing sex differences in LDI means (~=~0.38). The LDI correlated with consensus panel dementia diagnosis, Mini-Mental State Examination (MMSE), and dementia risk factors (low education, advanced age, and apolipoprotein ε4 [APOE-ε4] status) for men and women. The LDI validly captures dementia likelihood to permit estimation of sex differences. LDI sex differences indicate higher dementia likelihood in women, potentially due to social, environmental, and biological factors.

}, issn = {2352-8729}, doi = {10.1002/dad2.12433}, author = {Saenz, Joseph and Beam, Christopher R and Kim, Alice J} } @article {13506, title = {The devil{\textquoteright}s in the details: Variation in estimates of late-life activity limitations across national cohort studies.}, journal = {J of the American Geriatric Society}, volume = {71}, year = {2023}, pages = {858-868}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Cohort Studies, Disabled Persons, Medicare, Self Care}, issn = {1532-5415}, doi = {10.1111/jgs.18158}, author = {Ankuda, Claire K and Covinsky, Kenneth and Freedman, Vicki A and Kenneth M. Langa and Aldridge, Melissa D and Yee, Cynthia and Kelley, Amy S} } @article {12957, title = {Diabetes and Toothlessness Together Worsen Cognitive Decline}, year = {2023}, publisher = {New York University}, keywords = {Cognitive decline, Diabetes, toothlessness}, url = {https://www.nyu.edu/about/news-publications/news/2023/march/diabetes-toothlessness-cognitive-decline.html}, author = {New York University} } @article {12956, title = {Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis.}, journal = {Journal of Dental Research}, volume = {102}, year = {2023}, pages = {879-886}, abstract = {

Diabetes mellitus (DM) is a recognized risk factor for dementia, and increasing evidence shows that tooth loss is associated with cognitive impairment and dementia. However, the effect of the co-occurrence of DM and edentulism on cognitive decline is understudied. This 12-y cohort study aimed to assess the effect of the co-occurrence of DM and edentulism on cognitive decline and examine whether the effect differs by age group. Data were drawn from the 2006 to 2018 Health and Retirement Study. The study sample included 5,440 older adults aged 65 to 74 y, 3,300 aged 75 to 84 y, and 1,208 aged 85 y or older. Linear mixed-effect regression was employed to model the rates of cognitive decline stratified by age cohorts. Compared with their counterparts with neither DM nor edentulism at baseline, older adults aged 65 to 74 y (β = -1.12; 95\% confidence interval [CI], -1.56 to -0.65; < 0.001) and those aged 75 to 84 y with both conditions (β = -1.35; 95\% CI, -2.09 to -0.61; < 0.001) had a worse cognitive function. For the rate of cognitive decline, compared to those with neither condition from the same age cohort, older adults aged 65 to 74 y with both conditions declined at a higher rate (β = -0.15; 95\% CI, -0.20 to -0.10; < 0.001). Having DM alone led to an accelerated cognitive decline in older adults aged 65 to 74 y (β = -0.09; 95\% CI, -0.13 to -0.05; < 0.001); having edentulism alone led to an accelerated decline in older adults aged 65 to 74 y (β = -0.13; 95\% CI, -0.17 to -0.08; < 0.001) and older adults aged 75 to 84 (β = -0.10; 95\% CI, -0.17 to -0.03; < 0.01). Our study finds the co-occurrence of DM and edentulism led to a worse cognitive function and a faster cognitive decline in older adults aged 65 to 74 y.

}, keywords = {dental health, Epidemiology, Gerontology, oral-systemic disease(s), Public Health}, issn = {1544-0591}, doi = {10.1177/00220345231155825}, author = {Wu, B and Luo, H and Tan, C and Qi, X and Sloan, F A and Kamer, A R and Schwartz, M D and Martinez, M and Plassman, B L} } @article {13163, title = {Dietary Intake Levels of Iron, Copper, Zinc, and Manganese in Relation to Cognitive Function: A Cross-Sectional Study.}, journal = {Nutrients}, volume = {15}, year = {2023}, month = {2023 Jan 30}, abstract = {

: Previous studies have related circulating levels of trace metal elements, of which dietary intake is the major source, to cognitive outcomes. However, there are still relatively few studies evaluating the associations of dietary intake levels of iron, copper, zinc, and manganese with cognitive function (CF). : We leveraged the data of 6863 participants (mean [standard deviation] age = 66.7 [10.5] years) in the Health and Retirement Study (2013/2014). Dietary intake levels of iron, copper, zinc, and manganese were calculated from a semi-quantitative food frequency questionnaire. CF was assessed using the 27-point modified Telephone Interview for Cognitive Status (TICS). We used linear regression models to calculate the mean differences in global CF scores by quintiles of dietary intake levels of trace metal elements. : Among the study participants, the mean (SD) values of daily dietary intake were 13.3 (6.3) mg for iron, 1.4 (0.7) mg for copper, 10.7 (4.6) mg for zinc, and 3.3 (1.6) mg for manganese. Compared with the lowest quintile of dietary iron intake (<8.1 mg), the highest quintile (>=17.7 mg) was associated with a lower cognitive score (-0.50, -0.94 to -0.06, P-trend = 0.007). Higher dietary copper was significantly associated with poorer CF (P-trend = 0.002), and the mean difference in cognitive score between extreme quintiles (>=1.8 vs. <0.8 mg) was -0.52 (95\% confidence interval: -0.94 to -0.10) points. We did not observe significant associations for dietary intake of zinc (P-trend = 0.785) and manganese (P-trend = 0.368). : In this cross-sectional study, higher dietary intake of iron and copper was related to worse CF, but zinc and manganese intake levels were not significantly associated with CF.

}, keywords = {Aged, Cognition, Copper, Cross-Sectional Studies, Eating, Humans, Iron, Manganese, Trace Elements, Zinc}, issn = {2072-6643}, doi = {10.3390/nu15030704}, author = {Zhao, Dong and Huang, Yilun and Wang, Binghan and Chen, Hui and Pan, Wenfei and Yang, Min and Xia, Zhidan and Zhang, Ronghua and Yuan, Changzheng} } @mastersthesis {13406, title = {A Difference-in-Differences Approach for Estimating Survey Mode Effects}, volume = {Ph.D}, year = {2023}, month = {6/24/2023}, pages = {39}, school = {Duke University}, address = {Durham, North Carolina}, abstract = {: As surveys increasingly rely on new modes, it is important that researchers understand how mode influences survey responses. Two common designs for identifying mode effects are cross-sectional approaches and experiments. But cross-sectional designs risk a combination of omitted variable bias and post-treatment bias when conditioned on respondent characteristics that are themselves mode sensitive. In theory, experiments can obviate these biases, but only when the experiment occurs in tightly-controlled settings that avoid differential uptake across modes. Considering the costliness and paucity of such experiments, in this paper, I propose a differencein-differences approach for estimating mode effects. Leveraging mixed-mode panel surveys, mode effects can be identified by comparing changes in responses for panelists who switch modes across waves to those who remain in the same modes. Difference-in-differences offers a cost-free alternative to experiments and potentially large bias reduction gains vis-{\`a}-vis widelyutilized cross-sectional designs. I apply the difference-in-differences approach by estimating the effects of completing live interviews vs. web surveys on racial attitudes and political knowledge in the 2016-2020 ANES and on cognitive functioning measures in the 1992-2020 Health and Retirement Study.}, keywords = {mode, survey responses}, url = {https://preprints.apsanet.org/engage/api-gateway/apsa/assets/orp/resource/item/64961d7d2e632767b0ae18ab/original/a-difference-in-differences-approach-for-estimating-survey-mode-effects.pdf}, author = {Trent Ollerenshaw} } @article {13198, title = {Differences in Risk of Alzheimer{\textquoteright}s Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations.}, journal = {J Head Trauma Rehabil}, year = {2023}, abstract = {

OBJECTIVE: To directly compare the effect of incident age 68+ traumatic brain injury (TBI) on the risk of diagnosis of clinical Alzheimer{\textquoteright}s disease (AD) in the general population of older adults, and between male veterans and nonveterans; to assess how this effect changes with time since TBI.

SETTING AND PARTICIPANTS: Community-dwelling traditional Medicare beneficiaries 68 years or older from the Health and Retirement Study (HRS).

DESIGN: Fine-Gray models combined with inverse-probability weighting were used to identify associations between incident TBI, post-TBI duration, and TBI treatment intensity, with a diagnosis of clinical AD dementia. The study included 16 829 older adults followed over the 1991-2015 period. For analyses of veteran-specific risks, 4281 veteran males and 3093 nonveteran males were identified. Analysis of veteran females was unfeasible due to the age structure of the population. Information on occurrence(s) of TBI, and onset of AD and risk-related comorbidities was constructed from individual-level HRS-linked Medicare claim records while demographic and socioeconomic risk factors were based on the survey data.

RESULTS: Later-life TBI was strongly associated with increased clinical AD risk in the full sample (pseudo-hazard ratio [HR]: 3.22; 95\% confidence interval [CI]: 2.57-4.05) and in veteran/nonveteran males (HR: 5.31; CI: 3.42-7.94), especially those requiring high-intensity/duration care (HR: 1.58; CI: 1.29-1.91). Effect magnitude decreased with time following TBI (HR: 0.72: CI: 0.68-0.80).

CONCLUSION: Later-life TBI was strongly associated with increased AD risk, especially in those requiring high-intensity/duration care. Effect magnitude decreased with time following TBI. Univariate analysis showed no differences in AD risk between veterans and nonveterans, while the protective effect associated with veteran status in Fine-Gray models was largely due to differences in demographics, socioeconomics, and morbidity. Future longitudinal studies incorporating diagnostic procedures and documentation quantifying lifetime TBI events are necessary to uncover pathophysiological mediating and/or moderating mechanisms between TBI and AD.

}, keywords = {Alzheimer disease, Traumatic Brain Injury, veteran}, issn = {1550-509X}, doi = {10.1097/HTR.0000000000000865}, author = {Yashkin, Arseniy P and Gorbunova, Galina A and Tupler, Larry and Yashin, Anatoliy I and Doraiswamy, Murali and Akushevich, Igor} } @article {13254, title = {Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults.}, journal = {Am J Psychiatry}, year = {2023}, pages = {appiajp20220158}, abstract = {

OBJECTIVE: The authors sought to determine the impact of selected social determinants of health (SDoH) on psychological health and well-being (defined as depression, cognition, and self-rated health) among Black and Hispanic/Latinx adults relative to White adults 51-89 years of age.

METHODS: Disparities in depressive symptomatology, cognition, and self-rated health were measured among 2,306 non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 non-Hispanic/Latinx White adults who participated in the Health and Retirement Study (N=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected SDoH explained a larger share of the disparities than age, sex, measures of health, health behaviors, and health care utilization. Selected SDoH included education, parental education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage.

RESULTS: Black and Hispanic/Latinx adults reported worse depressive symptomatology, cognition, and self-rated health than White adults. Selected SDoH were associated with a larger proportion of the Black-White disparities in depressive symptomatology (51\%), cognition (39\%), and self-rated health (37\%) than were age, sex, measures of health, health behaviors, and health care utilization. SDoH were associated with a larger proportion of the Hispanic/Latinx-White disparity in cognition (76\%) and self-rated health (75\%), but age and physical health correlated with the disparity in depressive symptomatology (28\%). Education, parental education, years worked, income, and insurance parity were SDoH associated with these disparities.

CONCLUSIONS: Differences in SDoH underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key SDoH.

}, issn = {1535-7228}, doi = {10.1176/appi.ajp.20220158}, author = {Jester, Dylan J and Kohn, Jordan N and Tibiri{\c c}{\'a}, Lize and Thomas, Michael L and Brown, Lauren L and Murphy, James D and Jeste, Dilip V} } @article {13264, title = {Different Levels of Leisure Walking and Mental Health Among Older Adults With Mild Cognitive Impairment.}, journal = {J Aging Phys Act}, year = {2023}, month = {2023 Apr 20}, pages = {1-8}, abstract = {

Leisure walking has been found to be positively associated with increased mental health. However, the benefits of leisure walking of varying intensities on the mental health of older adults (>50~years old) with mild cognitive impairment are not clear. This study employed 2020 Health and Retirement Study data to investigate the benefits of leisure walking for three groups based on levels of participation (low, mid, and high). We conducted a multivariate analysis of covariance (n = 834) to examine the group mean differences (MDs). The respondents in the high and mid groups presented higher life satisfaction and happiness than those in the low group. The high group had lower loneliness and stress scores than those in the low and mid groups. These findings indicate that older adults with mild cognitive impairment gained more mental health benefits and life satisfaction through moderate and vigorous leisure walking than through light leisure walking.

}, issn = {1543-267X}, doi = {10.1123/japa.2022-0191}, author = {Lee, Jungjoo and Oh, Seok Min and Kim, Jaehyun and Kim, Junhyoung} } @article {13288, title = {Differential Effects of ADHD Polygenic Risk on Cognitive Performance in Later Life.}, journal = {J Atten Disord}, year = {2023}, pages = {10870547231172768}, abstract = {

OBJECTIVE: Understanding the association between polygenic risk for ADHD and cognition throughout aging has not been widely studied. This study aimed to determine whether ADHD risk influences cognitive performance among individuals at both young-old and middle-old age.

METHOD: Participants from the Health and Retirement Study, a biennial survey of 20,000 Americans, were compared on executive function and delayed recall measures using regression analyses.

RESULTS: There was no significant effect of ADHD risk on memory at both age waves for African-ancestry (AA; = 403) and European-ancestry (EA; = 2,286). There was, however, a significant association between ADHD risk and performance on executive function for EA at middle-old age ( = .028), but not young-old age; no such association was observed for AA adults.

CONCLUSION: This finding suggests that ADHD risk may differentially influence cognition among older adults throughout the aging process, with important implications for future research.

}, issn = {1557-1246}, doi = {10.1177/10870547231172768}, author = {Mansoor, Marrium and Katz, Benjamin} } @article {13603, title = {Disability and morbidity among US birth cohorts, 1998-2018: A multidimensional test of dynamic equilibrium theory.}, journal = {SSM - population health}, volume = {24}, year = {2023}, pages = {101528}, abstract = {

A substantial body of prior research has explored patterns of disability-free and morbidity-free life expectancy among older populations. However, these distinct facets of later-life health are almost always studied in isolation, even though they are very likely to be related. Using data from the US Health and Retirement Study and a multistate life table approach, this paper explores the interactions between disability, morbidity, and mortality by sex and education among four successive US birth cohorts, born from 1914 to 1923 to 1944-1953 and compared in the periods 1998-2008 and 2008-2018. We find little compression of disability but a marked expansion of morbidity across cohorts. However, disability-free life expectancy (DFLE) among those living with chronic morbidities has increased, even though at the population-level DFLE is largely unchanged. Broadly, these patterns suggest that successive cohorts of older populations in the US are experiencing a dynamic equilibrium, where the link between chronic morbidities and disability has weakened over successive cohorts. Investigating patterns by educational attainment, we find marked disparities where the least educated individuals not only live significantly fewer years free of disabilities or chronic morbidities but also have experienced an expansion in morbidity and disability. Our findings suggest that the future trajectory of disability-free life expectancy in the US is increasingly contingent on efforts to improve disease management and control the severe consequences of chronic morbidities.

}, keywords = {Aging, Disability, Dynamic equilibrium, Health expectancy, Morbidity}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2023.101528}, author = {Shen, Tianyu and Payne, Collin F} } @article {13202, title = {Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions.}, journal = {Lifestyle Genom}, year = {2023}, month = {2023 Feb 07}, abstract = {

INTRODUCTION: Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene x environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation).

METHODS: This was an observational study of 4,102 White/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination scale items. Polygenic risk scores (PRS) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium.

RESULTS: We found that greater PRS-BMI were significantly associated with more reports of discrimination (β= 0.04 {\textpm} 0.02; p= 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively.

DISCUSSION/CONCLUSION: Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population-level.

}, keywords = {Adulthood, discrimination exposure, Obesity}, issn = {2504-3188}, doi = {10.1159/000529527}, author = {Cuevas, Adolfo G and Mann, Frank D and Krueger, Robert F} } @article {13492, title = {Disparities Growing Between Low- and High-Income Retirement Accounts: GAO}, year = {2023}, publisher = {American Society of Pension Professionals \& Actuaries }, keywords = {Disparities, Income, retirement account}, url = {https://www.asppa-net.org/news/disparities-growing-between-low-and-high-income-retirement-accounts-gao}, author = {Godbout, Ted} } @article {13418, title = {Disparities in advance care planning among older US immigrants.}, journal = {J Am Geriatr Soc}, year = {2023}, abstract = {

BACKGROUND: Despite known racial disparities in advance care planning (ACP), little is known about ACP disparities experienced by US immigrants.

METHODS: We used data from the 2016 wave of the Health and Retirement Study. We defined ACP engagement as self-reported end-of-life (EOL) discussions, designation of a power of attorney (DPOA), documented living will, or "any" of the three behaviors. Immigration status was determined by respondent-reported birth outside the United States. Time in the United States was calculated by subtracting the year of arrival in the United States from the survey year of 2016. We used multivariable logistic regression to estimate the association between ACP engagement and immigration status and the relationship of acculturation to ACP engagement, adjusting for sociodemographics, religiosity, and life expectancy.

RESULTS: Of the total cohort (N = 9928), 10\% were immigrants; 45\% of immigrants identified as Hispanic. After adjustment, immigrants had significantly lower adjusted probability of any ACP engagement (immigrants: 74\% vs. US-born: 83\%, p < 0.001), EOL discussions (67\% vs. 77\%, p < 0.001), DPOA designation (50\% vs. 59\%, p = 0.001) and living will documentation (50\% vs. 56\%, p = 0.03). Among immigrants, each year in the United States was associated with a 4\% increase in the odds of any ACP engagement (aOR 1.04, 95\% CI 1.03-1.06), ranging from 36\% engaged 10 years after immigration to 78\% after 70 years.

CONCLUSION: ACP engagement was lower for US immigrants compared to US-born older adults, particularly for those that recently immigrated. Future studies should explore strategies to reduce disparities in ACP and the unique ACP needs among different immigrant populations.

}, keywords = {care planning, Disparities, Immigrants, United States}, issn = {1532-5415}, doi = {10.1111/jgs.18498}, author = {Mindo-Panusis, Dallas and Sudore, Rebecca L and Cenzer, Irena and Smith, Alexander K and Kotwal, Ashwin A} } @article {13674, title = {Disparities in LTSS Needs and Supportive Resources at Age 55, and Outcome Disparities During the Next Decade}, year = {2023}, institution = {ATI Advisory}, abstract = {Our research highlights disparities and differences in the prevalence of long-term services and supports (LTSS) needs and related resources among U.S. adults aged 55 and living in the community. We examine private finances, insurance coverage, and social supports, as well as long-term health, LTSS and financial outcomes over the next decade. Disparities and differences occurred along racial and ethnic, gender, and geographic lines. This report analyzes data from the University of Michigan Health and Retirement Study (HRS).}, keywords = {Disparities, Long-term services and supports}, url = {https://atiadvisory.com/resources/disparities-in-ltss-needs-and-supportive-resources-at-age-55-and-outcome-disparities-during-the-next-decade/}, author = {ATI Advisory} } @article {12954, title = {Do Older Adults Accurately Forecast Their Social Security Benefits?}, number = {31023}, year = {2023}, institution = {NBER}, abstract = {How accurate are older people{\textquoteright}s expectations about their future Social Security benefits? Using panel data from the Health and Retirement Study, we compare respondents{\textquoteright} observed Social Security claiming ages and benefits with subjective expectations provided during their 50s and early 60s. We find that, while older adults generally have accurate expectations about their claiming age, they underestimate their annual Social Security income by approximately $1,896 (11.5 percent) on average. However, both accuracy and precision increase with age, and the forecast error for people in their early 60s is not statistically different from zero. Exploiting plausibly exogenous variation in the mailing of Social Security statements, which contain personalized information about future benefits, we show that information provision reduces the forecast error in annual income by $344 (2.1 percent of the average benefit). }, keywords = {Expectations, Retirement Planning, Social Security Benefits}, doi = {10.3386/w31023}, author = {Seiter, Grant M. and Sita Nataraj Slavov} } @article {13273, title = {Do older adults adjust their control beliefs according to changes in mobility limitations? Evidence from a large-scale observational study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2023}, abstract = {

OBJECTIVES: This study examines cross-over, time-lagged (cross-lagged) effects of non-intervened changes between mobility limitations and control constraints/self-mastery.

METHODS: Using the Health and Retirement Study data from the years 2006 through 2016 from 10,690 participants, changes in mobility limitations, control constraints, and self-mastery were analyzed simultaneously with three latent change score models, to account for measurement error and pre-existing mobility issues prior to baseline.

RESULTS: An increase in mobility limitations predicts a decrease in mastery observed in the next interval, but not the other way around. Cross-lagged effects of changes are significant only between control and local mobility limitations concerning upper/lower extremity and associated large muscles.

DISCUSSION: The results indicate reciprocity between perceived control constraints and local mobility regardless of pre-existing limitations. To better facilitate recovery and prevention, future intervention designs should consider alleviating control constraints in addition to improving self-mastery.

}, issn = {1758-5368}, doi = {10.1093/geronb/gbad067}, author = {Oi, Katsuya} } @article {13648, title = {Do Pets Really Help Aging People Stay Mentally Sharp?}, year = {2023}, publisher = {Psychology Today}, keywords = {Cognition, ELSA, Pets}, url = {https://www.psychologytoday.com/us/blog/animals-and-us/202312/do-pets-really-help-aging-people-stay-mentally-sharp}, author = {Herzog, Hal} } @article {13668, title = {Documentation of lnterleukin-6 (IL-6) Assays from Dried Blood Spots 2014 and 2016}, year = {2023}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, MI}, abstract = {This document describes the collection of lnterleukin-6 (IL-6) in 2014 and 2016 Assays from Dried Blood Spots. }, keywords = {User guide}, author = {Crimmins, Eileen and Jessica Faul and Jung K Kim and David R Weir} } @article {12976, title = {Does Country Living Make Folks Happier? Maybe Not}, year = {2023}, publisher = {U.S. News \& World Report}, keywords = {Happiness, rural living, urban areas}, url = {https://www.usnews.com/news/health-news/articles/2023-03-14/does-country-living-make-folks-happier-maybe-not}, author = {Murez, Cara} } @article {13293, title = {Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults?}, journal = {Arch Gerontol Geriatr}, volume = {113}, year = {2023}, pages = {105055}, abstract = {

OBJECTIVE: Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential mediating role of psychosocial stress.

METHODS: This cross-sectional study included 7,679 community-dwelling older adults (>= 65) from Health and Retirement Study in the US (2006 and 2008). We used six dichotomized psychosocial stressors: a) loneliness, b) discrimination, c) financial strain, d) low subjective status, e) poor neighborhood cohesion, and f) traumatic life events to compute cumulative psychosocial stress. The Fried frailty phenotype defined frailty based on three features: slowness, poor strength, weight loss, fatigue, and low physical activity. Multivariable regressions were used to examine the structural determinants (gender, education, race, and ethnicity) frailty relationship and test whether cumulative psychosocial stress has a mediating role.

RESULTS: The frailty prevalence was 22\%. Females, Hispanics, Blacks, and those with less education had higher odds of frailty (p<.01). Race and ethnic minorities and non-college graduates experienced greater cumulative psychosocial stress relative to their White and college graduate counterparts (p<.05), respectively. Greater cumulative psychosocial stress was associated with increased odds of frailty (p < .001); however, it did not mediate the structural determinants and frailty relationship.

CONCLUSION: Contrary to expectations, cumulative psychosocial stress did not mediate the relationship between structural determinants and frailty. Rather, high cumulative psychosocial stress was independently associated with frailty. Further research should examine other psychosocial mediators to inform interventions to prevent/delay frailty.

}, issn = {1872-6976}, doi = {10.1016/j.archger.2023.105055}, author = {Shakya, Shamatree and Silva, Susan G and McConnell, Eleanor S and McLaughlin, Sara J and Cary, Michael P} } @article {13428, title = {Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India.}, journal = {Alzheimers Dement}, year = {2023}, abstract = {

INTRODUCTION: We compared gender disparities in later-life memory, overall and by education, in India and the United States (US).

METHODS: Data (N~=~7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N~=~4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N~=~3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education.

RESULTS: In the United States, older women had better memory than older men (0.28 SD-unit difference; 95\% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95\% CI: -0.20, -0.10), which attenuated with increasing education and literacy.

CONCLUSION: We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy.

}, keywords = {Education, gender disparities, India, memory function, United States}, issn = {1552-5279}, doi = {10.1002/alz.13404}, author = {Westrick, Ashly C and Avila-Rieger, Justina and Gross, Alden L and Hohman, Timothy and Vonk, Jet M J and Zahodne, Laura B and Lindsay C Kobayashi} } @article {doi:10.1016/S0735-1097(23)02223-4, title = {DOES INCIDENT CARDIOVASCULAR DISEASE LEAD TO GREATER ODDS OF DISABILITY? INSIGHTS FROM THE HEALTH AND RETIREMENT STUDY}, journal = {Journal of the American College of Cardiology}, volume = {81}, year = {2023}, pages = {1779-1779}, keywords = {Cardiovascular disease}, doi = {10.1016/S0735-1097(23)02223-4}, author = {Katherine L. Stone and Judy Zhong and Chen Lyu and Joshua Chodosh and Nina Blachman and John A. Dodson} } @article {13239, title = {Does Incident Cardiovascular Disease Lead to Greater Odds of Functional and Cognitive Impairment? Insights from the Health and Retirement Study.}, journal = {J Gerontol A Biol Sci Med Sci}, year = {2023}, abstract = {

BACKGROUND: While studies to date have broadly shown that cardiovascular disease (CVD) increases cognitive and physical impairment risk, there is still limited understanding of the magnitude of this risk among relevant CVD subtypes or age cohorts.

METHODS: We analyzed longitudinal data from 16,679 U.S. Health and Retirement Study (HRS) participants who were age >=65 years at study entry. Primary endpoints were physical impairment (ADL impairment) or cognitive impairment (Langa-Weir Classification of dementia). We compared these endpoints among participants who developed incident CVD versus those who were CVD-free, both in the short-term (<2 years post diagnosis) and long-term (>5 years), controlling for sociodemographic and health characteristics. We then analyzed effects by CVD subtype (atrial fibrillation, congestive heart failure, ischemic heart disease, stroke) and age-at-diagnosis (65-74, 75-84, >=85).

RESULTS: Over a median follow-up of 10 years, 8,750 participants (52\%) developed incident CVD. Incident CVD was associated with a significantly higher adjusted odds [aOR] of short-term and long-term physical and cognitive impairment. The oldest (>=85) age-at-diagnosis subgroup had the highest risk of short-term physical (aOR 3.01, 95\% confidence-interval [CI] 2.40-3.77) and cognitive impairment (aOR 1.96, 95\% CI 1.55-2.48), as well as long-term impairment. All CVD subtypes were associated with higher odds of physical and cognitive impairment, with the highest risk for patients with incident stroke.

CONCLUSIONS: Incident CVD was associated with increased risk of physical and cognitive impairment across CVD subtypes. Impairment risk after CVD was highest among the oldest patients (>=85 years) who should therefore remain a target for prevention efforts.

}, keywords = {Cardiovascular disease, cognitive impairment, functional impairment}, issn = {1758-535X}, doi = {10.1093/gerona/glad096}, author = {Stone, Katherine L and Zhong, Judy and Lyu, Chen and Chodosh, Joshua and Blachman, Nina L and Dodson, John} } @article {13090, title = {Does peak expiratory flow moderate trajectories of cognitive function among individuals with lung diseases? A longitudinal analysis of the National Health and Aging Trends Study.}, journal = {Respir Med}, volume = {207}, year = {2023}, pages = {107120}, abstract = {

INTRODUCTION: Impaired cognitive function can co-exist in chronic respiratory diseases. However, it is not clear if peak expiratory flow (PEF) impacts changes in cognitive function. Our objective was to explore whether peak expiratory flow moderates trajectories of memory, visuospatial abilities, and executive function in individuals with chronic respiratory diseases.

METHODS: This was an analysis of individuals with lung diseases from the National Health and Aging Trends Study. Multivariable-adjusted generalized linear mixed models were used to estimate trajectories of immediate and delayed recall, and clock drawing over a 10-year follow-up. The interaction between PEF and time were plotted using sex-specific values for peak expiratory flow at 10th, 50th and 90th percentiles.

RESULTS: In females, interactions of time-by-PEF were found for both immediate (n~=~489, t~=~2.73, p<0.01) and delayed recall (n~=~489, t~=~3.38, p<0.01). Females in the 10th vs. 90th percentile of PEF declined in immediate recall at 0.14 vs. 0.065 words/year, and 0.17 vs. 0.032 words/year for delayed recall. Among males, recall declined linearly over 10 years (immediate recall: n~=~296, t~=~-3.08, p~<~0.01; delayed recall: n~=~292, t~=~-2.46, p~=~0.02), with no interaction with PEF. There were no time-by-PEF interactions nor declines over time in clock drawing scores in both sexes (females: n~=~484, t~=~0.25, p~=~0.81; males: n~=~291, t~=~-0.61, p~=~0.55).

CONCLUSION: Females with the lowest PEF values experienced the greatest rates of decline in immediate and delayed recall over 10 years of follow-up, whereas males experienced similar declines in memory outcomes across all levels of PEF. Clock drawing scores remained stable over 10 years in both sexes.

}, keywords = {Aging, Cognition, Female, Humans, Lung Diseases, Male, Peak Expiratory Flow Rate, Respiratory Function Tests}, issn = {1532-3064}, doi = {10.1016/j.rmed.2023.107120}, author = {Wiley, Elise and Brooks, Dina and MacDermid, Joy C and Sakakibara, Brodie and Stratford, Paul W and Tang, Ada} } @article {13622, title = {Does personality always matter for health? Examining the moderating effect of age on the personality-health link from life span developmental and aging perspectives.}, journal = {Journal of personality and social psychology}, volume = {125}, year = {2023}, pages = {1189-1206}, abstract = {

Extensive evidence has been found for the associations between personality traits and health. However, it remains unknown whether the relationships between personality and health show differential patterns across different life stages. The current research examined how the associations between the levels of and changes in the Big Five personality traits and different types of health outcomes (self-rated, physical, and physiological health outcomes) differ across ages over the life span (Sample 1, age range: 15-100) and during the aging process (Sample 2, age range: 50-109) in particular. Using data from the two large longitudinal studies-the Household, Income, and Labor Dynamics in Australia Survey and the Health and Retirement Study, we observed three important patterns. First, levels of and changes in personality traits were significantly associated with health across different life phases, and these effects were observed even in very old ages. Second, overall, the prospective relations between personality traits/changes in personality traits and health outcomes increased in strength in middle adulthood and/or early stages of late adulthood; however, the strength of their connections diminished in very old ages. Finally, there were some trait-specific and health outcome-specific patterns in the age-differential associations between personality and health. Findings from the present study contribute to enhancing our understanding of the personality-health link from a developmental perspective and provide critical information for the design and implementation of screening and interventions targeting health promotion. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Aging, Humans, Longevity, Longitudinal Studies, Middle Aged, Personality, Personality Disorders, Young Adult}, issn = {1939-1315}, doi = {10.1037/pspp0000485}, author = {Luo, Jing and Zhang, Bo and Graham, Eileen K and Mroczek, Daniel K} } @article {12983, title = {Does pessimism really suppress annuity sales?}, year = {2023}, publisher = {Insurance Newsnet}, keywords = {Aging, Optimism, pessimism}, url = {https://insurancenewsnet.com/innarticle/does-pessimism-really-suppress-annuity-sales}, author = {Morelli, Steven} } @article {13426, title = {Does (re-)entering the labour market at advanced ages protect against cognitive decline? A matching difference-in-differences approach.}, journal = {J Epidemiol Community Health}, year = {2023}, abstract = {

BACKGROUND: While prolonged labour market participation becomes increasingly important in ageing societies, evidence on the impacts of entering or exiting work beyond age 65 on cognitive functioning is scarce.

METHODS: We use data from two large population-representative data sets from South Korea and the USA to investigate and compare the effects of the labour market (re-)entry and exit by matching employment and other confounder trajectories prior to the exposure. We chose the Korean Longitudinal Study of Aging (N=1872, 2006-2020) for its exceptionally active labour participation in later life and the Health and Retirement Study (N=4070, 2006-2020) for its growing inequality among US older adults in labour participation. We use the matching difference-in-differences (DID) method, which allows us to make causal claims by reducing biases through matching.

RESULTS: We find general positive effects of entering the labour market in South Korea (DID estimate: 0.653, 95\% CI 0.167 to 1.133), while in the USA such benefit is not salient (DID estimate: 0.049, 95\% CI -0.262 to 0.431). Exiting the late-life labour market leads to cognitive decline in both South Korea (DID estimate: -0.438, 95\% CI -0.770 to -0.088) and the USA (DID estimate: -0.432, 95\% CI -0.698 to -0.165).

CONCLUSIONS: Findings suggest that Korean participants cognitively benefited from late-life labour market participation, while US participants did not. Differences in participant characteristics and reasons for labour market participation may have led to the differential findings. We found the negative effects of exiting the late-life labour force in both countries.

}, keywords = {Cognitive decline, labour market}, issn = {1470-2738}, doi = {10.1136/jech-2022-220197}, author = {Kim, Jung Hyun and Muniz-Terrera, Graciela and Leist, Anja K} } @article {13337, title = {Does the ACA Medicaid Expansion Encourage Labor Market Exits of Older Workers?}, year = {2023}, abstract = {In this study, I examine the effects of the Affordable Care Act Medicaid expansion on the labor supply decisions of non-disabled, low-educated, childless adults ages 50-64. I employ a triple-differences (DDD) methodology, exploiting variation in individuals{\textquoteright} health insurance status and the expansion decisions of states. I find that with Medicaid expansion, insured workers without retirement health insurance (RHI) decreased full-time work by 7.06 percentage points relative to those with RHI and those without any employer-sponsored coverage at all. Among those no longer working full-time, 82 percent transitioned to complete retirement.}, doi = {https://doi.org/10.1007/s12122-023-09342-9}, author = {Sezen O. Onal} } @article {13635, title = {Dollars and sense: The case for teaching personal finance}, year = {2023}, publisher = {Institute for Economic Policy Research, Stanford University}, keywords = {Financial literacy, Personal finance, Retirement Planning}, url = {https://siepr.stanford.edu/news/dollars-and-sense-case-teaching-personal-finance}, author = {Crawford, Krysten} } @article {GOLDBERG2023e304, title = {Drainage Percutaneous Endoscopic Gastrostomy for Malignant Bowel Obstruction in Advanced Cancer: Patient Expectations and Decisional Regret (SA314A)}, journal = {Journal of Pain and Symptom Management}, volume = {65}, year = {2023}, pages = {e304}, abstract = {Outcomes: 1. Describe the potential benefits of decompressive percutaneous endoscopic gastrostomy (dPEG) in patients with a malignant bowel obstruction 2. Evaluate the importance of effective communication regarding dEPG in patients with advanced cancer Decompressive percutaneous endoscopic gastrostomy (dPEG) is often recommended for palliation of symptoms in patients with malignant bowel obstruction. While this intervention can help improve comfort, patients may have unrealistic expectations about their ability to resume eating, enhance nutritional status, build strength, and receive further disease-directed treatment. We undertook this study to evaluate patients{\textquoteright} expectations about the impact of dPEG placement. We prospectively enrolled 50 adult patients in our dedicated cancer hospital who were scheduled for dPEG for management of MBO between September 2019 to February 2022. Before the procedure, patients completed the FACT-G7, a closed-ended questionnaire about expected outcomes of the procedure, and a brief, semi-structured qualitative interview exploring their understanding of the procedure and expectations for the future. Two weeks after the procedure, patients were contacted to complete the FACT-G7 for a second time and Decision Regret Scale. Sociodemographic, clinical variables, and patient outcomes were collected. The most common primary tumors in this cohort were ovarian (28\%), pancreatic (24\%), and colon (14\%), and the median time to death after dPEG was 30 days (range 5{\textendash}780). Before the procedure, almost half of patients had unrealistic expectations about the potential benefits of dPEG on their ability to eat and to prolong their life and cited these expected benefits as important in their decision to undergo the procedure. At follow-up, one-third of patients expressed regret about the decision. However, patients reported improvement in symptom burden after the procedure compared to before. Our findings suggest ongoing needs to improve communication to help align patients{\textquoteright} expectations with their future experience and support them to manage challenges.}, keywords = {Cancer, decisional regret, patient expectations}, issn = {0885-3924}, doi = {https://doi.org/10.1016/j.jpainsymman.2022.12.131}, author = {Jessica Goldberg and Richard S. Sheppard and Afshana Hoque and Rushil V. Patel and Judith Nelson} } @article {12873, title = {Dynamic Job Market Signaling and Optimal Taxation}, year = {2023}, institution = {Massachusetts Institute of Technology }, address = {Cambridge, MA}, abstract = {How are optimal taxes affected by reputation building and imperfect information in labor markets? In this paper, I build a model of labor markets with incomplete and asymmetric information where job histories play a crucial role in transmitting information about workers{\textquoteright} productivity, which allows us to better understand the efficiency and distributive consequences of imperfect monitoring and screening in labor markets, and the tradeoffs the government faces when setting taxes. Optimal taxes are described by generalized versions of standard redistributive and corrective taxation formulas, which depend crucially on labor wedges: the marginal contribution to output relative to the increases in lifetime earnings that result from supplying one extra unit of labor at each period. Combining estimates from the literature and new estimates using data from the Health and Retirement Study, I find that the corrective component of taxes is likely to be large, especially at the top of the income distribution.}, keywords = {labor markets, optimal taxes, productivity}, url = {https://andresztutman.s3.amazonaws.com/jmp_sztutman.pdf}, author = {Sztutman, Andre} } @article {12683, title = {Data quality and response distributions in a mixed-mode survey.}, journal = {Journal of Longitudinal and Life Course Studies}, year = {2022}, abstract = {

Longitudinal surveys traditionally conducted by interviewers are facing increasing pressures to explore alternatives such as sequential mixed-mode designs, which start with a cheaper self-administered mode (online) then follow up using more expensive methods such as telephone or face-to-face interviewing. Using a designed experiment conducted as part of the 2018 wave of the Health and Retirement Study (HRS) in the US, we compare a sequential mixed-mode design (web then telephone) with the standard telephone-only protocol. Using an intent-to-treat analysis, we focus on response quality and response distributions for several domains key to HRS: physical and psychological health, financial status, expectations and family composition. Respondents assigned to the sequential mixed-mode (web) had slightly higher missing data rates and more focal responses than those assigned to telephone-only. However, we find no evidence of differential quality in verifying and updating roster information. We find slightly lower rates of asset ownership reported by those assigned to the web mode. Conditional on ownership, we find no detectable mode effects on the value of assets. We find more negative (pessimistic) expectations for those assigned to the web mode. We find little evidence of poorer health reported by those assigned to the web mode. We find that effects of mode assignment on measurement are present, but for most indicators the effects are small. Finding ways to remediate the differences in item-missing data and focal values should help reduce mode effects in mixed-mode surveys or those transitioning from interviewer- to self-administration.

}, keywords = {intent-to-treat analysis, Mode effects, sequential mixed-mode, Telephone, web}, issn = {1757-9597}, doi = {10.1332/175795921X16494126913909}, author = {Ofstedal, Mary Beth and Kezdi, Gabor and Couper, Mick P} } @article {11965, title = {The Death of a Child and Parents{\textquoteright} Psychological Distress in Mid to Later Life: Racial/Ethnic Differences in Exposure and Vulnerability.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {1561-1570}, abstract = {

OBJECTIVES: This study considered whether experiencing the death of a child is associated with subsequent psychological distress in older populations, as well as variation in both exposure and vulnerability to the death of a child among Black, Hispanic, and White older parents.

METHODS: We used multilevel models to link the death of a child with subsequent distress for 9,763 non-Hispanic White, 2,496 non-Hispanic Black, 1,014 foreign-born Hispanic, and 712 U.S.-born Hispanic parents from the Health and Retirement Study, 2006-2016.

RESULTS: The death of a child is associated with increased psychological distress in mid to later life for Black, White, and Hispanic parents, with greater vulnerability for foreign-born Hispanic parents. Notably, Black and U.S.-born Hispanic parents are disadvantaged because of the additive effects of their greater exposure to bereavement and their higher distress levels regardless of bereavement status. These effects persist net of additional stressors associated with race/ethnicity.

DISCUSSION: The death of a child is a traumatic life course event associated with lasting psychological distress for aging parents. Black and U.S.-born Hispanic parents are disadvantaged in that they are more likely than White parents to experience the death of a child, and foreign-born Hispanic parents may be disadvantaged by greater vulnerability to distress following child death.

}, keywords = {Bereavement, Cumulative advantage/disadvantage, Mental Health, Minority aging, Race/ethnicity}, issn = {1758-5368}, doi = {10.1093/geronb/gbab206}, author = {Debra Umberson and Rachel Donnelly} } @article {11478, title = {Death of a child, religion, and mental health in later life.}, journal = {Aging \& Mental Health}, volume = {26}, year = {2022}, pages = {623-631}, abstract = {

BACKGROUND AND OBJECTIVES: The death of a child may be one of the most stressful events for parents to experience. This study aims to assess how the death of a child prior to midlife is associated with the mental health of parents in later life, and how this association is contingent upon religious belief in a divine plan.

RESEARCH DESIGN AND METHODS: Using data from aging parents (aged 65 and older) in the six waves (2006-2016) of the Health and Retirement Study (HRS), we conducted negative binomial regression analyses to examine the main effects of the death of a child prior to midlife on late-life depressive symptoms, and the buffering effect of religious beliefs on this main effect ( = 8,248). Growth curve modeling was used to analyze the trajectories of depressive symptoms ( = 31,088).

RESULTS: Experiencing the death of a child prior to midlife is positively associated with depressive symptoms among older adults. Yet, the association is mitigated among respondents who exhibit a high level of belief in a divine plan at baseline. Further, a gradual decline in the number of depressive symptoms over time was observed among the bereaved parents who reported a high level of belief in a divine plan.

DISCUSSION AND IMPLICATIONS: Belief in a divine plan has a protective effect on older adults who cope with the aftermath of child loss. The findings in the study advance our knowledge about the complex interrelationships among stress, religion, and mental health in later life.

}, keywords = {Bereavement, divine beliefs, Mental Health, Religion}, issn = {1364-6915}, doi = {10.1080/13607863.2021.1889968}, author = {Jung, Jong Hyun and Lee, Hyo Jung} } @article {11699, title = {Deaths, Disparities, and Cumulative (Dis)Advantage: How Social Inequities Produce an Impairment Paradox in Later Life.}, journal = {The Journals of Gerontology, Series A }, volume = {77}, year = {2022}, pages = {392-401}, abstract = {

BACKGROUND: Research on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life. This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory. Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities.

METHODS: Using the Health and Retirement Study, we characterize the functional impairment histories of a nationally-representative sample of 8,464 older adults between 1994-2016. We employ non-parametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition.

RESULTS: Exposures to disadvantages are associated with poorer functional health in midlife and mortality. However, a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for white men and women and for Black women. The impact of educational attainment, occupation, wealth, and marriage on later life health differs across race and gender groups.

CONCLUSIONS: Observed stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages. Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.

}, keywords = {Disablement Process, Minority aging, socio-economic issues}, issn = {1758-535X}, doi = {10.1093/gerona/glab181}, author = {Heide Jackson and Michal Engelman} } @article {12806, title = {Declining wealth and rising cost of necessities are the real worries when it comes to senior poverty}, year = {2022}, publisher = {MarketWatch}, keywords = {Costs, senior poverty, Wealth}, url = {https://www.marketwatch.com/story/declining-wealth-and-cost-of-necessities-are-the-real-worry-when-it-comes-to-senior-poverty-11667403300}, author = {Alicia H. Munnell} } @article {12463, title = {Decreased Risk of 2-Year Incidence of Alzheimer{\textquoteright}s Disease Among Older Adults Who Report Sleep Symptoms}, journal = {Sleep}, volume = {45}, year = {2022}, pages = {A122{\textendash}A123}, abstract = {Introduction Those with dementia or Alzheimer{\textquoteright}s Disease report an elevated amount of sleep difficulties compared to age-matched controls. Sleep-based interventions may be especially useful for this group, such as cognitive behavioral therapy for insomnia or pharmacological interventions. Therefore, it is important to expand the current understanding of the nature of sleep difficulties in those with Alzheimer{\textquoteright}s Disease. Methods Data from the 2018 Health and Retirement Survey was collected from 17,146 older adults. Poisson regression analyses were used to explore the relationship between Alzheimer{\textquoteright}s Disease as diagnosed by a doctor and sleep difficulties. Individuals who reported no Alzheimer{\textquoteright}s Disease in the previous wave (N=16,751) were asked if they had since become diagnosed. N=101 individuals reported incident Alzheimer{\textquoteright}s Disease in the 2-year gap between assessments. Sleep difficulties were assessed by asking participants if they had difficulties initiating or maintaining sleep, waking up too early, and how rested they felt upon awakening. All 4 of these symptoms were coded as {\textquotedblleft}never,{\textquotedblright} {\textquotedblleft}sometimes,{\textquotedblright} or {\textquotedblleft}often.{\textquotedblright} Results Unexpectedly, there was a significant decreased risk of developing Alzheimer{\textquoteright}s Disease among those who reported difficulties maintaining sleep (IRR=0.9962; 95\%CI[0.9936,0.9988]; p=0.004), and early morning awakenings (IRR=0.9961; 95\%CI[0.9938,0.9984]; p=0.001) {\textquotedblleft}sometimes{\textquotedblright}. When the model was adjusted for sex, race, ethnicity, age, and depression, a similar finding of decreased risk for Alzheimer{\textquoteright}s Disease for those who reported difficulties maintaining sleep (IRR=0.9953; 95\%CI[0.9927,0.9980]; p<0.001), and early morning awakenings (IRR=0.9954; 95\%CI[0.9930,0.9978]; p=0.001), {\textquotedblleft}sometimes{\textquotedblright} were maintained. Conclusion Although previous studies have shown that poor sleep may lead to increased risk of Alzheimer{\textquoteright}s and related dementias, the present study, which examined longitudinal data from a large, national sample of older adults, found that there was no association between frequent sleep disturbances and 2-year incidence of Alzheimer{\textquoteright}s Disease, and a small association between more mild symptoms and decreased risk. It is possible that the 2-year observation window was insufficient to detect effects. Also, there is a risk of measurement error in collecting self-reported data on sleep and Alzheimer{\textquoteright}s diagnoses.}, keywords = {Alzheimer disease, cognitive-behavioral therapy, Dementia, Depressive Disorder, ethnic group, insomnia, pharmacotherapy, sleep disorders}, url = {https://doi.org/10.1093/sleep/zsac079.270}, author = {Mason, Brooke and Wills, Chloe and Tubbs, Andrew and Seixas, Azizi and Turner, Arlener and Jean-Louis, Girardin and Killgore, William and Grandner, Michael} } @article {12469, title = {Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004-2014: a longitudinal study.}, journal = {BMJ Open}, volume = {12}, year = {2022}, pages = {e051480}, abstract = {

OBJECTIVES: The access barrier to medication has been a persistent and elusive challenge in the US healthcare system and around the globe. Cost-related medication non-adherence (CRN) is an important measure of medication non-adherence behaviours that aim to avoid costs. Longitudinal study of CRN behaviours for the ageing population is rare.

DESIGN: Longitudinal study using the Health and Retirement Study to evaluate self-reported CRN biennially.

SETTING: General population of older Americans.

PARTICIPANTS: Three cohorts of Americans aged between 50 and 54 (baby boomers), 65-69 (the silent generation) and 80 or above (the greatest generation) in 2004 who were followed to 2014.

INTERVENTION: Observational with no intervention.

PRIMARY AND SECONDARY OUTCOME MEASURES: Longitudinal CRN rates for three generational cohorts from 2004 to 2014. Population-averaged effects of a broad set of variables including sociodemographics, income, insurance status, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and comorbid conditions on CRN were derived using generalised estimating equation by taking into account repeated measurements of CRN over time for the three cohorts, respectively.

RESULTS: The three cohorts of baby boomer, the silent generation and the greatest generation with 1925, 2839 and 2666 respondents represented 12.3 million, 8.2 million and 7.7 million people in 2004, respectively. Increasing age was associated with decreasing likelihood of reporting CRN in all three generational cohorts (p<0.05), controlling for demographics, income, insurance status, functional status and comorbid conditions. All three generational cohorts had a higher prevalence of diabetes, cancer, heart conditions, stroke, a higher percentage of respondents with Medicare-Medicaid dual eligibility and lower percentage with private insurance in 2014 compared with 2004 (p<0.05).

CONCLUSION: The paradox of decreasing CRN rates, independent of disease burden, income and insurance status, suggests populations{\textquoteright} CRN behaviours change as Americans age, bearing implications to social policy.

}, keywords = {Activities of Daily Living, Drug Costs, Medicare, Medication Adherence}, issn = {2044-6055}, doi = {10.1136/bmjopen-2021-051480}, author = {Zhang, James and Bhaumik, Deepon and Meltzer, David} } @article {12263, title = {Decumulation: Another Barometer of the DB-DC Shift}, year = {2022}, publisher = {American Society of Pension Professionals \& Actuaries}, keywords = {defined benefit plan, defined contribution plan, Pension}, url = {https://www.asppa-net.org/news/decumulation-another-barometer-db-dc-shift}, author = {Iekel, John} } @article {12430, title = {Defining Childlessness Among Middle-Aged and Older Americans: A Research Note.}, journal = {Demography}, volume = {59}, year = {2022}, pages = {813-826}, abstract = {

Measuring childlessness is complicated by the increasing complexity of family structure. Using data from the 2014 Health and Retirement Study, in this research note we compared three definitions of childlessness: (1) respondent never fathered/gave birth to a child, (2) respondent had no children who were living and in contact, and (3) respondent and spouse/partner had no children or stepchildren who were living and in contact. Results showed that the prevalence of childlessness among Americans aged 55 or older ranged from 9.2\% to 13.6\% depending on which definition was used. The association between select individual characteristics (gender and marital status) and the likelihood of childlessness, as well as the association between childlessness and loneliness and living arrangements, also varied depending on how childlessness was defined. Therefore, how we define childlessness can affect our understanding of its prevalence, correlates, and relationships with well-being. Future research on childlessness should carefully consider the choice of definition and its implications for research and policy discussions.

}, keywords = {Aged, Child, Family Characteristics, Gender Identity, Marital Status, Middle Aged, Residence Characteristics}, issn = {1533-7790}, doi = {10.1215/00703370-9987649}, author = {Xu, Xiao and Liang, Jersey and Raymo, James M and Kim, BoRin and Ofstedal, Mary Beth} } @article {13120, title = {Dementia and Care Transitions: Do Transition Care Management Codes Make a Difference?}, volume = {5}, year = {2022}, abstract = {Background: For older adults living with dementia, care transitions from acute or subacute care back to their community can have adverse outcomes such as hospital readmissions, medication errors, or even permanent nursing home placement. To address these adverse outcomes, Transition Care Management (TCM) codes were introduced by the Centers for Medicare and Medicaid Services (CMS) in October 2012. The efficacy of TCM codes has not been examined in the population of persons living with dementia. Thus, this study examines the effect of TCM codes on hospital readmission rates and hypothesizes that TCM codes are effective in decreasing readmission rates after care transitions for persons living with dementia. Methods: After an extensive literature review, we identified the Bynum Standard method for identifying persons living with dementia. We used a linked dataset from the Health and Retirement Study (HRS) and CMS claims to identify persons living with dementia with a hospital discharge between 2015 and 2018. Results: Our initial search has identified a cohort of 4,282 persons living with dementia. 1,584 (37\%) are male and 2,698 (63\%) are female. 3,433 are White, 656 are Black, 126 are Hispanic, 14 are Native American, 4 are Asian, and 49 are either of another race or did not report their race. Conclusion and Potential Impact: Thus far, we have identified a cohort of persons living with dementia from HRS-CMS linked data but have yet to identify who have had the TCM codes used by their provider. In the future, we will examine the effect that TCM codes have on hospital readmission rates within the studied population. Not only will this study determine if these billing codes provide effective care, but it can also tell us if it aids historically underserved groups.}, keywords = {care transitions, Dementia}, doi = {https://doi.org/10.18060/26804}, author = {Micah Hoeksema and Jennifer L. Carnahan} } @article {12442, title = {Dementia diagnosis can also make a big difference in health care costs}, year = {2022}, publisher = {News Medical Net }, keywords = {dementia diagnosis, Health Care Costs, Medicare}, url = {https://www.news-medical.net/news/20220531/Dementia-diagnosis-can-also-make-a-big-difference-in-health-care-costs.aspx}, author = {Henderson, Emily} } @article {12404, title = {Dementia diagnosis often comes as part of costly crisis}, year = {2022}, publisher = {Michigan Medicine, University of Michigan}, abstract = {People whose Alzheimer{\textquoteright}s disease gets diagnosed as part of a health crisis have much higher costs than those in whom screening shows significant cognitive issues.}, keywords = {Alzheimer disease, Dementia, Health Care Costs}, url = {https://labblog.uofmhealth.org/lab-notes/dementia-diagnosis-often-comes-as-part-of-costly-crisis}, author = {Gavin, Kara} } @article {12991, title = {DEMENTIA LIFE EXPECTANCIES: NEW KNOWLEDGE AND CONSIDERATIONS FROM THE HEALTH AND RETIREMENT STUDY}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, pages = {341}, abstract = {Alzheimer{\textquoteright}s disease and related dementias (ADRD) are a growing public health crisis. Estimates on the prevalence and incidence of ADRD across and within population-based studies have varied in part due to competing measures to assess dementia status. Disentangling these inconsistencies is crucial for understanding dementia disparities among racial/ethnic, and nativity groups among older adults. Based on the Health and Retirement Study we examined across (Whites, Blacks) and within-group differences (US- and non-US-born Latinos) in estimates of dementia life expectancy, using four competing algorithmic techniques (i.e., the Langa-Weir, Expert, Hurd, and Lasso) for the classification of dementia ascertainment. Estimates of dementia life expectancy across algorithms largely point to dementia disparities in the prevalence of the disease across racial/ethnic, and nativity groups, regardless of the algorithmic technique utilized. Elucidating algorithms that can be utilized with different racial/ethnic groups may reduce bias in dementia assessment in the future.}, keywords = {Dementia, life expectancies}, doi = {10.1093/geroni/igac059.1349}, author = {Garcia, Marc and Tarraf, Wassim and Chi-Tsun Chiu and Joseph L Saenz and Reyes, Adriana M} } @article {12808, title = {Dementia Rate Declining Among Older Americans: Study}, year = {2022}, publisher = {U.S. News \& World Report}, keywords = {Dementia, Disparities, rate}, url = {https://www.usnews.com/news/health-news/articles/2022-11-08/dementia-rate-declining-among-older-americans-study}, author = {Murez, Cara} } @article {12898, title = {Dementia Rates Have Decreased by Nearly One-Third, According to a New Report{\textemdash}These Healthy Habits Can Help You Lower Your Risk, Too}, year = {2022}, publisher = {Yahoo!}, keywords = {dementia rates, healthy habits}, url = {https://www.yahoo.com/lifestyle/dementia-rates-decreased-nearly-one-182329809.html}, author = {Walsh, Karla} } @article {13035, title = {Dementia Spousal Caregiving}, journal = {Alzheimer{\textquoteright}s \& Dementia }, volume = {18}, year = {2022}, pages = {e068344}, abstract = {Introduction Dementia family caregiving has been linked to depression, anxiety, insomnia, and other negative mental health symptoms, particularly among spousal caregivers who are most likely to have higher levels of caregiving hours. Further, depressive symptoms often present differently based on caregiver race and ethnicity. This study aimed to examine the association between spousal caregiving hours and self-reported depressive symptoms as well as identify any racial/ethnic disparities in depression self-reporting. Method Data was drawn from Wave 9 (2008) of the Health and Retirement Study and included 10,120 participants. Linear regression was used to evaluate the relationships between caregiving hours and depression symptoms. Further, a negative binomial model was used to test whether race/ ethnicity moderated the relationship between caregiving hours and self-reported depressive symptoms. Results As expected, self-reported depressive symptoms increased as caregiving hours increased (1.65, SD = 2.02, p <0.01). Among the racial and ethnic groups evaluated, Latinx participants experienced the highest levels of depressive symptoms relative to caregiving hours. Discussion Dementia affects families. Care and consideration of the family are as important as the care of the individual affected by a dementia-related diagnosis. Depression is a serious anticipated mental health outcome linked to dementia family caregiving responsibilities. As such, there is a need for increased culturally responsive professional screening and treatment for depression among family caregivers. Relatedly, primary care providers play an important role in identifying patients serving as family caregivers and offering necessary supports and referrals.}, keywords = {Caregiving, Dementia, spouse}, doi = {10.1002/alz.068344}, author = {Florence U Johnson and Sheria G Robinson-Lane and Philip Veliz} } @article {10.1093/geroni/igac059.526, title = {DEMENTIA TRAJECTORIES, MEDICAID COVERAGE, AND HEALTHCARE SERVICES USE}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, month = {12}, pages = {132-132}, abstract = {The evidence base linking dementia risk trajectories to transitions in Medicaid coverage and levels of health services is underdeveloped. We use Health and Retirement Study (2007/08-2015/16) data on adults 70-years and older (Unweighted N=8,227) at baseline to test how longitudinal dementia classifications (Langa-Weir), over 8-years, influence change in Medicaid coverage, nursing-home use (NHU) and inpatient hospitalizations (IH). We fit Joint Growth and Discrete-time Survival Mixture models to generate longitudinal risk classifications for dementia accounting for survival, and generalized linear models to test associations of these classifications with change in Medicaid coverage, NHU, and IH. Average baseline age was 78.4 years (SD=7.1), 3-in-5 were female, 1-in-4 had less than high school education, and 4-in-5 were non-Hispanic Whites. A three-class solution (C1=high dementia prevalence and mortality risk (8.6\%), C2=low prevalence (68.3\%), and C3=accelerated dementia prevalence and mortality risk (23.1\%)) provided the best fit to the data. We observed substantial increase in rates of for Medicaid coverage for C1 (21\%; 95\%CI=[18-25] to 51\%[36-65] among survivors) and C3 (12\%; 95\%CI=[10-14] to 32\%[27-37]), but not C2 (6\% to 8\%). NHU also accelerated substantially from 10 to 37\% in C1 and 7 to 38\% in C2. Rates of inpatient hospitalizations remained stable over time for all groups, with C1 and C2 being more likely to be hospitalized and have multiple re-admissions. Estimates were differentially attenuated through adjustment to covariables. We report important longitudinal dementia risk classifications, profile their socioeconomic and health attributes, and identify differential associations with critical health policy outcomes (Medicaid coverage and healthcare utilization).}, keywords = {Dementia, healthcare services, Medicaid}, issn = {2399-5300}, doi = {10.1093/geroni/igac059.526}, author = {Tarraf, Wassim and Garcia, Marc} } @article {12219, title = {Demographic and Health Characteristics of Older Latino Birth Cohorts in the Health and Retirement Study.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {2060-2071}, abstract = {

BACKGROUND AND OBJECTIVES: Latinos are the fastest aging racial/ethnic minority group in the United States One limitation to understanding the diverse experiences of older Latinos is the lack of nationally representative data necessary to examine factors contributing to changes in population-level health over time. This is needed to provide a more comprehensive picture of the demographic characteristics that influence the health and well-being of older Latinos.

METHODS: We utilized the steady-state design of the Health and Retirement Study (HRS) from 1992 to 2016 to examine the demographic and health characteristics of the five entry birth cohorts of older Latinos aged 51-56 (n=2,882). Adjusted Wald tests were used to assess statistically significant differences in demographic and health characteristics across the five HRS birth cohorts.

RESULTS: Cross-cohort comparisons of demographic and health characteristics of older Latinos indicate significant change over time, with later-born HRS birth cohorts less likely to identify as Mexican-origin, more likely to identify as a racial "other," and more likely to be foreign-born. In addition, we find that later-born cohorts are more educated and exhibit a higher prevalence of hypertension, diabetes, and obesity.

DISCUSSION: Increasing growth and diversity among the older U.S. Latino population make it imperative that researchers document changes in the demographic composition and health characteristics of this population as it will have implications for researchers, policymakers, health care professionals, and others seeking to anticipate the needs of this rapidly aging population.

}, keywords = {Demographics, health, Latinos/Hispanics, Well-being}, issn = {1758-5368}, doi = {10.1093/geronb/gbac017}, author = {Garc{\'\i}a, Catherine and Garcia, Marc A and Jennifer A Ailshire} } @article {11827, title = {Dental care use and other population characteristics of older Americans with self-reported chronic conditions in the Health and Retirement Study.}, journal = {Journal of Public Health Dentisty}, volume = {82}, year = {2022}, pages = {40-52}, abstract = {

OBJECTIVES: To analyze relative differences in oral health care utilization, oral health, and other population characteristics of older Americans with respect to self-reported chronic conditions in the health and retirement study.

METHODS: Differences in estimated percentages of those with specific chronic conditions by selected attributes were tested for statistical significance with standardized normal Z tests and logistic regressions. All estimates were based on weighted data from 1992 to 2016 Early Release RAND HRS Longitudinal file. SE estimates for the percentages accounted for the complex sample design of the survey.

RESULTS: We establish that the strength of the associations between regular use of dental care and the absence of a chronic condition is similar in magnitude to having a college education, living in a high-income family, never smoking, not having certain functional limitations, and being under 65 years of age.

DISCUSSION: These cross-sectional findings establish the relative strength of relationships between dental care use, oral health status, and other population characteristics and eight diagnosed conditions. Further work beyond the scope of this paper is needed to confirm these results as either attributes of those with the disease or causal risk factors for the onset of the condition.

}, keywords = {Chronic condition, Dental Care, Self-reported health}, issn = {1752-7325}, doi = {10.1111/jphd.12471}, author = {John F Moeller and Richard J. Manski and Chen, Haiyan and Meyerhoefer, Chad and John V Pepper and Terrin, Michael} } @article {12667, title = {Depression among those caring for partners with dementia can start a decade before dementia diagnosis}, year = {2022}, publisher = {Michigan News, University of Michigan}, address = {Ann Arbor, MI}, keywords = {Cognition, Dementia, depression, partner}, url = {https://news.umich.edu/depression-among-those-caring-for-partners-with-dementia-can-start-a-decade-before-dementia-diagnosis/}, author = {Bailey, Laura} } @article {CHOUNG2022101877, title = {Depression and financial planning horizon}, journal = {Journal of Behavioral and Experimental Economics}, volume = {98}, year = {2022}, pages = {101877}, abstract = {Major depression is associated with biased information processing and decision making. Previous research suggests that people dealing with depression view the future negatively and exhibit a higher discounting rate than healthy people do. This study tests the hypothesis that depression is associated with financial planning horizon{\textendash}the time horizon by which individuals and households formulate their saving and spending schedules. Analyses conducted using data drawn from multiple waves of the Health and Retirement Study showed an inverse association between major depressive episodes and financial planning horizon, indicating that depressed people plan their finances over a shorter horizon. We also found that major depression is associated with various health and financial outcomes representing evidence of myopic decision making. The link between depression and financial planning horizon is partially explained by depression-oriented differences in behavioral traits, such as optimism/pessimism, perceived control, perceived mastery, and self-assessed survival probability. Overall, our findings point to a significant economic cost of depression, which compounds through myopic financial planning.}, keywords = {Clinical depression, financial planning horizon, Intertemporal choice, Major depressive episode, Myopic decision, Time preference}, issn = {2214-8043}, doi = {10.1016/j.socec.2022.101877}, author = {Youngjoo Choung and Swarn Chatterjee and Tae-Young Pak} } @article {12677, title = {Depression and Loneliness Among the Elderly Poor}, number = {30330}, year = {2022}, institution = {NBER}, address = {Cambridge, MA}, abstract = {The mental health of the elderly in low- and middle-income countries (LMICs) is a largely neglected subject, both by policy and research. We combine data from the health and retirement family of surveys in seven LMICs (plus the US) to document that depressive symptoms among those aged 55 and above are more prevalent in those countries and increase sharply with age. Depressive symptoms in one survey wave are associated with a greater decline in functional abilities and higher probability of death in the next wave. Using data from a panel survey we conducted in Tamil Nadu with a focus on elderly living alone, we document that social isolation, poverty, and health challenges are three of the leading correlates of depression. We discuss potential policy interventions in these three domains, including some results from our randomized control trials in the Tamil Nadu sample.}, keywords = {depression, Loneliness, Low income}, doi = {10.3386/w30330}, author = {Banerjee, Abhitjit and Duflo, Esther and Grela, Erin and McKelway, Madeline and Schilbach, Frank and Sharma, Garima and Vaidyanathan, Girija} } @article {12654, title = {Depressive Symptoms and Caregiving Intensity Before and After Onset of Dementia in Partners: A Retrospective, Observational Study.}, journal = {Medical Care}, volume = {60}, year = {2022}, pages = {844-851}, abstract = {

BACKGROUND: Caring for a partner with dementia poses significant emotional burden and high care demands, but changes in impacts before and after dementia onset is unclear.

OBJECTIVE: Examine changes in depressive symptoms and hours of care provided by caregivers through the course of their partners{\textquoteright} cognitive decline.

METHODS: Retrospective, observational study using household survey data from 2000-2016 Health and Retirement Study and count models to evaluate older individuals{\textquoteright} (ages >=51~y) depressive symptoms (measured using the shortened Center for Epidemiologic Studies Depression Scale) and weekly caregiving in the 10 years before and after their partners{\textquoteright} dementia onset (identified using Telephone Interview Cognitive Status screening). Relationships were examined overall and by sex and race.

RESULTS: We identified 8298 observations for 1836 older caregivers whose partners developed dementia. From before to after partners{\textquoteright} dementia onset, caregivers{\textquoteright} mean (SD) depressive symptoms increased from 1.4 (1.9) to 1.9 (2.1) (P<0.001) and weekly caregiving increased from 4.4 (19.7) to 20.8 (44.1) (P<0.001) hours. Depressive symptoms and caregiving hours were higher for women compared with men. Depressive symptoms were higher for Blacks compared with Whites, while caregiving hours were higher for Whites. The expected count of caregivers{\textquoteright} depressive symptoms and caregiving hours increased by 3\% (P<0.001) and 9\% (P=0.001) before partners{\textquoteright} dementia onset and decreased by 2\% (P<0.001) and 1\% (P=0.63) following partners{\textquoteright} dementia onset. No differences observed by sex or race.

DISCUSSION: Depressive symptoms and instrumental burdens for caregivers increase substantially before the onset of dementia in partners. Early referral to specialty services is critical.

}, keywords = {Caregiving, Dementia, Depressive symptoms}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000001771}, author = {Harris, Melissa L and Errickson, Josh and Ha, Jinkyung and Hoffman, Geoffrey J} } @article {12103, title = {The destabilization and destandardization of social roles across the adult life course: Considering aggregate social role instability and its variability from a historical-developmental perspective.}, journal = {Developmental Psychology Publisher: American Psychological Association}, volume = {58}, year = {2022}, pages = {589-605}, abstract = {

Existing research focused on social role destabilization (historical increases in role instability) and destandardization (historical increases in variability of role instability) has primarily focused on discrete social roles during discrete periods of development. Building on this work, we applied a macro approach to elucidate the extent to which historical trends toward destabilization and destandardization are occurring at the aggregate among a key set of social roles (union formation, education, residential independence, and employment) and across the whole of adulthood. Applying a historical-developmental approach, we also document how historical trends toward destabilization and destandardization vary by age. We used 3 historical, longitudinal data sets: the Monitoring the Future study ( = 69,464; 55.4\% women; 75.5\% white), the Panel Study of Income Dynamics ( = 45,001; 51.4\% women; 54.3\% white), and The Health and Retirement Study ( = 30,913; 53.6\% women; 75.6\% white) that collectively cover the entire adult life course and over a century of U.S. birth cohorts. We found that aggregate destabilization and destandardization have occurred across the entirety of adulthood, although trends appear more pronounced at either end of the adult life course and the specific roles driving both trends vary across the adult life course. Findings were robust for educational attainment, and destabilization and destandardization were more pronounced among women. Findings highlight the importance of considering social role changes at the aggregate and singularly, and the need to evaluate social role changes in any 1 period of adulthood in conjunction with those occurring in other periods of adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

}, keywords = {life course, social roles}, issn = {1939-0599}, doi = {10.1037/dev0001303}, author = {Jager, Justin and Amy Rauer and Staff, Jeremy and Lansford, Jennifer E and Pettit, Gregory S and Schulenberg, John E} } @article {RePEc:gam:jijerp:v:19:y:2022:i:19:p:12059-:d:923426, title = {Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults >=50 Years during the Pandemic: 2006{\textendash}2020 Health and Retirement Study}, journal = {IJERPH}, volume = {19}, year = {2022}, pages = {1-24}, abstract = {Background: The coronavirus disease 19 (COVID-19) was declared a global pandemic on 11 March 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, >=50 years of age. Methods: Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006{\textendash}2018) linked to the 2020 HRS COVID-19 Project (57\% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services ({\textquotedblleft}Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?{\textquotedblright} and {\textquotedblleft}What type of care did you delay{\textquotedblright}) using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data. Results: Nearly 32.7\% delayed healthcare services, 5.8\% delayed surgical services and 31.4\% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60{\textendash}70\% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays. Conclusion: Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions.}, keywords = {cardiometabolic, COVID-19, healthcare services, lifestyle, Machine learning, socio-demographic}, url = {https://EconPapers.repec.org/RePEc:gam:jijerp:v:19:y:2022:i:19:p:12059-:d:923426}, author = {Beydoun, Hind A. and Beydoun, May A. and Alemu, Brook T. and Weiss, Jordan and Hossain, Sharmin and Gautam, Rana S. and Zonderman, Alan B.} } @article {12331, title = {Determinants of COVID-19 testing among late middle-aged and older adults: Applying the health belief model.}, journal = {Aging and Health Research}, volume = {2}, year = {2022}, pages = {100066}, abstract = {

Objectives: The purpose of this study was to examine correlates of taking a COVID-19 test among late middle-aged and older adults using nationally representative data.

Methods: Data were obtained from the 2020 Health and Retirement Study midway release COVID-19 module. Our sample was representative of community residing adults aged 51 and over in the United States (~=~2,870).

Measurements: We regressed taking a COVID-19 test on demographic characteristics, medical comorbidities, and measures related to the health belief model (i.e., perceived severity, perceived susceptibility, cues to action, and perceived barriers) using logistic regression, stratifying the model by 10-year age categories.

Results: Concern about the pandemic was associated with an increase in the likelihood of taking a test among late middle-aged adults. Knowing someone who was diagnosed with COVID-19 was associated with taking a test in most age categories. Financial barriers and knowing someone who died of COVID-19 were not associated with taking a test.

Conclusions: How late middle-aged and older adults perceive the COVID-19 pandemic may significantly influence their likelihood of taking a COVID-19 test.

}, keywords = {COVID-19, Health belief model, Perceived barriers}, issn = {2667-0321}, doi = {10.1016/j.ahr.2022.100066}, author = {Sun, Na and Hua, Cassandra L and Qiu, Xiao and Brown, J Scott} } @article {12243, title = {DETERMINANTS OF INSURANCE ENROLLMENT}, journal = {Journal of Research in Social Science and Humanities}, volume = {2}, year = {2022}, abstract = {Ownership of health insurance policy is a mechanism for protecting an individual family{\textquoteright}s financial security. It is also a means for a risk-aversion strategy for the cost of medical care, loss of productivity time during the illness, and in a more serious case death. This study examines the factors that influence the ownership of insurance policies at an individual level using a binary logistic regression model. The data used in this study was taken from the Health and Retirement Study (HRS), the fifth wave in 2002 with 3206 respondents of the survey, whereby thirty-nine percent of the respondents happened to have an insurance policy scheme. The outcome of this model indicated that retirement status, household income, years of schooling, and marital status variables were all found to have a statistically (at 95\% confidence level) associated with ownership of insurance policy. Contrastingly, the other covariates, namely: age at the time of the survey, race, and gender of the respondents had insignificantly relationship with the ownership of insurance policy. }, keywords = {Age, household income, Insurance policy, Marital Status, retirement status}, doi = {10.47679/jrssh.v2i1.25}, author = {Gudeta Kebede Asfaw} } @article {12024, title = {The Devastating Economic Impact of COVID-19 on Older Black and Latinx Adults: Implications for Health and Well-Being.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {1501-1507}, abstract = {

OBJECTIVES: While disparities in COVID-19 infections and mortality have been documented for older Black and Latinx populations, pandemic-related economic impacts have been less studied for these groups. Minoritized older adults may be particularly vulnerable to financial hardships given their precarious socioeconomic positions. Thus, we aim to highlight the devastating economic impact of the ongoing COVID-19 pandemic and subsequent economic recession on older Black and Latinx adults, with a particular focus on the foreign-born population.

METHODS: This study used data from the 2020 COVID-19 module of the Health and Retirement Study. The sample included adults >50 years of age who were U.S.-born non-Latinx White and Black, U.S.-born Latinx, and foreign-born Latinx (n=2,803). We estimated age-standardized prevalence and means of variables indicating financial impact and economic hardship during the pandemic. We further examined differences in these measures across racial/ethnic and nativity groups.

RESULTS: Our findings document stark racial/ethnic inequalities in the pandemic{\textquoteright}s economic impact on older adults. Results show the pandemic has negatively affected older Black and Latinx adults across a host of economic factors (e.g., paying bills, affording health-related needs, or purchasing food), with foreign-born Latinx experiencing greater economic hardships relative to other groups.

DISCUSSION: During the COVID-19 pandemic, older Black and Latinx adults are experiencing disparate economic effects, including lacking money to cover basic needs, compared to older White adults. The implications of the economic shocks of the pandemic for the health and well-being of older Black and Latinx adults warrant policy-oriented action towards promoting equity.

}, keywords = {COVID-19, economic inequality, Health Disparities}, issn = {1758-5368}, doi = {10.1093/geronb/gbab218}, author = {Garcia, Marc A and Amy D Thierry and Pendergrast, Claire B} } @article {12711, title = {Development and External Validation of a Mortality Prediction Model for Community-Dwelling Older Adults With Dementia.}, journal = {JAMA Internal Medicine}, volume = {182}, year = {2022}, pages = {1161-1170}, abstract = {

Importance: Estimating mortality risk in older adults with dementia is important for guiding decisions such as cancer screening, treatment of new and chronic medical conditions, and advance care planning.

Objective: To develop and externally validate a mortality prediction model in community-dwelling older adults with dementia.

Design, Setting, and Participants: This cohort study included community-dwelling participants (aged >=65 years) in the Health and Retirement Study (HRS) from 1998 to 2016 (derivation cohort) and National Health and Aging Trends Study (NHATS) from 2011 to 2019 (validation cohort).

Exposures: Candidate predictors included demographics, behavioral/health factors, functional measures (eg, activities of daily living [ADL] and instrumental activities of daily living [IADL]), and chronic conditions.

Main Outcomes and Measures: The primary outcome was time to all-cause death. We used Cox proportional hazards regression with backward selection and multiple imputation for model development. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (plots of predicted and observed mortality).

Results: Of 4267 participants with probable dementia in HRS, the mean (SD) age was 82.2 (7.6) years, 2930 (survey-weighted 69.4\%) were female, and 785 (survey-weighted 12.1\%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0-6.8) years, and 3466 (81.2\%) participants died by end of follow-up. The final model included age, sex, body mass index, smoking status, ADL dependency count, IADL difficulty count, difficulty walking several blocks, participation in vigorous physical activity, and chronic conditions (cancer, heart disease, diabetes, lung disease). The optimism-corrected iAUC after bootstrap internal validation was 0.76 (95\% CI, 0.75-0.76) with time-specific AUC of 0.73 (95\% CI, 0.70-0.75) at 1 year, 0.75 (95\% CI, 0.73-0.77) at 5 years, and 0.84 (95\% CI, 0.82-0.85) at 10 years. On external validation in NHATS (n = 2404), AUC was 0.73 (95\% CI, 0.70-0.76) at 1 year and 0.74 (95\% CI, 0.71-0.76) at 5 years. Calibration plots suggested good calibration across the range of predicted risk from 1 to 10 years.

Conclusions and Relevance: We developed and externally validated a mortality prediction model in community-dwelling older adults with dementia that showed good discrimination and calibration. The mortality risk estimates may help guide discussions regarding treatment decisions and advance care planning.

}, keywords = {community dwelling, Dementia, mortality risk}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2022.4326}, author = {Deardorff, W James and Barnes, Deborah E and Jeon, Sun Y and Boscardin, W John and Kenneth M. Langa and Covinsky, Kenneth E and Mitchell, Susan L and Whitlock, Elizabeth L and Smith, Alexander K and Lee, Sei J} } @article {12990, title = {DEVELOPMENT OF A FRAILTY INDEX FOR PEOPLE WITH DEMENTIA IN THE HEALTH AND RETIREMENT STUDY}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, pages = {429}, abstract = {Frailty indices (FI) have been found to predict adverse outcomes, such as, mortality, hospitalization, and institutionalization in older adults. However, traditional FIs often exclude people with dementia (PWD), who may not be able to consent to or complete all of the standard frailty items. While frailty is a known risk factor for onset of dementia and PWD have higher rates of frailty, little is known regarding how frailty predicts outcomes among PWD. Our study aims to develop an FI for PWD and to examine how this index relates to mortality, hospitalization, and nursing home stays. We used data from the Health and Retirement Study to create a 52-item FI for community-dwelling adults aged 50 years and over classified as having dementia (n = 1,107) in 2014. The index includes deficits in four domains: chronic health conditions, functional status, sensory problems, and overall health and wellbeing. A standardized FI score between 0 and 1 was calculated for each respondent. We used logistic regression to examine associations with FI and 2-year mortality, hospitalization, and nursing home stay, adjusting for age and gender. We found that a 0.1 unit increase in FI was significantly associated with higher odds of 2-year mortality (OR 1.39, p< 0.001), hospitalization (OR 1.45, p< 0.001), and nursing home stay (OR 1.38, p< 0.001) for people with dementia. This study developed an FI which is predictive for adverse outcomes among PWD. Future work should explore how socioeconomic and neighborhood factors contribute to the relationship between frailty and adverse outcomes among PWD.}, keywords = {Dementia, frailty index}, doi = {10.1093/geroni/igac059.1685}, author = {Wilkie, Rachel and Jennifer A Ailshire} } @article {11687, title = {Development of a physical function outcome measure to harmonize comparisons between three Asian adult populations.}, journal = {Quality of Life Research}, volume = {31}, year = {2022}, pages = {281-291}, abstract = {

PURPOSE: The purpose of this study was to use modern measurement techniques and create a precise functional status metric for Asian adults.

METHODS: The study subjects included Asian American adults from the 2012 Health and Retirement Study (n = 211), Chinese adults in the China Health and Retirement Longitudinal Study (n = 13,649), and Korean adults in the Korean Longitudinal Study of Aging (n = 7,486). The Rasch common-item equating method with nine self-care and mobility items from the three databases were used to create a physical function measure across the three Asian adult populations.

RESULTS: The created physical function measure included 23 self-care and mobility tasks and demonstrated acceptable psychometric properties (unidimensional, local independence, no misfit, no differential item functioning). A significant group difference in the estimated physical function across the three Asian adult populations ([Formula: see text] = 445.21, p < 0.0001) was identified. The American Asian adults (5.16 logits) had better physical function compared to the Chinese (4.15 logits) and Korean adults (3.32 logits).

CONCLUSION: Since the outcome measure was calibrated with the population-representative Asian samples, this derived physical function measure can be used for cross-national comparisons between the three countries. Using this precise functional status metric can help to identify factors that influence health outcomes in other Asian countries (China and Korea). This has the potential to generate numerous benefits, such as international disability monitoring and health-related policy development, improved shared decision making, and international syntheses of research findings.

}, keywords = {CHARLS, Cross-national comparison, KLoSA, Outcome measure development, Rasch model}, issn = {1573-2649}, doi = {10.1007/s11136-021-02909-y}, author = {Hong, Ickpyo and Hreha, Kimberly P and Hilton, Claudia L and Lee, Mi Jung} } @article {11604, title = {Diagnoses of Chronic Health Conditions and Change in Subjective Age: The Moderating Role of Chronological Age.}, journal = {Gerontologist}, volume = {62}, year = {2022}, pages = {276-285}, abstract = {

BACKGROUND AND OBJECTIVES: Health is a predictor of subjective age, and although inconclusive, the strength of this association is not uniform across different age groups. This study investigates if new diagnoses of chronic health conditions are associated with a change in subjective age and if chronological age moderates this relationship.

RESEARCH DESIGN AND METHODS: Using data from the Health and Retirement Study, residualized change regression analysis was performed for a sample of 5,158 respondents older than 50 years to examine their subjective age in 2014 relative to that reported in 2010. The main predictor was the number of chronic health conditions newly diagnosed between 2010 and 2014. Chronological age in 2010 was the moderator.

RESULTS: Results showed that each new diagnosis of a chronic health condition was significantly associated with a 0.68-year increase in subjective age reported in 2014, compared to subjective age reported in 2010. However, this increase in subjective age was attenuated by 0.05 years for each additional year in 2010 chronological age.

DISCUSSION AND IMPLICATIONS: According to Social and Temporal Comparison theories, people compare themselves to their age peers and earlier selves. Given expectations for better health at younger chronological ages, being diagnosed with chronic health conditions may have a stronger association with subjective age among middle-aged persons as compared to older persons. The findings suggest that subjective age may be used as a screening tool to predict how chronic disease diagnosis may influence peoples{\textquoteright} sense of self, which in turn shapes future health.

}, keywords = {Chronic Diseases, Felt age, Perceived age}, issn = {1758-5341}, doi = {10.1093/geront/gnab057}, author = {Prasad, Anyah and Edward Alan Miller and Jeffrey A Burr and Boerner, Kathrin} } @article {12207, title = {A diagnosis of diabetes and health behavior maintenance in middle-aged and older adults in the United States: The role of self-efficacy and social support.}, journal = {Preventive Medicine}, volume = {155}, year = {2022}, pages = {106958}, abstract = {

The present study aims to investigate the relationship between a diagnosis of diabetes and the maintenance of health behaviors, and whether self-efficacy and social support moderate the relationship. The study sample came from the 2006 to 2016 waves of the Health and Retirement Study in the United States (N~=~13,143). A diagnosis of diabetes was ascertained by self-reported physician-diagnosed condition. Self-efficacy was measured using a 5-item scale. Social support from family and friends were measured separately by a 3-item scale. Three health behaviors were examined, namely alcohol consumption, smoking, and physical activity. Cox proportional hazards regression models were performed to test the study aims. Respondents who reported a diagnosis of diabetes were 1.50 times more likely to fail to maintain physical activity (95\% CI~=~1.26, 1.77). This relationship was moderated by social support from family, which was related to lower hazards of failure to maintain physical activity among individuals who had a diagnosis of diabetes compared to those without a diagnosis. The study suggests that a diagnosis of diabetes may be a stressful health event that negatively affects physical activity maintenance. In addition, the findings highlight the importance of incorporating strategies to mobilize social support from family, which may help individuals sustain their efforts to maintaining health-promoting behaviors after a diabetes diagnosis.

}, keywords = {Diabetes diagnosis, Health behavior maintenance, Self-efficacy, Social Support}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2022.106958}, author = {Qin, Weidi} } @article {12302, title = {Diet Quality and Health in Older Americans.}, journal = {Nutrients}, volume = {14}, year = {2022}, pages = {1198}, abstract = {

Adequate nutrition is an essential component of healthy ageing. This study documents the quality of diets among older Americans and implications of healthy eating for their physical and mental health. Using a nationally representative longitudinal sample of adults aged >=50 years, from the Health and Retirement Study (HRS) 2010-2016 and food intake data from the 2013 Health Care and Nutrition Study (HCNS), the study evaluates the onset of health problems along the spectrum of diet quality measured by the Healthy Eating Index (HEI)-2015. Older adults adhering to healthier diets, in the high HEI group, have a significantly lower risk of developing limitations in activities of daily living (15.2\% vs. 19.6\%, \< 0.01) and depression (11.8\% vs. 14.9\%, \< 0.01), as compared to participants with low HEI scores. Consuming healthier diets also predicts more favorable health outcomes, as measured by blood-based biomarkers, including C-reactive protein (3.3 vs. 3.8, \< 0.05), cystatin C (1.1 vs. 1.2, \< 0.1), total cholesterol (192.1 vs. 196.4, \< 0.1), and high-density lipoprotein (57.2 vs. 53.8, \< 0.01). Most older Americans can benefit from improving diet to reduce their risk of disability, chronic disease, and depression.

}, keywords = {Activities of Daily Living, Aged, diet, Eating, Healthy, Nutritional Status}, issn = {2072-6643}, doi = {10.3390/nu14061198}, author = {Zhao, Hang and Andreyeva, Tatiana} } @article {12215, title = {Dietary Supplement Use in Middle-aged and Older Adults.}, journal = {The Journal of Nutrition, Health \& Aging}, volume = {26}, year = {2022}, pages = {133-138}, abstract = {

OBJECTIVES: Despite limited evidence of clinical benefits, dietary supplement use is increasingly common among older adults. The aim of this study was to characterise the prevalence of dietary supplement use in a national sample of community-dwelling middle-aged and older adults and investigate factors associated with its use.

DESIGN/SETTING/PARTICIPANTS: This was a cross-sectional study using data from the Health and Retirement Study (HRS), a biennial, nationally representative survey of individuals aged 50 years and older in the United States. This study combined data from the 2013/14 Health Care and Nutrition Survey (HCNS) and 2012 Core Survey.

MEASUREMENTS: The primary outcome was the use of any dietary supplement at least once a week. Secondary outcomes were the use of multivitamins and specific vitamin and supplement types. Multivariable regression models were used to identify factors associated with any dietary supplement use.

RESULTS: A total of 6045 participants (weighted n = 71,268,015) were included in the final analytical sample (mean age 67.7 years, 59.3\% female). Of these, 84.6\% (n=60,292,704) were regular dietary supplement users, with participants taking a mean of 3.2{\textpm}0.1 different dietary supplements and 41.9\% taking four or more. Multivitamins were the most common, used by 57.5\% (n=41,147,146) of participants. Other commonly used dietary supplements were vitamin D, fish oil, calcium, vitamin C, and vitamin B12. Older age (75+ years), female sex, higher education, daily alcohol use, vigorous physical activity, regular medication use, and arthritis were associated with higher odds of dietary supplement use.

CONCLUSIONS: In this sample of middle-aged and older Americans, more than 4 out of 5 used a dietary supplement. Certain demographic, behavioural, and clinical factors were associated with their use. Given the lack of evidence for improving health outcomes, our findings suggest potential overuse of dietary supplements in people over the age of 50.

}, keywords = {Animals, Cross-Sectional Studies, Dietary Supplements, Female, Male, Nutrition Surveys, Nutritional Status, United States, Vitamins}, issn = {1760-4788}, doi = {10.1007/s12603-022-1732-9}, author = {Tan, E C K and Eshetie, T C and Gray, S L and Marcum, Z A} } @article {LENKO2022849, title = {Differences in Informal and Formal Advance Care Planning Use by Race/Ethnicity Among U.S. Older Adults}, journal = {Journal of Pain and Symptom Management}, volume = {63}, year = {2022}, pages = {849}, abstract = {Outcomes 1. Identify key racial and ethnic disparities in various advance care planning strategies 2. Identify opportunities for advance care planning among a racially or ethnically diverse population Original Research Background Capturing patients{\textquoteright} healthcare treatment preferences is critical for guiding end-of-life care. Goals-of-care conversations (i.e., informal advance care planning [ACP]) may better capture these preferences than advance directives (i.e., formal ACP), particularly among historically marginalized racial and ethnic groups. Research Objectives To compare the use of informal versus formal ACP strategies by race and ethnicity among U.S. older adults. Methods We used 2012-2018 Health and Retirement Study data to assess ACP strategies among 14,148 older (>=65 years) respondents. ACP was categorized as (1) no ACP, (2) informal ACP only, (3) formal ACP only, and (4) both informal and formal ACP. Multinomial logistic regression models estimated relationships between self-identified race or ethnicity and ACP strategy, controlling for sociodemographic and health status characteristics. Adjusted risk ratios with delta standard errors were computed. Results Overall, 18.9\% of the sample reported no ACP, 15.4\% informal ACP only, 7.4\% formal ACP only, and 58.3\% both ACP strategies. In adjusted results (adjusted relative risk [95\% CI]), non-Hispanic Black and Hispanic respondents were 1.73 [1.56, 1.93] and 1.61 [1.39, 1.87] times more likely, respectively, to report no ACP than non-Hispanic White respondents. Compared to non-Hispanic White respondents, Hispanic respondents were 1.50 [1.28, 1.76] times more likely to report informal ACP only, and non-Hispanic Black respondents were 1.70 [1.41, 2.05] times more likely to report formal ACP only. Non-Hispanic Black and Hispanic respondents were 0.75 [0.71, 0.79] and 0.76 [0.70, 0.82] times as likely, respectively, to report using both ACP strategies than non-Hispanic White respondents. Conclusion and Implications Older individuals of racial and ethnic minority were less likely to use a combination of informal and formal ACP strategies and more likely to be without any ACP. Lower use of various ACP strategies among these populations may contribute to poor end-of-life outcomes and should be addressed by clinicians, researchers, and policymakers.}, keywords = {Advance care planning, race disparity}, issn = {0885-3924}, doi = {https://doi.org/10.1016/j.jpainsymman.2022.02.026}, author = {Rachel Lenko} } @article {12392, title = {Different Levels of Leisure-time Physical Activity, Coping, and Mental Health among Older Adults with Diabetes during the COVID-19 Pandemic.}, journal = {American Journal of Health Behavior}, volume = {46}, year = {2022}, pages = {177-185}, abstract = {

The COVID-19 has led public health researchers to try to improve mental health among older adults with diabetes. Leisure-time physical activity (LTPA) has emerged as a means of coping with mental health difficulties in the pandemic. We extracted 301 respondents from the Health and Retirement Study (HRS) based on the following criteria: over 50 years old and the onset of diabetes. We used multiple questionnaire items to assess mental health (ie, loneliness, happiness, and positive and negative affect) for older adults with diabetes. We used multivariate analysis of variance to investigate the relationships between the fixed variable (ie, LTPA) and outcome variables (ie, mental health). We categorized LTPA participation into 3 groups (ie, low, mid, and high) and examined mental health following various levels of LTPA participation. LTPA participation showed a significant group mean differences for loneliness, happiness, and positive affect, but not for negative affect. High-LTPA respondents presented lower loneliness and higher happiness than low-LTPA respondents. High-LTPA and mid-LTPA respondents indicated higher positive affect than low-LTPA respondents. This study provides evidence of the benefits of LTPA on mental health for older adults with diabetes and suggests that high-LPTA involvement can be effective in promoting mental health among older adults with diabetes in the COVID-19 era.

}, keywords = {Adaptation, COVID-19, Cross-Sectional Studies, Diabetes Mellitus, Exercise, Leisure activities, Mental Health, Pandemics, Psychological}, issn = {1945-7359}, doi = {10.5993/AJHB.46.2.7}, author = {Kim, Junhyoung and Han, Sua} } @article {11524, title = {The Differential Effects of Caregiving Intensity on Overnight Hospitalization.}, journal = {Western Journal of Nursing Research}, volume = {44}, year = {2022}, pages = {528-539}, abstract = {

This study aims to examine how caregiving for a spouse affects caregivers{\textquoteright} likelihood of overnight hospitalization. Using data from the Health and Retirement Study, we examine the odds of spousal caregivers experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and change in caregiving intensity. Caregivers were no more likely to experience an overnight hospitalization than noncaregivers ( = .92; CI [.84, 1.00]). Effects varied by intensity of care. Compared to noncaregivers, caregivers who reported providing no assistance with activities of daily living were less likely to experience overnight hospitalization ( = .77; CI [.66, .89]); however, caregivers who provided care to someone living with dementia for 4 to <6 years had 2.11 times the odds of experiencing an overnight hospitalization (CI [1.16, 3.85]). Although caregivers overall experience overnight hospitalization at a similar rate as noncaregivers, there are differences between caregivers by the intensity of care.

}, keywords = {Caregiving, Dementia, Health Services, hospitalizations, Policy}, issn = {1552-8456}, doi = {10.1177/01939459211002907}, author = {Meyer, Kylie and Zachary Gassoumis and Kathleen H. Wilber} } @article {12168, title = {Differential trends in disability among rich and poor adults in the US and England from 2002 to 2016.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {S189-S198}, abstract = {

OBJECTIVE: Disability in the US has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the US and England, would inform public policy aimed at reducing disparities in disability.

METHODS: Using the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimated annual percent change from 2002 to 2016 in disability among community dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with five instrumental activities of daily living (IADLs) and six activities of daily living (ADLs). We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design.

RESULTS: The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002--2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the US but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC=-3.60 95\% CI [-6.57,-0.63] for the US; AAPC=-6.06 95\% CI [-8.77,-3.35] for England).

DISCUSSION: Improvements in disability were more widespread in England than in the US between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.

}, keywords = {ADL limitation, Disability trend, ELSA, health disparity, IADL limitation}, issn = {1758-5368}, doi = {10.1093/geronb/gbac029}, author = {Choi, Hwa Jung and Robert F. Schoeni and Andrew Steptoe and Cho, Tsai-Chin and Kenneth M. Langa} } @article {12681, title = {Difficulties with Activities of Daily Living and Receipt of Care Among Older Adults with Cognitive Impairment: Differences Between Those Living Alone and Those Living with Others.}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {89}, year = {2022}, pages = {31-37}, abstract = {

We compared the prevalence of reporting difficulty with basic and instrumental activities of daily living without help received for persons with cognitive impairment living alone versus those living with others. We used data on 13,782 community-dwelling participants aged 55+ with cognitive impairment in the Health and Retirement Study (2000-2016). Models were stratified by gender and race/ethnicity. Among cognitively impaired older adults, those living alone were more likely to report difficulty without help received than those living with others. Results were similar by gender and race/ethnicity. Providers and policymakers might focus their efforts on ensuring the adequate provision of home and community-based services for older adults living alone with cognitive impairment.

}, keywords = {Activities of Daily Living, Cognitive Dysfunction, home environment, Independent Living, Prevalence}, issn = {1875-8908}, doi = {10.3233/JAD-220172}, author = {Yang, Yulin and Swinnerton, Kaitlin and Portacolone, Elena and Allen, Isabel Elaine and Torres, Jacqueline M and Duchowny, Kate} } @article {12172, title = {Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study.}, journal = {BMC Geriatrics}, volume = {22}, year = {2022}, pages = {181}, abstract = {

BACKGROUND: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure.

METHODS: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged >=50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers{\textquoteright} corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness.

RESULTS: During COVID-19, 18.4\% of older adults living alone reported ADL difficulties (ranging from 8.8\% in Switzerland to 29.2\% in the USA) and 56.8\% of those reporting difficulties received ADL assistance (ranging from 38.7\% in the UK to 79.8\% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19.

CONCLUSION: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.

}, keywords = {Activities of Daily Living, COVID-19, Domiciliary care, Living Alone}, issn = {1471-2318}, doi = {10.1186/s12877-022-02799-w}, author = {Chen, Shanquan and Jones, Linda A and Jiang, Shan and Jin, Huajie and Dong, Dong and Chen, Xi and Wang, Dan and Zhang, Yun and Xiang, Li and Zhu, Anna and Cardinal, Rudolf N} } @article {12863, title = {Digital exclusion and functional dependence in older people: Findings from five longitudinal cohort studies.}, journal = {eClinicalMedicine}, volume = {54}, year = {2022}, pages = {101708}, abstract = {

BACKGROUND: Older people are more likely to be excluded from the digital world, and this has been linked to poor health outcomes. The extent and direction of the influence of digital exclusion on functional dependency is, however, not well understood. We aimed to investigate the association between digital exclusion and functional dependency among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs).

METHODS: In this multicohort study, we pooled individual-level data from five longitudinal cohort studies that included nationally representative samples of older adults across 23 countries, including the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). The digital exclusion was recorded as an absence from internet use by self-reported. We assessed basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and we used interval-of-need methods to categorize the functional dependency. We applied generalized estimating equations models fitting Poisson model to investigate the association of digital exclusion with difficulties in BADL or IADL and functional dependency, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age level, labour force status, education, household wealth level, marital status, and co-residence with children.

FINDINGS: We included 108,621 participants recruited between 2010 and 2018 with a median follow-up of 3 phrases. Digital exclusion in older adults varied across countries, ranging from 23.8\% in Denmark (SHARE) to 96.9\% in China (CHARLS). According to the crude model, digital exclusion was significantly associated with functional dependency. In the MSAS-adjusted model, those associations remained statistically significant: HRS (incidence rate ratio [IRR]~=~1.40, 95\% confidence interval [CI] 1.34-1.48 for BADL; 1.71 [1.61-1.82] for IADL), ELSA (1.31~[1.22-1.40] in BADL and 1.37 [1.28-1.46] in IADL), SHARE (1.69 [1.61-1.78] in BADL and 1.70 [1.63-1.78] in IADL), CHARLS (2.15 [1.73-2.67] in BADL and 2.59 [2.06-3.25] in IADL), and MHAS (1.15 [1.09-1.21] in BADL and 1.17 [1.09-1.25] in IADL). In the subgroup analyses, the associations were more pronounced in the oldest-old (aged~>=~80 years old).

INTERPRETATION: There is a substantial proportion of older adults who are excluded from the Internet, especially those in LMIC. Older people excluded from the Internet regardless of whether they live in HICs or LMICs are more likely to develop functional dependency. It should be made a priority to remove barriers to Internet access in order to assist older people in maintaining their independence and, consequently, to reduce the care burden associated with the ageing population worldwide.

FUNDING: The National Natural Science Foundation of China (No. 71904004).

}, keywords = {CHARLS, Digital exclusion, ELSA, Functional dependency, IADLS, instrumental activities of daily living, MHAS, SHARE}, issn = {2589-5370}, doi = {10.1016/j.eclinm.2022.101708}, author = {Lu, Xinran and Yao, Yao and Jin, Yinzi} } @mastersthesis {12855, title = {Dimensions of Social Isolation and Adverse Health Outcomes among Older Men and Women in the United States: How Aging, Living Alone, and Obesity Contribute to Mortality}, year = {2022}, school = {University of Massachusetts Amherst}, address = {Amherst, MA}, abstract = {This dissertation examines the interaction of a series of potential social and biological mechanisms that may affect inequalities in mortality among those 65 or older. The mechanisms are social isolation and its relationships with obesity and diabetes. Although many prior studies have confirmed social isolation as a risk factor for adverse health outcomes such as obesity, diabetes, and even premature death, how and why social isolation works to generate adverse health outcomes remains mostly unknown. To extend the scholarship on social isolation and health, each chapter of this dissertation tests distinctive aspects of social isolation: living alone, rurality, and retirement, respectively, while using various datasets from the Health and Retirement Study. First, this dissertation finds that older women{\textquoteright}s living alone status is related to a lower likelihood of sarcopenic obesity, whereas their widowhood status showed a higher possibility of sarcopenic obesity. Second, while the rural-urban classification complicates results, older men experiencing severe food insecurity, accounting for rural-urban distinctions, tended to have a greater likelihood of obesity than not being obese. Last, older adults who were partly retired or had a pension had a lower mortality risk. However, their significance disappeared after adjusting for confounders. Yet, in-person contact emerged to be associated with a decreased mortality risk. The dissertation contributes three novel ideas for scholars with expertise in social determinants of health. First, it bears keeping in mind that although a composite construct such as social isolation can be effectively used to examine health outcomes, the relationship between each component of the variable and outcomes should also be carefully examined. Second, this thesis constructed a geographic metabolic risk partition measure in order to establish high-metabolic-risk states vs. low-risk states. This measure reflects the reality that the prevalence of obesity and diabetes is deeply rooted in an environmental context such as a state. Third, clinical research already focuses on sarcopenic obesity, but social factors for the disease are rarely studied. Since this dissertation found younger cohorts{\textquoteright} greater likelihood of sarcopenic obesity among older Americans, social scientists should pursue new frontiers in research focused on the social aspects of sarcopenic obesity.}, keywords = {health outcomes, Living Alone, Mortality, Obesity, social isolation}, doi = {10.7275/31020751}, author = {Bae, Youngjoon} } @inbook {12305, title = {Disability-free life trends at older ages: Implications for longevity risk management }, booktitle = {New Models for Managing Longevity Risk: Public-Private Partnerships}, year = {2022}, publisher = {Oxford University Press}, organization = {Oxford University Press}, chapter = {3}, keywords = {Activities of Daily Living, Disability}, isbn = {978{\textendash}0{\textendash}19{\textendash}285980{\textendash}8}, doi = {10.1093/oso/9780192859808.001.0001}, author = {Douglas A. Wolf and Olivia S. Mitchell} } @article {12489, title = {Discrimination, Mediating Psychosocial or Economic Factors, and Antihypertensive Treatment: A 4-Way Decomposition Analysis in the Health and Retirement Study.}, journal = {American Journal of Epidemiology}, volume = {191}, year = {2022}, pages = {1710-1721}, abstract = {

Untested psychosocial or economic factors mediate associations between perceived discrimination and suboptimal antihypertensive therapy. This study included two waves of data from the Health and Retirement Study participants with self-reported hypertension (N=8557, 73\% Non-Hispanic White, 17\% Non-Hispanic Black, and 10\% Hispanic/Latino) over four years (2008-2014). Our primary exposures were frequency of experiencing discrimination in everyday life or across seven lifetime circumstances. Candidate mediators were self-reported depressive symptoms, subjective social standing, and household wealth. We evaluated with causal mediation methods the interactive and mediating associations between each discrimination measure and reported antihypertensive use at the subsequent wave. In unmediated analyses, everyday (OR; 95\% CI: 0.86; 0.78, 0.95) as well as lifetime discrimination (OR; 95\% CI: 0.91; 0.85, 0.98) were associated with a lower likelihood of antihypertensive use. Discrimination was associated with lower wealth, greater depressive symptoms, and decreased subjective social standing. Estimates for associations due to neither interaction nor mediation resembled unmediated associations for most discrimination-mediator combinations. Lifetime discrimination was indirectly associated with reduced antihypertensive use via depressive symptomology (OR; 95\% CI: 0.99; 0.98, 1.00). In conclusion, the impact of lifetime discrimination on the underuse of antihypertensive therapy appears partially mediated by depressive symptoms.

}, keywords = {antihypertensive, causal mediation, Perceived Discrimination, Psychosocial, Wealth}, issn = {1476-6256}, doi = {10.1093/aje/kwac102}, author = {Sims, Kendra D and Batty, G David and Smit, Ellen and Hystad, Perry W and McGregor, Jessina C and Odden, Michelle C} } @article {12352, title = {Disparities in Mental Health and Well-Being between Heterosexual and Sexual Minority Older Adults during the COVID-19 Pandemic.}, journal = {Journal of Aging and Health}, volume = {34}, year = {2022}, pages = {939-950}, abstract = {

This study examines disparities in older adults{\textquoteright} mental health and well-being during the pandemic by sexual minority status. This study analyzed data on older adults from the Health and Retirement Study{\textquoteright}s COVID-19 Module (N = 3142 for heterosexuals and N = 75 for sexual minorities). Weighted regressions linked concern about COVID-19, depression, pandemic emotional stress, and changes in loneliness, in-person contacts, income, and work to sexual minority status, controlling for sociodemographic characteristics. Compared to heterosexuals, sexual minority older adults had more concern about the pandemic and emotional stress and showed a decrease in in-person contact during the pandemic-these differences were not explained by sociodemographic characteristics. Sexual minority older adults were also more likely to have changes in income and work during the pandemic, but these differences were explained by sociodemographic characteristics. Sexual minority older adults have experienced worse mental health outcomes than heterosexuals during the COVID-19 pandemic, which merits intervention.

}, keywords = {Coronavirus impact, COVID-19, Health Inequality, LGBTQ, minority experience, psychosocial health}, issn = {1552-6887}, doi = {10.1177/08982643221081965}, author = {Chen, Jen-Hao} } @article {12498, title = {DNA methylation "GrimAge" acceleration mediates sex/gender differences in verbal memory and processing speed: Findings from the Health and Retirement Study.}, journal = {The Journals of Gerontology, Series A}, year = {2022}, abstract = {

Whether sex/gender differences in rates of biological aging mediate sex/gender differences in cognition in older adults has not been fully examined. The aim of the current study was to investigate this association. Data from up to 1,928 participants (mean age = 75, SD = 7.04, female = 57\%) who took part in the 2016 Harmonized Cognitive Assessment Protocol and Venous Blood Study; sub-studies of the Health and Retirement Study were included in the current study. The residuals from four age-adjusted epigenetic clocks (Horvath, Hannum, PhenoAge, and GrimAge) were used to measure biological age acceleration. Sex/gender differences in cognition were tested using a series of ANCOVAs. Mediation analyses tested whether the measures of age acceleration accounted for these sex/gender differences, controlling for age, education, smoking status, and white blood cell count. Women outperformed men on measures of verbal learning, verbal memory, visual scanning, and processing speed. No other significant sex/gender differences were identified. Results from mediation analyses revealed that women{\textquoteright}s slower rates of GrimAge fully accounted for their faster processing speeds and partially accounted for their better performances on verbal learning, verbal memory, and visual scanning measures. None of the other measures of age acceleration were significant mediators. Accounting for sex/gender differences in biological aging may differentiate between cognitive sex/gender differences that are driven by universal (i.e., age-related) versus sex-specific mechanisms. More broadly, these findings support the growing evidence that the GrimAge clock outperforms other clocks in predicting cognitive outcomes.

}, keywords = {Biological age, Cognition, DNA Methylation, GrimAge, HCAP, sex/gender differences}, issn = {1758-535X}, doi = {10.1093/gerona/glac133}, author = {O{\textquoteright}Shea, Deirdre M and Maynard, Taylor and Tremont, Geoffrey} } @article {11618, title = {Do Disability Policies Shape How People Perceive Work Limitation? An International Perspective}, journal = {Journal of Disability Policy Studies}, volume = {33}, year = {2022}, pages = {35-45}, abstract = {This study explored the role that cross-country disability policy differences play in shaping individuals? work limitation reporting styles. We used anchoring vignettes available in comparable U.S. and European survey data to test and adjust for reporting differences in self-reported work limitation measures. We found that disability policy generosity scores showed statistically significant predictive power for respondents? work limitation classification scales, with the association stronger and more statistically significant at the lower end and the middle of the scale. That is, respondents under more generous disability regimes tended to apply a more inclusive (i.e., lenient) scale in classifying a mild, moderate, or severe work limitation. Because there is no natural interpretation of the magnitude of the correlation, we conducted counterfactual policy simulations to illustrate the strength of the association; for example, if the United States were to adopt more generous disability policies such as those in Sweden, there might be an associated increase of more than 36 percentage points in the proportion of Americans aged 50 years and above reporting work limitation (of any severity). This research contributes to a better understanding of the role of disability policy in reporting heterogeneity in comparative disability research, an area that has been seldom studied.}, keywords = {disability policy, work limitations}, isbn = {1044-2073}, doi = {10.1177/10442073211010135}, author = {Yin, Na and Frank Heiland} } @article {11942, title = {Do Early-Life Social, Behavioral, and Health Exposures Increase Later-Life Arthritis Incidence?}, journal = {Research on Aging}, volume = {44}, year = {2022}, pages = {479-493}, abstract = {

OBJECTIVES: This study investigates direct and indirect influences of childhood social, behavioral, and health exposures on later-life osteoarthritis and rheumatoid arthritis development.

METHODS: Drawing from cumulative inequality theory and six waves of the Health and Retirement Study (2004-2014), we estimate structural equation modeling-based discrete-time survival analysis of the association between six childhood exposure domains and both osteoarthritis and rheumatoid arthritis incidence for men ( = 2720) and women ( = 2974). Using the delta method to test for mediation, we examine indirect effects via selected health-related risks and resources.

RESULTS: Risky adolescent behavior is associated with rheumatoid arthritis incidence for women (h.O.R. = 1.883, 95\% C.I. [1.016, 3.490]), whereas several types of childhood exposures are associated with later-life osteoarthritis development for both men and women. Experiencing two or more childhood socioeconomic disadvantages is indirectly associated with osteoarthritis (men: coef. = 0.024, 95\% C.I. [0.003, 0.045]; women: coef. = 0.111, 95\% C.I. [0.071, 0.150]) and rheumatoid arthritis (men: coef. = 0.037, 95\% C.I. [0.000, 0.074]; women: coef. = 0.097, 95\% C.I. [0.035, 0.159]) development through adult body mass index.

DISCUSSION: Findings highlight the importance of childhood contexts in understanding the development of later-life osteoarthritis and rheumatoid arthritis.

}, keywords = {Adverse Childhood Experiences, Body Mass Index, Cumulative inequality theory, Osteoarthritis, rheumatoid arthritis}, issn = {1552-7573}, doi = {10.1177/01640275211044979}, author = {Blakelee R Kemp and Kenneth F Ferraro and Patricia M Morton and Thomas, Patricia A and Sarah A Mustillo and Eileen M. Crimmins} } @article {12264, title = {Do Households Save More When the Kids Leave? Take Two}, number = {IB$\#$22-5}, year = {2022}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {When kids leave home, parents consume less but they don{\textquoteright}t save more. So where is the money going? The analysis looks at three ways to square the circle: define saving more broadly: parents could be paying down debt faster; define consumption more broadly: they could be assisting grown children; and define income more precisely: they could be earning less than before. The results support the third explanation: when kids leave, parents work and earn less. But the results also show that consumption still declines relative to income without any rise in net worth, so this study does not fully resolve the puzzle.}, keywords = {consumption, Income, Saving}, url = {https://crr.bc.edu/briefs/do-households-save-more-when-the-kids-leave-take-two/}, author = {Andrew G. Biggs and Anqi Chen and Alicia H. Munnell} } @article {12159, title = {Does a Cancer Diagnosis in Mid-to-Later Life Modify Racial Disparities in Memory Aging?}, journal = {Alzheimer Disease \& Associated Disorders}, volume = {36}, year = {2022}, pages = {140-147}, abstract = {

BACKGROUND: It is unknown whether an incident cancer diagnosis differentially impacts acute and long-term memory aging between older White and Black Americans.

METHODS: Incident cancer diagnoses and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial study interviews in the US Health and Retirement Study (N=14,235, 1998-2016). We used multivariable segmented linear mixed-effects models to evaluate the rate of change in standardized memory score (SD/decade) in the years before, acutely at the time of, and in the years following an incident cancer diagnosis, compared to cancer-free adults, by race.

RESULTS: Black participants experienced faster memory decline than White participants (cancer-free group: -1.211 vs. -1.077; P<0.0001). An incident cancer diagnosis was associated with an acute memory drop in White, but not Black participants (-0.065 vs. 0.024; P<0.0001). However, White cancer survivors experienced slower memory decline than cancer-free White adults before and after diagnosis, but this memory advantage was not observed among Black cancer survivors.

CONCLUSIONS: Racial disparities in memory aging are not modified by an incident cancer diagnosis. The acute cancer-related memory decline and long-term memory advantage experienced by White, but not Black, cancer survivors relative to cancer-free older adults, requires further investigation.

}, keywords = {cancer diagnosis, Memory, Racial Disparities}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000493}, author = {Eastman, Marisa R and Ospina-Romero, Monica and Westrick, Ashly C and Jasdeep S Kler and M. Maria Glymour and Abdiwahab, Ekland and Lindsay C Kobayashi} } @mastersthesis {12574, title = {Does a Purposeful Life Mean a Healthy Life? Evaluating Longitudinal Associations between Sense of Purpose, Cognition, and Health}, volume = {Ph.D.}, year = {2022}, school = {University of Victoria}, keywords = {Cognition, health, life purpose}, url = {https://www.uvic.ca/socialsciences/psychology/assets/docs/oral/lewis-abstract.pdf}, author = {Nathan Alexander Lewis} } @article {12514, title = {Does Aging at Home Make Older Adults Healthy: Evidence from Medicaid Home and Community-Based Services}, year = {2022}, institution = {ZBW {\textendash} Leibniz Information Centre for Economics}, address = {Kiel, Germany}, abstract = {The Medicaid Home and Community-Based Services (HCBS) subsidizes long-term care to satisfy the increasing desire to age at home among older adults. The HCBS program may improve health outcomes of this population by allowing them to age-inplace, but less quality and quantity of home-based care comparing to nursing home care could offset some of the potential benefits. We use plausibly exogenous policy expenditure across states over time linked with detailed health information from the restricted Health and Retirement Study (HRS) to identify the causal effects of HCBS on general health, physical health, and mental health of older adults. Overall, our findings suggest that HCBS is beneficial to health: a $1,000 increase in HCBS per older person improves health status by 6 percent, mitigates functional mobility limitations by 5 percent, and reduces negative psychological feelings by 10 percent. The positive effect on physical health is concentrated among people with limited financial resources, while the reducing impact on mental health is significant among the richer group. The HCBS program improves health outcomes mainly through three mechanisms: decreasing risk behavior on drinking, increasing healthcare use, and spending more time accompanying with family. }, keywords = {health, Long-term Care, Medicaid HCBS}, url = {https://www.econstor.eu/bitstream/10419/260523/1/chapter3.pdf}, author = {Liu, Yinan and Zai, Xianhua} } @article {10.1093/workar/waac020, title = {Does Bridge Employment Mitigate or Exacerbate Inequalities Later in Life?}, journal = {Work, Aging and Retirement}, year = {2022}, abstract = {Most older Americans with career employment change jobs at least once before retiring from the labor market. Much is known about the prevalence and determinants of these bridge jobs, yet relatively little is known about the implications of such job changes{\textemdash}compared to direct exits from a career job{\textemdash}upon economic disparities in later life. In this article, we use 26 years of longitudinal data from the Health and Retirement Study to document the various pathways that older Americans take when exiting the labor force, and examine how bridge employment affects nonhousing wealth and total wealth, including the present discounted value of Social Security benefits. We find that gradual retirement in the form of bridge employment neither exacerbates nor mitigates wealth inequalities among Americans who hold career jobs later in life. That said, we do find some evidence that wealth inequalities grow among the subset of older career workers who transition from career employment to bridge employment at older ages. One policy implication of our article is that it provides evidence that might allay concerns about the potential for disparate financial impacts associated with the gradual retirement process.}, keywords = {Bridge employment, inequalities, labor force, Social Security Benefits}, issn = {2054-4650}, doi = {10.1093/workar/waac020}, author = {Cahill, Kevin E and Giandrea, Michael D and Quinn, Joseph F and Sacco, Lawrence B and Platts, Loretta G} } @article {12582, title = {Does Genetic Predisposition to Alzheimer Disease Contribute to Midlife Depression?}, year = {2022}, publisher = {NeurologyAdvisor}, keywords = {Alzheimer disease, depression, genetic data}, url = {https://www.neurologyadvisor.com/topics/alzheimers-disease-and-dementia/genetic-predisposition-alzheimer-disease-midlife-depression/}, author = {Jacobs, Sheila} } @article {12503, title = {Does glaucoma affect cognitive function}, year = {2022}, publisher = {EurekAlert!}, keywords = {cognitive function, Glaucoma}, url = {https://www.eurekalert.org/news-releases/956465}, author = {Wiley News} } @article {12256, title = {Does Living Alone Affect Self-Perceptions of Aging? Findings From Two Waves of the Health and Retirement Study.}, journal = {Gerontology and Geriatric Medicine}, volume = {8}, year = {2022}, pages = {23337214221077798}, abstract = {

The current study examined if living alone is associated with self-perceptions of aging (SPA). The study used two-wave longitudinal data, sampled from the Health and Retirement Study (HRS), and collected in 2014 and 2018. In total, 6506 older adults aged 60-99 years at baseline were followed up with a 4-year lag. Results indicated that there was no significant change in SPA at follow-up regardless of changes in living arrangements. However, at follow-up, there was a significant cross-sectional difference in SPA between older adults who remained in partnership and those who transitioned to living alone due to widowhood or separation/divorce over a 4-year period. Findings suggest that SPA is relatively stable over time and is barely affected by living alone.

}, keywords = {Living arrangement, Marital Status, self-perceptions of aging (SPA)}, issn = {2333-7214}, doi = {10.1177/23337214221077798}, author = {Lee, Sunwoo} } @article {13045, title = {DOES NEIGHBORHOOD DISADVANTAGE ALTER MEMORY AFTER A CANCER DIAGNOSIS? A US HEALTH AND RETIREMENT STUDY}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, month = {12/2022}, type = {Journal Article}, chapter = {8}, abstract = {We aimed to determine the influence of neighborhood socioeconomic status (NSES) on long-term cancer-related memory decline of older adults. Incident cancer diagnosis and memory were assessed in the U.S. Health and Retirement Study (N=15,074, 1998-2016). Proportion of female-headed households with children, households with public assistance income, people with income below poverty, and proportion 16+ years unemployed was categorized into NSES tertiles. Linear mixed-effects models compared the standardized memory trajectories by cancer status and NSES. Cancer-free individuals living in more disadvantaged neighborhoods had worse mean memory function at age 75 and steeper memory declines than participants from less disadvantaged neighborhoods. An incident cancer diagnosis was associated with an acute memory drop at diagnosis for those living in the least disadvantaged neighborhoods. Cancer survivors had better memory prior to but not after diagnosis compared to cancer-free individuals across NSES. These findings could inform future interventions to promote cancer survivor{\textquoteright}s long-term aging.}, keywords = {Cancer, Memory}, doi = { 10.1093/geroni/igac059.026}, author = {Ashly Westrick and Monica Ospina-Romero and Philippa Clarke and Lindsay C Kobayashi} } @inbook {Shiovitz-Ezra22, title = {Does Physical Activity Mediate the Effect of Loneliness on Inflammatory and Metabolic Processes?}, booktitle = {Geriatric Medicine and Healthy Aging}, year = {2022}, publisher = {IntechOpen}, organization = {IntechOpen}, chapter = {18}, address = {Rijeka}, abstract = {The study to be presented in the chapter explores one potential behavioral mechanism by which loneliness affects inflammatory and metabolic processes in old age. Specifically, it addresses whether physical activity mediates the loneliness{\textemdash}inflammatory/metabolic dysregulation association. Multivariate linear regressions were applied to data derived from the Health and Retirement Study (HRS). The findings revealed that loneliness was prospectively associated with elevated values of log C-reactive protein (log-CRP) and with amplified levels of Glycated hemoglobin (HbA1c), Cystatin C (CysC), and Body Mass Index (BMI), after controlling for socio-demographics. Second, physical activity mediated the association between loneliness with prospective values of log-CRP and also mediated associations between loneliness and prospective levels of metabolic biomarkers. These findings affirm the contribution (i.e., the mediation), of physical activity to the associations between loneliness and immune and metabolic processes and provide insights concerning the mechanism by which this social{\textemdash}biological connection operates.}, keywords = {Inflammation, Loneliness, metabolic process, Physical activity}, doi = {10.5772/intechopen.104915}, author = {Sharon Shiovitz-Ezra and Ohad Parag and Howard Litwin}, editor = {Assistant Prof. {\'E}lvio Gouveia and Dr. Bruna Raquel Gouveia and Prof. Adilson Marques and Dr. Andreas Ihle} } @article {EIBICH2022102185, title = {Does retirement affect voluntary work provision? Evidence from Europe and the U.S.}, journal = {Labour Economics}, volume = {76}, year = {2022}, pages = {102185}, abstract = {We examine whether retirement has a causal effect on the frequency of voluntary work provision in Europe and the U.S. We draw on data from the English Longitudinal Study of Ageing, The Irish Longitudinal Study on Ageing, the Survey of Health, Ageing and Retirement in Europe and the Health Retirement Study for the period 2009{\textendash}2017 and use eligibility ages for old age pensions in an instrumental variable estimation to address endogeneity. We find that retirement increases the frequency of voluntary work provision in all countries.}, keywords = {ELSA, instrumental variables, Retirement, SHARE, TILDA, voluntary work}, issn = {0927-5371}, doi = {https://doi.org/10.1016/j.labeco.2022.102185}, author = {Peter Eibich and Angelo Lorenti and Irene Mosca} } @article {12971, title = {Does the Chronic Stress of Everyday Discrimination or Race Itself Better Predict AD Onset Risk?}, journal = {Gerontology \& Geriatric Medicine}, volume = {8}, year = {2022}, pages = {23337214221142944}, abstract = {

Using evidence from the Health and Retirement Study, we explore racial disparities in Alzheimer{\textquoteright}s Disease (AD) onset risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race, and AD onset risk. Using Cox Proportional Hazard Models, we examined racial differences in exposure and vulnerability to everyday discrimination. Findings suggest that everyday discrimination predicts AD onset risk, and Black individuals experience more frequent exposure to everyday discrimination as a chronic strain. However, contrary to the stress process model, Black respondents were not more vulnerable to the effect of everyday discrimination on AD onset risk. Racial bias from medical professionals during the diagnostic process and mortality selection bias may explain this effect. Overall, the results of this study provide further evidence that discrimination is a key factor in predicting AD while also considering that many racial minorities with high rates of this type of social stress may not receive an unbiased diagnosis and/or survive to late life to develop AD.

}, keywords = {AD/ADRD, Discrimination, medical sociology, Racial Disparities, the stress process}, issn = {2333-7214}, doi = {10.1177/23337214221142944}, author = {Gary, Katharine M and Hoque, Masudul and Yashkin, Arseniy P and Yashin, Anatoliy I and Akushevich, Igor} } @inbook {12306, title = {Does working longer enhance old age?}, booktitle = {New Models for Managing Longevity Risk: Public-Private Partnerships}, year = {2022}, publisher = {Oxford University Press}, organization = {Oxford University Press}, chapter = {4}, keywords = {health, Retirement, working}, isbn = {978{\textendash}0{\textendash}19{\textendash}285980{\textendash}8}, doi = {10.1093/oso/9780192859808.001.0001}, author = {Maria D Fitzpatrick and Olivia S. Mitchell} } @article {10.1525/collabra.37611, title = {Dyadic Associations Between Conscientiousness Facets, Health, and Health Behavior Over Time}, journal = {Collabra: Psychology}, volume = {8}, year = {2022}, pages = {37611}, abstract = {Previous studies show consistent associations between conscientiousness and health outcomes. However, less is known about how various facets of conscientiousness, of both individuals and their partners, are associated with changes in health in older adults over time. Applying the actor{\textendash}partner interdependence model, we examined dyadic associations of broader conscientiousness and its six facets and changes in health, health behavior, and well-being in middle-aged and older couples. With a sample of 3,271 couples (N=6,542) from the Health and Retirement Study, we found that actor conscientiousness, orderliness, and industriousness were most reliably associated with better health outcomes over time. Partner orderliness was associated with better health and more positive health behavior. The remaining associations were near-zero in their effect sizes. Many of these associations persisted over the 10-year period of the study, and there was little evidence for gender differences or multiplicative interactions.}, keywords = {actor-partner interdependence model, Conscientiousness, depression, health, personality facets}, issn = {2474-7394}, doi = {10.1525/collabra.37611}, author = {Chopik, William and Lee, Ji Hyun} } @article {13200, title = {The Dynamic Effects of Health on the Employment of Older Workers: Impacts by Gender, Country, and Race}, year = {2022}, institution = {University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimate the impact of health on employment. Estimating the model separately by race and gender, we find that racial differences in employment can be partly explained by the worse health of minorities and the larger impact of health on employment for these groups. }, keywords = {country, gender, health, Older workers, race}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp451.pdf}, author = {Richard Blundell and Jack Britton and Monica Costa Dias and Eric French and Weijian Zou} } @article {https://doi.org/10.1002/aepp.13329, title = {The dynamic nature of poverty and food insecurity among older adults: Evidence from the Health and Retirement Study}, journal = {Applied Economic Perspectives and Policy}, year = {2022}, abstract = {Using data from the Health and Retirement Study, this paper examines the dynamics of food insecurity for older adults over the past two decades and how it relates to different poverty measures. The results show that the Supplemental Poverty Measure predicts the likelihood of food insecurity better than the official poverty measure. Although there is no evidence that the impact of poverty on food insecurity declines with age, we find that the discrepancy between food insecurity and poverty is greater for more recent cohorts. Beyond poverty, various demographic, economic, and health characteristics also determine food insecurity among older adults.}, keywords = {Food insecurity, Poverty}, doi = {https://doi.org/10.1002/aepp.13329}, author = {Mudrazija, Stipica and Butrica, Barbara A.} } @article {11777, title = {Dynamics of Financial Hardship in the United States: Health and Retirement Study 2006-2016.}, journal = {Journal of Gerontological Social Work}, volume = {65}, year = {2022}, pages = {241-251}, abstract = {

The purpose of this study was to examine the temporal trends and dynamics of financial hardship among older adults in the U.S. between 2006 and 2016 using the Health and Retirement Study. Sample included a total of 13,537 eligible person observations with a median age of 68~years. Financial hardship included measures of difficulty paying bills, food insecurity, taking less medication due to cost, and ongoing financial strain. Regression analyses were performed using a three-wave quadrennial model to estimate the prevalence of financial hardship over time, to explore temporal patterns and identify persistent hardship. Findings reveal that 51\% of respondents who experienced food insecurity at one or more waves were transient. This pattern was similar to respondents who experienced ongoing financial strain (52\% transient). Respondents who reported difficulty paying bills (68\%) and reduced medications due to cost (62\%) were also transient. Significant predictors across all four domains of financial hardship include age, years of education, marital status, self-rated health. Being African American was positively associated with reduced medication use and food insecurity. This study provides insight into the temporal dynamics of financial hardship in later life. It also highlights the contiguous, intermediate and transient nature of financial hardship among older adult populations.

}, keywords = {Financial hardship, Older Adults, Poverty, temporal trends}, issn = {1540-4048}, doi = {10.1080/01634372.2021.1953662}, author = {Gillian L Marshall and Bayaz-Ozturk, Gulgun and Eva Kahana and William T Gallo and Seghal, Ashwini} } @article {12022, title = {Daily tasks are {\textquoteleft}more problematic{\textquoteright} for women than men in old age}, journal = {Research and Innovation}, year = {2021}, publisher = {Nursing Times}, abstract = {Women are more likely than men to struggle with both regular daily tasks and mobility activities as they age, according to researchers from France and the UK.}, keywords = {Daily activities, ELSA, gender, mobility, SHARE, TILDA}, url = {https://www.nursingtimes.net/news/research-and-innovation/daily-tasks-are-more-problematic-for-women-than-men-in-old-age-03-12-2021/}, author = {Ford, Steve} } @article {11511, title = {Decoding Retiree Spending}, year = {2021}, institution = {T. Rowe Price}, address = {Baltimore, MD}, abstract = {KEY INSIGHTS ■ Income replacement strategies often assume inflation-adjusted spending in retirement is flat; however, the data reveals that retiree spending declines annually by 2\%, and it varies by wealth. ■ Retirees typically choose to adjust their nondiscretionary spending (often considered fixed spending) to match their guaranteed income, challenging the notion that these expenses are truly fixed. ■ Retiree spending behavior reveals a preference for asset preservation. Aligning products and services that account for this will hasten adoption of retirement income solutions. }, keywords = {Retirement, Spending}, url = {https://www.troweprice.com/content/dam/retirement-plan-services/pdfs/insights/research-findings/Decoding_Retiree_Spending.pdf}, author = {Sudipto Banerjee} } @article {11519, title = {Decreases in Stroke-Related Dementia Result from Smaller Memory Decrements}, year = {2021}, publisher = {NeurologyToday}, abstract = {​Declines in stroke-associated dementia may be due to a reduction in memory deficits occurring immediately after stroke onset, according to a cohort study published on March 16 in the journal Stroke.}, keywords = {Dementia, Stroke}, url = {https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.aspx?PostID=1096}, author = {Lyles, Ashley} } @article {11362, title = {Dementia and Cognitive Decline in Older Adulthood: Are Agricultural Workers at Greater Risk?}, journal = {The Journals of Gerontology: Series B}, volume = {76}, year = {2021}, pages = {1629-1643}, abstract = {

OBJECTIVES: To examine whether long-term exposure to agricultural work is associated with dementia prevalence and the rate of cognitive change in older adulthood.

METHODS: We employed data from the Health and Retirement Study (1998-2014). Multiple logistic regression was used to determine whether a longest-held job in the agricultural sector was associated with differences in dementia prevalence. We examined if hearing impairment, depression and physical health indicators mediated the relationship between agricultural work and cognitive functioning. Sub-group analyses were done by age, retirement status, job tenure, and cognitive domain. We employed growth curve models to investigate implications of agricultural work on age trajectories of cognitive functioning.

RESULTS: Longest-held job in agriculture, fishing, and forestry (AFF) was associated with 46\% greater odds of having dementia. The relationship between AFF exposure and cognitive functioning was not mediated by hearing impairment, depression, or physical health indicators. Results were stronger among younger and retired older adults as well as those with extensive job tenure. AFF exposure was associated with lower scores in working memory and attention and processing speed. Growth curve models indicated that while agricultural work exposure was associated with lower initial levels of cognitive functioning, over time the pattern reversed with individuals in non-AFF jobs showing more accelerated cognitive decline.

DISCUSSION: Consistent with European studies, results from the U.S. also demonstrate a higher prevalence of dementia among agricultural workers. The cognitive reserve framework may explain the seemingly paradoxical result on age patterning of cognitive performance across older adults with different work histories.

}, keywords = {agriculture, cognitive functioning, Dementia, growth curve models}, issn = {1758-5368}, doi = {10.1093/geronb/gbab005}, author = {Arora, Kanika and Xu, Lili and Bhagianadh, Divya} } @article {11911, title = {Dementia and disadvantage in the USA and England: population-based comparative study.}, journal = {BMJ Open}, volume = {11}, year = {2021}, pages = {e045186}, abstract = {

OBJECTIVES: To compare dementia prevalence and how it varies by socioeconomic status (SES) across the USA and England.

DESIGN: Population-based comparative study.

SETTING: Non-Hispanic whites aged over 70 population in the USA and England.

PARTICIPANTS: Data from the Health and Retirement Study and the English Longitudinal Study of Ageing, which are harmonised, nationally representative panel studies. The sample includes 5330 and 3147 individuals in the USA and England, respectively.

MAIN OUTCOME MEASURES: Between country differences in age-gender standardised dementia prevalence, across the SES gradient. Dementia prevalence was estimated in each country using an algorithm based on an identical battery of demographic, cognitive and functional measures.

RESULTS: Dementia prevalence is higher among the disadvantaged in both countries, with the USA being more unequal according to four measures of SES. Overall prevalence was lower in England at 9.7\% (95\% CI 8.9\% to 10.6\%) than the USA at 11.2\% (95\% CI 10.6\% to 11.8\%), a difference of 1.4 percentage points (pp) (p=0.0055). Most of the between country difference is driven by the bottom of the SES distribution. In the lowest income decile individuals in the USA had 7.3 pp (p<0.0001) higher prevalence than in England. Once past health factors and education were controlled for, most of the within country inequalities disappeared; however, the cross-country difference in prevalence for those in lowest income decile remained disproportionately high.

CONCLUSIONS: There is inequality in dementia prevalence according to income, wealth and education in both the USA and England. England has lower dementia prevalence and a less steep SES gradient. Most of the cross-country difference is concentrated in the lowest SES group, which provides evidence that disadvantage in the USA is a disproportionately high risk factor for dementia.

}, keywords = {Dementia, Health Economics, Public Health}, issn = {2044-6055}, doi = {10.1136/bmjopen-2020-045186}, author = {Arapakis, Karolos and Brunner, Eric and Eric French and McCauley, Jeremy} } @article {11742, title = {Dementia Diagnosis Disparities by Race and Ethnicity.}, journal = {Medical Care}, volume = {59}, year = {2021}, pages = {679-686}, abstract = {

BACKGROUND: Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups.

OBJECTIVE: The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia.

RESEARCH DESIGN: This was a prospective cohort study.

SUBJECTS: A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims.

MEASURES: We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity.

RESULTS: A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46\% and 54\% vs. 41\%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95\% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95\% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites.

CONCLUSIONS: Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.

}, keywords = {dementia diagnosis, Racial Disparities}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000001577}, author = {Lin, Pei-Jung and Allan T Daly and Olchanski, Natalia and Joshua T Cohen and Peter J Neumann and Jessica Faul and Howard M Fillit and Karen M Freund} } @article {11059, title = {Demographic and Socioeconomic Disparities in Life Expectancy with Hearing Impairment in the U.S.}, journal = {The Journals of Gerontology: Series B}, volume = {76}, year = {2021}, pages = {944-955}, abstract = {Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired. We investigate the number of years an {\textquotedblleft}average{\textquotedblright} person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n=20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50. Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy. Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes.}, keywords = {Aging, Bayesian multistate life table methods, Hearing impairment, Life Expectancy}, isbn = {1079-5014}, doi = {10.1093/geronb/gbaa166}, author = {Jessica S West and Scott M Lynch} } @article {11666, title = {Demographic Characteristics Driving Disparities in Receipt of Long-term Services and Supports in the Community Setting.}, journal = {Medical Care}, volume = {59}, year = {2021}, pages = {537-542}, abstract = {

BACKGROUND: Research suggests that growth in Black and Hispanic (minority) older adults{\textquoteright} nursing home (NH) use may be the result of disparities in access to community-based and alternative long-term services and supports (LTSS).

OBJECTIVE: We aimed to determine whether minority groups receiving care in NHs versus the community had fewer differences in their functional needs compared with the differences in nonminority older adults, suggesting a disparity.

METHODS: We identified respondents aged 65 years or above with a diagnosis of Alzheimer disease or dementia in the 2016 Health and Retirement Study who reported requiring LTSS help. We performed unadjusted analyses to assess the difference in functional need between community and NH care. Functional need was operationalized using a functional limitations score and 6 individual activities of daily living. We compared the LTSS setting for minority older adults to White older adults using difference-in-differences.

RESULTS: There were 186 minority older adults (community=75\%, NH=25\%) and 357 White older adults (community=50\%, NH=50\%). Between settings, minority older adults did not differ in education or marital status, but were younger and had greater income in the NH versus the community. The functional limitations score was higher in NHs than in the community for both groups. Functional needs for all 6 activities of daily living for the minority group were greater in NHs compared with the community.

CONCLUSION: Functional need for minority older adults differed by setting while demographics varied in unexpected ways. Factors such as familial and financial support are important to consider when implementing programs to keep older adults out of NHs.

}, keywords = {community setting, Demographics, Long-term services and supports, Minority, race disparity}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000001544}, author = {Travers, Jasmine L and Naylor, Mary D and Norma B Coe and Meng, Can and Li, Fangyong and Cohen, Andrew B} } @article {11710, title = {Dental Care Use, Edentulism, and Systemic Health among Older Adults.}, journal = {Journal of Dental Research}, volume = {100}, year = {2021}, pages = {1468-1474}, abstract = {

Past research suggests there are systematic associations between oral health and chronic illness among older adults. Although causality has not yet been credibly established, periodontitis has been found to be associated with higher risk of both heart disease and stroke. We advance this literature by estimating the direct association between dental care use and systemic health using multiple waves of the 1992 to 2016 Health and Retirement Study. Through the inclusion of individual fixed effects in our regression models, we account for unobservable time-invariant characteristics of individuals that might otherwise bias estimates of the association between dental care use and health. We find statistically significant negative associations between dental care use and the number of health conditions, self-reported overall health, the incidence of heart disease, and the incidence of stroke. In particular, the use of dental care within the past 2 y is associated with a 2.7\% reduction in the likelihood of being diagnosed with a heart condition and a reduction in the likelihood of a stroke diagnosis of between 5.3\% and 11.6\%. We also find large positive correlations between edentulism and the measures of chronic illness. Associations from models estimated separately for men and women are qualitatively similar to one another. These findings provide additional motivation for the consideration of a Medicare dental benefit.

}, keywords = {Cancer, Chronic conditions, Dental Care, Heart disease, Oral Health, Stroke}, issn = {1544-0591}, doi = {10.1177/00220345211019018}, author = {Meyerhoefer, C D and John V Pepper and Richard J. Manski and John F Moeller} } @article {11629, title = {Depression as a Mediator of the Association Between Wealth Status and Risk of Cognitive Impairment and Dementia: A Longitudinal Population-Based Cohort Study.}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {80}, year = {2021}, pages = {1591-1601}, abstract = {

BACKGROUND: Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown.

OBJECTIVE: To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships.

METHODS: We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992-2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used.

RESULTS: During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95\% confidence intervals] were 1.35 [1.08-1.70] and 1.96 [1.48-2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8-29.7\%) mediated by depression.

CONCLUSION: Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.

}, keywords = {cognitive impairment, Dementia, depression, mediation analysis, wealth status}, issn = {1875-8908}, doi = {10.3233/JAD-201239}, author = {Zhou, Rui and Liu, Hua-Min and Li, Fu-Rong and Yang, Hai-Lian and Zheng, Jia-Zhen and Zou, Meng-Chen and Zou, Lian-Wu and Wu, Xiao-Xiang and Wu, Xian-Bo} } @article {11350, title = {Depressive Symptoms and Multimorbidity: Is There an Association for Older Black Americans?}, journal = {Journal of Aging and Health}, volume = {33}, year = {2021}, pages = {310-316}, abstract = {

Many existing studies have reported a higher prevalence of depressive symptoms among older Black Americans. They also experience a disproportionate burden of multimorbidity, the presence of multiple chronic conditions. Therefore, this study was to identify the association between depressive symptomatology and multimorbidity among older Black Americans. This study analyzed the 2014 Health and Retirement Study ( = 1206). A negative binomial regression was applied to assess the association between multimorbidity and depressive symptomatology. Higher levels of chronic health problems were associated with higher levels of depressive symptomatology among older Black Americans ( = 1.093; = .002). Lower self-reported health, lower income, and lower educational attainment were also related to higher depressive symptoms. Older Black Americans experience vulnerability on multiple levels, and shouldering additional psychosocial and financial burdens adds to already established physical health disparities. This requires critical attention from both practice and policy.

}, keywords = {Chronic Diseases, Depressive symptoms, mental health disparities}, issn = {1552-6887}, doi = {10.1177/0898264320981244}, author = {Cho, Seungjong and Tyrone C Hamler} } @article {11279, title = {Development and validation of prediction model to estimate 10-year risk of all-cause mortality using modern statistical learning methods: a large population-based cohort study and external validation.}, journal = {BMC Medical Research Methodology}, volume = {21}, year = {2021}, pages = {8}, abstract = {

BACKGROUND: In increasingly ageing populations, there is an emergent need to develop a robust prediction model for estimating an individual absolute risk for all-cause mortality, so that relevant assessments and interventions can be targeted appropriately. The objective of the study was to derive, evaluate and validate (internally and externally) a risk prediction model allowing rapid estimations of an absolute risk of all-cause mortality in the following 10 years.

METHODS: For the model development, data came from English Longitudinal Study of Ageing study, which comprised 9154 population-representative individuals aged 50-75 years, 1240 (13.5\%) of whom died during the 10-year follow-up. Internal validation was carried out using Harrell{\textquoteright}s optimism-correction procedure; external validation was carried out using Health and Retirement Study (HRS), which is a nationally representative longitudinal survey of adults aged >=50 years residing in the United States. Cox proportional hazards model with regularisation by the least absolute shrinkage and selection operator, where optimisation parameters were chosen based on repeated cross-validation, was employed for variable selection and model fitting. Measures of calibration, discrimination, sensitivity and specificity were determined in the development and validation cohorts.

RESULTS: The model selected 13 prognostic factors of all-cause mortality encompassing information on demographic characteristics, health comorbidity, lifestyle and cognitive functioning. The internally validated model had good discriminatory ability (c-index=0.74), specificity (72.5\%) and sensitivity (73.0\%). Following external validation, the model{\textquoteright}s prediction accuracy remained within a clinically acceptable range (c-index=0.69, calibration slope β=0.80, specificity=71.5\% and sensitivity=70.6\%). The main limitation of our model is twofold: 1) it may not be applicable to nursing home and other institutional populations, and 2) it was developed and validated in the cohorts with predominately white ethnicity.

CONCLUSIONS: A new prediction model that quantifies absolute risk of all-cause mortality in the following 10-years in the general population has been developed and externally validated. It has good prediction accuracy and is based on variables that are available in a variety of care and research settings. This model can facilitate identification of high risk for all-cause mortality older adults for further assessment or interventions.

}, keywords = {Absolute risk, Mortality, Population-based longitudinal study, Prognostic factors, Statistical learning, Survival}, issn = {1471-2288}, doi = {10.1186/s12874-020-01204-7}, author = {Ajnakina, Olesya and Agbedjro, Deborah and Ryan J McCammon and Jessica Faul and Murray, Robin M and Stahl, Daniel and Andrew Steptoe} } @article {12565, title = {Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium.}, journal = {International Journal of Epidemiology}, volume = {50}, year = {2021}, pages = {880-892}, abstract = {

BACKGROUND: Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts.

METHODS: In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10.

RESULTS: A common scale was created for 343~915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality.

CONCLUSIONS: The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing.

}, keywords = {Aging, Cohort Studies, Health Status, healthy aging, Humans, Reproducibility of Results}, issn = {1464-3685}, doi = {10.1093/ije/dyaa236}, author = {Sanchez-Niubo, Albert and Forero, Carlos G and Wu, Yu-Tzu and Gin{\'e}-V{\'a}zquez, Iago and Prina, Matthew and de la Fuente, Javier and Daskalopoulou, Christina and Critselis, Elena and De La Torre-Luque, Alejandro and Panagiotakos, Demosthenes and Arndt, Holger and Ayuso-Mateos, Jos{\'e} Luis and Bayes-Marin, Ivet and Bickenbach, Jerome and Bobak, Martin and Caballero, Francisco F{\'e}lix and Chatterji, Somnath and Egea-Cort{\'e}s, Laia and Garc{\'\i}a-Esquinas, Esther and Leonardi, Matilde and Koskinen, Seppo and Koupil, Ilona and Mellor-Mars{\'a}, Blanca and Olaya, Beatriz and Paj{\k a}k, Andrzej and Prince, Martin and Raggi, Alberto and Rodr{\'\i}guez-Artalejo, Fernando and Sanderson, Warren and Scherbov, Sergei and Tamosiunas, Abdonas and Tobias-Adamczyk, Beata and Tyrovolas, Stefanos and Haro, Josep Maria} } @article {12598, title = {Development, Validation, and Performance of a New Physical Functioning-Weighted Multimorbidity Index for Use in Administrative Data.}, journal = {Journal of General Internal Medicine}, volume = {36}, year = {2021}, pages = {2427-2433}, keywords = {Activities of Daily Living, multimorbidity}, issn = {1525-1497}, doi = {10.1007/s11606-020-06486-7}, author = {Wei, Melissa Y and Luster, Jamie E and Ratz, David and Mukamal, Kenneth J and Kenneth M. Langa} } @article {11817, title = {Development, Validation, and Performance of a New Physical Functioning{\textendash}Weighted Multimorbidity Index for Use in Administrative Data}, journal = {Journal of General Internal Medicine}, volume = {36}, year = {2021}, pages = {2427{\textendash}2433}, keywords = {Medicaid, Medicare, multimorbidity index, physical functioning}, doi = {10.1007/s11606-020-06486-7}, author = {Melissa Y Wei and Jamie E Luster and Ratz, David and Kenneth J Mukamal and Kenneth M. Langa} } @article {11979, title = {Diagnosis of Alzheimer{\textquoteright}s and Related Dementias Reduces Social Activity}, year = {2021}, publisher = {Newswise}, abstract = {Despite the belief that early diagnosis of Alzheimer{\textquoteright}s disease and other dementias is crucial, a new Rutgers study found that the diagnosis may unintentionally impact social relationships and activity.}, keywords = {Alzheimer{\textquoteright}s disease, Dementia, Social activity}, url = {https://www.newswise.com/articles/diagnosis-of-alzheimer-s-and-related-dementias-reduces-social-activity}, author = {Rutgers University-New Brunswick} } @mastersthesis {11837, title = {Diagnosis of Diabetes and Health Behaviors in Middle-Aged and Older Adults: The Role of Self-Efficacy and Social Support}, volume = {Ph.D. }, year = {2021}, school = {Case Western Reserve University}, address = {Cleveland, OH}, abstract = {Focusing on middle-aged and older adults, the present study objectives are to investigate the effects of a diabetes diagnosis on the initiation and maintenance of healthy behaviors and whether self-efficacy and social support modify the relationships. The study sample came from the Health and Retirement Study. The predictor variables were diabetes diagnosis, self-efficacy, and social support from family and friends. The outcome variables were three health behaviors (alcohol consumption, smoking status, and physical activity) and utilization of four preventive care services (blood test for cholesterol, influenza vaccination, prostate cancer exam, and mammography). Study 1 utilized a matched case-control difference-in-differences approach to estimate the effect of a diabetes diagnosis on the likelihood of change in health behaviors and utilization of preventive care services. Study 2 applied mixed-effects regression models to analyze the longitudinal effects of diabetes diagnosis, self-efficacy, and social support on health behavior changes and to examine the moderating effects of self-efficacy and social support. Study 3 performed Cox proportional hazards regression models to examine the effects of a diabetes diagnosis, self-efficacy, and social support on the hazards of failure to maintain healthy behaviors and to examine the moderating effects of self-efficacy and social support. Results from study 1 indicated that individuals reduced alcohol consumption and increased utilization of blood tests for cholesterol and influenza vaccination after a diagnosis of diabetes. Findings from study 2 showed that a diagnosis of diabetes was associated with reduced drinking. A significant interaction between social support from family and diabetes diagnosis was found in predicting drinking and smoking. Last, study 3 reported that a diagnosis of diabetes was associated with higher hazards of failure to maintain physical activity. A significant interaction between social support from family and diabetes diagnosis was found in predicting physical activity maintenance. The collective findings of the three studies suggest that a diagnosis of diabetes can be both a teachable moment that motivates the initiation of reducing health-risking behaviors, and a stressful health event that hinders maintenance of health-promoting behaviors. Mobilizing social support from family may help individuals adopt and maintain healthy behaviors after a diabetes diagnosis.}, keywords = {Diabetes, Self-efficacy, Social Support}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=case1625841228065432}, author = {Qin, Weidi} } @article {11770, title = {Dietary quality modifies the association between multimorbidity and change in mobility limitations among older Americans.}, journal = {Preventive Medicine}, volume = {153}, year = {2021}, pages = {106721}, abstract = {

To identify potentially modifiable risk-factors in the age-related disablement process, we examined the association between change in mobility limitations and multimorbidity and how dietary quality moderates this association. Information from 3320 adults aged 65 and older in 2012 was drawn from the Health and Retirement Study and the Health Care and Nutrition Study. Mobility limitations reported in 2012 and change in mobility limitations from 2012 to 2014 were regressed on multimorbidity measured as number of chronic conditions in 2012, dietary quality measured in 2013 using the Alternative Healthy Eating Index-2010 (AHEI-2010), and their interaction term using Poisson regression. Respondents reported an average of 2.9 (SD, 2.9) mobility limitations in 2012 and 3.1 (SD, 3.0) mobility limitations in 2014, an average of 2.64 (SD, 1.4) chronic conditions in 2012, and mean AHEI-2010 score in 2013 of 57.1 (SD, 10.9). Greater AHEI-2010 scores were associated with fewer mobility limitations at baseline (p~<~.001) and slower progression of mobility limitations over the two-year observational window (p~<~.001). For those with AHEI-2010 scores >=48.4, dietary quality appeared to moderate the association between multimorbidity and change in mobility limitations. These results suggest that improving dietary quality may be an effective means of reducing the progression of mobility limitations among older adults and that dietary quality may modify the effect of multimorbidity on progressive disablement. Our work adds to research supporting dietary quality as a potentially intervenable factor in the reduction of disablement in aging populations.

}, keywords = {diet quality, Health care and nutrition study, Mobility limitations, multimorbidity}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2021.106721}, author = {Nicholas J Bishop and Sarah Ullevig and Wang, Kaipeng and Krystle E Zuniga} } @article {11609, title = {Difference in predictors and barriers to arts and cultural engagement with age in the United States: A cross-sectional analysis using the Health and Retirement Study}, journal = {PLoS One}, volume = {16}, year = {2021}, pages = {e0261532}, abstract = {Introduction: Arts and cultural engagement are associated with a range of mental and physical health benefits, including promoting heathy aging and lower incidence of age-related disabilities such as slower cognitive decline and slower progression of frailty. This suggests arts engagement constitutes health-promoting behaviour in older age. However, there are no large-scale studies examining how the predictors of arts engagement vary with age. Methods: Data from the Health and Retirement Study (2014) were used to identify sociodemographic, life satisfaction, social, and arts appreciation predictors of (1) frequency of arts engagement, (2) cultural attendance, (3) difficulty participating in the arts, and (4) being an interested non-attendee of cultural events. Logistic regression models were stratified by age groups [50-59, 60-69, 70] for the frequency of arts participation outcome and [50-69 vs 70] all other outcomes. Results: Findings indicated a number of age-related predictors of frequent arts engagement, including gender, educational attainment, wealth, dissatisfaction with ageing, and instrumental activities of daily living (iADL). For cultural event attendance, lower interest in the arts predicted lack of engagement across age groups, whereas higher educational attainment and more frequent religious service attendance became predictors in older age groups (> 70). Adults in both age groups were less likely to report difficulties engaging in the arts if they had lower neighbourhood safety, whilst poor self-rated health and low arts appreciation also predicted reduced likelihood of this outcome, but only in the younger (50-69) age group. Adults in the older (> 70) age group were more likely to be interested non-attendees of cultural events if they had higher educational attainment and less likely if they lived in neighbourhoods with low levels of safety. Conclusions: Our results suggest that certain factors become stronger predictors of arts and cultural engagement and barriers to engagement as people age. Further, there appear to be socioeconomic inequalities in engagement that may increase in older ages, with arts activities overall more accessible as individuals age compared to cultural engagement due to additional financial barriers and transportation barriers. Ensuring that these activities are accessible to people of all ages will allow older adults to benefit from the range of health outcomes gained from arts and cultural engagement.}, keywords = {Arts, cross-sectional, Culture, health, Well-being}, doi = {10.1371/journal.pone.0261532}, author = {Meg Fluharty and Paul, Elise and Jessica K Bone and Feifei Bu and Fancourt, Daisy} } @article {11962, title = {Different hypertension thresholds and cognitive decline: a pooled analysis of three ageing cohorts.}, journal = {BMC Medicine}, volume = {19}, year = {2021}, pages = {287}, abstract = {

BACKGROUND: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for high blood pressure (BP) in adults came up with a new definition of hypertension with a threshold BP level of 130/80 mmHg. But the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines adhered to a conventional hypertension definition as BP >= 140/90 mmHg. We aimed to compare the trajectories of cognitive decline between participants with BP < 130/80 mmHg in all BP measurement waves and others with all BP < 140/90 mmHg.

METHODS: This pooled analysis involved middle-aged and older participants from three nationally representative ageing cohorts, including the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), and the China Health Retirement Longitudinal Study (CHARLS). Participants were divided into the Normal (BP < 130/80 mmHg on all occasions throughout the study), the Borderline (BP < 140/90 mmHg on all occasions throughout the study but not in the Normal group), and the High (the rest of participants) BP groups. Global cognitive Z score was calculated from tests on memory, executive function, and orientation.

RESULTS: A total of 17,590 participants (HRS 6964, median follow-ups 12 years; ELSA 5334, median follow-ups 16 years; CHARLS 5292, median follow-ups 7 years) were included. No significant difference in global cognitive decline rate was detected between the Normal and the borderline groups (men, pooled β = - 0.006 standard deviation [SD]/year; 95\% confidence interval [CI], - 0.020 to 0.008; P = 0.377; women, pooled β = 0.006 SD/year; 95\% CI - 0.005 to 0.018; P = 0.269). Participants in the High group had a significantly faster cognitive decline (men, pooled β = - 0.011 SD/year; 95\% CI - 0.020 to - 0.002; P = 0.013; women, pooled β = - 0.017 SD/year; 95\% CI - 0.026 to - 0.008; P < 0.001) than that in the Borderline group.

CONCLUSIONS: Individuals in the Borderline group did not experience significantly faster cognitive decline compared with those in the Normal group. It might not be necessary for individuals with borderline BP (between 130/80 and 140/90 mmHg) to initiate antihypertension therapy in consideration of cognitive decline.

}, keywords = {Blood pressure, CHARLS, Cognitive Dysfunction, ELSA, Hypertension}, issn = {1741-7015}, doi = {10.1186/s12916-021-02165-4}, author = {Ma, Yanjun and Hua, Rong and Yang, Zhenchun and Zhong, Baoliang and Yan, Li and Xie, Wuxiang} } @article {11608, title = {Disability in Childhood, Special Education Histories, and Lifetime Health Outcomes in the United States}, journal = {Journal of Aging and Health}, volume = {33}, year = {2021}, pages = {919-930}, abstract = {Objectives: We evaluated special education as an indicator of childhood disability and used that indicator to estimate lifetime dependency and life expectancy. Methods: Data: Panel Study of Income Dynamics and Health and Retirement Study (n = 20,563). Dependency: Nursing home care or equivalent. Analysis: We first analyzed special education as an indicator of childhood disability; multinomial logistic Markov models and microsimulation then compared populations with and without childhood disability. Results: Special education history was a valid indicator of childhood disability. For example, with parents who did not complete high school, 3.8\% with no special education history were dependent at least 5 years of adult life; that result with special education was 15.2\%. Life expectancy from age 20 was 58.3 years without special education, 46.0 years with special education (both p < .05). Discussion: Special education history can indicate childhood disability. People with that history had significantly a more dependency than others and significantly shorter lives.}, keywords = {dependency, developmental delay, developmental disability, Life Expectancy, Mortality}, isbn = {0898-2643}, doi = {10.1177/08982643211018918}, author = {Laditka, Sarah B. and Laditka, James N. and Hoyle, Jessica N.} } @article {11221, title = {Disability Incidence Rates for Men and Women in 23 Countries: Evidence on Health Effects of Gender Inequality.}, journal = {The Journals of Gerontology, Series A }, volume = {76}, year = {2021}, pages = {328-338}, abstract = {

BACKGROUND: Inequality in gender varies across social contexts, which may influence the health of both men and women. Based on theories of gender as a social system, we examine whether systematic gender inequality at the macro level influences health of men and women.

METHODS: Using harmonized panel data from the Gateway to Global Aging Data in 23 high and middle income countries (N=168,873), we estimate disability prevalence and incidence for men and women ages 55 to 89 (2000-2016). Within each country or geographic region, we also investigate gender differences in age gradients of the probability of disability onset. We, then, pool data from all countries and test the hypothesis that gender inequality increases the probability of disability onset.

RESULTS: We found substantial cross-country variation in disability incidence rates, and this variation is greater for women than for men. Among ages 65-69, disability incidence rates ranged from 0.4 to 5.0 for men and from 0.5 to 9.4 for women. Our within-country analysis showed significant gender differences in age gradients of the probability of disability onset in the U.S., Korea, Southern Europe, Mexico, and China, but not in Northern, Central, and Eastern Europe, England and Israel. Testing hypothesized effects of gender inequality, we find that gender inequality is significantly associated with the probability of disability onset for women, but not for men.

CONCLUSIONS: Macro-level societal gender inequality is significantly associated with the probability of disability onset for women. Reducing and eliminating gender inequality is crucial to achieving good health for women.

}, keywords = {Activities of Daily Living, CHARLS, Cross-Country, ELSA, health disparity, KLoSA, Longitudinal analysis, MHAS, SHARE}, issn = {1758-535X}, doi = {10.1093/gerona/glaa288}, author = {Jinkook Lee and Erik Meijer and Drystan F. Phillips and Hu, Peifeng} } @inbook {doi:https://doi.org/10.1002/9781119272076.ch2, title = {Disclosure Limitation and Confidentiality Protection in Linked Data}, booktitle = {Administrative Records for Survey Methodology}, year = {2021}, pages = {25-59}, publisher = {John Wiley \& Sons, Ltd}, organization = {John Wiley \& Sons, Ltd}, chapter = {2}, abstract = {This chapter provides an overview of the methods that have been developed and implemented to safeguard privacy, while providing researchers the means to draw valid conclusions from protected data. It focuses on the protections that pertain to the linked nature of the data. The protection mechanisms are both physical and statistical, but exist because of the need to balance the privacy of the respondents, including the confidentiality protection their data receive, with society{\textquoteright}s need and desire for ever more detailed, timely, and accurate statistics. To illustrate the application of new disclosure avoidance techniques, the chapter describes three examples of linked data and the means by which confidentiality protection is applied to each. Health and Retirement Study{\textendash}Social Security Administration (SSA) data, Survey of Income and Program Participation{\textendash}SSA{\textendash}Internal Revenue Service, inked Establishment and Employee Records Several methods are currently used by national statistical offices and other data collecting agencies to provide access to confidential data.}, keywords = {confidentiality protection, disclosure limitation, legal protections, physical protections, Restricted data, Social Security Administration}, isbn = {9781119272076}, doi = {https://doi.org/10.1002/9781119272076.ch2}, author = {Abowd, John M. and Schmutte, Ian M. and Vilhuber, Lars}, editor = {Asaph Young Chun and Larsen, Michael D. and Durrant, Gabriele and Reiter, Jerome P.} } @article {10476, title = {Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples}, journal = {The Journals of Gerontology: Series B}, volume = {76}, year = {2021}, pages = {451-460}, abstract = {Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms.The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006{\textendash}2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner{\textquoteright}s baseline report of negative marital quality and number of chronic conditions in each wave.Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions.Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood.}, keywords = {Chronic conditions, Couples, Depressive symptoms, Longitudinal analysis}, issn = {1079-5014}, doi = {10.1093/geronb/gbz137}, author = {Courtney A Polenick and Kira S. Birditt and Turkelson, Angela and Bugajski, Benjamin C and Helen C Kales} } @article {12121, title = {Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry.}, journal = {The American Journal of Human Genetics}, volume = {108}, year = {2021}, pages = {564-582}, abstract = {

Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5\%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained <=20 variants in the credible sets that jointly account for 99\% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.

}, keywords = {Africa, African Americans, Blacks, Body Height, Europe, Female, Genome-Wide Association Study, Humans, Male, Polymorphism, Single Nucleotide}, issn = {1537-6605}, doi = {10.1016/j.ajhg.2021.02.011}, author = {Graff, Mariaelisa and Justice, Anne E and Young, Kristin L and Marouli, Eirini and Zhang, Xinruo and Fine, Rebecca S and Lim, Elise and Buchanan, Victoria and Rand, Kristin and Feitosa, Mary F and Wojczynski, Mary K and Yanek, Lisa R and Shao, Yaming and Rohde, Rebecca and Adeyemo, Adebowale A and Aldrich, Melinda C and Matthew A. Allison and Ambrosone, Christine B and Ambs, Stefan and Amos, Christopher and Donna K Arnett and Atwood, Larry and Bandera, Elisa V and Traci M Bartz and Becker, Diane M and Berndt, Sonja I and Bernstein, Leslie and Bielak, Lawrence F and Blot, William J and Erwin P Bottinger and Bowden, Donald W and Bradfield, Jonathan P and Brody, Jennifer A and Broeckel, Ulrich and Burke, Gregory and Brian E Cade and Cai, Qiuyin and Caporaso, Neil and Carlson, Chris and John Carpten and Casey, Graham and Chanock, Stephen J and Chen, Guanjie and Chen, Minhui and Chen, Yii-Der I and Chen, Wei-Min and Chesi, Alessandra and Chiang, Charleston W K and Chu, Lisa and Coetzee, Gerry A and Conti, David V and Cooper, Richard S and Cushman, Mary and Ellen W Demerath and Deming, Sandra L and Dimitrov, Latchezar and Ding, Jingzhong and Diver, W Ryan and Duan, Qing and Michele K Evans and Falusi, Adeyinka G and Jessica Faul and Myriam Fornage and Caroline S Fox and Freedman, Barry I and Garcia, Melissa and Gillanders, Elizabeth M and Phyllis J Goodman and Gottesman, Omri and Grant, Struan F A and Guo, Xiuqing and Hakonarson, Hakon and Haritunians, Talin and Tamara B Harris and Harris, Curtis C and Henderson, Brian E and Hennis, Anselm and Dena G Hernandez and Hirschhorn, Joel N and McNeill, Lorna Haughton and Howard, Timothy D and Howard, Barbara and Hsing, Ann W and Hsu, Yu-Han H and Hu, Jennifer J and Huff, Chad D and Huo, Dezheng and Ingles, Sue A and Irvin, Marguerite R and John, Esther M and Johnson, Karen C and Jordan, Joanne M and Kabagambe, Edmond K and Kang, Sun J and Sharon L R Kardia and Keating, Brendan J and Rick A Kittles and Eric A Klein and Kolb, Suzanne and Kolonel, Laurence N and Charles Kooperberg and Kuller, Lewis and Kutlar, Abdullah and Leslie A Lange and Langefeld, Carl D and Loic Le Marchand and Leonard, Hampton and Lettre, Guillaume and Levin, Albert M and Li, Yun and Li, Jin and Liu, Yongmei and Liu, Youfang and Liu, Simin and Kurt Lohman and Lotay, Vaneet and Lu, Yingchang and Maixner, William and JoAnn E Manson and McKnight, Barbara and Meng, Yan and Monda, Keri L and Monroe, Kris and Moore, Jason H and Thomas H Mosley and Mudgal, Poorva and Murphy, Adam B and Nadukuru, Rajiv and Michael A Nalls and Nathanson, Katherine L and Nayak, Uma and N{\textquoteright}Diaye, Amidou and Nemesure, Barbara and Neslund-Dudas, Christine and Neuhouser, Marian L and Nyante, Sarah and Ochs-Balcom, Heather and Ogundiran, Temidayo O and Ogunniyi, Adesola and Ojengbede, Oladosu and Okut, Hayrettin and Olopade, Olufunmilayo I and Olshan, Andrew and Padhukasahasram, Badri and Palmer, Julie and Palmer, Cameron D and Palmer, Nicholette D and George J Papanicolaou and Patel, Sanjay R and Pettaway, Curtis A and Peyser, Patricia A and Press, Michael F and Rao, D C and Rasmussen-Torvik, Laura J and Redline, Susan and Reiner, Alex P and Rhie, Suhn K and Rodriguez-Gil, Jorge L and Charles N Rotimi and Rotter, Jerome I and Ruiz-Narvaez, Edward A and Rybicki, Benjamin A and Babatunde Salako and Sale, Michele M and Sanderson, Maureen and Eric E Schadt and Schreiner, Pamela J and Schurmann, Claudia and Schwartz, Ann G and Daniel Shriner and Signorello, Lisa B and Andrew B Singleton and David S Siscovick and Smith, Jennifer A and Smith, Shad and Elizabeth K Speliotes and Spitz, Margaret and Stanford, Janet L and Stevens, Victoria L and Stram, Alex and Strom, Sara S and Sucheston, Lara and Yan V Sun and Tajuddin, Salman M and Taylor, Herman and Taylor, Kira and Bamidele O Tayo and Michael J Thun and Tucker, Margaret A and Vaidya, Dhananjay and Van Den Berg, David J and Vedantam, Sailaja and Vitolins, Mara and Wang, Zhaoming and Erin B Ware and Wassertheil-Smoller, Sylvia and David R Weir and Wiencke, John K and Williams, Scott M and L Keoki Williams and Wilson, James G and Witte, John S and Wrensch, Margaret and Wu, Xifeng and Yao, Jie and Zakai, Neil and Zanetti, Krista and Zemel, Babette S and Zhao, Wei and Jing Hua Zhao and Zheng, Wei and Zhi, Degui and Zhou, Jie and Zhu, Xiaofeng and Ziegler, Regina G and Zmuda, Joe and Alan B Zonderman and Psaty, Bruce M and Ingrid B Borecki and Cupples, L Adrienne and Liu, Ching-Ti and Christopher A Haiman and Ruth J F Loos and Ng, Maggie C Y and Kari E North} } @article {11539, title = {Discriminating Heterogeneous Trajectories of Resilience and Depression After Major Life Stressors Using Polygenic Scores.}, journal = {JAMA Psychiatry}, volume = {78}, year = {2021}, pages = {744-752}, abstract = {

Importance: Major life stressors, such as loss and trauma, increase the risk of depression. It is known that individuals show heterogeneous trajectories of depressive symptoms following major life stressors, including chronic depression, recovery, and resilience. Although common genetic variation has been associated with depression risk, genomic factors that could help discriminate trajectories of risk vs resilience following adversity have not been identified.

Objective: To assess the discriminatory accuracy of a deep neural net combining joint information from 21 psychiatric and health-related multiple polygenic scores (PGSs) for discriminating resilience vs other longitudinal symptom trajectories with use of longitudinal, genetically informed data on adults exposed to major life stressors.

Design, Setting, and Participants: The Health and Retirement Study is a longitudinal panel cohort study in US citizens older than 50 years, with data being collected once every 2 years between 1992 and 2010. A total of 2071 participants who were of European ancestry with available depressive symptom trajectory information after experiencing an index depressogenic major life stressor were included. Latent growth mixture modeling identified heterogeneous trajectories of depressive symptoms before and after major life stressors, including stable low symptoms (ie, resilience), as well as improving, emergent, and preexisting/chronic symptom patterns. Twenty-one PGSs were examined as factors distinctively associated with these heterogeneous trajectories. Local interpretable model-agnostic explanations were applied to examine PGSs associated with each trajectory. Data were analyzed using the DNN model from June to July 2020.

Exposures: Development of depression and resilience were examined in older adults after a major life stressor, such as bereavement, divorce, and job loss, or major health events, such as myocardial infarction and cancer.

Main Outcomes and Measures: Discriminatory accuracy of a deep neural net model trained for the multinomial classification of 4 distinct trajectories of depressive symptoms (Center for Epidemiologic Studies-Depression scale) based on 21 PGSs using supervised machine learning.

Results: Of the 2071 participants, 1329 were women (64.2\%); mean (SD) age was 55.96 (8.52) years. Of these, 1638 (79.1\%) were classified as resilient, 160 (7.75) in recovery (improving), 159 (7.7\%) with emerging depression, and 114 (5.5\%) with preexisting/chronic depression symptoms. Deep neural nets distinguished these 4 trajectories with high discriminatory accuracy (multiclass micro-average area under the curve, 0.88; 95\% CI, 0.87-0.89; multiclass macro-average area under the curve, 0.86; 95\% CI, 0.85-0.87). Discriminatory accuracy was highest for preexisting/chronic depression (AUC 0.93), followed by emerging depression (AUC 0.88), recovery (AUC 0.87), resilience (AUC 0.75).

Conclusions and Relevance: The results of the longitudinal cohort study suggest that multivariate PGS profiles provide information to accurately distinguish between heterogeneous stress-related risk and resilience phenotypes.

}, keywords = {depression, polygenic score, Resilience}, issn = {2168-6238}, doi = {10.1001/jamapsychiatry.2021.0228}, author = {Schultebraucks, Katharina and Choi, Karmel W and Isaac R Galatzer-Levy and George A. Bonanno} } @conference {11806, title = {On the Distribution and Dynamics of Medical Expenditure among the Elderly}, booktitle = {Retirement and Disability Research Consortium 23rd Annual Meeting}, year = {2021}, month = {08/2021}, publisher = {Center for Financial Security, University of Wisconsin-Madison}, organization = {Center for Financial Security, University of Wisconsin-Madison}, address = {Virtual Event}, abstract = {Using data from the Health and Retirement Study (HRS), we estimate the stochastic process for total medical spending and its components. By focussing on dynamics, we consider not only the risk of catastrophic expenses in a single year, but also the risk of moderate but persistent expenses that accumulate into a catastrophic lifetime cost. We also assess the reduction in out-of-pocket medical spending risk provided by public insurance schemes such as Medicare or Medicaid.}, keywords = {dynamics, Medicaid, Medical spending, Medicare}, url = {https://cfsrdrc.wisc.edu/files/2021-RDRC-Meeting-Booklet.pdf$\#$page=7}, author = {Arapakis, Karolos and Eric French and John Bailey Jones and McCauley, Jeremy} } @article {11681, title = {Do adverse health shocks induce myopic financial planning?}, journal = {Financial Planning Review}, volume = {4}, year = {2021}, pages = {e1124}, abstract = {Abstract Health and financial planning have both been found to be crucial to long-term financial stability. However, the impact of a health shock on financial planning horizon was not directly tested. This article traces the trajectories of the financial planning horizon before and after the occurrence of work-limiting health shocks, using longitudinal panel data from the Health and Retirement Study. Results show that, during the 10?years following a health shock, individuals are 20 to 39\% more likely to focus on the near term (i.e., the next few months) than baseline levels. Moreover, people with lower socioeconomic status or poor general health are more prone to switching to myopic planning after a health shock.}, keywords = {Financial planning, Health Shocks}, doi = {10.1002/cfp2.1124}, author = {Streeter, Jialu L.} } @article {11377, title = {Do Big Five Personality Traits Moderate the Effects of Stressful Life Events on Health Trajectories? Evidence From the Health and Retirement Study.}, journal = {The Journals of Gerontology, Series B }, volume = {76}, year = {2021}, pages = {44-55}, abstract = {

OBJECTIVES: Theory suggests that individuals with higher neuroticism have more severe negative reactions to stress, though empirical work examining the interaction between neuroticism and stressors has yielded mixed results. The present study investigated whether neuroticism and other Big Five traits moderated the effects of recent stressful life events on older adults{\textquoteright} health outcomes.

METHOD: Data were drawn from the subset of Health and Retirement Study participants who completed a Big Five personality measure (N = 14,418). We used latent growth curve models to estimate trajectories of change in depressive symptoms, self-rated physical health, and C-reactive protein levels over the course of 10 years (up to six waves). We included Big Five traits and stressful life events as covariates to test their effects on each of these three health outcomes. We examined stressful life events within domains of family, work/finances, home, and health, as well as a total count across all event types.

RESULTS: Big Five traits and stressful life events were independently related to depressive symptoms and self-rated health. There were no significant interactions between Big Five traits and stressful life events. C-reactive protein levels were unrelated to Big Five traits and stressful life events.

DISCUSSION: Findings suggest that personality and stressful life events are important predictors of health outcomes. However, we found little evidence that personality moderates the effect of major stressful events across a 2-year time frame. Any heightened reactivity related to high neuroticism may be time-limited to the months immediately after a major stressful event.

}, keywords = {Mental Health, Personality, Physical Health, Stress reactivity, Stressful Life Events}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa075}, author = {Lauren L Mitchell and Zmora, Rachel and Finlay, Jessica M and Jutkowitz, Eric and Joseph E Gaugler} } @article {11769, title = {Do depressive symptoms link chronic diseases to cognition among older adults? Evidence from the Health and Retirement Study in the United States.}, journal = {Journal of Affective Disorders}, volume = {294}, year = {2021}, pages = {357-365}, abstract = {

BACKGROUND: Few studies have assessed psychological pathways that connect the association between non-psychotropic chronic disease and cognition. We assessed the extent to which the association between the two was mediated by depressive symptoms in older adults.

METHODS: Data came from waves 10-13 (2010-2016) of the Health and Retirement Study in the United States (7,651 men and 10,248 women). Multilevel path analysis, allowing for random intercepts and slopes, was employed to estimate the extent to which depressive symptoms mediated the total effect of a chronic disease on cognition.

RESULTS: We found that the presence of stroke, high blood pressure, diabetes, heart problems, and comorbidity, in both men and women, and lung disease in women, was associated with lower levels of cognition. The total effects of chronic diseases on cognition were partially mediated through depressive symptoms. Depressive symptoms mediated approximately 19\%-39\% and 23\%-54\% of the total effects of chronic diseases on cognition in men and women, respectively.

LIMITATIONS: We relied on self-reported diagnoses of diseases and depressive symptoms. Our use of a multilevel path analysis with random slopes precluded the inclusion of binary/categorical dependent variables, and the estimation of standardized beta values.

CONCLUSIONS: To understand the cognitive challenges that chronically ill older adults face, practitioners and policymakers should consider not just the direct symptoms related to chronic diseases, but also the often overlooked psychological conditions faced by older adults.

}, keywords = {Chronic condition, cognitive aging, depression, Psychological condition}, issn = {1573-2517}, doi = {10.1016/j.jad.2021.07.012}, author = {Lu, Wentian and Pai, Manacy and Shaun Scholes and Xue, Baowen} } @article {12032, title = {Do Households Increase Their Savings When the Kids Leave Home?}, journal = {The Journal of Retirement}, volume = {9}, year = {2021}, pages = {21-35}, abstract = {Much of the disagreement over whether households are adequately prepared for retirement reflects differences in assumptions regarding the extent to which consumption declines when the kids leave home. If consumption declines substantially when the kids leave home, as some life-cycle models of retirement saving assume, households need to achieve lower replacement rates in retirement and need to accumulate less wealth. Using administrative tax data from the Health and Retirement Study (HRS), as well as the Survey of Income and Program Participation (SIPP), this article investigates whether household consumption declines when kids leave the home and, if so, by how much. Because consumption data are noisy and savings is the flip side of consumption, this article examines whether savings in 401(k) plans increase when the kids leave home. The article also investigates alternative methods of saving, including non-401(k) savings and increased mortgage payments.}, keywords = {children, consumption, Households, Savings}, doi = {https://doi.org/10.3905/jor.2021.1.091}, author = {Irena Dushi and Alicia H. Munnell and Geoffrey T. Sanzenbacher and Anthony Webb and Anqi Chen} } @article {11820, title = {Do people plan to leave bequests? Do they have wills?}, journal = {Retirement}, year = {2021}, publisher = {MarketWatch}, abstract = {Like everyone, I have been thinking about the Black/white wealth gap. Yes, the gap is greatly reduced once Social Security wealth is included in the calculation. But Social Security comes late in life, which means that young Black families have much less to provide for themselves and their children. Then the question arises as to how this gap evolved {\textemdash} how much is due to saving and asset returns, and how much to inheritances? Just as I was thinking about inheritances, a man called absolutely fixated on inheritances and wills. So my colleague Gal Wettstein agreed to take a look at responses regarding wills and bequests in the Health and Retirement Study (HRS), a longitudinal survey of people over age 50 conducted every two years since 1992. New cohorts are added every six years, so the survey now includes 26,500 households. }, keywords = {Bequests, Inheritance, Racial Disparities, wealth disparities, Wills}, url = {https://www.marketwatch.com/story/do-people-plan-to-leave-bequests-do-they-have-wills-11629757010}, author = {Alicia H. Munnell} } @article {12018, title = {Do People Save More When Their Kids Fly The Coop?}, journal = {FA Online}, year = {2021}, publisher = {Financial Advisor}, keywords = {children, consumption, Savings}, url = {https://www.fa-mag.com/news/do-people-save-more-when-their-kids-fly-the-coop-65062.html}, author = {Rasmussen, Eric} } @article {12072, title = {Do Retirees Want to Consume More, Less, or the Same as They Age?}, number = {IB$\#$21-21}, year = {2021}, institution = {Center for Retirement Research at Boston College}, address = {Newton, MA}, abstract = {The conventional view is that retirees prefer steady consumption as they age, but research focusing on new retirees tends to show a sharp drop right at retirement. This study looks at consumption over longer periods and explores whether wealth and health constraints might cause retirees to consume less than they prefer. The findings confirm that, for households as a whole, consumption does decline. However, these declines are at least partly driven by constraints, because households that are wealthier and healthier have relatively flat consumption.}, keywords = {consumption, Retirees}, url = {https://crr.bc.edu/briefs/do-retirees-want-to-consume-more-less-or-the-same-as-they-age/}, author = {Anqi Chen and Alicia H. Munnell} } @article {11587, title = {Do Stronger Employment Discrimination Protections Decrease Reliance on Social Security Disability Insurance? Evidence from the U.S. Social Security Reforms}, number = {WP$\#$2021-7}, year = {2021}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {This paper examines spillovers onto Social Security Disability Insurance (SSDI) that occurred due to the Social Security Amendments of 1983, which, among other changes, gradually increased the retirement age for full benefits from 65 to 67. We determine whether the spillovers onto SSDI were different in states with age and disability discrimination laws that were broader (covered more people) or stronger (allowed for more damages for plaintiffs) than the federal Age Discrimination in Employment Act and the Americans with Disabilities Act. Our paper uses three sources of data: (1) counts of the universe of SSDI applications and receipts by state, age group, sex, and year; (2) the Health and Retirement Study, merged with restricted-access state identifiers; and, (3) the Health and Retirement Study, merged with restricted access state identifiers and Social Security Administration Form-831 disability records. To quantify the moderating impact of existing state laws on spillovers onto SSDI applications, receipts and employment, we use a difference-in-differences approach, comparing age cohorts who were affected by the reforms to similar age cohorts who were unaffected, and then this comparing this affected-unaffected difference across states by state law. Using the Health and Retirement Study data, we also conduct heterogeneity analysis to determine if effects differed for different age groups (ages 55-61, ages 62-64, ages 65 to the full benefits retirement age), those with or without disabilities, and by sex}, keywords = {Discrimination, Employment, Social Security Disability Insurance}, url = {https://crr.bc.edu/working-papers/do-stronger-employment-discrimination-protections-decrease-reliance-on-social-security-disability-insurance-evidence-from-the-u-s-social-security-reforms/}, author = {Patrick Button and Khan, Mashfiqur R. and Penn, Mary} } @article {10597, title = {Does Gender Matter in the Receipt of Informal Care Among Community-dwelling Older Adults? Evidence from a Cross-National Comparative Study across the United States, South Korea, and China}, journal = {The Journals of Gerontology: Series B}, volume = {76}, year = {2021}, pages = {S64-S75}, abstract = {This study compares patterns of gender difference in the receipt of informal care among community-dwelling older adults across the United States, Korea, and China where family-oriented systems for providing care to older adults are emphasized.Data came from the 2014 Health and Retirement Study, the 2014 Korea Longitudinal Study of Aging, and the 2015 China Health and Retirement Longitudinal Study. Logistic regression models were used to predict the receipt of informal care by gender. We also examined how the effects of health and living arrangement on the receipt of informal care differ depending on gender.In the United States and China, older women were more likely to receive informal care than men. However, older Korean women were less likely to receive informal care than men. The effects of health and living arrangement on the use of informal care were moderated by gender in different ways across countries.This study provides evidence that patterns of gender differences in the receipt of informal care vary across the three countries. More attention needs to be paid to the design and implementation of long-term supports and services to address the unique patterns of gender difference in care arrangement in each country.}, keywords = {Caregiving, CHARLS, Disability, gender, KLoSA, Living arrangement}, issn = {1079-5014}, doi = {10.1093/geronb/gbaa018}, author = {Kwak, Minyoung and Kim,, BoRin and Lee, Hyunjoo and Jiaan Zhang} } @article {11646, title = {Does Having a Happy Spouse Lead to a Longer Life?}, year = {2021}, publisher = {Psychology Today}, abstract = {KEY POINTS A person{\textquoteright}s spouse affects their life in many ways. Some characteristics in one{\textquoteright}s spouse are linked to higher income and health, studies show. People aged 50 or older whose spouses report greater life satisfaction are more likely to be alive eight years later, according to research. Happier people are more likely to have a healthy lifestyle, which may guide their partner to adopt that lifestyle and increase longevity. }, keywords = {Happiness, Income, Life Satisfaction, Longevity, spouse}, url = {https://www.psychologytoday.com/ca/blog/positively-negative/202105/does-having-happy-spouse-lead-longer-life}, author = {Stavrova, Olga} } @article {11776, title = {Does it Matter Who Decides? Outcomes of Surrogate Decision-Making for Community-Dwelling, Cognitively Impaired Older Adults Near the End of Life.}, journal = {Journal of Pain and Symptom Management}, volume = {62}, year = {2021}, pages = {1126-1134}, abstract = {

CONTEXT: Cognitively impaired older adults frequently need surrogate decision-making near the end-of-life. It is unknown whether differences in the surrogate{\textquoteright}s relationship to the decedent are associated with different end-of-life treatment choices.

OBJECTIVES: To describe differences in end-of-life care for community dwelling, cognitively impaired older adults when children and spouses are involved in decision-making.

METHODS: Retrospective observational study.

RESULTS: Among 742 community-dwelling adults with cognitive impairment (mild cognitive impairment or dementia) prior to death, children participated in end-of-life decisions for 615 patients (83\%) and spouses participated in decisions for 258 patients (35\%), with both children and spouses participating for 131 patients (18\%). When controlling for demographic characteristics, decedents with only a spouse decision-maker were less likely to undergo a life-sustaining treatment than decedents with only children decision-makers (P < 0.05). There was no difference in the probability of in-hospital death or burdensome transfers across facilities across decedent-decision-maker relationships. Differences in rates of life-sustaining treatment were greater when we restricted to decedents with dementia.

CONCLUSION: Decedents with cognitive impairment or dementia were less likely to receive life-sustaining treatments when spouses versus children were involved with end-of-life treatment decisions but were no less likely to experience other measures of potentially burdensome end-of-life care.

}, keywords = {end-of-life decisions, Family, surrogate decision-making}, issn = {1873-6513}, doi = {10.1016/j.jpainsymman.2021.06.009}, author = {Micah Y. Baum and Gallo, Joseph J and Nolan, Marie T and Kenneth M. Langa and Halpern, Scott D and Macis, Mario and Lauren Hersch Nicholas} } @article {11741, title = {Does Perceived Loneliness Matter for Diverse Older Men and Their Prostate-Specific Antigen Testing Behaviors?}, journal = {Social Work Research}, volume = {45}, year = {2021}, pages = {117{\textendash}128}, abstract = {Loneliness is associated with poorer health practices and fewer health-promoting behaviors and may be associated with greater use of the health care system. Given national conversations about aging in context, this investigation explored the relationship between perceptions of loneliness in 2008 and prostate cancer screening participation in 2008 and 2012. Using data from the Health and Retirement Study, authors examined the relationship between loneliness and prostate cancer screening in 2008 and 2012 among Black, Hispanic, and non-Hispanic White men, ages 50 to 74 years (N = 4,875) using a series of logistic regression models. Findings indicate that White men who indicated being more lonely were less likely to participate in screening in 2008 and 2012. For Black men, there was a reduced likelihood of screening in 2012 with one aspect of decreasing loneliness. Social workers have unique training focusing on the person-in-environment model. Use of the person-in-environment model can help health care providers understand men{\textquoteright}s experiences and their feelings or needs related to cancer screening participation. Given the lack of focus on men{\textquoteright}s health-promoting behaviors related to loneliness, this study provides formative data to test interventions to increase the well-being of older men.}, keywords = {Antigens, Men, perceived loneliness, prostate}, isbn = {1070-5309}, doi = {10.1093/swr/svab002}, author = {Tamara J. Cadet and Shanna Lynn Burke and Mitchell, Jamie and Conner, Kyaien O and Frances R. Nedjat-Haiem} } @article {11726, title = {Does postponing retirement affect cognitive function? A counterfactual experiment to disentangle life course risk factors}, journal = {SSM - Population Health}, volume = {15}, year = {2021}, pages = {100855}, abstract = {Evidence suggests that contemporaneous labor force participation affects cognitive function; however, it is unclear whether it is employment itself or endogenous factors related to individuals{\textquoteright} likelihood of employment that protects against cognitive decline. We exploit innovations in counterfactual causal inference to disentangle the effect of postponing retirement on later-life cognitive function from the effects of other life-course factors. With the U.S. Health and Retirement Study (1996{\textendash}2014, n = 20,469), we use the parametric g-formula to estimate the effect of postponing retirement to age 67. We also study whether the benefit of postponing retirement is affected by gender, education, and/or occupation, and whether retirement affects cognitive function through depressive symptoms or comorbidities. We find that postponing retirement is protective against cognitive decline, accounting for other life-course factors (population: 0.34, 95\% confidence interval (CI): 0.20,0.47; individual: 0.43, 95\% CI: 0.26,0.60). The extent of the protective effect depends on subgroup, with the highest educated experiencing the greatest mitigation of cognitive decline (individual: 50\%, 95\% CI: 32\%,71\%). By using innovative models that better reflect the empirical reality of interconnected life-course processes, this work makes progress in understanding how retirement affects cognitive function.}, keywords = {Causal inference, cognitive function, Labor force participation, life course, Retirement}, isbn = {2352-8273}, doi = {10.1016/j.ssmph.2021.100855}, author = {Jo Mhairi Hale and Maarten J. Bijlsma and Angelo Lorenti} } @article {10.1093/geroni/igab046.1092, title = {Does Relationship End Precede Cognitive Decline? An Analysis of the Health and Retirement Study}, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {281}, abstract = {Relationship status is thought to be associated with cognitive health in older adults, with married persons performing better on memory assessments than unmarried-cohabitating, single, divorced, and widowed persons. However, questions remain about whether relationship termination causes cognitive decline, is a result of it, or whether they share a cause; and the mechanisms by which such a relationship might operate. To address this gap in the literature, we hypothesized that relationship termination could affect cognition via the following five pathways: (1) post-termination depression; (2) loss of distributed-cognition partner; (3) cognitive depletion from caring for partner in declining and ultimately terminal health; (4) divorce to preserve assets to qualify for Medicaid to cover healthcare for cognitive decline; and (5) post-termination changes in neuropsychiatric symptoms alongside a pre-existing neurodegenerative condition that also causes cognitive decline. Using data from the 2000{\textendash}2016 waves of the Health and Retirement Study (HRS; N = 23,393), we found that relationship termination, whether due to divorce or widowhood, was associated with cognitive decline. Using mixed-effects regression we found that the rate of cognitive decline increased after relationship termination (widowhood: □ = -0.587, p \<0.001; divorce: □ = -0.221, p \<0.001), supporting mechanism (5). Using HRS data for respondents and their spouses{\textquoteright} mental and physical health, health insurance, and activities of daily living, we also find support for mechanisms (1) and (3). Relationship termination is a critical juncture in a person{\textquoteright}s life course that has multiple implications and may, ultimately, worsen patients{\textquoteright} conditions.}, keywords = {Cognitive decline, Divorce, Relationships}, issn = {2399-5300}, doi = {10.1093/geroni/igab046.1092}, author = {Hanes, Douglas and Clouston, Sean} } @article {11873, title = {Does the ACA Medicaid Expansion Encourage Early Retirement?}, year = {2021}, institution = {University of Wisconsin-Milwaukee}, address = {Milwaukee, WI}, abstract = {In this study, I examine the effect of the Affordable Care Act Medicaid expansion on the retirement plans of low-educated, childless adults, aged 50-64. I employ a triple-differences (DDD) methodology, exploiting variation in individuals{\textquoteright} health insurance status and the timing of the expansion decisions of states. I find that with Medicaid expansion, insured workers without retirement health insurance (RHI) prior to the expansion decreased full-time work by 7.8 percentage points relative to those with RHI and those without any employer-sponsored coverage whatsoever. Among those no longer working full-time, 94 percent transitioned to complete retirement.}, keywords = {Affordable Care Act, Labor force participation, Medicaid, Retirement}, url = {https://uwm.edu/economics/wp-content/uploads/sites/205/2021/08/Ozcan_Onal.pdf}, author = {Sezen Ozcan Onal} } @article {11736, title = {Dose-Response Relationship Between Long-Term Blood Pressure Variability and Cognitive Decline.}, journal = {Stroke}, volume = {52}, year = {2021}, pages = {3249{\textendash}3257}, abstract = {

BACKGROUND AND PURPOSE: We aimed to test whether higher long-term blood pressure variability was associated with accelerated rate of cognitive decline and evaluate potential dose-response relationship.

METHODS: Original survey data from the Health and Retirement Study and the English Longitudinal Study of Ageing were used. Standardized score of cognitive function was the main outcome measure. Visit-to-visit blood pressure SD, coefficient of variation, and variation independent of mean were used. Linear mixed model and restricted spline were applied to assess association and explore dose-response pattern. Segmented regression was used to analyze dose-response relationship and estimate turning point. Meta-analysis using random-effects model was conducted to pool results, with used to test heterogeneity.

RESULTS: A total of 12 298 dementia-free participants were included (mean age: 64.6{\textpm}8.6 years). Significant association was observed between blood pressure variability and cognitive decline. Each 10\% increment in coefficient of variation of systolic and diastolic blood pressure was associated with accelerated global cognitive decline of 0.026 SD/y (95\% CI, 0.016-0.036, 0.001) and 0.022 SD/y (95\% CI, 0.017-0.027, 0.001), respectively. Nonlinear dose-response relationship was found (0.001 for nonlinearity), with clear turning point observed (0.001 for change in slopes).

CONCLUSIONS: Higher long-term blood pressure variability was associated with accelerated cognitive decline among general adults aged >=50 years, with nonlinear dose-response relationship. Further randomized controlled trials are warranted to evaluate potential benefits of blood pressure variability-lowering strategies from a cognitive health perspective.

}, keywords = {Blood pressure, Cognitive decline, ELSA, Hypertension, Retirement}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.120.033697}, author = {Li, Chenglong and Ma, Yanjun and Hua, Rong and Yang, Zhenchun and Zhong, Baoliang and Wang, Hongyu and Xie, Wuxiang} } @mastersthesis {12016, title = {Dyadic Associations between Body Mass Index, Stress and Type 2 Diabetes Complications }, volume = {M.A.}, year = {2021}, school = {Carleton University}, address = {Ottawa, ON, CA}, abstract = {Type 2 diabetes (T2DM) can result in complications, including kidney problems or cardiovascular disease. Intrapersonal risk factors such as body mass index (BMI) and stress have been associated with increased odds of developing T2DM complications. However, little is known about interpersonal risk factors. The present study aimed to test associations among partner{\textquoteright}s BMI, partner{\textquoteright}s stress and T2DM complications development among married couples in which one partner has diabetes and if negative marital quality moderates these associations. Data (n=274) came from the Health and Retirement Study. BMI, stress, diabetes status and complications were self-reported at baseline (2006). Complications were assessed every two years from 2008-2016. Data were analyzed using logisitic regression models. Unadjusted and adjusted models revealed no associations among partner BMI, partner stress, and incident T2DM complications, p>0.05. Furthermore, marital quality did not moderate these associations, p>0.05. Future research should consider other interpersonal risk factors onto intrapersonal health outcomes}, keywords = {Body Mass Index, Diabetes Complications, dyads, negative marital quality, Stress, type 2 diabetes}, url = {https://curve.carleton.ca/system/files/etd/81a3c6cc-10bf-4177-b77b-11ecc25ae70a/etd_pdf/d30ebf3366387c665f274d97ef608408/fardfini-dyadicassociationsbetweenbodymassindexstress.pdf}, author = {Fardfini, Kimia} } @article {11598, title = {Dyadic Loneliness and Changes to HbA1c Among Older US Couples: The Role of Marital Support as Stress Buffer.}, journal = {Journal of Aging and Health}, volume = {33}, year = {2021}, pages = {698-708}, abstract = {

Both experiencing loneliness and having a lonely partner can be psychosocial stressors, with implications for health. Yet, marital support may buffer against the cardiometabolic effects of loneliness. This study examines (1) whether own and/or partner{\textquoteright}s loneliness predict changes in HbA1c over 4~years and (2) whether marital support moderates these effects. Actor-partner interdependence models analyzed data from 1,854 older couples who provided psychosocial and biomarker data at two timepoints (2008/2012 or 2010/2014) of the Health and Retirement Study. Neither partner{\textquoteright}s loneliness predicted changes in HbA1c overall. However, significant interactions indicated that both own baseline loneliness and partner{\textquoteright}s baseline loneliness predicted significant increases to HbA1c over 4~years among those who reported below-average marital support. Both the experience of loneliness and loneliness of a dyadic partner may have longitudinal consequences for cardiometabolic health. However, these effects are contingent upon perceived quality of the marriage, specifically marital support.

}, keywords = {Biomarkers, Cardiovascular disease, Marriage, Well-being}, issn = {1552-6887}, doi = {10.1177/08982643211006498}, author = {Jeffrey E Stokes and Barooah, Adrita} } @article {11416, title = {The dynamic association between body mass index and cognition from midlife through late-life, and the effect of sex and genetic influences}, journal = {Scientific Reports}, volume = {11}, year = {2021}, pages = {7206}, abstract = {Body mass index (BMI) is associated with cognitive abilities, but the nature of the relationship remains largely unexplored. We aimed to investigate the bidirectional relationship from midlife through late-life, while considering sex differences and genetic predisposition to higher BMI. We used data from 23,892 individuals of European ancestry from the Health and Retirement Study, with longitudinal data on BMI and three established cognitive indices: mental status, episodic memory, and their sum, called total cognition. To investigate the dynamic relationship between BMI and cognitive abilities, we applied dual change score models of change from age 50 through 89, with a breakpoint at age 65 or 70. Models were further stratified by sex and genetic predisposition to higher BMI using tertiles of a polygenic score for BMI (PGSBMI). We demonstrated bidirectional effects between BMI and all three cognitive indices, with higher BMI contributing to steeper decline in cognitive abilities in both midlife and late-life, and higher cognitive abilities contributing to less decline in BMI in late-life.\&nbsp;The effects of BMI on change in cognitive abilities were more evident in men compared to women, and among those in the lowest tertile of the PGSBMI compared to those in the highest tertile, while the effects of cognition on BMI were similar across groups. In conclusion, these findings highlight a reciprocal relationship between BMI and cognitive abilities, indicating that the negative effects of a higher BMI persist from midlife through late-life, and that weight-loss in late-life may be driven by cognitive decline.}, keywords = {Cognition, Epidemiology, Genetics, longitudinal, Obesity}, isbn = {2693-5015}, doi = {10.21203/rs.3.rs-186197/v1}, author = {Ida Karlsson and Margaret Gatz and Thalida E. Arpawong and Anna K. Dahl Aslan and Chandra A Reynolds} } @article {11637, title = {Dynamic latent variable models for the analysis of cognitive abilities in the elderly population.}, journal = {Statistics in Medicine}, volume = {40}, year = {2021}, pages = {4410-4429}, abstract = {

Cognitive functioning is a key indicator of overall individual health. Identifying factors related to cognitive status, especially in later life, is of major importance. We concentrate on the analysis of the temporal evolution of cognitive abilities in the elderly population. We propose to model the individual cognitive functioning as a multidimensional latent process that accounts also for the effects of individual-specific characteristics (gender, age, and years of education). The proposed model is specified within the generalized linear latent variable framework, and its efficient estimation is obtained using a recent approximation technique, called dimensionwise quadrature. It provides a fast and streamlined approximate inference for complex models, with better or no degradation in accuracy compared with standard techniques. The methodology is applied to the cognitive assessment data from the Health and Retirement Study combined with the Asset and Health Dynamic study in the years between 2006 and 2010. We evaluate the temporal relationship between two dimensions of cognitive functioning, that is, episodic memory and general mental status. We find a substantial influence of the former on the evolution of the latter, as well as evidence of severe consequences on both cognitive abilities among less-educated and older individuals.

}, keywords = {generalized linear latent variable models, health mental status, intractable likelihood, vector autoregressive process}, issn = {1097-0258}, doi = {10.1002/sim.9038}, author = {Bianconcini, Silvia and Cagnone, Silvia} } @article {11125, title = {A data-driven prospective study of dementia among older adults in the United States.}, journal = {PLoS One}, volume = {15}, year = {2020}, month = {2020}, abstract = {

BACKGROUND: Studies examining risk factors for dementia have typically focused on testing a priori hypotheses within specific risk factor domains, leaving unanswered the question of what risk factors across broad and diverse research fields may be most important to predicting dementia. We examined the relative importance of 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors across the life course in predicting incident dementia and how these rankings may vary across racial/ethnic (non-Hispanic white and black) and gender (men and women) groups.

METHODS AND FINDINGS: We conducted a prospective analysis of dementia and its association with 65 risk factors in a sample of 7,908 adults aged 51 years and older from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine and Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the semi-competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups such that at most four risk factors were consistently observed in the top ten predictors across the four demographic strata (non-Hispanic white men, non-Hispanic white women, non-Hispanic black men, non-Hispanic black women).

CONCLUSIONS: We identified leading risk factors across racial/ethnic and gender groups that predict incident dementia over a 14-year period among a nationally representative sample of US aged 51 years and older. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.

}, issn = {1932-6203}, doi = {10.1371/journal.pone.0239994}, author = {Weiss, Jordan and Puterman, Eli and Aric A Prather and Erin B Ware and David Rehkopf} } @article {10877, title = {A data-driven prospective study of incident dementia among older adults in the United States}, year = {2020}, institution = {Cornell University}, address = {Ithaca, NY}, abstract = {We conducted a prospective analysis of incident dementia and its association with 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors in a sample of 7,908 adults over the age of 50 from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine-Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.}, keywords = {data-driven, Dementia, Fine-Gray models, risk of death}, url = {https://arxiv.org/abs/2006.13275}, author = {Weiss, Jordan and Puterman, Eli and Aric A Prather and Erin B Ware and David Rehkopf} } @article {10161, title = {Death by a thousand cuts: Stress exposure and black-white disparities in physiological functioning in late life.}, journal = {The Journals of Gerontology, Series B}, volume = {75}, year = {2020}, pages = {1937-1950}, abstract = {

OBJECTIVES: This paper investigates Black-White differences in stress-including diverse measures of chronic, acute, discrimination-related, and cumulative stress exposure-and examines whether race differences in these stress measures mediate Black-White disparities in C-reactive protein (CRP) and metabolic dysregulation in later life.

METHODS: Using data from the Health and Retirement Study (HRS) (2004-2012), this study uses stepwise OLS regression models to examine the prospective associations between multiple stressors-including traumatic and stressful life events, financial strain, chronic stress, everyday and major life discrimination, and measures of cumulative stress burden-and CRP and metabolic dysregulation. Mediation analyses assessed the contribution of stress exposure to Black-White disparities in the outcomes.

RESULTS: Blacks experienced more stress than Whites across domains of stress, and stress exposure was strongly associated with CRP and metabolic dysregulation. Race differences in financial strain, everyday and major life discrimination, and cumulative stress burden mediated Black-White gaps in the outcomes, with measures of cumulative stress burden mediating the greatest proportion of the racial disparities.

DISCUSSION: The "thousand cuts" that Blacks experience from their cumulative stress exposure across domains of social life throughout the life course accelerate their physiological deterioration relative to Whites and play a critical role in racial health disparities at older ages.

}, keywords = {Life trajectories, Racial/ethnic differences, Stress}, issn = {1758-5368}, doi = {10.1093/geronb/gbz068}, author = {Courtney Boen} } @article {11130, title = {Death certificates may not adequately report dementia as cause of death}, journal = {News \& Events}, year = {2020}, publisher = {National Institute on Aging}, address = {Bethesda, MD}, abstract = {The actual number of deaths linked to dementia may be about three times greater than what is reported on U.S. death certificates, according to a recent NIA-supported study. The findings were published online August 24, 2020, in JAMA Neurology. Previous studies have established that doctors and medical examiners may be underreporting Alzheimer{\textquoteright}s disease and related dementias as an underlying cause of death on death certificates. To investigate whether the impact from the underreporting was substantial, a research team led by investigators at Boston University compared dementia-related deaths determined by a nationally representative study to what is reported on death certificates. The researchers also calculated deaths related to cognitive impairment because about one-third of people with cognitive impairment develop dementia within five years.}, keywords = {Alzheimer disease, Death Certificates, Dementia}, url = {https://www.nia.nih.gov/news/death-certificates-may-not-adequately-report-dementia-cause-death}, author = {National Institute on Aging} } @article {11184, title = {Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities.}, journal = {The Journals of Gerontology, Series B}, volume = {75}, year = {2020}, pages = {1983-1995}, abstract = {

OBJECTIVES: This study considers whether experiencing the death of a child prior to midlife (by parental age 40) is associated with subsequent dementia risk, and how such losses, which are more common for black than for white parents, may add to racial disparities in dementia risk.

METHODS: We use discrete-time event history models to predict dementia incidence among 9,276 non-Hispanic white and 2,182 non-Hispanic black respondents from the Health and Retirement Study, 2000-2014.

RESULTS: Losing a child prior to midlife is associated with increased risk for later dementia, and adds to disparities in dementia risk associated with race. The death of a child is associated with a number of biosocial variables that contribute to subsequent dementia risk, helping to explain how the death of child may increase risk over time.

DISCUSSION: The death of a child prior to midlife is a traumatic life course stressor with consequences that appear to increase dementia risk for both black and white parents, and this increased risk is explained by biosocial processes likely activated by bereavement. However, black parents are further disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk.

}, keywords = {Bereavement, Cumulative advantage/disadvantage, Dementia, Minority aging}, issn = {1758-5368}, doi = {10.1093/geronb/gbz154}, author = {Debra Umberson and Rachel Donnelly and Xu, Minle and Farina, Matthew and Michael A Garcia} } @article {10727, title = {Debt and Financial Vulnerability on the Verge of Retirement}, journal = {Journal of Money, Credit and Banking}, volume = {52}, year = {2020}, pages = {1005-1034}, type = {Journal}, abstract = {Abstract We analyze older individuals{\textquoteright} debt and financial vulnerability using data from the Health and Retirement Study (HRS) and the National Financial Capability Study (NFCS). In the HRS, we compare three groups of people age 56{\textendash}61 in 1992, 2004, and 2010, to assess cross-cohort changes in debt over time. Two waves of the NFCS (2012 and 2015) provide additional insights into debt management and older individuals{\textquoteright} capacity to shield themselves against shocks. We conclude that recent cohorts hold more debt and face more financial insecurity than in the past. This will render them particularly vulnerable to forecasted interest rate increases.}, keywords = {Personal finance, retirement plans}, issn = {00222879}, doi = {10.1111/jmcb.12671}, author = {Annamaria Lusardi and Olivia S. Mitchell and Oggero, Noemi} } @article {11179, title = {A decade of experience for high-needs beneficiaries under Medicare Advantage.}, journal = {Healthcare (Amsterdam)}, volume = {8}, year = {2020}, abstract = {

OBJECTIVE: To describe the association between longitudinal enrollment in Medicare Advantage (MA) and utilization, access, quality of care, and health outcomes for beneficiaries with complex health needs.

DATA SOURCES/STUDY SETTING: Beneficiary characteristics, enrollment, and outcomes data from the 2004-2016 waves of the Health and Retirement Study (HRS).

STUDY DESIGN: Using the HRS panel structure, we identified beneficiaries consistently reporting high needs as well as enrollment in MA versus traditional Medicare (TM). We first evaluated a robust set of beneficiary characteristics to identify those that distinguish beneficiaries who consistently enrolled in MA versus TM. We then described adjusted differences in outcomes between high-needs beneficiaries who consistently enrolled in MA versus TM.

PRINCIPAL FINDINGS: Among high-needs beneficiaries, there was a modest amount of favorable selection into MA based on health. Controlling for several characteristics, MA enrollees used less care (with a 6.6 percentage point (pp) lower probability of hospitalization, 4.7 fewer physician visits, and a 5.1 pp lower probability of using home health care), had a 4.1 pp greater probability of being unable to afford their care, and had a 5.7 pp lower probability of reporting that they were very satisfied with their care. Compared to associations between MA and outcomes for high-needs beneficiaries, for non-high-needs beneficiaries MA enrollment was associated with smaller decreases in utilization and no statistically significant difference in the inability to afford care.

CONCLUSIONS: Our descriptive findings raise the possibility that high-needs beneficiaries may experience unique challenges in MA compared to their non-high-needs counterparts.

}, keywords = {Access, health outcomes, High-needs beneficiaries, Medicare advantage, Quality of care}, issn = {2213-0772}, doi = {10.1016/j.hjdsi.2020.100490}, author = {Levinson, Zachary and Adler-Milstein, Julia} } @article {10715, title = {A decade of research on the genetics of entrepreneurship: a review and view ahead}, journal = {Small Business Economics}, year = {2020}, month = {2020/04/28}, abstract = {Studies analyzing the heritability of entrepreneurship indicate that explanations for why people engage in entrepreneurship that ignore genes are incomplete. However, despite promises that were solidly backed up with ex ante power calculations, attempts to identify specific genetic variants underlying the heritable variation in entrepreneurship have until now been unsuccessful. We describe the methodological issues hampering the identification of associations between genetic variants and entrepreneurship, but we also outline why this search will eventually be successful. Nevertheless, we argue that the benefits of using these individual genetic variants for empirical research in the entrepreneurship domain are likely to be small. Instead, the use of summary indices comprising multiple genetic variants, so-called polygenic risk scores, is advocated. In doing so, we stress the caveats associated with applying population-level results to the individual level. By drawing upon the promises of {\textquotedblleft}genoeconomics,{\textquotedblright} we sketch how the use of genetic information may advance the field of entrepreneurship research.}, keywords = {Entrepreneurship, Genetics, Polygenic risk scores}, isbn = {1573-0913}, doi = {10.1007/s11187-020-00349-5}, author = {Cornelius A Rietveld and Eric Slob and A. Roy Thurik} } @mastersthesis {10812, title = {Decision-Making in Health Insurance Markets}, volume = {Doctor of Philosophy}, year = {2020}, school = {Arizona State Univeristy}, address = {Tempe}, abstract = {Prior research on consumer behavior in health insurance markets has primarily focused on individual decision making while relying on strong parametric assumptions about preferences. The aim of this dissertation is to improve the traditional approach in both dimensions. First, I consider the importance of joint decision-making in individual insurance markets by studying how married couples coordinate their choices in these markets. Second, I investigate the robustness of prior studies by developing a non-parametric method to assess decision-making in health insurance markets. To study how married couples make choices in individual insurance markets I estimate a stochastic choice model of household demand that takes into account spouses{\textquoteright} risk aversion, spouses{\textquoteright} expenditure risk, risk sharing, and switching costs. I use the model estimates to study how coordination within couples and interaction between couples and singles affects the way that markets adjust to policies designed to nudge consumers toward choosing higher value plans, particularly with respect to adverse selection. Finally, to assess consumer decision-making beyond standard parametric assumptions about preferences, I use second{\textendash}order stochastic dominance rankings. Moreover, I show how to extend this method to construct bounds on the welfare implications of choosing dominated plans.}, keywords = {health insurance markets, Spouses}, url = {https://search.proquest.com/openview/1f63cc112a2bd2ed2cbe1412a1076a2a/1?pq-origsite=gscholar\&cbl=18750\&diss=y}, author = {Sanguinetti, Tomas P.} } @article {Case202012350, title = {Decoding the mystery of American pain reveals a warning for the future}, journal = {Proceedings of the National Academy of Sciences}, year = {2020}, abstract = {The elderly in the United States report less pain than those in midlife{\textemdash}suggesting, perhaps, that once people move into old age, their morbidity will fall. Unfortunately, assessing pain by age at one point in time masks the fact that each successive birth cohort reports more pain at any given age than the cohorts that came before it. We cannot use the experience of the elderly today to project pain prevalence of the elderly tomorrow. Today{\textquoteright}s elderly have experienced less pain throughout their lives than those in midlife today, who will be tomorrow{\textquoteright}s elderly. If these patterns continue, pain prevalence will continue to increase for all adults; tomorrow{\textquoteright}s elderly will be sicker than today{\textquoteright}s elderly, with serious implications for healthcare.There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain. Using multiple datasets and definitions of pain, we show today{\textquoteright}s midlife Americans have had more pain throughout adulthood than did today{\textquoteright}s elderly. Disaggregating the cross-section of ages by year of birth and completion of a bachelor{\textquoteright}s degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age{\textemdash}a result not found for those with a bachelor{\textquoteright}s degree. Thus, the gap in pain between the more and less educated has widened in each successive birth cohort. The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950. If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow{\textquoteright}s elderly will be sicker than today{\textquoteright}s elderly, with potentially serious implications for healthcare.The European and US official data are publicly available, although the European data require permission from Eurostat. The US data can be freely downloaded from the Web. We have prepared code that can be used to replicate our results. The underlying Gallup data are proprietary, and are not publicly available. We have prepared a replication dataset, containing all of the data that will allow replication of the results. Gallup will hold these data, but researchers can obtain permission from Gallup, and Gallup will give them access to the data for replication or further research. Please contact permissionsatgallup.com for more information.}, keywords = {birth cohort analysis, educational divide, international comparisons, pain prevalence}, issn = {0027-8424}, doi = {10.1073/pnas.2012350117}, author = {Case, Anne and Deaton, Angus and Arthur A. Stone} } @article {11103, title = {Dementia Is Associated With Earlier Mortality for Men and Women in the United States.}, journal = {Gerontology and Geriatric Medicine}, volume = {6}, year = {2020}, pages = {2333721420945922}, abstract = {

Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. Our study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, we identified a retrospective cohort of adults with at least one International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM) dementia diagnosis code ( = 3,714). For each case, we randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year ( = 9,531), and assigned comparators the diagnosis date of their matched case. Participants were followed for up to 60 months following diagnosis. We estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. On average, dementia cases were 80.5 years old at diagnosis. Most were female, had less than college-level education, and approximately 40\% were married at diagnosis. In multivariate analyses, dementia diagnosis was associated with earlier mortality for women (predicted median survival of 54.5 months vs. 62.5 months; dementia coefficient = -0.13; 95\% confidence interval [CI] = [-0.22, -0.04]; = .003), but even more so among men (predicted median survival of 35.5 months vs. 54.5 months; dementia coefficient = -0.42; 95\% CI = [-0.52, -0.31]; < .001). We found substantial heterogeneity in the relationship between dementia and survival, associated with both education and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.

}, keywords = {Dementia, gender, Medicare, Medicare administrative data}, issn = {2333-7214}, doi = {10.1177/2333721420945922}, author = {White, Lindsay and Fishman, Paul and Basu, Anirban and Paul K Crane and Eric B Larson and Norma B Coe} } @article {12281, title = {The Democrat Disaster: Hurricane Exposure, Risk Aversion and Insurance Demand}, year = {2020}, institution = {London School of Economics \& Political Science}, abstract = {How do voters respond to heightened risk? Dominant theories expect accountability issues to surface or distributional conflict to intensify once threats become salient. Unsatisfactorily, these accounts rely on compound treatment effects of exposure not only to risk but also to direct losses or self-selection into unfortunate circumstances. To circumvent this, I use difference-in-differences estimates of hurricane nearly-hit areas in the US to study the effect of risk on vote choice. I find that Democrats{\textquoteright} vote share decreases in both House and Senate races between 2002-2014 following a near-miss. Conventional explanations related to religiosity, authority, or competence fail to explain this effect. Instead, I propose Republican gains are driven by voters{\textquoteright} spending on private insurance and increased willingness to take risks when spared from disaster. I therefore advance an alternative explanation of voting under risk by relying on novel data on hurricane trajectories, precinct electoral returns, risk-aversion, and private insurance inquiries. These results are politically meaningful not least because US general elections follow closely after the hurricane season.}, keywords = {Causal inference, Insurance, natural disaster, Risk, uncertainty, voter behavior}, url = {https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3515282}, author = {Raluca L. Pahontu} } @article {jindra_li_tsang_bauermeister_gallacher_2020, title = {Depression and memory function {\textendash} evidence from cross-lagged panel models with unit fixed effects in ELSA and HRS}, journal = {Psychological Medicine}, year = {2020}, abstract = {Background Individuals with depression are often found to perform worse on cognitive tests and to have an increased risk of dementia. The causes and the direction of these associations are however not well understood. We looked at two specific hypotheses, the aetiological risk factor hypothesis and the reverse causality hypothesis. Method We analysed observational data from two cohorts, English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS), using cross-lagged panel models with unit fixed effects. Each model was run once with depression and repeated with cognition as the dependent variable and the other variable as the main explanatory variable. All models were estimated separately for contemporaneous effects and lagged effects up to 8 years in the past. We contrasted the results with models making the random effects assumption. Results Evidence from the fixed effects models is mixed. We find no evidence for the reverse causality hypothesis in ELSA and HRS. While there is no evidence for the aetiological risk factors hypothesis in ELSA, results from HRS indicate some effects. Conclusion Our findings suggest that current levels of cognitive function do not influence future levels of depression. Results in HRS provide some evidence that current levels of depressive symptoms influence future cognition.}, keywords = {Cognition, cross-lagged panel models, depression, ELSA, fixed effects}, doi = {10.1017/S0033291720003037}, author = {Jindra, Christoph and Li, Chenlu and Tsang, Ruby S. M. and Bauermeister, Sarah and Gallacher, John} } @mastersthesis {11099, title = {Depression and the Financial Planning Horizon}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Georgia}, address = {Athens, GA}, abstract = {With greater numbers of people living longer, the question of how to prepare for financial security is an important issue. However, there is a noticeable increase in the prevalence of mental disorders, which deteriorates financial well-being in later life. Especially, depression is amongst the most common psychological disorders in older adults. People with depression have great difficulty tackling the task of planning and are more likely to make short-sighted financial decisions. Designing and managing a long-term financial plan can be particularly challenging for depressed people. To mitigate this problem, there is a growing need for research on factors that may affect the financial time preferences of older adults who suffer from depression. This is because financial time preference plays a vital role in determining the choices that people make when deciding between their saving and consumption trade-offs within the constraints of their financial resources and time horizon. Previous literature has found that people with depression have a lower preference for long-term economic benefits than healthy people when they face intertemporal choices. Depressed people{\textquoteright}s abnormal time perception, insufficient resources, and negative expectations with regards to the future have a significant influence on their time preference. Hence, financial decision making for the future with a far-sighted perspective is especially needed for older adults who suffer from depression. However, there exist scant studies on the extent to which the financial planning horizon shifts with the onset of depressive symptoms. To fill this gap in the literature, this study utilized a five-category financial planning horizon measure in the Health and Retirement Study (HRS) and estimated regression models that identify depression as a determinant of the financial planning horizon. The purpose of this study is to explore whether depression contributes to greater preference for a shorter financial planning horizon of individuals. The result from the empirical analyses of this study finds that depression is negatively associated with the financial planning horizon. The implications of this finding can have ramifications for individuals with depression who need a long-term financial plan for the future.}, keywords = {Depressed people, financial decision making, Financial security}, isbn = {9798645489533}, author = {Choung, Youngjoo} } @article {9939, title = {Depression in Later Life: The Role of Adult Children{\textquoteright}s College Education for Older Parents{\textquoteright} Mental Health in the United States.}, journal = {Journals of Gerontology, Series B: Psychological Sciences \& Social Sciences}, year = {2020}, abstract = {

Objectives: Research on the socioeconomic gradient in mental health links disadvantaged family background with subsequent symptoms of depression, demonstrating the "downstream" effect of parental resources on children{\textquoteright}s mental health. This study takes a different approach by evaluating the "upstream" influence of adult children{\textquoteright}s educational attainment on parents{\textquoteright} depressive symptoms.

Methods: Using longitudinal data from the U.S. Health and Retirement Study (N=106,517 person-years), we examine whether children{\textquoteright}s college attainment influences their parents{\textquoteright} mental health in later life and whether this association increases with parental age. We also assess whether the link between children{\textquoteright}s college completion and parents{\textquoteright} depression differs by parents{\textquoteright} own education.

Results: Parents with children who completed college have significantly lower levels of depressive symptoms than parents without college-educated children, although the gap between parents narrows with age. In addition, at baseline, parents with less than a high school education were more positively affected by their children{\textquoteright}s college completion than parents who themselves had a college education, a finding which lends support to theories of resource substitution.

Discussion: Offspring education is an overlooked resource that can contribute to mental health disparities among older adults in a country with unequal access to college educations.

}, keywords = {Adult children, Depressive symptoms, Education}, issn = {1758-5368}, doi = {10.1093/geronb/gby135}, author = {Jenjira J Yahirun and Connor M Sheehan and Krysia N Mossakowski} } @mastersthesis {11388, title = {Depression trajectories of older adults in the transition to widowhood }, volume = {Doctor of Philosophy}, year = {2020}, school = {Iowa State University}, address = {Ames, IA}, abstract = {As a significant life event and a turning point in the life course, losing a spouse to death is one of the most stressful experiences that requires the most intense readjustment in life. The immediate psychological effects of spousal death are usually severe, and there might be a significant increase in depression level right after the death of the spouse. For most people, psychological distress usually resolves over time. For a small number of widowed adults, however, the impact of widowhood on emotional health and depression levels might last for years. Unlike most studies that use cross-sectional data to investigate the level of depression at a specific time point after the loss of a spouse, this study uses longitudinal data from the Health and Retirement Study to investigate the heterogeneity in the changes in depression level of widowed older adults (n = 446) over eight years before and after the death of a spouse. Continuously married adults (n = 1,611) were also included in the analysis as a comparison group. The study first compared the differences in characteristics at baseline and depression levels at four waves between widowed and continuously married adults using the χ2 test for independence and t-test. Then, paired-samples t-tests were conducted to compare five key continuous variables at baseline and immediate wave after for both widowed and continuously married adults. Next, a latent class growth analysis was conducted to identify possible depression trajectories of adults in both widowed and continuously married groups. I then compared differences across four trajectory groups for both widowed and continuously married adults. Finally, sequential multinomial logistic regressions were computed to identify demographic variables and contextual factors that differentiate respondents in distinct depression trajectory groups. The comparison between widowed adults and continuously married adults shows distinct group differences. Compared to continuously married adults, widowed adults were more likely to be older, female, non-White, and with lower socioeconomic status and worse health conditions. Furthermore, the widowed adults were less close with their spouse at baseline, and they reported lower scores on positive and higher scores on negative social support from various resources. The findings support the hypothesis that heterogeneity exists in the adjustments to the death of a spouse. Four groups of adults with distinct depression trajectories in widowhood were identified: {\textquotedblleft}No Depression Group,{\textquotedblright} {\textquotedblleft}Increasing Depression Group,{\textquotedblright} {\textquotedblleft}Decreasing Depression Group,{\textquotedblright} and {\textquotedblleft}Chronic Depression Group.{\textquotedblright} Except for education level, all the other demographic variables did not differentiate widowed adults from different depression trajectories. Furthermore, the findings show that health status, functional limitations, and negative social support could significantly differentiate widowed adults from distinct depression trajectories. The findings of this study deepen the understanding of distinct depression trajectories in the transition to widowhood and the effects of demographic variables and contextual factors on these depression trajectories. The findings are also of great significance for early professional intervention for adults experiencing increasing and chronic depression after the death of a spouse. In addition, to improve the quality of emotional support and avoid relationship strain, support for widowed adults should also focus on improving self-care and health promotion. This is especially essential for those who are initially in poor health and hence are most vulnerable to long-term and intense psychological distress.}, keywords = {depression, Widowhood}, url = {https://lib.dr.iastate.edu/cgi/viewcontent.cgi?article=9442\&context=etd}, author = {Zhao, Feng} } @article {11025, title = {Depression worsens over time for older caregivers of newly diagnosed dementia patients}, journal = {Michigan News}, year = {2020}, address = {Ann Arbor, MI}, abstract = {Caring for a partner or spouse with a new diagnosis of Alzheimer{\textquoteright}s or related dementia is associated with a 30\% increase in depressive symptoms, compared to older adults who don{\textquoteright}t have a spouse with dementia{\textemdash}and these symptoms are sustained over time, a new University of Michigan study found.}, keywords = {Alzheimer disease, Caregivers, Dementia, depression}, url = {https://news.umich.edu/depression-worsens-over-time-for-older-caregivers-of-newly-diagnosed-dementia-patients/}, author = {Bailey, Laura} } @article {10067, title = {Depressive symptoms among aging Hispanic Americans: Longitudinal effects of positive spousal support and previous depressive symptoms.}, journal = {Journal of Aging and Health}, volume = {32}, year = {2020}, pages = {481-490}, abstract = {

OBJECTIVE: We aimed to investigate the longitudinal effects of spousal support on aging Hispanic Americans{\textquoteright} depressive symptoms using population-based data from the Health and Retirement Study (HRS).

METHOD: Using hierarchical multiple regressions, we investigated whether baseline positive spousal support and previous depressive symptoms were significant predictors of depressive symptoms 8 years later in a sample of 264 aging Hispanic Americans.

RESULTS: We discovered that previous depressive symptoms, baseline chronic conditions, and positive spousal support were all significant predictors of long-term depressive symptoms.

DISCUSSION: Our findings underline the need to address persistent depression and chronic diseases in the aging Hispanic population. We also highlight the potential benefits of empowering spouses as a resource for promoting mental health in this group. These findings are also encouraging for future studies in depression, aging, and comorbidity, especially in the vastly increasing population of aging Hispanic Americans.

}, keywords = {Depressive symptoms, Hispanic, Marriage, Racial/ethnic differences, Social Support}, issn = {08982643}, doi = {10.1177/0898264319825755}, url = {http://www.ncbi.nlm.nih.gov/pubmed/30829098?dopt=Abstract}, author = {James R Muruthi and Lauren C Zalla and Denise C Lewis} } @article {11696, title = {Depressive Symptoms and Loneliness Among Black and White Older Adults: The Moderating Effects of Race.}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {igaa048}, abstract = {

Background and Objectives: Loneliness is consistently linked to worse depression/depressive symptoms; however, there are few studies that have examined whether the relationship between loneliness and depressive symptoms varies by race. The purpose of this study was to determine whether race moderated the relationship between loneliness and depressive symptoms.

Research Design and Methods: Data come from the 2014 wave of the Health and Retirement Study (HRS) Core survey and Psychosocial Leave-Behind Questionnaire; only black and white older adults were included in the analysis ( = 6,469). Depressive symptoms were operationalized by the eight-item Center for Epidemiological Studies-Depression scale; however, the "felt lonely" item was removed given concerns with collinearity. Loneliness was operationalized using the Hughes 3-Item Loneliness Scale. Sociodemographic variables included gender, age, education, household income, employment status, marital status, and living alone or with others. Furthermore, social support and negative interactions from family members and friends, and religious service attendance were included in the analysis. Lastly, we created an interaction term between race and loneliness. All analyses used survey weights to account for the complex multistage sampling design of the HRS. Missing data were multiply imputed.

Results: In multivariable analysis, we found race significantly moderated the relationship between loneliness and depressive symptoms while controlling for sociodemographic covariates, social support and negative interaction variables, and religious service attendance.

Discussion and Implications: Our findings demonstrate a differential racial effect for loneliness and depressive symptoms. For both blacks and whites, greater loneliness affected depressive symptoms; however, the effect was stronger among whites than it was for blacks. Given this is one of the first studies to examine the differential effects of race on loneliness and depressive symptoms, more research is necessary to determine the consistency of these results.

}, keywords = {Mental Health, Negative interactions, Social networks, Social Support}, issn = {2399-5300}, doi = {10.1093/geroni/igaa048}, author = {Taylor, Harry O and Ann W Nguyen} } @mastersthesis {11124, title = {Depressive Symptoms in Late Life: The Role of Sociodemographic Factors, Retirement Timing, and Post-Acute Care}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {The mental well-being of older Americans is a pressing public health concern given the aging population and recent increases in midlife suicide and substance use. Depressive symptoms specifically are a common cause of poor quality of life in old age, and one of the leading causes of disability. This dissertation uses nationally-representative longitudinal data from the Health and Retirement Study to improve understandings of depressive symptoms in mid- and late life, their social patterning, and their intersection with post-hospital recoveries. In Chapter 2, I used mixed-effect models to characterize population trends in how depressive symptoms change over ages 51-90 by gender, race/ethnicity, educational attainment, and birth cohort. This research highlighted large disparities in depressive symptoms in midlife by educational attainment, pointing to the importance of early life exposures for late life health. Results also reaffirmed mental health concerns about recent birth cohorts. Looking at a key life event for this age group, I next focused on retirement timing. This research examined how expectations about full time work at age 62, reported between ages 51- 61, align with realized labor force status to determine whether unmet expectations about retirement timing relate to depressive symptoms across sociodemographic groups. The results revealed that unmet retirement expectations are more common among Hispanic and Black Americans compared to White Americans. In addition, those of low educational attainment were at high risk of unexpectedly not working at age 62. Interestingly, unexpectedly working was not associated with depressive symptoms, pointing to the benefits of work for mental health at older ages and the resilience of those adapting to staying in the labor force. Unexpectedly not working was associated with a small increase in depressive symptoms at age 62, which was explained by health declines between expectations and reaching age 62. Future research attention should be directed at mitigating health-related early labor force departures, which differentially occur among disadvantaged groups in America. Finally, I linked survey data from the Health and Retirement Study to Medicare claims data to consider the role of depressive symptoms in recovering from acute hospitalizations. I tested whether different post-acute care settings might mitigate the association between depressive symptoms and poor health outcomes {\textendash} hospital readmissions, falls, and mortality. Risk for 30-day hospital readmissions increased with increasing depressive symptoms for those recovering at home with or without home health, but not for patients in inpatient rehabilitation settings such as Skilled Nursing Facilities. Post-acute care settings did not modify the relationships between depressive symptoms and each of falls or mortality; therefore, referring depressed patients to inpatient rehabilitation settings could help hospitals avoid financial penalties for readmissions, but will not improve patients{\textquoteright} risks for falls or mortality. Together, this research provides a rich interdisciplinary look at social factors related to depressive symptoms in the aging population and gives insights into one aspect of health services that may address the harmful repercussions of depressive symptoms on other health outcomes. }, keywords = {Depressive symptoms, sociodemographics}, url = {https://deepblue.lib.umich.edu/bitstream/handle/2027.42/163101/lrabrams_1.pdf?sequence=1}, author = {Leah R. Abrams} } @article {Reedebnurs-2019-103246, title = {Depressive symptoms in the last year of life: early screening and varied treatment pathways needed}, journal = {Evidence-Based Nursing}, year = {2020}, abstract = {Depression is linked to poor quality of life as individuals near the end of life.1 This study examines the epidemiology of depressive symptoms in the year prior to death, assessing sociodemographic and clinical factors and their impact on the trajectory of depressive symptoms.}, keywords = {depression}, issn = {1367-6539}, doi = {10.1136/ebnurs-2019-103246}, url = {https://ebn.bmj.com/content/early/2020/02/07/ebnurs-2019-103246}, author = {Reed, Jacqueline} } @mastersthesis {10789, title = {DETERMINANTS OF LONG-TERM CARE INSURANCE: ARE SPOUSES SUBSTITUTES?}, volume = { University Honors}, year = {2020}, school = {University of Northern Iowa}, type = {Thesis}, address = {Cedar Falls}, abstract = {As the U.S. population continues to age due to medical advancements and the aging of the largest generation in the history of the U.S. (baby boomers), the number of people in long-term care facilities has increased significantly; however, the percentage of people with long-term care insurance is small. Research conducted in the early 2000s focused on factors such as availability of children, risk aversion, health status, age, having Medicaid, and other variables that describe personal attributes to explain why the market is so small. This paper will use recent data from the Health and Retirement Study to determine whether or not having a living spouse is a substitute for having long-term care insurance. In particular I investigated this question for those classified as middle baby-boomers. I found that being married has a positive and statistically significant impact on the whether or not an individual has long-term care insurance.}, keywords = {Long-term Care, Long-term care insurance, Spouses}, url = {https://scholarworks.uni.edu/hpt/426/?utm_source=scholarworks.uni.edu\%2Fhpt\%2F426\&utm_medium=PDF\&utm_campaign=PDFCoverPages}, author = {Jacob Harold-Matthew Haag} } @article {11242, title = {Development of Algorithmic Dementia Ascertainment for Racial/Ethnic Disparities Research in the US Health and Retirement Study.}, journal = {Epidemiology}, volume = {31}, year = {2020}, pages = {126-133}, abstract = {

BACKGROUND: Disparities research in dementia is limited by lack of large, diverse, and representative samples with systematic dementia ascertainment. Algorithmic diagnosis of dementia offers a cost-effective alternate approach. Prior work in the nationally representative Health and Retirement Study has demonstrated that existing algorithms are ill-suited for racial/ethnic disparities work given differences in sensitivity and specificity by race/ethnicity.

METHODS: We implemented traditional and machine learning methods to identify an improved algorithm that: (1) had <=5 percentage point difference in sensitivity and specificity across racial/ethnic groups; (2) achieved >=80\% overall accuracy across racial/ethnic groups; and (3) achieved >=75\% sensitivity and >=90\% specificity overall. Final recommendations were based on robustness, accuracy of estimated race/ethnicity-specific prevalence and prevalence ratios compared to those using in-person diagnoses, and ease of use.

RESULTS: We identified six algorithms that met our prespecified criteria. Our three recommended algorithms achieved <=3 percentage point difference in sensitivity and <=5 percentage point difference in specificity across racial/ethnic groups, as well as 77\%-83\% sensitivity, 92\%-94\% specificity, and 90\%-92\% accuracy overall in analyses designed to emulate out-of-sample performance. Pairwise prevalence ratios between non-Hispanic whites, non-Hispanic blacks, and Hispanics estimated by application of these algorithms are within 1\%-10\% of prevalence ratios estimated based on in-person diagnoses.

CONCLUSIONS: We believe these algorithms will be of immense value to dementia researchers interested in racial/ethnic disparities. Our process can be replicated to allow minimally biasing algorithmic classification of dementia for other purposes.

}, keywords = {Algorithms, Alzheimer{\textquoteright}s disease, Dementia, Disparities, Machine learning, Measurement}, issn = {1531-5487}, doi = {10.1097/EDE.0000000000001101}, author = {Kan Z Gianattasio and Ciarleglio, Adam and Melinda C Power} } @article {11302, title = {Diet Quality and Biological Risk in a National Sample of Older Americans}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {920}, abstract = {Biomarkers are sensitive to current health status and capture aspects of health that may precede the development of disease and other health problems. Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. For the analysis, we used nutrition and biomarker data from 3,641 older adults (over age 50) in the Health and Retirement Study. Eleven out of 13 individual dietary components were associated with lower biological risk. After controlling for SES, health behaviors, and access to health care, a high intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids and a low intake of sodium and saturated fat were still associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. After controlling for SES, health behaviors, and access to health care, respondents with poor/suboptimal quality diet continued to exhibit higher biological risk than those with good quality diet, though the differences in biological risk were reduced. Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids, while limiting consumption of sodium and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity.}, keywords = {biological risk, diet quality}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.3378}, author = {Choi, Yeon Jin and Jennifer A Ailshire and Jung K Kim and Eileen M. Crimmins} } @article {zuniga_bishop_turner_2020, title = {Dietary lutein and zeaxanthin are associated with working memory in an older population}, journal = {Public Health Nutrition}, year = {2020}, abstract = {Objective: The purpose of the study was to examine the association between dietary lutein and zeaxanthin (L + Z) intake and immediate word recall (IWR) and delayed word recall (DWR), and to identify the major contributors to dietary L + Z intake in a recent and representative sample of the older US population. Design: In this cross-sectional analysis, multivariate path analytic models estimated the association between L + Z consumption and cognitive performance while adjusting for covariates. Setting: Observations were drawn from the 2014 Health and Retirement Study, a nationally representative panel study of older US adults, and the 2013 Health Care and Nutrition Study, which assessed dietary intake via FFQ in a subsample of respondents. Participants: The analytic sample included 6390 respondents aged >=50 years. Results: L + Z intake was 2{\textperiodcentered}44 {\textpm} 2{\textperiodcentered}32 mg/d on average, and L + Z intake differed significantly across quartiles (P < 0{\textperiodcentered}001). For example, average L + Z intake in Q1 was 0{\textperiodcentered}74 {\textpm} 0{\textperiodcentered}23 mg/d and in Q4 was 5{\textperiodcentered}46 {\textpm} 2{\textperiodcentered}88 mg/d. In covariate adjusted models, older adults in the highest quartiles of L + Z intake had significantly greater IWR and DWR scores than those in the lowest quartile. Leafy vegetables, cruciferous vegetables, dark yellow vegetables, fish and seafood, legumes, eggs and fruit were significant and meaningful predictors of dietary L + Z intake. Conclusion: A high consumption of vegetables, fish and seafood, legumes, eggs and fruit is associated with a higher intake of L + Z and greater word recall among older adults.}, keywords = {Carotenoid, Cognition, Episodic Memory, Lutein, Memory, Older adult, Zeaxanthin}, doi = {10.1017/S1368980019005020}, author = {Krystle E Zuniga and Nicholas J Bishop and Turner, Alexandria S} } @article {10975, title = {Differences in Longitudinal Trajectories between Groups - The Multi-Group Latent Growth Components Approach }, year = {2020}, institution = {9th European Congress of Methodology}, abstract = {Purpose: In this article, we propose a multi-group approach for analyzing complex nonlinear longitudinal trajectories. Method: The approach is based on the latent growth components approach (LGCA) that offers a flexible framework for defining growth components and extends the same for the use with multiple groups. The approach benefits from known advantages of the LGCA and adds more capabilities from the multi-group framework, that is, (1) it can flexibly include complex nonlinear growth components, (2) incorporate a measurement model for the latent state variables and latent covariates, (3) it can model differences in growth components based on categorical covariates, and (4) treat covariates and group weights as fixed or stochastic. Results and conclusions: We demonstrate the approach using data from the Health and Retirement Study that includes individuals diagnosed with cancer. We analyze trajectories in depressive symptoms before and after the cancer diagnosis with respect to a subset of categorical covariates (i.e., groups). We further present the open-source R package semnova that implements the proposed approach and makes it conveniently accessible for applied researchers. }, keywords = {Average effects, Latent growth components approach, Latent growth models, Longitudinal research, Multi-group analysis}, url = {https://adeit-estaticos.econgres.es/20_EAM/Symposium/47784_Torre.pdf}, author = {Langenberg, Benedikt and Axel Mayer} } @article {KAMPFEN2020100579, title = {Differences in physical health across populations and their implications for the old-age dependency ratio in high-, middle- and low-income countries}, journal = {SSM - Population Health}, volume = {11}, year = {2020}, abstract = {The standard approach for comparing the potential challenges of population aging across countries based on conventional old-age dependency ratios (OADR) does not account for cross-population differences in health, functional capacity or disability, despite their importance for labor force participation and dependency more broadly. We investigate how OADRs observed across selected low-, middle-, and high-income countries change if population differences in physical health measured by hand-grip strength are accounted for. Specifically, we propose and calculate an adjusted measure of the OADR based on hand-grip strength, which serves as an objective indicator of muscle function and has been shown to predict future morbidity, disability and mortality. We show that adjusting the OADR for differences in hand-grip strength results in substantial changes in country rankings by OADR compared to a ranking based on the conventional OADR definition. Accounting for cross-population differences in hand-grip strength, the estimated OADRs for low- and middle-income countries tend to increase compared to the conventional OADR approach based on age only, whereas the estimated OADRs in high-income countries decline substantially relative to the standard approach. Since hand-grip strength is an important prerequisite for maintaining functional capacity and productivity and preventing disability {\textendash}especially in economies in low-income settings{\textendash} our grip-strength-adjusted OADRs clearly show that population aging is not just a challenge in high-income countries but also an important concern for economies in the developing world.}, keywords = {Age/cohort profile of work, Cross-country comparisons, Hand-grip strength, Old-age dependency ratio, Physical Health}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2020.100579}, author = {Fabrice K{\"a}mpfen and Iliana V. Kohler and Mamadou Bountogo and James Mwera and Hans-Peter Kohler and J{\"u}rgen Maurer} } @article {10868, title = {Difficulty and help with activities of daily living among older adults living alone with cognitive impairment}, journal = {Alzheimer{\textquoteright}s \& DementiaAlzheimer{\textquoteright}s \& DementiaAlzheimer{\textquoteright}s Dement.}, year = {2020}, month = {2020/06/26}, abstract = {Abstract Introduction There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity. Methods For U.S. Health and Retirement Study (2000?2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help. Results Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46\% reported an I/ADL difficulty; 72\% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22\% more likely to report a difficulty without help, and Latina women were 36\% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries. Discussion Findings call for targeted efforts to support older adults living alone with cognitive impairment.}, keywords = {Activities of Daily Living, Aging in place, CIND, Dementia, Disability, limitations, Living arrangement, population-based study, service gaps}, isbn = {1552-5260}, doi = {10.1002/alz.12102}, author = {Ryan D. Edwards and Willa D Brenowitz and Portacolone, Elena and Kenneth E Covinsky and Bindman, Andrew and M. Maria Glymour and Jacqueline M Torres} } @article {11134, title = {Difficulty with Taking Medications Is Associated with Future Diagnosis of Alzheimer{\textquoteright}s Disease and Related Dementias.}, journal = {Journal of General Internal Medicine}, year = {2020}, abstract = {

BACKGROUND: Medication management requires complex cognitive functioning, and therefore, difficulty taking medications might be an early sign of cognitive impairment and could be a risk factor for Alzheimer{\textquoteright}s disease and related dementias (ADRD). Accordingly, people with difficulty taking medications may benefit from more detailed cognitive screening, potentially aiding in the diagnosis of ADRD, which is underdiagnosed. We are unaware of evidence on medication management difficulties that precede a real-world ADRD diagnosis in the USA.

OBJECTIVE: Examine the association between difficulty taking medications and subsequent real-world ADRD diagnoses.

DESIGN: Case-control study, using Health and Retirement Study (HRS) survey data linked to Medicare claims.

PARTICIPANTS: A total of 1461 HRS respondents with an ADRD diagnosis observed from 1993 to 2012 (cases), matched by year of birth, wave of HRS entry, and sex to 3771 controls with no ADRD diagnosis.

MAIN MEASURES: We examined the association between diagnosis of ADRD and self-reported difficulty taking medications in the preceding years (1-2 and 3-4~years prior to case definition). Control individuals were assigned the index date from their matched case. Conditional logistic regressions adjusted for age, sex, race, education, and comorbidities.

KEY RESULTS: Compared with matched controls, cases had higher prevalence of difficulty taking medications 1-2~years prior to diagnosis (11.0\% versus 2.3\%), and 3-4~years prior to diagnosis (5.8\% versus 2.3\%). Adjusted analyses showed that compared with individuals without ADRD, those with an ADRD diagnosis had more than four times higher odds of difficulty taking medications 1-2~years prior (OR = 4.56 (CI 3.30-6.31)), and more than two times higher odds of difficulty taking medications 3-4~years prior (OR = 2.41 (CI 1.61-3.59)).

CONCLUSIONS: Odds of medication difficulty 1-2~years prior were more than four times greater for individuals with ADRD diagnoses compared with those without ADRD. Medication management difficulties may prompt further cognitive screening, potentially aiding in earlier recognition of ADRD.

}, keywords = {Alzheimer{\textquoteright}s disease and related dementias, cognitive screening, medication management}, issn = {1525-1497}, doi = {10.1007/s11606-020-06279-y}, author = {Douglas Barthold and Marcum, Zachary A and Chen, Shuxian and White, Lindsay and Ailabouni, Nagham and Basu, Anirban and Norma B Coe and Gray, Shelly L} } @article {11155, title = {Disability and Wealth: Exploring the Liquid Asset Trajectories of SSI and SSDI Applicants}, year = {2020}, institution = {University of Wisconsin-Madison}, address = {Madison,WI}, abstract = {Social safety net programs provide benefits that insure against disability, poor health, unemployment, and old age. These programs stabilize the financial lives of beneficiaries. In this study, I investigate whether the disability programs Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) protect household wealth, including household savings and liquid assets. Using longitudinal data from the 1992{\textendash}2016 waves of the Health and Retirement Study (HRS), I examine the liquid wealth trajectories of disability program applicants by application timing and decision. I also examine how these trajectories differ by net worth for SSI applicants subject to asset tests. In addition to this descriptive evidence, I employ a panel events study design to examine the effect of application timing on savings net of fixed year and individual effects as well as observed time-varying characteristics. I do not find evidence that disability application timing significantly affects liquid assets.}, keywords = {Disability, Household Savings, Social Security Disability Insurance, Supplemental Security Income, Wealth}, url = {https://cfsrdrc.wisc.edu/files/working-papers/WI19_JSIT_03_lesperance_revised-(1).pdf}, author = {L{\textquoteright}Esperance, Madelaine} } @article {9766, title = {Disentangling the Stress Process: Race/Ethnic Differences in the Exposure and Appraisal of Chronic Stressors among Older Adults.}, journal = {Journals of Gerontology Series B: Psychological Sciences \& Social Sciences}, year = {2020}, abstract = {

Objectives: Exposure to stressors is differentially distributed by race/ethnicity with minority groups reporting a higher stress burden than their white counterparts.~However, to really understand the extent to which some groups bear a disproportionate stress burden we need to consider race/ethnic differences in stress appraisal, specifically how upsetting stressors may be, in addition to stress exposure. We examine racial/ethnic differences in both the number of reported chronic stressors across 5 domains (health, financial, residential, relationship and caregiving) and their appraised stressfulness among a diverse sample of older adults.

Method: Data come from 6,567 adults ages 52+ from the 2006 Health and Retirement Study.

Results: Results show older blacks, US and foreign-born Hispanics report more chronic stress exposure than whites and are two to three times as likely to experience financial strain and housing-related stress. Socioeconomic factors fully explain the Hispanic-white difference in stress exposure, but black-white differences remain. Despite experiencing a greater number of stressors, blacks and US-born Hispanics are less likely to be upset by exposure to stressors than whites. US-born Hispanics are less upset by relationship-based stressors specifically, while blacks are less upset across all stress domains in fully adjusted models. Foreign-born Hispanics are only less upset by caregiving strain.

Discussion: The distinction between exposure and appraisal based measures of stress may shed light on important pathways that differentially contribute to race/ethnic physical and mental health disparities.

}, keywords = {Chronic stress, Depressive symptoms, Racial/ethnic differences, Socioeconomic factors}, issn = {1758-5368}, doi = {10.1093/geronb/gby072}, author = {Lauren L Brown and Uchechi A Mitchell and Jennifer A Ailshire} } @article {11153, title = {Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study.}, journal = {PLoS One}, volume = {15}, year = {2020}, pages = {e0238356}, abstract = {

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample.

METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men{\textquoteright}s mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health.

RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency.

IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.

}, keywords = {Adult, African Americans, Aged, Aged, 80 and over, Chronic disease, Communication, Cross-Sectional Studies, Follow-Up Studies, Healthcare Disparities, Hispanic Americans, Humans, Insurance Coverage, Male, Middle Aged, Patient Education as Topic, Patient-Centered Care, Physician-Patient Relations, Prognosis, Racism}, issn = {1932-6203}, doi = {10.1371/journal.pone.0238356}, author = {Mitchell, Jamie A and Perry, Ramona} } @article {11133, title = {Dispositional optimism (and pessimism), wealth, and stock market participation}, journal = {Journal of Economic Psychology}, year = {2020}, abstract = {In this paper I analyze the relationship between dispositional optimism (pessimism) and saving decisions. The key contribution of this paper is the use of direct psychometric measures of psychological dispositions as available in the Health and Retirement Study (HRS). The psychometric measures allow me to control for optimism and pessimism separately. Dispositional pessimism is shown to be significantly related to wealth holdings and stock market participation {\textendash} optimism is not significantly related. A one standard deviation decrease in pessimism is associated with holding 64 thousand US- more overall wealth and an increase in the likelihood of holding stocks of 2.4\%.}, keywords = {Dispositional optimism, household finance, Saving behavior}, isbn = {0167-4870}, doi = {https://doi.org/10.1016/j.joep.2020.102328}, author = {Grevenbrock, Nils} } @article {10696, title = {Disrespect at Work, Distress at Home: A Longitudinal Investigation of Incivility Spillover and Crossover Among Older Workers}, journal = {Working, Aging and Retirement}, year = {2020}, type = {Journal}, abstract = {The prevalence of workplace mistreatment toward older adults is well-documented, yet its effects are understudied. We applied the strength and vulnerability integration model (SAVI) to hypothesize that, despite its low intensity, workplace incivility has numerous deleterious outcomes for older employees over time. Specifically, we investigated whether and how incivility relates to well-being outside of work, among both targeted employees and their partners. We drew on affective events theory to examine how incivility {\textquotedblleft}spills over{\textquotedblright} to older targets{\textquoteright} personal lives. We also tested whether incivility is potent enough to {\textquotedblleft}crossover{\textquotedblright} to the well-being of older targets{\textquoteright} partners at home. Based on longitudinal data from a national study of older workers (N = 598; 299 couples), results demonstrate that workplace incivility related to decrements in targets{\textquoteright} affective well-being, which in turn, was associated with life dissatisfaction, interference with work, and lower overall health. Workplace incivility also predicted declines in partner well-being, although these crossover effects varied by gender: Men{\textquoteright}s postincivility affective well-being predicted their female partners{\textquoteright} life satisfaction but not vice versa. However, women{\textquoteright}s uncivil experiences directly related to the affective well-being of their male partners. These results suggest that for both older workers and their partners, the harms of incivility eventually extend beyond the organizations where they originate.}, keywords = {Older Adults, Workplace incivility}, doi = {10.1093/workar/waaa007}, author = {Lisa A Marchiondo and Gwenith G Fisher and Cortina, Lilia M. and Matthews, Russell A.} } @inbook {11531, title = {The Distributional Financial Accounts of the United States}, booktitle = {MEASURING DISTRIBUTION AND MOBILITY OF INCOME AND WEALTH}, year = {2020}, note = {SERIES: STUDIES IN INCOME AND WEALTH}, publisher = {UNIVERSITY OF CHICAGO PRESS}, organization = {UNIVERSITY OF CHICAGO PRESS}, address = {Chicago, IL}, abstract = {This paper describes the construction of the Distributional Financial Accounts (DFA), a dataset containing quarterly estimates of the distribution of U.S. household wealth since 1989. The DFA builds on two existing Federal Reserve Board statistical products{\textemdash}quarterly aggregate measures of household wealth from the Financial Accounts of the United States, and triennial wealth distribution measures from the Survey of Consumer Finances{\textemdash}to incorporate distributional information into a national accounting framework. The DFA complements other sources by generating distributional statistics that are consistent with macro aggregates by providing quarterly data on a timely basis, and by constructing wealth distributions across demographic characteristics. We encourage policymakers, researchers, and other interested parties to use the DFA to better understand issues related to the distribution of U.S. household wealth.}, keywords = {Distributional Financial Accounts}, url = {https://www.nber.org/books-and-chapters/measuring-distribution-and-mobility-income-and-wealth/distributional-financial-accounts-united-states}, author = {Batty, Michael M. and Bricker, Jesse and Briggs, Joseph S. and Friedman, Sarah and Nemschoff, Danielle and Nielsen, Eric and Sommer, Kamila and Alice Henriques Volz} } @article {11009, title = {Disuse as time away from a cognitively demanding job; how does it temporally or developmentally impact late-life cognition?}, journal = {Intelligence}, volume = {82}, year = {2020}, abstract = {Cognitive aging and disuse atrophy during a non-working period are often indiscernible due to retirement. This study uses a latent growth curve model that estimates cognitive change, independently and jointly by time over a period, time away from work, and the cognitive job demands of the latest job, while adjusting for attrition biases. Data consist of 14,124 Health and Retirement Study participants whose cognition was assessed at least twice between 1996 and 2016, with the word-recall and the vocabulary tests. Independently of cognitive aging, the word-recall score temporarily declines for the following 17 years of a disuse period while the vocabulary score slightly and constantly improves. In both tests, cognitive aging accelerates over time away from work, and leaving a more cognitively demanding job attenuates cognitive decline during a disuse period and does not slow cognitive aging itself.}, keywords = {cognitive aging, Cognitive Reserve, Disuse atrophy, Joint modeling, Longitudinal analysis,, Use-or-lose-it hypothesis}, isbn = {0160-2896}, doi = {https://doi.org/10.1016/j.intell.2020.101484}, author = {Oi, Katsuya} } @article {BasuRoy2020, title = {Do Hispanic immigrants spend less on medical care? Implications of the Hispanic health paradox}, journal = {Applied Economics}, year = {2020}, note = {cited By 0}, type = {Journal}, abstract = {The literature of the Hispanic heath paradox has found that in the U.S. Hispanic immigrants have better health than U.S. natives, even though they tend to have lower socioeconomic status. The main objective of the current study is to investigate whether Hispanic immigrants also use less medical care goods and services. Main contributions of the article include using a data set of older Americans from the Health and Retirement Study covering the period from 1992 to 2012 as well as using three new measures of health, rather than the more common use of morbidity or mortality. We estimate the impact of relevant factors including health, race, and immigrant status upon five different measures of healthcare usage. Even though Hispanic immigrants do have lower mean levels of most measures of healthcare usage, when controlling for other factors in our regressions we find some evidence of increased healthcare usage for Hispanic immigrants. Increased health care utilization may be one explanation for the Hispanic health paradox. {\textcopyright} 2020, {\textcopyright} 2020 Informa UK Limited, trading as Taylor \& Francis Group.}, keywords = {Demand for medical care, healthcare utilization, Hispanic health paradox, latent health stock}, doi = {10.1080/00036846.2020.1726863}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85080038143\&doi=10.1080\%2f00036846.2020.1726863\&partnerID=40\&md5=cfb70e4c0ea2a9569335cb2ae3905bc4}, author = {Basu Roy, S. and Olsen, R.N. and Tseng, H.} } @article {11329, title = {Do Mediators Linking Childhood Conditions to Late-Life Chronic Inflammation Vary by Race?}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {461-462}, abstract = {Recent findings suggest that childhood exposures can lead to chronic inflammation decades later, but the mechanisms underlying this relationship are relatively unknown. We investigate how childhood exposures influence adult chronic inflammation (measured by C-reactive protein) and examine five potential mediators comprising two midlife domains: socioeconomic status (SES) and health lifestyles. Using a sample of 8,891 adults aged 51 and older from the Health and Retirement Study (HRS), the analysis tests whether these life course mediators operate differently for Black, White, and Hispanic Americans. Among the six childhood domains examined, low SES and risky parental behaviors predict adult chronic inflammation, but adult health lifestyles mediate the effects of childhood SES and parental behavior. Adult SES also mediates the effect of childhood SES. Smoking and wealth exert stronger direct and indirect effects on adult inflammation for White Americans compared to Black Americans whereas BMI and exercise exert stronger direct and indirect effects for White Americans compared to Hispanic Americans. Although education mediated the effect of childhood SES on adult chronic inflammation, its effects did not vary by race. These results demonstrate that the physiological consequences of childhood exposures are carried into late-life via adult lifestyle factors and SES. In addition, the life course antecedents of chronic inflammation are distinct for Black, White, and Hispanic Americans. Future research investigating the early origins of adult health should consider not only multiple midlife mechanisms but also how resource mediation varies by race and ethnicity.}, keywords = {childhood conditions, chronic inflammation, race}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1494}, author = {Kenneth F Ferraro and Patricia M Morton} } @article {10932, title = {Do Older Workers Without Benefits Find Health and Retirement Coverage?}, number = {IB$\#$20-12}, year = {2020}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {Workers in nontraditional jobs, without health and retirement benefits, have to seek coverage elsewhere.On the health side, most do obtain coverage {\textendash} often through a spouse{\textquoteright}s employer or a private individual policy.And the percentage remaining uninsured has been declining in the wake of the Affordable Care Act, particularly in states that expanded Medicaid coverage.On the retirement side, workers often end up with no viable option, as they rarely open an IRA and their spouses with a 401(k) do not save more to compensate.The failure on the retirement side highlights the need for auto-IRA programs.}, keywords = {health coverage, nontraditional jobs, Older workers, Retirement}, url = {https://crr.bc.edu/briefs/do-older-workers-without-benefits-find-health-and-retirement-coverage/}, author = {Matthew S. Rutledge} } @article {10684, title = {Do Satisfied Older Employees Perceive More Social Support Over Time? A Cross-Lagged Examination}, journal = {Journal of Applied Gerontology}, year = {2020}, note = {PMID: 32129127}, type = {Journal}, abstract = {Perceived social support has traditionally been examined as an antecedent of well-being, including job satisfaction. The current study offers a new perspective in which job satisfaction can be both an antecedent and outcome of support in older employees. Two wave data from 910 older employees who participated in the Health and Retirement Study were used to test the hypotheses using a cross-lagged panel model. The results indicate that job satisfaction predicts subsequent perceived support from both supervisors and coworkers. However, perceived support from either supervisors or coworkers does not predict subsequent job satisfaction. The discussion suggests that unsatisfied employees, who likely are in greater need of support from their supervisors and peers, perceive having less support available to them. Practically, interventions aimed at increasing satisfaction might also benefit employees{\textquoteright} perceived support, and organizations could leverage our findings to create more favorable work environments.}, keywords = {cross-lagged model, Job Satisfaction, older employees, perceived social support}, doi = {10.1177/0733464820910043}, author = {Shani Pindek and Dikla Segel-Karpas} } @article {11336, title = {Do Social Support and Strain Mediate the Relationship Between Childhood Exposures and Frailty in Later Life?}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {497}, abstract = {Previous studies have identified the early origins of physical frailty, notably poor childhood health and socioeconomic status, but relatively few studies examine whether social support in later life mitigates the influence of early noxious exposures on frailty. Given the established relationship between health and social relationships in older adults, this research uses data from the Health and Retirement study (2004-2016) to examine whether social support and strain mediate the effect of childhood exposures on frailty in later life. A series of linear regression and pathway models were estimated to test whether childhood exposures, including socioeconomic status, infectious and chronic diseases, impairments, and risky adolescent parental behaviors, were associated with phenotypic frailty (Fried et al. 2001). After adjusting for demographic and adult factors, accumulated childhood misfortune was directly (b=0.015, p<.01) and indirectly (b=0.007, p<.001) associated with more frailty. Average social support, but not strain, from one{\={a}}{\texteuro}{\texttrademark}s spouse, children, family and friends significantly mediated the relationship between accumulated misfortune and frailty (b= -.002, p<.01). Path analysis revealed that social support reduces later life frailty directly (b=-0.106 ,p<.001) and indirectly through a reduction in adult morbidity (b=-0.031, p<.001). However, counterintuitively we found that accumulated misfortune was associated with more social support. Supplemental analyses reveal that one or more infectious diseases in childhood were responsible for the positive relationship (b= 0.393, p<.001). These results have implications for how we may reduce the burden of frailty on those who have experienced misfortune early in life.}, keywords = {Childhood exposures, Frailty, Social strain, Social Support}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1606}, author = {Monica Williams-Farrelly and Kenneth F Ferraro} } @article {11343, title = {DO WEALTH SHOCKS MATTER FOR THE LIFE SATISFACTION OF THE ELDERLY? EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY }, number = {DDP2002}, year = {2020}, institution = {Department of Economics, University of Victoria}, address = {Victoria, B.C., Canada}, abstract = {This note studies the determinants of life satisfaction for the elderly and near-elderly in the U.S., using data from the Health and Retirement Study. The econometric analysis exploits the 2008-09 financial crisis as a source of exogenous variation in wealth, caused by a long-lasting decrease in asset prices. Although absolute changes in wealth are not found to systematically affect individuals{\textquoteright} well-being, losing 60\% or more of the pre-crisis wealth negatively impacted measures of life satisfaction.}, keywords = {Life Satisfaction, Subjective well-being, Uninsurable shocks, Wealth}, issn = {1914-2838 }, url = {https://www.uvic.ca/socialsciences/economics/assets/docs/discussion/ddp2002.pdf}, author = {Cozzi, Marco and Li, Qiushan} } @article {10998, title = {Does being active mean being purposeful in older adulthood? Examining the moderating role of retirement.}, journal = {Psychology and Aging}, year = {2020}, abstract = {

The degree to which individuals engage in leisure activities has been shown to predict well-being in older adults, but it is not known whether such activities may help older adults maintain purposefulness into retirement. The current study sought to address whether activity engagement is associated with purpose in life and whether this association differs based on retirement status. We used data from three waves of the Health and Retirement Study between 2008 and 2016. Multilevel growth models accounted for both within- and between-person effects of leisure activity participation and retirement status on change in sense of purpose in life. Participants reported higher sense of purpose on occasions when they engaged more in leisure activities, and more active participants exhibited less decline in purpose over time. Retired individuals showed steeper declines in sense of purpose, but this effect was mitigated among participants reporting greater activity engagement. Leisure activity participation may help to support sense of purpose in life, particularly among retired individuals. These findings underscore the potential for leisure activity interventions to help older adults compensate for loss of work-related roles and maintain purposefulness into retirement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

}, keywords = {Activity engagement, life purpose, Retirement}, issn = {1939-1498}, doi = {10.1037/pag0000568}, author = {Nathan A Lewis and Patrick L Hill} } @article {11203, title = {Does Late-Career Nontraditional Work Improve Retirement Security?}, number = {IB$\#$20-15}, year = {2020}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {Policymakers and the media have expressed concern that nontraditional jobs lack stability and financial security. Indeed, having a nontraditional job {\textendash} defined here as a job without employer health and retirement benefits {\textendash} during the prime saving years of ages 50-61 is associated with less retirement security.1 But nontraditional jobs need not be {\textquotedblleft}bad jobs{\textquotedblright} for all workers. Compared to traditional work, they may be a better fit for those in their 60s looking to prolong their careers by offering less stress and more flexibility.2 This brief, based on a recent study, examines how workers use nontraditional jobs after age 62, relying on data from the Health and Retirement Study linked to administrative earnings.3 It explores two questions. First, are workers in their early 60s who are underprepared for retirement more likely to use nontraditional jobs? Second, are such jobs a useful alternative to traditional work for those seeking to enhance their retirement security? The discussion proceeds as follows. The first section introduces the data and the sample. The second section describes the analytic approach, which follows three groups of workers with different employment patterns in their 60s. The third section compares the retirement security of these three groups at ages 61-62 and examines the changes they experience in retirement security by ages 67-68. The final section concludes that the workers who start out less prepared for retirement are not more likely to switch to nontraditional work in their mid-60s. But underprepared workers who do switch improve their retirement security as much as those who stay in traditional work. These results suggest that extended careers are financially beneficial, even in jobs without health and retirement benefits.4}, keywords = {nontraditional jobs, retirement security}, url = {https://crr.bc.edu/briefs/does-late-career-nontraditional-work-improve-retirement-security/}, author = {Matthew S. Rutledge and Gal Wettstein} } @article {10846, title = {Does Perceived Ageism Widen the Digital Divide? And Does It Vary by Gender?}, journal = {Gerontologist}, volume = {60}, year = {2020}, pages = {1213-1223}, abstract = {Existing literature presents a widening digital divide among older adults in addition to the consideration of the potential adverse impacts of ageism on internet use among the older adult population. Our study aimed to investigate (1) whether older adults{\textquoteright} perceived ageism will be associated with their use of the internet and (2) whether the relationship between perceived ageism and internet use will be moderated by age groups and binary gender.Using the data from the 2016 Health and Retirement Study, regression analyses were separately performed by gender. Two measures of perceived ageism were considered: (1) self-perception of aging and (2) perceived age discrimination.Our findings suggested that greater exposure to ageism is generally related to less use of the internet. In addition, we found divergent patterns in the relationship between ageism and internet use by gender. For women, a lower level of internet use was predicted by more negative perceptions of aging, whereas men{\textquoteright}s internet use was associated with the experience of age discrimination. Furthermore, interaction effects between age groups and ageism varied across gender. The negative perception of aging was more strongly associated with less internet use in older women than middle-aged women. In comparison, the perceived age discrimination predicted less internet use in middle-aged men than older men.Our findings suggest that perceived ageism is significantly associated with internet use, and its association differs by gender.}, keywords = {Ageism, gender issues, Technology}, isbn = {0016-9013}, doi = {10.1093/geront/gnaa066}, author = {Eun-Young Choi and Kim, Youngsun and Chipalo, Edson and Lee, Hee Yun} } @article {RePEc:dem:wpaper:wp-2020-013, title = {Does postponing retirement affect cognitive function? A counterfactual experiment to disentangle life course risk factors}, number = {2020-013}, year = {2020}, institution = {Max Planck Institute for Demographic Research}, type = {Report}, address = {Rostock, Germany}, abstract = {Life-course sociodemographic and behavioral factors affect later-life cognitive function. Some evidence suggests that contemporaneous labor force participation also affects cognitive function; however, it is unclear whether it is employment itself or endogenous factors related to individuals{\textquoteright} likelihood of employment that protects against cognitive decline. We exploit innovations in counterfactual causal inference to disentangle the effect of postponing retirement on later-life cognitive function from the effects of other life-course factors. With the U.S. Health and Retirement Study (1996-2014, n=20,469), we use the parametric g-formula to estimate the population-averaged effect (PAE) of postponing retirement to age 67, the average treatment on the treated (ATT), the moderating effect of gender, education, and occupation, and the mediating effect via depressive symptoms and comorbidities. We find that postponing retirement is protective against cognitive decline, accounting for other life-course factors (age 67 PAE: 0.34, 95\% confidence interval (CI): 0.20,0.47; ATT: 0.43, 95\% CI: 0.26,0.60). The extent of the protective effect depends on subgroup, with the highest educated experiencing the greatest reduction in cognitive decline (age 67 ATT: 50\%, 95\% CI: 32\%,71\%). By using innovative models that better reflect the empirical reality of interconnected life-course processes, this work makes progress in understanding how retirement affects cognitive function.}, keywords = {Age at retirement, Ageing, Labor, length of working life, Retirement}, doi = {10.4054/MPIDR-WP-2020-013}, url = {https://ideas.repec.org/p/dem/wpaper/wp-2020-013.html}, author = {Jo Mhairi Hale and Maarten J. Bijlsma and Angelo Lorenti} } @article {10695, title = {Does retirement affect voluntary work provision? Evidence from England, Ireland and the U.S.}, number = {N299-20}, year = {2020}, institution = {National University of Ireland Maynooth}, type = {Report}, address = {Maynooth}, abstract = {Voluntary work is an important contribution for many non-profit organizations, such as charities, political and religious organizations. Older individuals make up a sizable share of the volunteer workforce, and volunteering is often regarded as an example of {\textquotedblleft}active ageing{\textquotedblright}. In this study, we examine whether retirement has a causal effect on the frequency of voluntary work provision in three English-speaking countries {\textendash} England, Ireland and the U.S. We draw on data from the ELSA, TILDA and HRS studies and employ a harmonised approach in the empirical analysis. We use eligibility ages for old age pensions in an instrumental variable estimation to address potential confounding. We find that retirement increases the frequency of voluntary work provision in all three countries, especially among men. This suggests that labour market policies aimed at increasing labour force participation at older ages might have unintended consequences for the size of the volunteer workforce. }, keywords = {ELSA, instrumental variables, Retirement, TILDA, voluntary work}, url = {http://repec.maynoothuniversity.ie/mayecw-files/N299-20.pdf}, author = {Eibich, Peter and Angelo Lorenti and Mosca, Irene} } @article {10938, title = {Does Retirement Get Under the Skin and Into the Head? Testing the Pathway from Retirement to Cardio-Metabolic Risk, then to Episodic Memory}, journal = {Research on Aging}, year = {2020}, abstract = {Many studies document significant causal impacts of retirement on cognitive abilities. It remains unclear if cognitive functioning could be hindered in post-retirement due to heightened physiological responses to stress. Using repeated observations of biomarkers, retirement status, and the word-recall test score from the Health and Retirement Study (n = 25,367; 15,343 among women and 10,024 among men), the study tests this pathway, separately for men and women. The study employs the two-stage least squares fixed-effects model that simultaneously fits three equations predicting the total-recall score, cardio-metabolic risk index, and retirement status. Being retired for at least a year decreases cardio-metabolic risk for men and women, and the resulting relief of cardio-metabolic risk improves cognitive functioning for women but not for men. Retirement does not lead to a downward health spiral as previously suggested; rather, it provides a much needed relief from stressors for those who are at health risks.}, keywords = {Cognitive decline, gender, labor force, Retirement, Stress}, isbn = {0164-0275}, doi = {https://doi.org/10.1177/0164027520941161}, author = {Oi, Katsuya} } @article {10.1093/geront/gnz187, title = {Does Sexual Orientation Relate to Health and Well-Being? Analysis of Adults 50+ Years of Age}, journal = {Gerontologist}, volume = {60}, year = {2020}, pages = {1282-1290}, abstract = {Based on the Minority Stress Theory, this article examines the associations between sexual orientation and self-reported measures of physical, mental, and cognitive health, as well as health risk behaviors.The analytical sample included members of the 2016 wave of the Health and Retirement Study aged 50+ years. Binary and ordered logistic regressions were conducted to assess whether being a sexual minority was associated with poorer self-rated physical, mental, and cognitive health, as well as being more likely to engage in health risk behaviors.In analyses using overall and propensity-matched samples, lesbian, gay, and bisexual (LGB) participants were about twice as likely to report ever having depression as their heterosexual counterparts but were also more likely to report better self-rated health. The LGB group was more likely to report ever having smoked but were not significantly different in any of the other health risk behaviors.LGB individuals appear to be at greater risk of ever experiencing depression than heterosexual individuals but, at the same time, report better physical health. This may suggest a tendency for resilience. Differences in health risk behavior may also exist. Mental health and other medical professionals should receive special training to better understand the unique problems of LGB individuals.}, keywords = {depression, LGB, Minority Stress Theory}, issn = {0016-9013}, doi = {10.1093/geront/gnz187}, author = {Nelson, Christi L and Andel, Ross} } @article {11283, title = {Does Spouse{\textquoteright}s Dementia Diagnosis Make Individuals Skimp on Health Care?}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, month = {2020/12/16}, pages = {475 }, abstract = {Dementia is a costly disease that places great burden on individuals, families, and health care systems. The substantial time and financial resources taken away by living with persons with dementia (PWDs) may make their spouses forgo needed health care, thus deteriorating long-term health. To quantify the effect of dementia on spouses{\textquoteright} health investment, I employed a difference-in-difference approach, comparing use of preventive services and doctor visits before and after spouses{\textquoteright} dementia onset. Using Health and Retirement Study (HRS) with linkage to Medicare claims, I identified 650 older adults whose spouses had incident dementia during 1993 to 2007, and matched them to 1,816 controls whose spouses were dementia-free. Primary analysis reveals that individuals whose spouse had dementia did not change their use of most health services, relative to dementia-free controls. In stratified analysis, middle-class individuals skimped on flu shot and diabetes screening. Providing help for activities of daily living (ADLs) was associated with 1.9 less doctor visits, the effect of which was stronger among females (2.5 less visits). Help with instrumental activities of daily living (IADLs) was not a predictor of any utilization outcome. In conclusion, externalities of dementia imposed on family members are more profound and complex than deprivation of time. Certain subgroups were worse off in health investment when facing the trade-off between caring for spouses with dementia and caring for themselves. When understanding dementia burden, the externality imposed on spouses and its heterogeneity should be considered.}, keywords = {Dementia, spouse}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1537}, author = {Chen, Yi} } @article {11306, title = {Does the Sharing of Resources Impact Health Among Married Couples? New Findings From Dyadic Models}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {582}, abstract = {As married couples aging together, their health behaviors and outcomes could be shaped by both one{\textquoteright}s own and the spouse{\textquoteright}s characteristics. Using dyadic datasets, speakers in this symposium explored the interdependence nature of marital relations by identifying the mechanisms of how shared resources or strains affect spouses{\textquoteright} physical and mental health outcomes among married couples. Wang, Kim, and Burr identified distinct types of personality configurations among older couples using the Health and Retirement Study, and examined how personality compatibilities could buffer negative effects of adverse life events on older couples{\textquoteright} mental health. Using data from the National Social Life, Health, and Aging Project, Proulx, Skoblow, and Han further investigated the associations between marital quality and mental health among caregiving dyads, with a special focus on a comparison of different caregiving groups (spouse, child, others). From a physical health perspective, Wilson and Novak presented the dynamic behind relationship quality, joint health behaviors, health problems, health satisfaction, and health similarity between spouses. Finally, Kim, Jang, Park, and Chiriboga focused on couple contexts for acculturation among older Korean immigrants in the U.S., and examined how each spousal acculturation level affects healthcare utilization and difficulties in health service use. Focusing on married couples, this symposium showcases the interplay of family experiences, health behaviors, and relational dynamics of both spouses in shaping their health, and highlights the benefits of dyadic approaches. Speakers and our discussant, Dr. Karen Lyons, will discuss implications for social program design and future research.}, keywords = {dyadic models, health, Married Individuals}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1941}, author = {Wang, Shuangshuang and Kim, Kyungmin and Lyons, Karen} } @article {10721, title = {Does the Transition to Grandparenthood Deter Gray Divorce? A Test of the Braking Hypothesis}, journal = {Social Forces}, volume = {99}, year = {2020}, pages = {1209-1232}, abstract = {The gray divorce rate, which describes divorce among individuals aged 50 and older, has doubled since 1990. Extending prior research that showed the transition to parenthood has a {\textquotedblleft}braking effect{\textquotedblright} on divorce, we examined whether the transition to grandparenthood, an emotionally meaningful midlife event that typically renews midlife marriages, exerts an analogous {\textquotedblleft}braking effect{\textquotedblright} on gray divorce. Using panel data from the 1998{\textendash}2014 Health and Retirement Study, we found that becoming biological grandparents has a large deterrent effect on gray divorce that persists even after accounting for a host of other factors known to be associated with divorce. However, the transition to step grandparenthood has no protective effect on gray divorce. Our study demonstrates the importance of the larger family system and in particular the life webs connecting the generations for promoting marital stability among midlife couples.}, keywords = {Divorce, generations, grandparent}, doi = {10.1093/sf/soaa030}, author = {Susan L. Brown and Lin, I-Fen and Kagan A Mellencamp} } @article {10992, title = {Does Working Longer Enhance Old Age? }, number = {WP2020-20}, year = {2020}, institution = {The Wharton School, University of Pennsylvania}, address = {Philadelphia, PA}, abstract = {Understanding the link between retirement and health is crucial for both improving people{\textquoteright}s wellbeing and for designing optimal public policy around retirement. Yet, to date, the economics literature has been inconclusive about whether retirement causes improvements or deterioration in health. The lack of consensus is likely driven by differences in study design, population, and the age of workers and set of health outcomes studied. In this paper, I explain and distill the literature, highlight patterns in the highestquality studies, and discuss the implications of the findings for longevity risk management and worker and retiree health going forward. }, keywords = {health, Retirement, Social Security, Working Longer}, url = {https://repository.upenn.edu/cgi/viewcontent.cgi?article=1691\&context=prc_papers}, author = {Maria D Fitzpatrick} } @article {11026, title = {DOL Could Better Inform Divorcing Parties About Dividing Savings}, number = {GAO-20-541}, year = {2020}, institution = {United States Government Accountability Office}, address = {Washington, D.C.}, abstract = {Although more than one-third of adults aged 50 or older have experienced divorce, few people seek and obtain a Qualified Domestic Relations Order (QDRO), according to large plan sponsors GAO surveyed. A QDRO establishes the right of an alternate payee, such as a former spouse, to receive all or a portion of the benefits payable to a participant under a retirement plan upon separation or divorce. There are no nationally representative data on the number of QDROs, but plans and record keepers GAO interviewed and surveyed reported that few seek and obtain QDROs. For example, the Pension Benefit Guaranty Corporation administered retirement benefits to about 1.6 million participants, and approved about 16,000 QDROs in the last 10 years. GAO{\textquoteright}s analysis of other survey data found about one-third of those who experienced a divorce from 2008 to 2016 and reported their former spouse had a retirement plan also reported losing a claim to that spouse{\textquoteright}s benefits. Many experts stated that some people{\textemdash}especially those with lower incomes{\textemdash}face challenges to successfully navigating the process for obtaining a QDRO, including complexity and cost. Individuals seeking a QDRO may be charged fees for preparation and review of draft orders before they are qualified as QDROs and, according to experts GAO interviewed, these fees vary widely. These experts cited concerns about QDRO review fees that they said in some cases were more than twice the amount of typical fees, and said they may discourage some from pursuing QDROs. Department of Labor (DOL) officials said the agency generally does not collect information on QDRO fees. Exploring ways to collect and analyze information from plans on fees could help DOL ensure costs are reasonable.}, keywords = {Divorce, Qualified Domestic Relations Order}, url = {https://www.gao.gov/assets/710/708566.pdf}, author = {United States Government Accountability Office} } @article {11044, title = {Don{\textquoteright}t ignore genetic data from minority populations}, journal = {Nature}, volume = {585}, year = {2020}, pages = {184-186}, abstract = {Geneticists have known for more than a decade that their focus on people with European ancestry exacerbates health disparities1. A 2018 analysis of studies looking for genetic variants associated with disease found that under-representation persists: 78\% of study participants were of European ancestry, compared to 10\% of Asian ancestry and 2\% of African ancestry. Other ancestries each represented less than 1\% of the total2. Several projects, such as H3Africa3, are starting to increase participation of under-represented groups, both among participants and among researchers. Large biobanks assembled in Europe and North America, combining biological samples with health-related data, also set sampling targets to increase diversity}, keywords = {ethics, Genomics, Society}, doi = {doi: 10.1038/d41586-020-02547-3}, author = {Ben-Eghan, Chief and Sun, Rosie and Hleap, Jose Sergio and Diaz-Papkovich, Alex and Munter, Hans Markus and Grant, Audrey V and Dupras, Charles and Gravel, Simon} } @article {9592, title = {Double Disadvantage in the Process of Disablement: Race as a Moderator in the Association Between Chronic Conditions and Functional Limitations.}, journal = {Journals of Gerontology Series B: Psychological Sciences \& Social Sciences}, year = {2020}, month = {2018 Apr 16}, abstract = {

Objectives: This study evaluated (a) whether the association between chronic conditions and functional limitations vary by race/ethnicity, and (b) whether socioeconomic status accounted for any observed racial variation in the association between chronic conditions and functional limitations.

Method: The Health and Retirement Study data were used to assess whether race/ethnicity moderated the association between chronic conditions and functional limitations, and whether education, income, and/or wealth mediated any of the observed moderation by race/ethnicity.

Results: Results from structural equation models of latent growth curves with random onset indicated that (a) the positive association between chronic conditions and functional limitations onset was larger for African Americans and Hispanics than it was for Whites, but (b) this difference largely persisted net of socioeconomic status.

Discussion: African Americans and Hispanics endure a multiplicative double disadvantage in the early stages of the disablement process where they experience (a) a more rapid onset and higher levels of functional limitations, and (b) greater risk of functional limitation onset associated with chronic conditions compared to their White counterparts. Moreover, basic economic policies are unlikely to curtail the greater risk of functional limitations onset associated with chronic conditions encountered by African Americans and Hispanics.

}, keywords = {Chronic conditions, Functional limitations, Racial/ethnic differences}, issn = {1758-5368}, doi = {10.1093/geronb/gby027}, author = {Ben Lennox Kail and Miles G Taylor and Rogers, Nick} } @article {RENNANE2020102248, title = {A double safety net? Understanding interactions between disability benefits, formal assistance, and family support}, journal = {Journal of Health Economics}, volume = {69}, year = {2020}, type = {Journal}, abstract = {While the main insurance sources for individuals with disability are understood, less is known about how family support interacts with federal disability benefits. Using the Health and Retirement Study matched to administrative records, I examine how disability benefits affect family support by comparing accepted and rejected disability applicants before and after benefit receipt. Receipt of disability insurance increases the probability of receiving any assistance from children by 18 percent and more than doubles the amount of in-kind assistance. Disability insurance also increases the probability that children are paid for their help and reduces children{\textquoteright}s labor supply. These findings are largest for low-income beneficiaries and those who recently lost a spouse, suggesting that child assistance complements income provided by disability insurance, and substitutes for other family assistance. Receipt of disability benefits allows the family to re-optimize how they provide support, and disability insurance is shared within the family in complementary ways.}, keywords = {Crowd out, Disability, Family transfers, Informal assistance}, issn = {0167-6296}, doi = {https://doi.org/10.1016/j.jhealeco.2019.102248}, url = {http://www.sciencedirect.com/science/article/pii/S0167629619303868}, author = {Stephanie Rennane} } @article {doi:10.1002/ajhb.23390, title = {Dried blood spots: Effects of less than optimal collection, shipping time, heat, and humidity}, journal = {American Journal of Human Biology}, volume = {32}, year = {2020}, pages = {e23390}, abstract = {Abstract Objectives This study investigates how factors related to collection, storage, transport time, and environmental conditions affect the quality and accuracy of analyses of dried blood spot (DBS) samples. Methods Data come from the 2016 Health and Retirement Study (HRS) DBS laboratory reports and the HRS merged with the National Climatic Data Center (NCDC) Global Historical Climate Network Daily (NCDC GHCN-Daily) and the NCDC Local Climatological Data, by zip code. We ran regression models to examine the associations between assay values based on DBS for five analytes (total cholesterol, high-density lipoprotein (HDL) cholesterol, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and cystatin C) and the characteristics of DBS cards and drops, shipping time, and temperature, and humidity at the time of collection. Results We found cholesterol measures to be sensitive to many factors including small spots, shipping time, high temperature and humidity. Small spots in DBS cards are related to lower values across all analytes. Longer DBS transit time before freezing is associated with lower values of total and HDL cholesterol and cystatin C. Results were similar whether or not venous blood sample values were included in equations. Conclusions Small spots, long shipping time, and exposure to high temperature and humidity need to be avoided if possible. Quality of spots and cards and information on shipping time and conditions should be coded with the data to make adjustments in values when necessary. The different results across analytes indicate that results cannot be generalized to all DBS assays.}, keywords = {Dried Blood Spot Testing}, doi = {10.1002/ajhb.23390}, author = {Eileen M. Crimmins and Yuan S Zhang and Jung K Kim and Frochen, Stephen and Kang, Hyewon and Shim, Hyunju and Jennifer A Ailshire and Potter, Alan and Cofferen, Jake and Jessica Faul} } @article {10845, title = {Driving Status and Religious Service Attendance among Older Americans}, journal = {Activities, Adaptation \& AgingActivities, Adaptation \& Aging}, volume = {44}, year = {2020}, note = {doi: 10.1080/01924788.2019.1618688}, pages = {132 - 145}, abstract = {ABSTRACTWe investigated the relationship between driving status and religious service attendance among older Americans and how the perceived importance of religion influences the relationship. Data are from the 2012 wave of the Health and Retirement Study (n = 9,660). After controlling for covariates, the odds of regular religious service attendance were reduced by 55\% for non-drivers relative to active drivers among those who indicated that religion was very important in their lives. No significant association was observed in those who rated religion as somewhat/not too important. Future research should explore how non-drivers who value religion make decisions about religious service attendance.}, keywords = {Church attendance, driving cessation, Social participation, Transportation}, isbn = {0192-4788}, doi = {10.1080/01924788.2019.1618688}, author = {Sara J McLaughlin and Brown, Karen M. and Jonathon M Vivoda and Cathleen M. Connell} } @article {10843, title = {Dual Sensory Impairment and Perceived Everyday Discrimination in the United States}, journal = {JAMA Ophthalmology}, volume = {138}, year = {2020}, pages = {1-7}, abstract = {Perceived everyday discrimination is a psychosocial stressor that has been linked to adverse health outcomes including increased mortality. We assessed the association of vision, hearing and dual sensory impairments (VI, HI, and DSI, respectively) with the perception of everyday discrimination using a cross-sectional analysis of the Health and Retirement Study 2006 and 2008 visits. Perceived everyday discrimination was measured on the validated Williams scale (range 0 to 5). Participants rated their vision and hearing, using eyeglasses or hearing aids if applicable, on an ordinal scale (poor, fair, good, very good, excellent). Sensory impairment was defined as poor or fair self-rated ability in the relevant sensory modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI. Linear regression models were used to estimate differences in perceived discrimination associated with sensory impairment, after adjusting for age, sex, race, ethnicity, foreign birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, non-skin cancer, and arthritis). Analyses were adjusted for the complex survey design and differential nonresponse. Nursing home residents were excluded. We included 13,092 individuals. After applying survey weights, 11.7\% had VI alone, 13.1\% had HI alone, and 7.9\% had DSI. In the fully adjusted model, participants with VI alone (β = 0.07; CI = 0.02 {\textendash} 0.13) and HI alone (β = 0.07; CI = 0.02 {\textendash} 0.11) perceived greater everyday discrimination compared with participants with NSI. The DSI group perceived greater discrimination (β = 0.23; CI = 0.16 {\textendash} 0.29) compared with NSI, VI alone (β = 0.16; CI = 0.08 {\textendash} 0.23), and HI alone (β = 0.16; CI = 0.09 {\textendash} 0.23) groups. Older adults with hearing or vision loss in the United States perceive greater discrimination in their day-to-day lives than non-sensory impaired older adults. Older adults with both hearing and vision loss perceive even more discrimination than those with either hearing or vision loss alone. }, keywords = {Discrimination, hearing, impairments, vision}, isbn = {1552-5783}, doi = {10.1001/jamaophthalmol.2020.3982}, author = {Ahmed F Shakarchi and Lama Assi and Joshua R Ehrlich and Deal, Jennifer A and Nicholas S. Reed and Bonnielin K Swenor} } @article {10379, title = {Dyadic Associations Between Body Mass Index and the Development of Type 2 Diabetes in Romantic Couples: Results From the Health and Retirement Study}, journal = {Annals of Behavioral Medicine: a Publication of the Society of Behavioral Medicine}, volume = {54}, year = {2020}, pages = {291-296}, type = {Journal}, abstract = {Body mass index (BMI) is linked to Type 2 diabetes (T2D). Although romantic partners influence each other{\textquoteright}s health outcomes, it is unclear if partner{\textquoteright}s BMI is related to the development of T2D.To test prospective, dyadic associations between BMI and the development of T2D in middle-aged and older adult couples over 8 years.Data came from 950 couples in the Health and Retirement Study. Neither partner had diabetes at baseline (2006). The actor{\textendash}partner interdependence model was used to examine dyadic associations between BMI at baseline and the development of T2D during the next 8 years.After adjusting for covariates, a significant actor effect was observed such that one{\textquoteright}s BMI at baseline was positively associated with one{\textquoteright}s own odds of developing T2D during follow-up (odds ratio [OR] = 1.08, p \< .001). A significant partner effect was also observed such that the BMI of one{\textquoteright}s partner at baseline was positively associated with one{\textquoteright}s own odds of developing T2D during follow-up above and beyond one{\textquoteright}s own baseline BMI (OR = 1.0}, keywords = {actor-partner interdependence model, Body Mass Index, dyads, type 2 diabetes}, issn = {0883-6612}, doi = {10.1093/abm/kaz042}, author = {Burns, Rachel J} } @article {11312, title = {The Dyadic Effects of Perceived Support on Depression in Spousal Care Partners}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {354}, abstract = {Relationship quality is an important factor affecting care partners{\textquoteright} health and wellbeing. Supportive marital relationships are associated with better physical and subjective health, whereas strain is associated with poorer health. Recent studies now indicate a dyadic effect of relationship quality on health outcomes, such that an individual{\textquoteright}s perceptions of their relationship also affects their partner{\textquoteright}s outcomes. Few studies have examined the dyadic effects of relationship quality on mental health among older cognitively intact caregiving couples. To address the lack of dyadic research about how perceived support from one{\textquoteright}s spouse related to experiences of depression for individuals and their care partners, we apply cross-sectional actor partner interdependence models (APIMs) to data from the Health and Retirement Study (HRS) (N=490 dyads). APIM regression models controlled for participant demographic characteristics, relationship length, and care recipient functional ability. Findings showed that positive perceived support from a spouse had a stronger negative association with one{\textquoteright}s own depression for care recipients than for caregivers. Similarly, greater negative perceived support from a partner was associated with higher levels of depression; whether the partner was the caregiver or care recipient did not make a difference in this model. Although there are hundreds of caregiver interventions to address caregivers{\textquoteright} mental health, few have demonstrated improvement in care recipient outcomes. Observation of both actor and partner effects in this study suggests there may be opportunities to improve care recipient and caregiver mental health by targeting interventions to promote high quality relationships with caregivers or both members of the care dyad.}, keywords = {depression, dyadic effects, perceived support, Spouses}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1139}, author = {Meyer, Kylie and Patel, Neela and White, Carole} } @article {11341, title = {Dyadic Patterns of Marital Quality During Later Life}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {344}, abstract = {Although earlier cross-sectional studies suggested a U-shaped curve in marital quality over the life course, recent longitudinal studies find stability or continual decline (Proulx, Ermer, \& Kanter, 2017). It is important to better understand patterns of marital quality during later life, as marital quality is associated with older adults{\textquoteright} marital stability, health, and longevity. However, few studies have utilized couple-level data to examine marital quality trajectories, and only one has examined dyadic patterns during later life (Wickrama et al., 2020). We use nationally-representative data from the 2006-2016 waves of the Health and Retirement Study (HRS) to examine positive and negative dimensions of marital quality among a sample of continuously-married couples over age 50 in which both partners provided data on marital quality at three time points (n = 1,389 couples). A survey-weighted latent growth curve model simultaneously examines two marital quality trajectories: own and spouse{\textquoteright}s. Preliminary results show that mean baseline positive and negative marital quality are similar for own and spouse{\textquoteright}s trajectories. Although growth rates are statistically non-significant for positive marital quality, the variance of growth rate is statistically significant for spouse{\textquoteright}s trajectory (0.001, p < 0.05), and greater baseline own positive marital quality is associated with negative growth of spouse{\textquoteright}s positive marital quality. Growth rates are similar for own and spouse{\textquoteright}s trajectories of negative marital quality, and variance of growth rate is statistically significant for spouse{\textquoteright}s negative marital quality trajectory. Results point to stability in marital quality over time, and suggest the importance of using couple-level data.}, keywords = {dyadic patterns, Marital quality}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1106}, author = {Jennifer R. Bulanda and Yamashita, Taka and J Scott Brown} } @article {10690, title = {Dyadic profiles of personality among older couples: Associations with marital quality}, journal = {Journal of Social and Personal Relationships}, volume = {37}, year = {2020}, abstract = {Understanding dyadic personality configurations and their associations with marital quality helps identify couples who are at high risk of marital strain. However, current research on personality similarity among spouses usually confounds couples with similarly positive and similarly negative personalities. This study aimed to (1) provide a clearer classification of dyadic personality profiles among older couples, (2) examine the associations between these profiles and both partners{\textquoteright} marital quality, and (3) explore gender differences in these associations. Data came from 3,178 older couples drawn from the 2010/2012 waves of the Health and Retirement Study. Latent profile analysis was used to identify dyadic personality profiles based on spouses{\textquoteright} standardized Big Five personality scores. Multilevel models examined associations between dyadic personality profiles and each partner{\textquoteright}s marital quality, testing for gender differences as well. Six dyadic personality profiles were identified, including two opposite profiles (52\%; positive wife{\textendash}negative husband and positive husband{\textendash}negative wife), two similar profiles (40\%; similarly positive and similarly negative), and two extreme profiles (8\%; extremely negative husband and extremely negative wife). Couples in the similarly positive profile reported the best marital quality, whereas couples in the similarly negative profile and the two extreme profiles reported the worst marital quality. The associations between profiles characterized by negative traits and marital quality were more pronounced among wives than husbands. This study advances the understanding of personality similarity and its consequences, suggesting heterogeneous subgroups of dyadic personalities among older couples and providing evidence of gender differences in the implications of personality similarity for relationship quality.}, keywords = {Dyadic data analysis, Gender Differences, Marriage, Personality}, issn = {02654075}, doi = {10.1177/0265407520916246}, author = {Wang, S. and Kyungmin Kim and Jeffrey E Stokes} } @mastersthesis {11170, title = {DYNAMIC STRUCTURE OF THE U.S. HEALTH SPENDING}, volume = {Doctor of Philosophy}, year = {2020}, school = {State University of New York at Buffalo}, address = {Buffalo, NY}, abstract = {Health expenditure is a compelling problem to study in the context of US economic resources allocation. At the individual level, healthcare consumption is high, ranking fifth in consumption categories only after food, housing, apparel and services, and transportation. Additionally, there is a big heterogeneity in individual health spending. For people who face severe health conditions, the health spending burden could be extremely large. In the context of the life-cycle model, De Nardi et al (2011) pointed out that health spending affected households{\textquoteright} saving and consumption decisions over a lifetime. In this dissertation, I look at individuals{\textquoteright} health spending from the lifetime perspective to study the long-term effects of health shocks. The research question of aggregating an individual{\textquoteright}s health spending over time is complicated by the inter-temporal relationship of an individuals{\textquoteright} health spending. To address this question, I start by looking at health spending from a cross-sectional perspective, then study the dynamic evolution of individuals{\textquoteright} spending. The research is based on panel data from the Health and Retirement Study (HRS) by RAND Center, focusing on the original HRS cohort from survey year 1996 to year 2014 (wave 3 to wave 12). }, keywords = {Health Shocks, health spending, Healthcare}, author = {Chen, Xinyan} } @article {10455, title = {DEATH OF A CHILD AND MORTALITY RISK OVER THE LIFE COURSE: RACIAL DISADVANTAGE IN THE U.S.}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, pages = {S436-S436}, abstract = {Numerous studies show that bereavement, including bereavement following the death of a minor child, increases mortality risk in white populations. The death of a child prior to midlife has received much less attention. Moreover, recent research shows that black Americans are substantially more likely to lose a child compared to white Americans, but this racial disadvantage is largely unexplored. Losing a child is a traumatic event that may activate biopsychosocial and behavioral risk factors that add to mortality risk. We analyze longitudinal data from the Health and Retirement Study (1992-2014) to assess the association of child loss prior to midlife with mortality risk in mid to later life, and the possible biopsychosocial and behavioral covariates linking child death to mortality. The analytic sample includes 20,489 non-Hispanic white respondents and 5,328 non-Hispanic black respondents who have ever given birth to or fathered at least one child. Findings suggest that that the death of a child prior to midlife is associated with increased mortality risk, net of sociodemographic controls. Psychological (e.g., depressive symptoms), behavioral (e.g., alcohol use, smoking), and social (e.g., income, marital status) factors explain this heightened mortality risk. Although the heightened mortality risk for child loss is similar for black and white parents, black parents experience a greater disadvantage as they are almost twice as likely as white parents to lose a child prior to midlife. Child loss and the resulting health risks disproportionately burden black families, functioning as a unique source of disadvantage for black Americans.}, keywords = {child death, mortality risk, race, race-ethnicity, Racial Disparities}, isbn = {2399-5300}, doi = {10.1093/geroni/igz038.1630}, author = {Rachel Donnelly and Debra Umberson and Robert A Hummer and Michael A Garcia} } @article {10622, title = {Debt, Religious Beliefs, and Life Satisfaction }, journal = {Journal of Financial Therapy}, volume = {10}, year = {2019}, type = {Journal}, abstract = {The purpose of this study was to explore religious factors as a resource for coping with indebtedness. Using a sample (n = 3,174) extracted from the Health and Retirement Study (HRS), we examined the relationship between household debt and life satisfaction, and tested for stress-buffering (i.e., moderation) from religious identification, religious beliefs, and prayer frequency. Results suggest that some religious factors may play a small role in moderating the relationship between indebtedness and life satisfaction, and that such moderation is itself dependent on one{\textquoteright}s religious identification. Implications for practice (particularly faith-based providers of financial counseling) and recommendations for future research are discussed.}, keywords = {complex data analysis, debt; religiosity, Life Satisfaction}, issn = { 1944-9771}, doi = {10.4148/1944-9771.1195}, url = {https://newprairiepress.org/cgi/viewcontent.cgi?article=1195\&context=jft}, author = {Ammerman, David D. and Stueve, Cherie and Hayward, Stephen} } @article {10530, title = {Debt Stress and Mortgage Borrowing in Older Age: Implications for Economic Security in Retirement}, number = {WI19-06}, year = {2019}, institution = {Retirement and Disability Research Center- University of Wisconsin-Madison}, abstract = {The amount of financial debt held by seniors in the U.S. has grown substantially over the past decade. Prior research links higher levels of debt to increased psychological stress and decreased physical health. For seniors, these effects may be exacerbated by fixed incomes and limited ability to offset higher monthly debt obligations through increased labor supply. This study will quantify stress associated with different forms of debt held by seniors{\textemdash}including reverse mortgages, a type of debt available only to seniors; and will explore the relationships between different types and timing of mortgage debt and older adults{\textquoteright} decisions regarding labor force participation and claiming of Social Security Benefits. To analyze these relationships, we use panel data from six waves of the Health and Retirement Study (HRS), supplemented with our own survey data on more than 1,000 reverse mortgage borrowers. Reverse mortgage borrowers are underrepresented in traditional survey populations and thus have been understudied despite potential growth in the market. This research links directly to the SSA{\textquoteright}s focal area of measuring sources of income and adequacy, and in particular consumer debt as part of a household{\textquoteright}s financial portfolio in retirement that presents an evolving risk to economic security. Debt stress among seniors can also have implications for labor force participation and the timing of draws from OASI. In addition to identifying the relationship between debt stress and retirement decisions, we examine the role of reverse mortgages for alleviating debt stress.}, keywords = {debt. mortgage, Finance, Stress}, url = {https://cfsrdrc.wisc.edu/project/wi19-06}, author = {Stephanie Moulton and Donald Haurin and C{\"a}zilia Loibl} } @article {10145, title = {Decreased handgrip strength is associated with impairments in each autonomous living task for aging adults in the United States.}, journal = {Journal of Frailty and Aging}, volume = {8}, year = {2019}, pages = {141-145}, abstract = {

OBJECTIVES: The primary purpose of this study was to determine the time-varying associations between decreased handgrip strength (HGS) and individual instrumental activities of daily living (IADL) impairments for a nationally-representative sample of aging adults in the United States.

DESIGN: Longitudinal-Panel.

SETTING: Detailed interviews were completed in person and core interviews were typically completed over the telephone.

PARTICIPANTS: A total of 15,336 participants aged at least 50 years who participated in the 2006 wave of the Health and Retirement Study were followed biennially for 8-years.

MEASUREMENTS: A hand-held dynamometer assessed HGS and performance in IADLs were self-reported.

RESULTS: Every 5-kilogram decrease in HGS was associated with an increased odds ratio for the following IADL impairments: 1.11 (95\% confidence interval (CI): 1.09, 1.13) for using a map, 1.10 (CI: 1.07, 1.12) for grocery shopping, 1.09 (CI: 1.05, 1.14) for taking medications, 1.07 (CI: 1.05, 1.09) for preparing hot meals, 1.06 (CI: 1.04, 1.08) for managing money, and 1.05 (CI: 1.02, 1.09) for using a telephone.

CONCLUSIONS: Decreased HGS was associated with each IADL impairment, and slightly different associations were observed in individual IADL tasks for aging adults in the United States. Our findings suggest that decreased HGS, which is reflective of reduced function of the neuromuscular system, is associated with diminished performance in autonomous living tasks during aging. Losses in HGS may lead to the development of an IADL impairment. Therefore, health-care providers working with aging adults should utilize measures of HGS as a screening tool for identifying future deficits in neuromuscular functioning. Interventions designed to preserve IADLs in aging adults should also include measures of HGS for detecting early changes in IADL capacity, and intervening at the onset of HGS declines may help aging adults retain their ability to live autonomously.

}, keywords = {Cognitive Ability, Grip strength, Muscle Weakness, Physical measures}, issn = {2260-1341}, doi = {10.14283/jfa.2018.47}, author = {Ryan P McGrath and Erlandson, Kristine M. and Brenda Vincent and Kyle J Hackney and Stephen D. Herrmann and Brian C Clark} } @article {10217, title = {Dementia: Study reveals {\textquoteleft}surprising{\textquoteright} lifestyle factor - how to lower your risk}, journal = {Express}, volume = {2019}, number = {09/2019}, year = {2019}, publisher = {Express}, type = {Tabloid}, address = {London, UK}, abstract = {DEMENTIA is a life-changing diagnosis for the person affected and their loved ones. While there is currently no way to completely prevent dementia, certain lifestyle decisions can mitigate the risk. A new study reveals a surprising link.}, keywords = {Dementia}, url = {https://www.express.co.uk/life-style/health/1176826/dementia-care-symptoms-what-is-how-to-reduce-risk} } @article {9489, title = {Depression Associated With Transitions Into and Out of Spousal Caregiving}, journal = {The International Journal of Aging and Human Development}, volume = {88}, year = {2019}, type = {Journal}, abstract = {This study investigates depressive symptoms among spousal caregivers in three groups: those who become caregivers, those who continue care, and those who exit caregiving, compared with those who remain non-caregivers. We also examine depressive symptoms among widowed caregivers by length of bereavement. We use four waves of the U.S. Health and Retirement Study (2006, 2008, 2010, and 2012), for a total of 43,262 observations. Findings show elevated levels of depressive symptoms for new caregivers, continuing caregivers, and exit caregivers. Among exit caregivers, symptoms were elevated when measured in the first 15 months after the spouse{\textquoteright}s death but declined thereafter. These findings add to the evidence that spousal caregiving carries a risk for depression, and symptoms are likely to peak near the end of the caregiving episode. These results underscore the need to provide support to newly widowed individuals.}, keywords = {Caregiving, Couples, Depressive symptoms, Transitions}, issn = {0091-4150}, doi = {10.1177/0091415018754310}, url = {https://journals.sagepub.com/doi/10.1177/0091415018754310}, author = {Jay S Kaufman and Lee, Yeonjung and Vaughon, Wendy and Unuigbe, Aig and William T Gallo} } @article {9976, title = {Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study.}, journal = {Journal of Psychosomatic Research}, volume = {117}, year = {2019}, pages = {22-29}, abstract = {

OBJECTIVE: This study examined whether diabetic morbidity mediates the relationship of food insecurity with depression among older adults with diabetes.

METHODS: Data came from the 2010-2014 waves of the Health and Retirement Study and analyses were limited to respondents with diabetes (n = 2951). Depression was indexed by the 8-item Centers for Epidemiologic Studies Depression Scale. Weighted logistic regression was used to examine relationships of food insecurity and diabetic morbidity with depressive symptoms, both cross-sectionally and longitudinally. Path analysis quantified the contribution of diabetic morbidity as a mediation of the relationship of food insecurity with depressive symptoms.

RESULTS: Food insecurity was associated with having poor diabetes control (odds ratio (OR) = 1.7; 95\% confidence interval (CI) = 1.1-2.5) and diabetes-related kidney problems (OR = 1.6; 95\% CI = 1.1-2.5). Additionally, food insecurity was associated with depression contemporaneously (OR = 2.0, 95\% CI = 1.7-2.4) and longitudinally (OR = 1.5, 95\% CI = 1.3-1.8). However, food insecurity was no longer associated with depression when adjusting for diabetic morbidity. In path analyses, diabetic morbidity explained 12.7\% (p-value = .04) of the association of food insecurity with depressive symptoms in 2012 and 18.5\% (p-value = .09) of the association with depressive symptoms in 2014.

CONCLUSION: The relationship of food insecurity with depression was attributable to worse diabetes morbidity. Interventions that reduce food insecurity among older adults with diabetes may improve disease management and reduce depression severity.

}, keywords = {Depressive symptoms, Diabetes, Racial/ethnic differences}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2018.12.007}, author = {Rachel S. Bergmans and Zivin, Kara and Briana Mezuk} } @article {10489, title = {Depression symptoms increase over last year of life}, journal = {Reuters}, year = {2019}, abstract = {Many people experience worsening depression symptoms over their final year of life, and a U.S. study suggests that women, younger adults and poor people may be especially vulnerable. For the study, researchers examined data on 3,274 adults who participated in the nationwide Health and Retirement Study and died within one year of the assessment. All of the participants had completed mental health questionnaires and provided information on any medical issues they had as well as demographic factors like income and education levels. Rates of depressive symptoms increased over the last year of life, particularly within the final months, the study found. By the last month of life, 59\% of the participants had enough symptoms to screen positive for a diagnosis of depression, although they were not formally evaluated and diagnosed by clinicians.}, keywords = {depression}, url = {https://www.reuters.com/article/us-health-terminalcare-depression/depression-symptoms-increase-over-last-year-of-life-idUSKBN1XN2N2} } @article {canady2019depression, title = {Depression symptoms increase sharply in last months of life}, journal = {Mental Health Weekly}, volume = {29}, year = {2019}, month = {12}, pages = {4{\textendash}5}, abstract = {Although depression impacts quality of life at all stages, not much is known about depressive symptoms in the year prior to death, according to researchers of a new study who say that patients with depression have worse survival outcomes than nondepressed patients. Consequently, depression becomes a critical issue to screen for and manage in the context of serious illness, they stated.}, keywords = {depression}, issn = {1058-1103}, doi = {10.1002/mhw.32154}, url = {https://doi.org/10.1002/mhw.32154}, author = {Canady, Valerie A.} } @article { ISI:000490313400008, title = {Depressive Symptoms among Former Spousal Caregivers: Comparing Stressors, Resources, and Circumstances of Caregiving Cessation among Older Husbands and Wives}, journal = {JOURNAL OF GERONTOLOGICAL SOCIAL WORK}, volume = {62}, year = {2019}, month = {AUG 18}, pages = {682-700}, type = {Article}, abstract = {Little research focuses on the mental health of caregivers (CGs) who stop providing care to their community-dwelling spouse. We examine depressive symptoms of former primary CG spouses who stopped caregiving over a two-year follow-up period when the care recipient (CR): (1) no longer has functional problems; (2) continues having functional problems; or (3) dies. Using data from the Health and Retirement Study (2000-2014), we located 2,370 couples who were both 50+ at baseline and where one partner provided help with ADL and/or IADL limitations but did not do so two years later. OLS regressions stratified by gender indicated that both male and female former spousal CGs whose CR died had significantly more depressive symptoms than those who ceased caregiving when their spouse did or did not still have functional problems. Former wife CGs who were older and whose husbands had more baseline ADLs had fewer follow-up depressive symptoms; wife CGs whose husbands had a nursing home stay had more depressive symptoms. Former husband CGs who had provided longer monthly hours of care had fewer follow-up symptoms. Findings underscore the importance of targeting mental and physical health services to both former caregiving husbands and wives, especially after spousal death.}, keywords = {Bereavement, Caregiving cessation, gender, spousal caregiving}, issn = {1540-4048}, doi = {10.1080/01634372.2019.1647906}, author = {Angela K Perone and Ruth E Dunkle and Sheila Feld and Shen, Huei-Wern and Kim, Min Hee and Pace, Garrett T.} } @article {King20191122, title = {Depressive Symptoms and the Buffering Effect of Resilience on Widowhood by Gender}, journal = {The Gerontologist}, volume = {59}, year = {2019}, note = {cited By 0}, pages = {1122-1130}, abstract = {BACKGROUND AND OBJECTIVES: Spousal loss is a stressful life event that often results in significant depressive symptoms, with men often experiencing more significant depressive symptoms than women. Recent research suggests that psychological resilience may play a role in shaping how well people recover from the loss of a spouse. This study examined the moderating effect of resilience on widowhood in relation to changes in depressive symptoms for men and women. RESEARCH DESIGN AND METHODS: This study used data from the Health and Retirement Study to examine a change in depressive symptoms for men and women who experience spousal loss compared to those who remain continuously married (N = 5,626). We used the Simplified Resilience Score, which is based on measures drawn from the psychosocial and lifestyle questionnaire. Ordinary least squares regression was used to assess depression following reported spousal loss for widows relative to their continuously married counterparts. RESULTS: Results show resilience moderated depressive symptoms following spousal loss, but these effects varied by gender. Resilience was significantly and negatively associated with depressive symptoms for married but not for widowed women. However, for widowed men, resilience was significantly and negatively associated with depressive symptoms, and a high resilience score buffered the effect of widowhood. DISCUSSION AND IMPLICATIONS: Our study suggests that having high levels of resilience prior to spousal loss may help offset persistent depressive symptoms, especially for men. Implications for future research and clinical practice are discussed. {\textcopyright} The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.}, keywords = {depression, gender, Gender Differences, Widowhood, Widows}, issn = {17585341}, doi = {10.1093/geront/gny115}, url = {https://www.ncbi.nlm.nih.gov/pubmed/30247641}, author = {Brittany M. King and Dawn C Carr and Miles G Taylor} } @article {10054, title = {Depressive symptoms following later-life marital dissolution and subsequent repartnering.}, journal = {Journal of Health and Social Behavior}, year = {2019}, abstract = {The doubling of the divorce rate among individuals over age 50 during the past 20 years underscores the urgency of studying the consequences of gray divorce and subsequent repartnering for adult well-being. We filled this gap by using the 1998-to-2014 Health and Retirement Study to evaluate how the levels of depressive symptoms changed following gray divorce versus widowhood. Individuals who divorced or became widowed already had experienced higher levels of depressive symptoms before dissolution relative to those who remained married. Compared with those who became widowed, those who transitioned to divorce experienced a lower elevation and a shorter time to recovery in depressive symptoms. When repartnering, both groups experienced similar magnitudes of initial reduction and subsequent rates of increase. Both the negative consequences of marital dissolution and the beneficial effects of repartnership for mental health persisted for several years, although ultimately they reverted to their predissolution levels of depressive symptoms.}, keywords = {Depressive symptoms, Divorce, Family Roles/Relationships, Marriage, Widowhood}, issn = {2150-6000}, doi = {10.1177/0022146519839683}, author = {Lin, I-Fen and Susan L. Brown and Matthew R Wright and Anna M Hammersmith} } @mastersthesis {10249, title = {Depressive Symptoms Trajectories Following Child Death in Later Life: Variation by Race-Ethnicity}, volume = {Master of Arts}, year = {2019}, month = {2019}, pages = {87}, school = {Bowling Green State University}, address = {Bowling Green, OH}, abstract = {Child death is among the most traumatic experiences a parent can endure. Prior studies have shown that this event is associated with immediate and protracted detriments to parents\' psychological well-being earlier in the life course. Yet research examining child death experienced in mid-to-late life is scant. Moreover, no study has considered whether and how the death of a child may influence parents\' psychological well-being differently across various racial-ethnic groups. To fill these gaps in the literature, I applied growth curve models to the 1998-2014 Health and Retirement Study to address two research aims. First, I mapped a trajectory of bereaved parents\' depressive symptoms before and after child death and compared it to that of nonbereaved parents among adults aged 50 and older. Second, I compared the depressive symptoms trajectories of bereaved black and Hispanic parents to that of bereaved white parents. On average, both mothers and fathers experienced an immediate elevation in depressive symptoms following child death. It took bereaved mothers about 5 years to recover to depressive symptoms levels comparable to nonbereaved mothers\' but bereaved fathers never fully recovered. Results from the second aim painted a more nuanced picture. Parental bereavement was equally detrimental in the short- and long-term for white, black, and Hispanic mothers, who all recovered in about 4 years, as well as for white and Hispanic fathers, who recovered in 6 years, suggesting child death is an acute stressor. However, black fathers displayed resilience as resistance to the initial detrimental effect of parental bereavement by reporting a surprising reduction in depressive symptoms immediately following child death. Black fathers who experienced child death reported worse well-being relative to white fathers both prior to and after child death, and even after reporting a decrease in depressive symptoms following bereavement, never reverted to nonbereaved levels of depressive symptoms, suggesting that black fathers\' cumulative disadvantages in later life may provide them the coping repertoire necessary to resist the immediate psychological detriments associated with child death. Together, these findings suggest that future research should examine adjustment to bereavement separately by race-ethnicity and gender to unpack any heterogeneity in the short- and long-term outcomes associated with family death. }, keywords = {acute, child death, chronic, cumulative disadvantage, Depressive symptoms, Growth curve modelling, later life, parental bereavement, race-ethnicity, Resilience, trajectory}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1563465712524515}, author = {Kagan A Mellencamp} } @article {9719, title = {Determinants of Hearing Aid Use Among Older Americans With Hearing Loss}, journal = {The Gerontologist}, year = {2019}, abstract = {Background and Objectives Hearing loss (HL) is common among older adults and is associated with significant psychosocial, cognitive, and physical sequelae. Hearing aids (HA) can help, but not all individuals with HL use them. This study examines how social determinants may impact HA use. Research Design and Methods We conducted an explanatory sequential mixed methods study involving a secondary analysis of a nationally representative data set, the Health and Retirement Study (HRS; n = 35,572). This was followed up with 1:1 qualitative interviews (n = 21) with community participants to clarify our findings. Both samples included individuals aged 55 and older with a self-reported HL, with or without HA. The main outcome measure was the proportion of participants with a self-reported HL who use HA. Results and Discussion Analysis of HRS data indicated that younger, nonwhite, non-Hispanic, lower income, and less-educated individuals were significantly less likely to use HA than their referent groups (all p values < .001). Area of residence (e.g., urban) were not significantly associated with HA use. Qualitative findings revealed barriers to HA included cost, stigma, vanity, and a general low priority placed on addressing HL by health care providers. Facilitators to obtaining and using HA included family/friend support, knowledge, and adequate insurance coverage for HA. Implications Many socioeconomic factors hinder individuals{\textquoteright} ability to obtain and use HA, but these obstacles appeared to be mitigated in part when insurance plans provided adequate HA coverage, or when their family/friends provided encouragement to use HA.}, keywords = {Hearing aids, Hearing loss, Social Support, Stigma}, issn = {0016-9013}, doi = {10.1093/geront/gny051}, url = {https://academic.oup.com/gerontologist/advance-article/doi/10.1093/geront/gny051/5000029http://academic.oup.com/gerontologist/advance-article-pdf/doi/10.1093/geront/gny051/24836322/gny051.pdf}, author = {Michael M McKee and Choi, Hwajung and Wilson, Shelby and Melissa J DeJonckheere and Zazove, Philip and Helen G Levy} } @article {10055, title = {Determinants of hip and knee replacement: The role of social support and family dynamics.}, journal = {Inquiry}, volume = {56}, year = {2019}, month = {2019 Jan-Dec}, pages = {46958019837438}, abstract = {The objective of this study was to examine variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics. We analyzed data from the US Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression to analyze the probability of receiving knee or hip replacement by gender and age (<65, 65+). We estimated the effect of demographic, health needs, economic, and familial support variables on the rate of JR. We found that being married/partnered with a healthy spouse/partner is positively associated with JR utilization in both age groups (65+ group OR: 1.327 and <65 group OR: 1.476). While this finding holds for men, it is not statistically significant for women. Among women younger than 65, having children younger than 18 lowers the odds (OR: 0.201) and caring for grandchildren increases the odds (1.364) of having a JR. Finally, elderly women who report availability of household assistance from a child have higher odds of receiving a JR as compared with elderly women without a child who could assist (OR: 1.297). No effect of available support from children was observed for those below 65 years old and elderly men. Our results show that intrafamily dynamics and familial support are important determinants of JR; however, their effects vary by gender and age. Establishing appropriate support mechanisms could increase access to cost-effective JR among patients in need of surgery.}, keywords = {Family Roles/Relationships, Health care utilization, Joint replacement, Social Support}, issn = {1945-7243}, doi = {10.1177/0046958019837438}, author = {Demiralp, Berna and Koenig, Lane and Jennifer T Nguyen and Samuel A Soltoff} } @article {10070, title = {Diabetes-multimorbidity combinations and disability among middle-aged and older adults.}, journal = {Journal of General Internal Medicine}, year = {2019}, month = {2019 Feb 27}, abstract = {

BACKGROUND: Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity).

OBJECTIVE: To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes.

DESIGN: A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability.

PARTICIPANTS: Analytic sample included 3841 HRS participants with diabetes, aged 51~years and older.

MAIN MEASURES: The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score >= 4).

KEY RESULTS: The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1\%); diabetes-hypertension (n = 481, 12.5\%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10\%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment.

CONCLUSIONS: Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.

}, keywords = {Chronic disease, Comorbidity, Diabetes, Disabilities}, issn = {1525-1497}, doi = {10.1007/s11606-019-04896-w}, author = {Ana R Qui{\~n}ones and Markwardt, Sheila and Anda Botoseneanu} } @article {10141, title = {Differential associations between state-level educational quality and cardiovascular health by race: Early-life exposures and late-life health.}, journal = {SSM Population Health}, volume = {8}, year = {2019}, pages = {100418}, abstract = {Cardiovascular diseases (CVD) are patterned by educational attainment but educational quality is rarely examined. Educational quality differences may help explain racial disparities. Health and Retirement Study respondent data (1992-2014; born 1900-1951) were linked to state- and year-specific educational quality measures when the respondent was 6 years old. State-level educational quality was a composite of state-level school term length, student-to-teacher ratio, and per-pupil expenditure. CVD-related outcomes were self-reported (N = 24,339) obesity, heart disease, stroke, ever-smoking, high blood pressure, diabetes and objectively measured (N = 10,704) uncontrolled blood pressure, uncontrolled blood sugar, total cholesterol, high-density lipoprotein cholesterol (HDL), and C-reactive protein. Race/ethnicity was classified as White, Black, or Latino. Cox models fit for dichotomous time-to-event outcomes and generalized estimating equations for continuous outcomes were adjusted for individual and state-level confounders. Heterogeneities by race were evaluated using state-level educational quality by race interaction terms; race-pooled, race by educational quality interaction, and race-specific estimates were calculated. In race-pooled analyses, higher state-level educational quality was protective for obesity (HR = 0.92; 95\%CI(0.87,0.98)). In race-specific estimates for White Americans, state-level educational quality was protective for high blood pressure (HR = 0.95; 95\%CI(0.91,0.99). Differential relationships among Black compared to White Americans were observed for obesity, heart disease, stroke, smoking, high blood pressure, and HDL cholesterol. In race-specific estimates for Black Americans, higher state-level educational quality was protective for obesity (HR = 0.88; 95\%CI(0.84,0.93)), but predictive of heart disease (HR = 1.07; 95\%CI(1.01,1.12)), stroke (HR = 1.20; 95\%CI(1.08,1.32)), and smoking (HR = 1.05; 95\%CI(1.02,1.08)). Race-specific hazard ratios for Latino and Black Americans were similar for obesity, stroke, and smoking. Better state-level educational quality had differential associations with CVD by race. Among minorities, better state-level educational quality was predominately associated with poorer CVD outcomes. Results evaluate the 1900-1951 birth cohorts; secular changes in the racial integration of schools since the 1950s, means results may not generalize to younger cohorts.}, keywords = {Cardiovascular health, Education, Heart disease, Late-life Health, Racial/ethnic differences}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2019.100418}, author = {Anusha M Vable and Thu T Nguyen and David Rehkopf and M. Maria Glymour and Hamad, Rita} } @article {Robinette388, title = {Differential vulnerability to neighbourhood disorder: a gene{\texttimes}environment interaction study}, journal = {Journal of Epidemiology \& Community Health}, volume = {73}, year = {2019}, pages = {388{\textendash}392}, abstract = {Background Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D.Method We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D.Results Greater perceptions of neighbourhood disorder (OR=1.11, p\<0.001) and higher polygenic scores for T2D (OR=1.42, p\<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10}, keywords = {Diabetes, Genetics, neighborhood}, issn = {0143-005X}, doi = {10.1136/jech-2018-211373}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935762/}, author = {Jennifer W Robinette and Jason D Boardman and Eileen M. Crimmins} } @article {9960, title = {Differential vulnerability to neighbourhood disorder: a gene{\texttimes}environment interaction study}, journal = {Journal of Epidemiology and Community Health}, volume = {73}, year = {2019}, month = {05/2019}, pages = {388-392}, abstract = {Background: Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D. Method: We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D. Results: Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10, p=0.001). This significant gene{\texttimes}environment interaction was observed after adjusting for years of schooling, age, gender, levels of physical activity and obesity. Conclusion: Findings in the present study suggested that minimising people{\textquoteright}s exposure to vandalism, vacant buildings, trash and circumstances viewed by residents as unsafe may reduce the burden of this prevalent chronic health condition, particularly for subgroups of the population who carry genetic liability for T2D.}, keywords = {Diabetes, Genetics, Neighborhoods}, issn = {0143-005X}, doi = {10.1136/jech-2018-211373}, url = {http://jech.bmj.com/lookup/doi/10.1136/jech-2018-211373https://syndication.highwire.org/content/doi/10.1136/jech-2018-211373}, author = {Jennifer W Robinette and Jason D Boardman and Eileen M. Crimmins} } @article {9928, title = {The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity.}, journal = {Gerontologist}, volume = {59}, year = {2019}, abstract = {

Background and Objectives: Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use.

Design and Methods: Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes.

Results: Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health.

Discussion and Implications: Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.

}, keywords = {Health Services Utilization, Racial/ethnic differences, Technology}, issn = {1758-5341}, doi = {10.1093/geront/gny138}, author = {Uchechi A Mitchell and Perla G. Chebli and Ruggiero, Laurie and Muramatsu, Naoko} } @article {10127, title = {Dimensions of religious involvement represent positive pathways in cognitive aging.}, journal = {Research on Aging}, year = {2019}, abstract = {Older Black and Hispanic adults report more religious involvement, and religious involvement has been linked to better cognition. This study examined which aspects of religious involvement are associated with better longitudinal episodic memory and whether religious involvement offsets racial and ethnic inequalities in episodic memory. Using Health and Retirement Study data ( = 16,069), latent growth curves estimated independent indirect pathways between race and ethnicity and 6-year memory trajectories through religious attendance, private prayer, and religious belief, controlling for nonreligious social participation, depressive symptoms, chronic health diseases, age, education, and wealth. Negative direct effects of Black race and Hispanic ethnicity on memory were partially offset by positive indirect pathways through more private prayer and religious attendance. While results were significant for memory intercept and not subsequent memory change, religious attendance and private prayer were independently associated with better cognitive health among diverse older adults. Findings may inform culturally relevant intervention development to promote successful aging and reduce older adults{\textquoteright} cognitive morbidity.}, keywords = {undefined}, issn = {1552-7573}, doi = {10.1177/0164027519862745}, author = {A Zarina Kraal and Sharifian, Neika and Afsara B. Zaheed and Sol, Ketlyne and Laura B Zahodne} } @article {Fong2019323, title = {Disability incidence and functional decline among older adults with major chronic diseases}, journal = {BMC geriatrics}, volume = {19}, year = {2019}, note = {cited By 0}, pages = {323}, abstract = {BACKGROUND: More than 80\% of elderly Americans have at least one chronic disease. While past studies have shown that hierarchical patterns of functional loss may differ by gender and institutional settings, little is known about whether such patterns differ in relation to chronic health condition. The aim of this study is to investigate the pattern of functional loss among older adults with major chronic illnesses, and to compare their onset and ordering of incident ADL disability with those of persons without such conditions. METHODS: We use a nationally representative sample of persons aged 80+ from the 1998-2014 Asset and Health Dynamics of the Oldest Old survey. The group with major noncommunicable diseases (including cardiovascular disease, cancer, chronic respiratory disease, and diabetes) comprises 3,514,052 subjects, while the comparison group comprises 1,073,263 subjects. Self-reports of having difficulty with six distinct ADLs are used to estimate disability incidence rate. Nonparametric statistical methods are used to derive median onset ages and ADL loss sequence separately for each group. RESULTS: Older adults with major chronic diseases have higher rates of incident disability across all ADL items. Estimated median onset ages of ADL disabilities for the full sample range from 91.5 to 95.6. Disability occurs earlier for chronically ill persons (onset ages 91.1-95.0) than for those in the comparison group (onset ages 93.5-98.1). Among those with major chronic diseases, the ADL loss sequence ordered by median ages of disability onset is bathing, walking, dressing, toileting, transferring and eating. The activities are also distinctly separated into an early-loss cluster and a late-loss cluster. Although the loss sequence derived for the comparison group is largely similar, disability progression for those with major chronic diseases is compressed within a shorter timeframe and the timing gaps between adjacent disabilities are smaller. CONCLUSIONS: Older Americans with major noncommunicable diseases face an earlier and steeper slope of functional decline. Chronic care delivery programs should adapt to dynamic changes in older patients{\textquoteright} functional status. Health interventions to help patients delay disability onset and optimize functional autonomy within emerging models of chronic care should especially target early-loss activities such as bathing, dressing, and walking.}, keywords = {Chronic Diseases, Disability, functional decline}, issn = {14712318}, doi = {10.1186/s12877-019-1348-z}, url = {https://www.ncbi.nlm.nih.gov/pubmed/31752701}, author = {Joelle H Fong} } @article {NBERw26513, title = {Disability Insurance: Error Rates and Gender Differences}, journal = {The National Bureau of Economic Research}, volume = {Working Paper No. 26513}, year = {2019}, month = {11/2019}, abstract = {We show the extent of errors made in the award of disability insurance using matched survey-administrative data. False rejections (Type I errors) are widespread, and there are large gender differences in these type I error rates. Women with a severe, work-limiting, permanent impairment are 20 percentage points more likely to be rejected than men, controlling for the type of health condition, occupation, and a host of demographic characteristics. We investigate whether these gender differences in Type I errors are due to women being in better health than men, to women having lower pain thresholds, or to women applying more readily for disability insurance. None of these explanations are consistent with the data. We use evidence from disability vignettes to suggest that there are different acceptance thresholds for men and women. The differences by gender arise because women are more likely to be assessed as being able to find other work than observationally equivalent men. Despite this, after rejection, women with a self-reported work limitation do not return to work, compared to rejected women without a work limitation.}, keywords = {Disability, disability insurance, gender, Insurance}, doi = {10.3386/w26513}, url = {http://www.nber.org/papers/w26513}, author = {Low, Hamish and Pistaferri, Luigi} } @mastersthesis {10342, title = {Discovery and Characterization of Genetic Variants Associated with Extreme Longevity}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-10-16}, pages = {133}, school = {Boston University}, type = {phd}, abstract = {Over the last decade, there have been multiple genome-wide association studies (GWASs) of human extreme longevity (EL). However, only a limited number of genetic variants have been identified as significant, and only few of these variants have been replicated in independent studies. There are two possible reasons for this limitation. First, genetic variants might have a varying effect on EL in different populations, and GWAS applied to a dataset as a whole may not pinpoint such differences. Second, EL is a very rare trait in a population, and rare and uncommon variants might be important factors in explaining its heritability but GWASs have focused on the analyses of variants that are relatively common in the population. In this dissertation, I present three projects that address these issues. First, I propose PopCluster: an algorithm that automatically discovers subsets of individuals in which the genetic effects of a variant are statistically different. PopCluster provides a simple framework to directly analyze genotype data without prior knowledge of subjects ethnicities. Second, I investigate ethnic-specific effects of APOE alleles on EL in Europeans. APOE is a well-studied gene with multiple effects on aging and longevity. The gene has 3 alleles: e2, e3 and e4, whose frequencies vary by ethnicity. I identify several ethnically different clusters in which the effect of the e2 and e4 alleles on EL changes substantially. Furthermore, I investigate the interaction of APOE alleles with the country of residence. Results of this analysis suggest possible interaction of this gene with dietary habits or other environmental factors. For the third project, I perform a GWAS of rare variants and EL in a case-control dataset with median age of cases 104 years old. I analyze 4.5 million high-imputation quality rare SNPs imputed with HRC panel with minor allele frequency < 0.05. The analysis replicates all previous genome-wide level significant SNPs and identifies a few more potential targets. Additionally, I use serum protein data available for a subset of subjects and find significant pQTLs which have potential functional role. Based on these analyses, both genetic and environmental factors appear to be important factors for EL.}, keywords = {0308:Biostatistics, 0351:Gerontology, 0493:Aging, 0715:Bioinformatics, 0719:Physiology, Aging, Bioinformatics, Biostatistics, Dietary habits, Gerontology, Human extreme longevity, Physiology, PopCluster, Serum protein data}, isbn = {9781085779098}, url = {https://open.bu.edu/handle/2144/37092}, author = {Gurinovich,Anastasia} } @article {9970, title = {Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults}, journal = {SSM - Population Health}, volume = {7}, year = {2019}, pages = {100306}, abstract = {Introduction: Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to older adults who are more likely to have existing risk factors or medical conditions that require on-going care. The purpose of this study is to investigate the associations between patient-reported health care discrimination and biomarkers of cardiometabolic risk. Methods: We used 2008{\textendash}2014 data from the Health and Retirement Study, a nationally representative study of US adults ages 50+ (n=12,695 participants contributing up to 16,179 observations) to examine the association between patient-reported experiences of health care discrimination and biomarkers of cardiometabolic risk: high sensitivity C-reactive protein (CRP), Hemoglobin A1c (HbAlc), high-density lipoprotein (HDL), total cholesterol, cystatin C and blood pressure and whether relationships were modified by race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) or gender. We fit generalized estimating equation (GEE) models specifying a binomial distribution and logit link to account for dependency of repeated measures on individuals. Results: Health care discrimination was associated with higher odds of CRP>3 mg/L (OR: 1.20 (95\% CI: 1.10, 1.30) and HbA1c>6.5\% (OR: 1.23 (95\% CI: 1.10, 1.38) but not associated with other biomarkers of cardiometabolic health in the sample as a whole. However, subgroup differences were detected. While health care discrimination was positively associated with elevated HbA1c for non-Hispanics, it was inversely associated with HbA1c for Hispanics. Conclusions: Health care discrimination was associated with increased cardiometabolic risk based on selected biomarkers.}, keywords = {Biomarkers, Discrimination, Racism, Risk Factors}, issn = {23528273}, doi = {10.1016/j.ssmph.2018.10.006}, author = {Thu T Nguyen and Anusha M Vable and M. Maria Glymour and Allen, Amani M.} } @article {10129, title = {Disputes of self-reported chronic disease over time: The role of race, ethnicity, nativity, and language of interview.}, journal = {Medical Care}, volume = {57}, year = {2019}, pages = {625-632}, abstract = {

BACKGROUND: Respondents in longitudinal health interview surveys may inconsistently report their chronic diseases across interview waves. Racial/ethnic minority adults have an increased burden of chronic diseases and may dispute chronic disease reports more frequently.

OBJECTIVE: We evaluated the longitudinal association between race/ethnicity, nativity, and language of interview with disputing previously reported chronic diseases.

METHODS: We performed secondary data analysis of nationally representative longitudinal data (Health and Retirement Study, 1998-2010) of adults 51 years or older (n=23,593). We estimated multilevel mixed-effects logistic models of disputes of previously reported chronic disease (hypertension, heart disease, lung disease, diabetes, cancer, stroke, arthritis).

RESULTS: Approximately 22\% of Health and Retirement Study respondents disputed prior chronic disease self-reports across the entire study period; 21\% of non-Latino white, 20.5\% of non-Latino black, and 28\% of Latino respondents disputed. In subgroup comparisons of model-predicted odds using postestimation commands, Latinos interviewed in Spanish have 34\% greater odds of disputing compared with non-Latino whites interviewed in English and 35\% greater odds of dispute relative to non-Latino blacks interviewed in English.

CONCLUSIONS: The odds of disputing a prior chronic disease report were substantially higher for Latinos who were interviewed in Spanish compared with non-Latino white or black counterparts interviewed in English, even after accounting for other sociodemographic factors, cognitive declines, and time-in-sample considerations. Our findings point toward leveraging of multiple sources of data to triangulate information on chronic disease status as well as investigating potential mechanisms underlying the higher probability of dispute among Spanish-speaking Latino respondents.

}, keywords = {Chronic conditions, Racial/ethnic differences, Survey Methodology}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000001148}, author = {Ana R Qui{\~n}ones and Melekin, Amanuel and Christine T Cigolle and Corey L Nagel} } @article {10026, title = {Do family caregivers offset healthcare costs for older adults? A mapping review on the costs of care for older adults with versus without caregivers}, journal = {The Gerontologist}, volume = {59}, year = {2019}, type = {Journal}, abstract = {Background and Objectives Older adults face significant long-term care and health care costs. But some of these costs can potentially be offset through family caregivers who may serve as substitutes for formal care or directly improve the care recipient{\textquoteright}s health and reduce health care utilization and expenditures. This article reviews the current literature to determine whether it is possible through existing work to compare the costs of care for individuals with versus without family caregivers and, if not, where the data, measurement, and other methodological challenges lie. Research Design and Methods A mapping review of published works containing information on health care utilization and expenditures and caregiving was conducted. A narrative approach was used to review and identify methodological challenges in the literature. Results Our review identified 47 articles that met our criteria and had information on caregiving and health care costs or utilization. Although findings were mixed, for the most part, having a family caregiver was associated with reduced health care utilization and a decreased risk of institutionalization however, the precise difference in health care expenditures for individuals with caregivers compared to those without was rarely examined, and findings were inconsistent across articles reviewed. Discussion and Implications The number of family caregivers providing care to loved ones is expected to grow with the aging of the Baby Boomers. Various programs and policies have been proposed to support these caregivers, but they could be costly. These costs can potentially be offset if family caregivers reduce health care spending. More research is needed, however, to quantify the savings stemming from family caregiving.}, keywords = {Adult children, Caregiving, Health care utilization}, issn = {0016-9013}, doi = {10.1093/geront/gny182}, url = {https://academic.oup.com/gerontologist/article/59/5/e535/5427472}, author = {Esther M Friedman and Rodakowski, Juleen and Schulz, Richard and Scott Beach and Martsolf, Grant R and James, A Everette} } @article {10203, title = {Do Immigrants Delay Retirement and Social Security Claiming?}, journal = {National Bureau of Economic Research Working Paper Series}, volume = {No. 25518}, year = {2019}, note = {Author contact info:Mary LopezOccidental CollegeE-Mail: mlopez@oxy.eduSita SlavovSchar School of Policy and GovernmentGeorge Mason University3351 Fairfax Drive, MS 3B1Arlington, VA 22201Tel: 703/993-3171E-Mail: sslavov@gmu.edu}, month = {2019}, abstract = {As the share of older immigrants residing in the U.S. begins to rise, it is important to understand how immigrants{\textquoteright} retirement behavior and security compare to that of natives. This question has implications for the impact of immigration on government finances and for the retirement security of immigrants. We use data from the Health and Retirement Study (HRS) to examine how immigrants{\textquoteright} retirement and Social Security claiming patterns compare to those of natives. We find that immigrants are significantly less likely than natives to retire or claim Social Security in their early 60s. We do not find heterogeneous effects by ethnicity or age of arrival to the U.S. We also find no evidence that immigrants exit the survey at higher rates than U.S. natives in their late 50s through 60s, a finding that is consistent with immigrants retiring in the U.S. rather than abroad.}, keywords = {Immigrants, Immigration, Social Security}, doi = {10.3386/w25518}, url = {http://www.nber.org/papers/w25518}, author = {Lopez, Mary J and Sita Nataraj Slavov} } @article {9813, title = {Do Nationally Representative Cutpoints for Clinical Muscle Weakness Predict Mortality? Results from Nine Years of Follow-up in the Health and Retirement Study.}, journal = {Journals of Gerontology, Series A: Biological Sciences and Medical Sciences}, year = {2019}, abstract = {

Background: Muscle weakness, as measured by handgrip strength, is associated with cardiovascular and all cause-mortality; however, there are wide inconsistences in the magnitude of these effects due to divergent definitions used to define muscle weakness across studies. Therefore, the objective of this study was to examine the relationship between previously defined sex- and race-specific cutpoints of clinical muscle weakness and early mortality.

Methods: Data come from the 2006-2014 Health and Retirement Study. Time-varying clinical muscle weakness, as defined by handgrip strength cutpoints, was the primary exposure. Time to death, ascertained from the National Death Index, was the outcome of interest. The association between time-varying clinical muscle weakness and early mortality across a 9-year observation period was determined using Kaplan-Meier methods and extended Cox regression.

Results: Out of the 8,326 individuals in the study, 1,799 deaths (21\%) occurred during the observation period. Median follow-up time was 8.3 years (SD {\textpm}1.9 years). Weak individuals had a steeper decline in their survival trajectory, compared to non-weak individuals (Log-Rank test, p<.001). After adjusting for sociodemographic factors and time-varying smoking history, weak individuals were over 50\% more likely to die earlier than non-weak individuals (HR=1.52, 95\% CI= 1.15, 1.47).

Conclusions: This is the first study to use muscle weakness cut-points derived in a nationally-representative sample to identify those individuals who may be at greatest risk for premature mortality. Results underscore the importance of muscle weakness, as defined by handgrip strength, as a key risk factor for premature mortality in older Americans.

}, keywords = {Cut points, Health Conditions and Status, Mortality}, issn = {1758-535X}, doi = {10.1093/gerona/gly169}, author = {Kate A Duchowny} } @article {9726, title = {Do older adults with Alzheimer{\textquoteright}s disease engage in estate planning and advance care planning preparation?}, journal = {Aging \& Mental Health}, volume = {23}, year = {2019}, pages = {872-879 }, abstract = {Objectives: This study investigated the estate planning and advance care planning (ACP) of older adults diagnosed with Alzheimer{\textquoteright}s disease (AD) for the presence of (1) a valid will, (2) a durable power of attorney for health care, and (3) a living will. Method: We analyzed 10,273 adults aged 65 and older from the 2012 Health and Retirement Study (HRS) using multilevel logistic regression. Results: We found that a diagnosis of AD was significantly associated with the ACP variables. Older adults with AD were more likely to assign a durable power of attorney for health care and have a written living will than older adults without an AD diagnosis. However, we found no significant association between a diagnosis of AD and having a valid will. These findings were robust when adjusting for demographic and socioeconomic variables. Other factors decreased engagement in estate planning and ACP, including lower socioeconomic status, being male, and being a minority. Conclusion: Our findings suggest that a diagnosis of AD is associated with more engagement in ACP for individuals and their families, but important barriers exist for people with fewer resources.}, keywords = {Advance directives, Alzheimer{\textquoteright}s disease, Estate tax}, issn = {1360-7863}, doi = {10.1080/13607863.2018.1461192}, url = {https://www.tandfonline.com/doi/full/10.1080/13607863.2018.1461192https://www.tandfonline.com/doi/pdf/10.1080/13607863.2018.1461192}, author = {Shinae L Choi and Kim, Minjung and Ian M McDonough} } @article {10103, title = {Do post-menopausal women provide more care to their kin?: Evidence of grandparental caregiving from two large-scale national surveys}, journal = {Evolution and Human Behavior}, volume = {40}, year = {2019}, pages = {355-364}, abstract = {Drawing on the logical principles of life-history theory, it may be hypothesized that{\textemdash}compared to pre-menopausal women{\textemdash}post-menopausal women will spend more time caring for grandchildren and other kin. This hypothesis was tested in two studies, on results obtained from two large datasets documenting altruistic behaviors of pre-menopausal and post-menopausal women in the United States (n = 7161) and Australia (N = 25,066). Results from both studies revealed that (even when controlling statistically for age, health, financial resources, and other pertinent variables), post-menopausal women devoted more time to grandparental caregiving. This effect was specific to kin care: Menopause status was not as strongly related to a measure of non-kin-directed altruistic behavior (time spent volunteering). These results provide the first empirical support for a previously-untested behavioral implication of menopause.}, keywords = {Family Roles/Relationships, Grandparents, Menopause, Women and Minorities}, issn = {10905138}, doi = {10.1016/j.evolhumbehav.2019.04.002}, author = {Hofer, Marlise K. and Collins, Hanne K. and Mishra, Gita D. and Schaller, Mark} } @article {10135, title = {Do race and everyday discrimination predict mortality risk? Evidence from the Health and Retirement Study.}, journal = {Gerontology \& Geriatric Medicine}, volume = {5}, year = {2019}, month = {2019 Jan-Dec}, pages = {2333721419855665}, abstract = {Everyday discrimination is a potent source of stress for racial minorities, and is associated with a wide range of negative health outcomes, spanning both mental and physical health. Few studies have examined the relationships linking race and discrimination to mortality in later life. We examined the longitudinal association among race, everyday discrimination, and all-cause mortality in 12,081 respondents participating in the Health and Retirement Study. Cox proportional hazards models showed that everyday discrimination, but not race, was positively associated with mortality; depressive symptoms and lifestyle factors partially accounted for the relationship between everyday discrimination and mortality; and race did not moderate the association between everyday discrimination and mortality. These findings contribute to a growing body of evidence on the role that discrimination plays in shaping the life chances, resources, and health of people, and, in particular, minority members, who are continuously exposed to unfair treatment in their everyday lives.}, keywords = {Discrimination, Mortality, Racial/ethnic differences}, issn = {2333-7214}, doi = {10.1177/2333721419855665}, author = {Heather R. Farmer and Linda A. Wray and Jason R Thomas} } @article {10444, title = {DOES A PERCEIVED CONNECTION TO A NEIGHBORHOOD REDUCE LONELINESS?}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, month = {2019/11/08}, pages = {S534 - S534}, abstract = {This study investigated whether perceived neighborhood quality was associated with chronic loneliness for adults 60 and older in the United States. Although loneliness can be episodic and overcome, chronic loneliness has been identified as a social determinant of health. Utilizing ecological systems theory we hypothesized that higher levels of neighborhood social cohesiveness would be associated with lower odds of chronic loneliness. We postulated that the networks available to people in the proximal area where they live could provide social opportunities for reducing loneliness. This idea was consistent with prior findings indicating the salience of neighborhoods for retirees, but inconsistent with research indicating the importance of a confidant in reducing loneliness. Data from the 2008 and 2012 Health and Retirement Study Psychosocial Surveys were used (n = 3530). Loneliness was measured using the 3-item scale developed by Hughes and colleagues in 2004. Findings from unadjusted logistic regression indicated that loneliness was inversely related to neighborhood cohesion as measured by an index of the trustworthiness, friendliness and helpfulness of neighbors and cleanliness, occupancy, lack of graffiti, and sense of belonging in the area (OR = .73, p < .001). When demographic and health-related factors were entered into the model the odds of being lonely were significantly lower for those with higher ratings of social cohesion (OR = .83, p < .001). These findings were consistent with the idea that neighborhoods are an important social place for older persons and interventions at the neighborhood level may be more effective than individualized treatment plans.}, keywords = {Loneliness, neighborhood}, isbn = {2399-5300}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841328/}, author = {Kimberly J. Johnson and Adeniji, Dolapo O} } @article {10081, title = {Does gender differentiate the effects of retirement on cognitive health?}, journal = {Research on Aging}, year = {2019}, abstract = {Prior research on change in cognitive performance before and after retirement suffers from inattention to gender context. This study theoretically motivates the testing of gender differences in cognitive decline after retirement. I drew 67,905 observations of cognitive function based on the Telephone Interview for Cognitive Status from 18,453 participants (7,830 men and 10,623 women) in the Health and Retirement Study (1992-2014). I used fixed-effects two-stage least square models to account for unobserved heterogeneity between men and women in the sample and the endogeneity of retirement decision. I also controlled for change in depressive symptoms, mobility limitations, individual wealth, medical expenses, and spousal income. Retirement predicts a decrease in the cognitive score by 2.168 on a scale of 0-35 for women, but no change for men. Continued employment may buffer against risk factors that aggravate women{\textquoteright}s cognitive health.}, keywords = {Cognition \& Reasoning, Gender Differences, Retirement Planning \& Satisfaction}, issn = {1552-7573}, doi = {10.1177/0164027519828062}, author = {Oi, Katsuya} } @mastersthesis {10289, title = {Does Gray Divorce Delay Retirement?}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-09-20}, pages = {246}, school = {State University of New York at Binghamton}, type = {phd}, abstract = {Baby Boomers are the only demographic cohort whose divorce rate increased from 1990 to 2010. All other age groups experienced lower rates of both marriage and divorce. Divorce tends to reduce wealth at the time it occurs, but longer-term effects differ by gender. Divorcing after or just before retiring may have devastating financial consequences for hundreds of thousands of older adults. Baby Boomers are the largest cohort to face retirement to date. In 2018, 70 million Boomers are age 54 {\textendash} 72 years old. Yet, most of them have not saved enough to sustain decades- long retirement periods. The short- and long-term economic effects of a massive drop in workforce participation and application for government-paid retirement benefits could be enormous. This study used the 2014 wave of a large, national representative dataset to look at Baby Boomers in their 60s. Multinomial logistic regression was conducted on a unique outcome variable that combined being retired or not with receiving Social Security benefits or not. A focused selection of predictor variables included demographic, marital status, and other lifecycle-related variables. The {\textquotedblleft}Yes/No{\textquotedblright} gray divorce variable was merged with the variable measuring divorce recency to unify the context of economic shocks at different lifecycle stages. The regression models were run separately by gender. Gray divorce was not a significant predictor for any combination of retiring and receiving Social Security benefits. Later-life marital dissolution did not play a role in respondents{\textquoteright} retirement behavior. A significant effect was found for divorces that had occurred 13 {\textendash} 24 years earlier, when respondents were in their 40s. The study has implications for future research, policy, and practitioners.}, keywords = {0508:Finance, 0510:Labor economics, 0628:Individual \& family studies, Baby Boomers, Divorce, Finance, Gray divorce, Individual \& family studies, Labor economics, Retirement, Social Security}, isbn = {9781085576499}, url = {https://krex.k-state.edu/dspace/handle/2097/39513}, author = {Berkowicz,Sara S.} } @article {10030, title = {Does home equity affect decisions on long-term care insurance purchases? Evidence from the United States.}, journal = {Research on Aging}, volume = {41}, year = {2019}, month = {07/2019}, abstract = {The low uptake of private long-term care insurance (LTCI) by the elderly in the United States, despite visible risks, has left economists puzzled. Prior studies have hypothesized that home equity can be a substitute for LTCI and hence may partly explain the low uptake. We test this hypothesis empirically. We utilize exogenous variation in house prices at the level of the metropolitan statistical area (MSA) as an instrument for home equity for individuals residing in that MSA and data from the Health and Retirement Study. In the most robust specifications, we find no evidence that the elderly change their decision on LTCI based on variation in their home equity, and even specifications requiring stronger identification assumptions imply only small effect magnitudes. Home equity as a substitute for LTCI does not appear to be a major contributing factor to low LTCI take up.}, keywords = {Decision making, Homeownership, Long-term care insurance}, issn = {1552-7573}, doi = {10.1177/0164027519830078}, author = {Richard A Hirth and Acharya, Yubraj and Helen G Levy and Kenneth M. Langa} } @article {11256, title = {Does salivary telomere length explain race/ethnic differences in aging?}, journal = {Biodemography and Social Biology}, volume = {65}, year = {2019}, pages = {351-369}, abstract = {ABSTRACT Telomere length (TL) is a biomarker that can be used to characterize variability in aging and may explain race/ethnic differences in aging. Yet, it remains unclear if TL is related to aging-associated health risks in multi-ethnic populations or if it explains race/ethnic differences in health. We examine whether salivary TL (STL) explains any of the race/ethnic variability in 15 indicators of high-risk biological, physical, and cognitive health among 4,074 White, Black, and Latinx older adults ages 54+ in the 2008 Health and Retirement Study. TL was assayed from saliva using quantitative PCR (T/S ratio). Decomposition analyses from logistic regression models show variation in STL does not account for any of the observed race/ethnic differences health. In age-adjusted, race-stratified models, STL was associated with HDL, total cholesterol, and lung function among Whites, but was not associated with any markers of health among Black or Latinx groups. In this diverse national sample of older adults, STL does not account for race/ethnic differences in late life health, is associated with relatively few indicators of health among Whites, and is not associated with indicators of health among Black or Latinx groups. STL may not be a useful biomarker for understanding racial/ethnic differences in population aging among older adults.}, keywords = {Aging, Biomarkers, ethnicity, race, Telomere length}, isbn = {1948-5565}, doi = {10.1080/19485565.2020.1798736}, author = {Brown, Lauren and Garc{\'\i}a, Catherine and Jennifer A Ailshire} } @article {9753, title = {Does the Health of Adult Child Caregivers Vary by Employment Status in the United States?}, journal = {Journal of Aging and Health}, year = {2019}, abstract = {

OBJECTIVE: This study investigates whether the health effects of informal caregiving for aging parents vary by employment status in the United States. Two opposing hypotheses are tested: dual role strain and role enhancement.

METHOD: Using national longitudinal data from the U.S. Health and Retirement Study, multivariate regression models predicted self-rated health and mental health among older adult children caregiving for their parents (2009-2012) and noncaregivers.

RESULTS: A statistically significant interaction was found between caregiving duration and employment, indicating that employed caregivers had significantly worse health than retired caregivers. Caregiving duration also predicted significantly higher levels of depressive symptoms.

DISCUSSION: Our results support the dual role strain hypothesis and suggest that caregiving for a parent up to 4 years is enough to predict significantly worse health among older adult Baby Boomers, especially those in the labor force. The broader implications for public health and workplace policies are discussed.

}, keywords = {Adult children, Caregiving, Employment and Labor Force, Retirement Planning and Satisfaction}, issn = {1552-6887}, doi = {10.1177/0898264318782561}, author = {Noreen M Kohl and Krysia N Mossakowski and Ivan I Sanidad and Omar T. Bird and Lawrence H Nitz} } @article {9762, title = {Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer}, journal = {American Journal of Medicine}, volume = {131}, year = {2018}, month = {10/2018}, pages = {1187-1199}, abstract = {

PURPOSE: To evaluate the impact of cancer upon a patient{\textquoteright}s depletion of net worth and incursion of debt in the U.S.

METHODS: This longitudinal study used the Health and Retirement Study (HRS) from 1998-2014. Persons >=50 years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models were employed to assess changes in net worth and debt (consumer, mortgage, home equity) at two-and four-years following diagnosis (Year, Year) after controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality. A two-year period prior to cancer diagnosis served as an historical control.

RESULTS: Across 9.5 million total estimated new diagnoses of cancer from 2000-2012, individuals averaged 68.6{\textpm}9.4 years with slight majorities being married (54.7\%), not retired (51.1\%), and Medicare beneficiaries (56.6\%). At Year, 42.4\% depleted their entire life{\textquoteright}s assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, socio-economic factors (i.e., increasing age/income/household size, female sex), clinical characteristics (i.e., current smoker, worse self-reported health, hypertension, diabetes, lung disease), Medicaid, and uninsured (p<0.05); average losses were -$92,098. At Year, financial insolvency extended to 38.2\%, with several consistent socio-economic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion.

CONCLUSION: Using nationally-representative data, this investigation of an estimated 9.5 million newly-diagnosed persons with cancer >=50 years of age found a substantial proportion incurring financial toxicity. As large financial burdens have been found to adversely affect access to care and outcomes among cancer patients, the active development of approaches to mitigate these effects among already vulnerable groups remain of key importance.

}, keywords = {Cancer, Debt, Financial burden, Medical Expenses}, issn = {1555-7162}, doi = {10.1016/j.amjmed.2018.05.020}, author = {Adrienne M. Gilligan and David S Alberts and Denise J Roe and Grant H Skrepnek} } @article {10353, title = {Delayed Retirement and the Growth in Income Inequality at Older Ages}, year = {2018}, month = {02/2018}, institution = {The Urban Institute}, abstract = {As concerns about retirement savings have intensified, many older adults have begun working beyond traditional retirement age. By working longer, they can improve their retirement security by increasing their future monthly Social Security payments and shortening the time they must rely on their savings. But does delaying retirement deepen income inequality for older adults by leaving those with health problems behind? Delayed retirement can boost financial security but excludes workers with health problems Employment and income for 62-to-64-year-olds has increased substantially over the past two decades for people in good health. But employment and income have stagnated for older Americans with health problems, who face lower income than their healthier counterparts for the rest of their lives. To assess how later retirement affects income inequality at older ages, we examined how the relationship between health status, employment, and income has shifted for people eligible for early Social Security retirement benefits but too young to receive full retirement benefits.}, keywords = {Income inequality, Retirement}, url = {https://www.urban.org/research/publication/delayed-retirement-and-growth-income-inequality-older-ages}, author = {Richard W. Johnson} } @article {9589, title = {Dementia Prevalence in the United States in 2000 and 2012: Estimates Based on a Nationally Representative Study.}, journal = {Journals of Gerontology Series B: Psychological Sciences and Soc Sciences}, volume = {73}, year = {2018}, pages = {S10-S19}, abstract = {

Objectives: Age- and sex-specific rates of dementia are estimated in the U.S. population aged 65 or older in 2000 and 2012 using a large nationally representative dataset, the Health and Retirement Study (HRS), and accounting for mortality selection and specificities of the interview protocol.

Method: A latent cognitive ability model is estimated by maximum simulated likelihood. Prevalence of dementia is identified using HRS cognition measures and the Aging, Demographics and Memory Study (ADAMS), a subset of the HRS (n = 856) with clinical assessment for dementia. Different cognitive measures are collected in self and proxy interviews. From 2006 onward, the HRS collected fewer interviews by proxy. Selection into proxy interviews is modeled as well as survival into the ADAMS sample from the previous HRS interview.

Results: The prevalence of dementia decreased from 12.0\% (SE = 0.48\%) in 2000 to 10.5\% (SE = 0.49\%) in 2012 in the 65+ population, a statistically significant decline of 12.6\% (p < .01). The percentage change in prevalence was larger among males (16.6\% vs 9.5\%), and younger individuals.

Discussion: The prevalence of dementia among those 65 or older decreased between 2000 and 2012, although less rapidly than reported in other studies. The difference is primarily due to our modeling selection into proxy interviews.

}, keywords = {Cognitive Ability, Dementia}, issn = {1758-5368}, doi = {10.1093/geronb/gbx169}, author = {P{\'e}ter Hudomiet and Michael D Hurd and Susann Rohwedder} } @article {9506, title = {Demographic factors and retrieval of object and proper names after age 70}, journal = {PLOS ONE}, volume = {13}, year = {2018}, pages = {e0191876}, abstract = {Purpose This research aimed to investigate whether demographic factors are similarly related to retrieval of object and proper names. Methods The sample included 5,907 individuals above age 70 who participated in the Health and Retirement Study between 2004 and 2012. Participants were asked to name two objects as well as the US President and Vice President. Latent growth curve models examined the associations of age, education, and self-rated health with baseline levels and change trajectories in retrieval. Results Age and education were more strongly related to retrieval of proper names than to retrieval of object names, both for baseline scores and for change trajectory. Similar effects of selfrated health emerged for both types of stimuli. Conclusions The results show that examining object names and proper names together as indication of cognitive status in the HRS might overlook important differences between the two types of stimuli, in both baseline performance and longitudinal change. }, keywords = {Cognitive Ability, Education, Memory}, doi = {10.1371/journal.pone.0191876}, author = {Kav{\'e}, Gitit and Fridkin, Shimon and Liat Ayalon}, editor = {Vigliecca, Nora Silvana} } @article {9903, title = {Depression And Anxiety Linked To Higher Risk Of Other Major Health Conditions, Suggests New Study}, journal = {Forbes}, volume = {2018}, number = {12/18/2018}, year = {2018}, publisher = {Forbes}, address = {New York City}, keywords = {Depressive symptoms, Loneliness, News}, url = {https://www.forbes.com/sites/daviddisalvo/2018/12/17/depression-and-anxiety-may-damage-health-as-much-as-smoking-and-obesity-suggests-study/$\#$7c85c79e21f1}, author = {DiSalvo, David} } @article {9828, title = {Depression and depressive symptoms as risk factors of labour deactivation and early or disability retirement in economically active adults in different age groups}, journal = {Postepy Psychiatrii i Neurologii}, volume = {27}, year = {2018}, chapter = {59-63}, abstract = {Purpose: Over the recent years, the number of people over 54 years of age, who decide to make use of early retirement, has systematically increased. Economic inactivation is also an emerging problem in the group of younger adults. Depression or depressive symptoms should be taken into consideration in analysing variables that may play a role in the decisional process regarding occupational activities. The aim of the present work is to summarise the role of depression or depressive symptoms in the process of decision-making to continue occupational activities or to quit them. Review: The authors listed and discussed the most recent and representative surveys and studies regarding causes of retirement, concentrating especially on depression and depressive symptoms. The studies summarised here include the Health and Retirement Study, English Longitudinal Study of Ageing, Survey of Health, Ageing and Retirement in Europe and WHO{\textquoteright}s Study on Global Ageing and Adult Health. It has been shown, that prevalence of depressive symptoms of different severity in professionally active people may range from 6\% to 32\%. Depressive symptoms significantly increase the chance for retirement. Conclusions: Depressive disorders can affect people in all age categories and are one of the main cause of early disability retirement or early retirement tendencies. It is important to consider depressive disorders in policies supporting labour force participation. {\textcopyright} 2018 Institute of Psychiatry and Neurology. Production and hosting by Termedia sp. z o.o. }, keywords = {Depressive symptoms, Disabilities, Retirement, SHARE}, issn = {12302813}, author = {Konopko, M. and Antosik-Wojcinska, A. and Swiecicki, L. and Wojnar, M. and Bienkowski, P. and Sienkiewicz-Jarosz, H.} } @article {9243, title = {Depressive symptoms and cognitive functioning among older adults with cancer.}, journal = {Aging \& Mental Health}, volume = {22}, year = {2018}, pages = {1465-1470}, abstract = {

OBJECTIVE: The US population of older adults is growing, with an increase in diseases like cancer. As cancer rates increase, there is a concomitant increase in adverse correlates, such as cognitive impairment and depressive symptomatology. In order to develop appropriate interventions, it is vital to assess relationships among cancer, depressive symptoms and cognitive functioning.

METHODS: The sample consisted of 403 older adults with cancer diagnoses from the Health and Retirement Study. Using latent class growth analysis, longitudinal data were explored. The goals were to investigate trajectories of cognitive functioning, and to identify whether depressive symptoms and demographic factors predicted membership in the cognitive classes.

RESULTS: Three classes of cognitive functioning best fit the data: High, Middle and Low Recall, fairly stable trajectories from pre-diagnosis to a period four years after diagnosis. More depressive symptoms after diagnosis (but not prior) significantly predicted membership in the Low Recall class. Depressive symptoms did not distinguish between the High and Middle Recall classes.

CONCLUSION: Depressive symptomatology is thought to affect cognition in late life. We found that depressive symptoms after a cancer diagnosis, but not before, successfully differentiated between those who had Low Recall from those with Middle and High Recall. Implications are discussed.

}, keywords = {Cancer screenings, Cognitive Ability, Depressive symptoms}, issn = {1364-6915}, doi = {10.1080/13607863.2017.1363868}, author = {Ruth T Morin and Midlarsky, Elizabeth} } @article {9475, title = {Determinants of health trajectories in England and the US: an approach to identify different patterns of healthy aging.}, journal = {Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {73}, year = {2018}, pages = {1512-1518}, abstract = {

Background: Aging is a multidimensional process with a remarkable inter-individual variability. This study is focused on identifying groups of population with similar aging patterns, and to define the health trajectories of these groups. Socio-demographic and health determinants of these trajectories are also identified.

Methods: Data from the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) were used. A set of self-reported health items and measured tests were used to generate a latent health metric by means of a Bayesian multilevel IRT model, assessing the ability of the metric to predict mortality. Then, a Growth Mixture Model (GMM) was conducted in each study to identify latent classes and assess health trajectories. Kaplan-Meier survival curves were obtained for each class and a multinomial logistic regression was used to identify determinants of these trajectories.

Results: The health score generated showed an adequate ability to predict mortality over ten years in ELSA [AUC=0.74; 95\% CI=(0.72,0.75)] and HRS [AUC=0.74; 95\% CI=(0.73,0.75)]. By means of GMM, four latent classes were identified in ELSA and five in HRS. Chronic conditions, no qualification and low level of household wealth were associated to the classes which showed a higher mortality in both studies.

Conclusion: The method based on the creation of a common metric of health and the use of GMM to identify similar patterns of aging, allows for the comparison of trajectories of health across longitudinal surveys. Multimorbidity, educational level and household wealth could be considered as determinants associated to these trajectories.

}, keywords = {Cross-National, Health Trajectories, Successful aging}, issn = {1758-535X}, doi = {10.1093/gerona/gly006}, author = {de la Fuente, Javier and Francisco F{\'e}lix Caballero and Albert S{\'a}nchez-Niub{\'o} and Demosthenes B Panagiotakos and Matthew Prina and Arndt, Holger and Haro, Josep Maria and Chatterji, Somnath and Ayuso-Mateos, Jos{\'e} Luis} } @article {9586, title = {Development, Construct Validity, and Predictive Validity of a Continuous Frailty Scale: Results from Two Large U.S. Cohorts.}, journal = {American Journal of Epidemiology}, volume = {187}, year = {2018}, pages = {1752-1762}, abstract = {Frailty is an age-related clinical syndrome of decreased resilience to stressors. Among numerous assessments of frailty, the frailty phenotype (FP) scale, proposed by Fried and colleagues has been the most widely used one. We aimed to develop a continuous frailty scale that may overcome limitations facing the categorical FP scale and to evaluate its construct validity, predictive validity, and measurement properties. Data were from the Cardiovascular Health Study (N~=~4243) and Health and Retirement Study (N~=~7600). Frailty was conceptualized as a continuous construct, measured by five measures used in FP scale: gait speed, grip strength, exhaustion, physical activity, and weight loss. We used confirmatory factor analysis to investigate the relationship between five indicators and the latent frailty construct. We examined the association of the continuous frailty scale with mortality and disability. The unidimensional model fit the data satisfactorily; similar factor structure was observed across two cohorts. Gait speed and weight loss were the strongest and weakest indicators, respectively; grip strength, exhaustion, and physical activity had similar strength in measuring frailty. In each cohort, the continuous frailty scale was strongly associated with mortality and disability and persisted to be associated with outcomes among robust and prefrail persons classified by the FP scale.}, keywords = {Comparisons, Frailty, Survey Methodology}, issn = {1476-6256}, doi = {10.1093/aje/kwy041}, author = {Wu, Chenkai and G John Geldhof and Xue, Qian-Li and Dae H Kim and Anne B Newman and Michelle C Odden} } @article {8576, title = {Differences in the Progression of Disability: A U.S.-Mexico Comparison.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {913-922}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Disabled Persons, disease progression, Female, Humans, Male, Mexico, MHAS}, issn = {1758-5368}, doi = {10.1093/geronb/gbw082}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27436102}, author = {D{\'\i}az-Venegas, Carlos and Timothy A Reistetter and Rebeca Wong} } @article {9195, title = {Discrete time survival analysis via latent variable modeling: A note on lagged depression links to stroke in middle and late life}, journal = {Structural Equation Modeling: A Multidisciplinary Journal}, volume = {25}, year = {2018}, pages = {115-120}, abstract = {This article is concerned with a latent variable modeling approach to discrete time survival analysis that includes both time-invariant and time-varying covariates. The approach is illustrated with data from the Health and Retirement Study, which are utilized to study further the relationship of depression to stroke in middle and late life. Employing lag-1 depression scores as time-varying covariates, in addition to a set of relevant medical and demographic variables as time-invariant covariates collected at baseline, the article addresses a particular aspect of the prominent vascular depression hypothesis representing an important area in aging research, gerontology, geriatrics, and medicine. The results indicate considerable links of immediately prior depression levels to subsequent occurrences of stroke in middle-aged and older adults. The findings complement those reported by Raykov, Gorelick, Zajacova, and Marcoulides (2017), and are consistent with that hypothesis implying depression as a potential warning sign of an impending stroke.}, keywords = {Depressive symptoms, Latent Variable Modeling, Mortality}, issn = {1070-5511}, doi = {10.1080/10705511.2017.1327817}, url = {https://www.tandfonline.com/doi/full/10.1080/10705511.2017.1327817https://www.tandfonline.com/doi/pdf/10.1080/10705511.2017.1327817}, author = {Raykov, Tenko and Gorelick, Philip B. and Zajacova, Anna and Marcoulides, George A.} } @article {9492, title = {The Distribution of Time in Retirement: Evidence From the Health and Retirement Survey}, journal = {Work, Aging and Retirement}, volume = {4}, year = {2018}, pages = {251-261}, abstract = {This is the first study to investigate the distribution of retirement time. We apply hot-deck imputation to Health and Retirement Study data to construct a synthetic sample of people who lived natural human life spans to measure their duration of time between withdrawing from the labor force and death. Men are more likely than women to die without retiring and Blacks and women with low educational attainment have shorter retirements and spend larger shares of their retirement time needing assistance with one or more activities of daily living (ADLs). We also find defined benefit pensions offset the negative impact of male low socioeconomic status how much time is spent in retirement needing assistance with ADLs impaired. Some groups with shorter than average life spans cannot entirely compensate by retiring early. In the United States, access to retirement time is unequally distributed and may become more unequal as pension wealth and longevity inequalities increase.}, keywords = {Retirement Planning and Satisfaction, Time Use}, issn = {2054-4642}, doi = {10.1093/workar/way001}, url = {https://academic.oup.com/workar/advance-article/doi/10.1093/workar/way001/4865893http://academic.oup.com/workar/advance-article-pdf/doi/10.1093/workar/way001/23978292/way001.pdf}, author = {Teresa Ghilarducci and Anthony Webb} } @article {9614, title = {Distributional Effects of Alternative Strategies for Financing Long-Term Services and Supports and Assisting Family Caregivers}, number = {WP$\#$2018-1}, year = {2018}, month = {03/2018}, pages = {2-65}, institution = {Center for Retirement Research at Boston College}, address = {Boston, MA}, abstract = {We use two historical data sources {\textendash} the Health and Retirement Study and the Medicare Current Beneficiary Study {\textendash} to consider the patterns in older Americans{\textquoteright} severe disability and their use of long-term services and supports (LTSS) by age and socioeconomic status. We then use a dynamic microsimulation model to project how the effects of various interventions to support those with severe disabilities and their caregivers would be distributed across the income distribution. The interventions that we examine fall into three broad classes: tax credits for caregiving expenses, respite care for people in the community with family caregivers, and new social insurance programs. Within each broad class of policies, we examine how sensitive outcomes are to changes in policy details (such as, in the case of tax credits, deductible levels, refundability, and income phase-outs). This paper found that: Older adults with less education and less wealth are more likely to report disabilities and service use than their more educated and wealthier counterparts.This pattern persists when we look at people at a point in time but also, more robustly, when we look at their disabilities prospectively. In a sample of older adults who do not report disabilities at baseline, we find that those with fewer economic resources earlier in life are generally more likely to develop disabilities and use paid LTSS over the next two decades, but the differences narrow when we restrict the sample to people who do not develop disabilities until their late 70s. The policy implications of this paper are: The uneven distribution of disability risks across the population poses challenges for developing effective LTSS policies. Those most likely to need LTSS often lack enough resources to contribute to LTSS programs, and programs that try to contain costs by using underwriting or imposing work requirements often disqualify those who most need coverage.Certain classes of policies, such as respite care benefits, tend to direct much of their benefits to those in lower income quintiles, according to our projections. Caregiver tax credits and social insurance programs generally distribute benefits more proportionally, although impacts vary depending on how the policies are specified.Policy design details can significantly affect distributional outcomes. Provisions{\textquoteright} effects can be sensitive to the stacking order in which they are implemented.It can be useful to examine trends and proposals not only cross-sectionally but also over longer time periods. For example, the distributional effects of social insurance programs depend on the relatively high early-life mortality of those with less education and lower earnings and wealth. }, keywords = {Disabilities, Insurance, Taxes}, url = {http://crr.bc.edu/wp-content/uploads/2018/03/wp_2018-1.pdf}, author = {Melissa Favreault and Richard W. Johnson} } @article {9850, title = {Divorce and health in middle and older ages}, journal = {Review of Economics of the Household}, year = {2018}, month = {May-10-2018}, abstract = {The prevalence and incidence of divorce at older ages have doubled since 1990. We use Health and Retirement Study data to describe associations between divorce, remarriage and health in middle and later life, following individuals and couples through divorce and remarriage in models with individual or couple fixed effects. At middle and older ages, divorce is more often associated with adverse physical and mental health changes for women than for men. Remarriage is associated with a restoration of health and depression to pre-divorce levels for men and women. However, men are more likely to remarry. Evidence from couple models suggests that for husbands, but not wives, remarriage may be associated with less depression than the baseline marriage. Differences in self-reported health associated with divorce appear linked to (diagnosed) mental health conditions among wives and physical health conditions among husbands. }, keywords = {Depressive symptoms, Divorce, Gender Differences, health, Mental Health, Remarriage}, issn = {1569-5239}, doi = {10.1007/s11150-018-9435-z}, url = {http://link.springer.com/10.1007/s11150-018-9435-zhttp://link.springer.com/content/pdf/10.1007/s11150-018-9435-z.pdfhttp://link.springer.com/content/pdf/10.1007/s11150-018-9435-z.pdfhttp://link.springer.com/article/10.1007/s11150-018-9435-z/fulltext.html}, author = {Alice Zulkarnain and Korenman, Sanders} } @article {9963, title = {Do Medicare Advantage Rebates Reduce Enrollees{\textquoteright} Out-of-Pocket Spending?}, journal = {Medical Care Research \& Review}, year = {2018}, abstract = {The majority of Medicare Advantage (MA) plans receive payments that exceed their costs of providing basic Medicare benefits. There is controversy about whether these payments are passed on to the enrollees as supplemental benefits or are retained by plans. We used survey data on MA beneficiaries{\textquoteright} actual out-of-pocket (OOP) spending linked to MA payment information to test whether higher plan payments and rebates lowered enrollee OOP spending. We used instrumental variables regression models to address concerns that plan payments and rebates may reflect anticipation of enrollees with particular health-spending profiles. We found that beneficiaries recovered only $0.65 of every $1.00 in payments exceeding fee-for-service spending through lower OOP spending but more than fully recovered the value of the rebates supporting supplemental benefits.}, keywords = {Medicare linkage, Medicare/Medicaid/Health Insurance}, issn = {1552-6801}, doi = {10.1177/1077558718807847}, author = {Lauren Hersch Nicholas and Wu, Shannon} } @article {9827, title = {Do Older SSDI Applicants Denied Benefits on the Basis of their Work Capacity Return to Work After Denial?}, number = {2083857692}, year = {2018}, month = {09/2018}, institution = {Princeton}, address = {Princeton, NJ}, abstract = {Key Findings: * Very few older denied SSDI applicants returned to work in the years following denial. * Among those who worked in the years before or after application, average earnings were lower after initial denial relative to before applying for SSDI. * The majority of older SSDI applicants denied on the basis of residual work capacity ultimately receive SSDI before full retirement age (FRA), either after appeal or reapplication. In this issue brief, we document the post-denial employment and benefit experiences of older applicants who are initially denied Social Security Disability Insurance (SSDI) for {\textquotedblleft}work capacity{\textquotedblright} reasons. Specifically, a disability examiner determined that these applicants had a severe impairment, but denied benefits because the applicants{\textquoteright} residual functional capacity allowed them to perform past work or other work. For simplicity, we use {\textquotedblleft}work capacity{\textquotedblright} denials for these cases, though that is not SSA{\textquoteright}s official nomenclature. We follow the experience of older SSDI applicants from the time they receive an initial denial for SSDI benefits through full retirement age (FRA; age 65 or 66, depending on their birth year). The information in this brief highlights findings from a longer manuscript (Schimmel Hyde et al. 2018). Our findings shed light on the types of policies that might be most beneficial to older workers who experience disability onset to remain working and therefore delay claiming Social Security benefits.}, keywords = {Disabilities, Insurance, Social Security, Work}, url = {https://search.proquest.com/docview/2083857692/abstract/40375250D95640A2PQ/1?accountid=14667}, author = {Jody Schimmel Hyde and April Yanyuan Wu} } @mastersthesis {10244, title = {Do perceptions reflect reality? Three essays exploring how perceptions are related to objective measures of financial well-being and knowledge.}, volume = {Doctor of Philosophy}, year = {2018}, month = {08/2018}, pages = {87}, school = {Texas Tech University}, address = {Lubbock, TX}, abstract = {Financial well-being is likely a factor in many individual{\textquoteright}s utility function. Financial wellness can be measured using objective measures as well as subjective perceptions. In the first two essays, objective measures are compared to subjective perceptions to see if there is a relationship between the two. Three financial ratios, including the liquidity ratio, the debt-to-asset ratio, and the investment ratio, are used as objective measures of financial wellness. Subjective perceptions are measured by a question that asks respondents how satisfied they are with their financial condition. The first essay analyzes at older Americans using the Health and Retirement Study. The second essay analyzes early-to-mid-career Americans using the Panel Study of Income Dynamics. The findings in this analysis suggest that there is a statistically and economically significant relationship between the investment ratio and individuals perceptions of financial satisfaction, particularly for older individuals. Financial ratios only play a small but important role in the overall financial situation. The goal of the third study is to analyze the relationship between objective measures of financial knowledge and individuals{\textquoteright} perceptions of their own financial knowledge. In addition, this paper looks at how perceptions of financial knowledge change over time. The focus of this paper is emerging adults who attend college and then transition into careers after college. The data for this study are from the Arizona Pathways to Life Success for University Students (APLUS) survey. The findings of this research suggest a positive correlation between objective measures and perceptions of financial wellness. College seniors in this study have a higher probability of perceiving themselves as financially knowledgeable compared to when they were in their first year of college. However, these same college seniors perceive themselves as more financially literate then they do 2 and 5 years after college. This study highlights the importance of financial education during college. It also shows that individuals are likely to perceive themselves as more financially literate than they are.}, keywords = {Finance, Financial well-being, Perception}, url = {https://ttu-ir.tdl.org/handle/2346/74372?show=full}, author = {Tenney, Jacob A.} } @article {9469, title = {Do resources buffer the prospective association of psychosocial work stress with depression? Longitudinal evidence from ageing workers.}, journal = {Scandinavian Journal of Work, Environment and Health}, volume = {44}, year = {2018}, pages = {183-191}, abstract = {Objectives There is now convincing evidence that psychosocial work stressors are linked to depression. Few studies, however, have tested if individual resources can buffer the longitudinal effects of psychosocial work stressors on depressive symptoms. This study investigates how two types of resources (internal and external resources) affect the association between psychosocial work stressors and depressive symptoms. Methods Data were obtained from the US Health and Retirement Study, with baseline information on psychosocial work stressors [job strain and effort-reward imbalance (ERI)] and on internal ("high mastery" and "low constraints") and external resources ("private social support") among initially healthy workers. This information was linked to elevated depressive symptoms two years later. The sample includes 5473 observations and we report relative risks (RR) and effect modification on the additive and multiplicative scale. Results Psychosocial stressors and low resources (internal and external) were both independently related to depressive symptoms. Individuals with both, psychosocial stressors and low resources, had the highest risk of developing elevated depressive symptoms (eg, RR ERI-LowMastery3.32, 95\% CI 2.49-4.42; RR JobStrain-LowMastery2.89, 95\% CI 2.18-3.84). Yet, based on interaction analyses, only social support from friends buffered the association between work stressors and depressive symptoms. Conclusions Our findings have demonstrated that psychosocial stressors at work are related to mental health, and that in most cases this relationship holds true both for people with high and with low resources. Therefore, there is no clear indication that internal or external resources buffer the association between psychosocial work stressors and depressive symptoms.}, keywords = {Depressive symptoms, Psychosocial, Well-being}, issn = {1795-990X}, doi = {10.5271/sjweh.3694}, author = {Lunau, Thorsten and Morten Wahrendorf and M{\"u}ller, Andreas and Wright, Bradley and Dragano, Nico} } @article {9356, title = {Does Becoming A Volunteer Attenuate Loneliness Among Recently Widowed Older Adults?}, journal = {Journals of Gerontology Series B: Psychological Sciences \& Social Sciences}, volume = {73}, year = {2018}, pages = {501-510}, abstract = {

Objectives: Loneliness is a significant public health concern, particularly for those who have lost a spouse through widowhood. This study examines whether becoming a volunteer at the time of widowhood is associated with reduction of these risks.

Method: A pooled sample of 5,882 married adults age 51+, drawn from the 2006-2014 waves of the Health and Retirement Study, was used to estimate regression models of the relationship between becoming widowed (relative to staying continuously married) and loneliness, and whether the associated loneliness of having lost a spouse is moderated by starting to volunteer (<2 hr, 2+ hr/week).

Results: Our results show that for those who become widowed, loneliness is significantly higher than those who stay continuously married. However, starting to volunteer 2+ hr per week is related to attenuated loneliness among the widowed such that widows who volunteer at that intensity have levels of loneliness similar to those of continuously married individuals volunteering at the same intensity.

Discussion: This study suggests higher intensity volunteering may be a particularly important pathway for alleviating loneliness among older adults who have recently become widowed. Results are discussed in light of theory, future research, and potential interventions.

}, keywords = {Bereavement, Depressive symptoms, Loneliness, Volunteerism, Widowhood}, issn = {1758-5368}, doi = {10.1093/geronb/gbx092}, author = {Dawn C Carr and Ben Lennox Kail and Matz-Costa, Christina and Yochai Z Shavit} } @article {9735, title = {Does cognitive aging affect portfolio choice?}, journal = {Journal of Economic Psychology}, volume = {66}, year = {2018}, pages = {1-12}, abstract = {The association between cognitive aging and portfolio reallocation towards riskless assets is well documented. Past studies have suggested several mechanisms such as rising information costs or preference changes to explain the shift away from financial risk. However, these narratives appear to be at odds with the evidence that some domains of cognitive functions improve with age, and many individuals are not cognizant of their intellectual decline. Using data from the Health and Retirement Study, this study examines whether or not cognitive decline leads to a safer portfolio choice and how much can be attributed to causal. Our empirical analysis develops an instrumental variable approach that exploits seasonal variation in cognition triggered by a seasonal affective disorder. While the fixed effects estimates show strong positive correlations between cognition and stock ownership, these estimates lose significance in the instrumental variable models. Our findings suggest that cognitive function is not a major determinant of portfolio riskiness.}, keywords = {Cognitive Ability, Depressive symptoms, Finances, Portfolios}, issn = {01674870}, doi = {10.1016/j.joep.2018.03.001}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0167487017303215http://api.elsevier.com/content/article/PII:S0167487017303215?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0167487017303215?httpAccept=text/plain}, author = {Tae-Young Pak and Patryk D. Babiarz} } @mastersthesis {10242, title = {Does In-home Social Engagement Mitigate Depressive Symptoms after Driving Reduction or Cessation?}, volume = {Doctor of Philosophy}, year = {2018}, month = {2018}, pages = {101}, school = {Miami University}, address = {Oxford, OH}, abstract = {Driving offers people a sense of independence, the ability to connect with other people, and access to goods and services. Yet, many older Americans reduce or cease driving each year, with detrimental effects. Previous studies have shown associations between driving cessation, decreased social engagement, increased numbers of depressive symptoms, and mortality. Little information examines driving reduction and social engagement. Role theory and stressors occurring during life transitions may provide a theoretical understanding of these outcomes.This study uses four administrations of Health and Retirement Study survey data to determine whether driving reduction and/or cessation are associated with increased numbers of depressive symptoms or decreased levels of social engagement that takes place away from the home setting. Additionally, this study examines the effects of driving reduction and cessation on depressive symptoms when considering levels of social engagement that may occur within the home setting and aims to determine if in-home social engagement mitigates depressive symptoms after driving reduction or cessation. Finally, this study considers males and females separately to determine if gender differences occur.Results indicated that depressive symptoms increase and away from home social engagement decreases after driving reduction, but not cessation, for both men and women. When factoring in at-home social engagement, depressive symptoms still increase after driving reduction, but not cessation. Additionally, when considering the direct and interactive effects of in-home social engagement on depressive symptoms after driving reduction or cessation, mitigating effects of in-home social engagement were not evident.These results suggest that practitioners may wish to allocate resources to extend the safe driving careers of older adults and provide transportation to older adults who reduce or stop driving. Given these results, increasing in-home social engagement is, unfortunately, not a promising approach to mitigating depressive symptoms after driving reduction or cessation. Future research may include a wider variety of measures of social engagement, driving reduction, and cessation. Additionally, future research may enhance the understanding of factors that may mitigate depressive symptoms after driving reduction or cessation. Ultimately, such research may provide answers to enhance the quality of life for older adults who reduce or cease driving.}, keywords = {Depressive symptoms, driving cessation, driving reduction, Gender Differences, Older Adults, social engagement}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=miami1532348747212058}, author = {Brown, Karen M.} } @article {9126, title = {Does oral health predict functional status in late life? Findings from a national sample.}, journal = {Journal of Aging and Health}, volume = {30}, year = {2018}, pages = {924-944}, abstract = {

OBJECTIVE: This study aims to examine the association between oral health and the decline in functional status among middle-aged and older adults in the United States.

METHOD: Generalized estimation equation (GEE) Poisson regression models with robust standard errors were used to analyze the longitudinal panel data (2008-2014) from the Health and Retirement Study ( N = 1,243). Oral health was evaluated using self-rated oral health, poor mouth condition, and tooth loss. Decline in functional status was assessed by disabilities in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: Respondents with poor oral health were more likely to experience decline in ADLs/IADLs. Adjusting for sociodemographics and comorbidities attenuated the effects of oral health.

DISCUSSION: Findings suggest that oral health might be one of the important predictors of functioning decline in late life, after adjusting sociodemographics and comorbidities.

}, keywords = {Dental Care, Functional limitations}, issn = {1552-6887}, doi = {10.1177/0898264317698552}, author = {Wei Zhang and Wu, Yan Yan and Bei Wu} } @article {9554, title = {Does personality change following spousal bereavement?}, journal = {Journal of Research in Personality}, volume = {72}, year = {2018}, pages = {10-21}, abstract = {Personality has been shown to be a large predictor of intrapersonal adjustment during the bereavement transition. However, the degree to which bereaved spouses{\textquoteright} personalities change is relatively unclear, and extant studies that have examined this phenomenon have provided mixed results. In the current study, personality change following spousal bereavement was examined in two samples (N = 9944 and N = 535). There was little evidence for differences in mean-level changes in personality between bereaved and control participants. However, rank-order stability was considerably lower among bereaved participants over time, suggesting that personality change occurs less systematically than previously thought. The current study provides additional information about the conditions under which personality changes and suggests exciting new avenues for future research. (C) 2016 Elsevier Inc. All rights reserved.}, keywords = {Bereavement, Marriage, Personality}, issn = {00926566}, doi = {10.1016/j.jrp.2016.08.010}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0092656616301076http://api.elsevier.com/content/article/PII:S0092656616301076?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0092656616301076?httpAccept=text/plain}, author = {William J. Chopik} } @article {9805, title = {Does retirement improve health and life satisfaction?}, journal = {Health Economics}, volume = {27}, year = {2018}, pages = {2067-2086}, abstract = {We utilize panel data from the Health and Retirement Study to investigate the impact of retirement on physical and mental health, life satisfaction, and health care utilization. Because poor health can induce retirement, we instrument for retirement using eligibility for Social Security and employer-sponsored pensions and coverage by the Social Security earnings test. We find strong evidence that retirement improves reported health, mental health, and life satisfaction. In addition, we find evidence of improvements in functional limitations in the long run. Although the impact on life satisfaction occurs within the first 4~years of retirement, many of the improvements in health show up four or more years later, consistent with the view that health is a stock that evolves slowly. We find no evidence that the health improvements are driven by increased health care utilization. In fact, results suggest decreased utilization in some categories.}, keywords = {Life Satisfaction, Optimism, Retirement Planning and Satisfaction}, issn = {1099-1050}, doi = {10.1002/hec.3821}, author = {Gorry, Aspen and Gorry, Devon and Sita Nataraj Slavov} } @article {9474, title = {Does Telomere Length Indicate Biological, Physical and Cognitive Health Among Older Adults? Evidence from the Health and Retirement Study.}, journal = {Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {73}, year = {2018}, month = {07/2019}, pages = {905-905}, abstract = {Telomere length (TL) has been suggested as a biomarker that can indicate individual variability in the rate of aging. Yet, it remains unclear whether TL is related to recognized indicators of health in an aging, older nationally representative sample. We examine whether TL is associated with 15 biological, physical and cognitive markers of health among older adults ages 54+. TL was assayed from saliva using quantitative PCR (T/S ratio) in the 2008 Health and Retirement Study (n=4,074). We estimated probability of high risk levels across indictors of health by TL and age-singly and jointly. TL was associated with seven indicators of poor functioning: HDL and total cholesterol, cystatin C, pulse pressure, BMI, lung function, and walking speed. However, after adjusting for age, associations were substantially attenuated; only associations with cholesterol and lung function remained significant. Additionally, findings show TL did not add to the predictive power of chronological age in predicting poor functioning. While TL may not be a useful clinical marker of functional aging in an older adult population, it may still play an important role in longitudinal studies in young and middle aged populations that attempt to understand aging.}, keywords = {Biomarkers, Cognitive Ability, Health Conditions and Status, Telomeres}, issn = {1758-535X}, doi = {10.1093/gerona/gly001}, author = {Lauren L Brown and Yuan S Zhang and Colter Mitchell and Jennifer A Ailshire} } @mastersthesis {10241, title = {Drinking Behaviors and Health in Old Age.}, volume = {Master of Social Work}, year = {2018}, month = {04/2018}, pages = {26}, school = {University of New Hampshire}, address = {Durham, NH}, abstract = {Alcohol abuse among the elderly population is rapidly becoming a widespread public health concern. As it goes undetected and undiagnosed in many within this age cohort, there is an increased need to further examine the effects of alcohol consumption on physical and mental health. This study investigated how and to what extent drinking behaviors affect physical and mental health in older people. Data came from the 2012 and 2014 Health and Retirement study, a nationally representative survey of Americans aged 51 and older. Our sample was restricted to people who participated in both waves of the survey from 2012 and 2014 (N=19,719). Drinking behavior was split into three groups: non-drinker, moderate drinker, and binge drinker. Three independent variables were examined to explore overall health of respondents: self-rated health, chronic conditions, and depression. Chi-squares and ANOVA testing were used to determine characteristics of binge drinkers in old age. OLS regression was used to examine how drinking behavior affected self-rated health and chronic conditions and logistic regression was used to explore how drinking behavior affected depression in old age. We found that non-drinkers have the worst physical and mental health with a self-rated health score of 3.09 (SD = 1.07) and the highest number of chronic conditions (2.47; SD = 1.58). Moderate drinkers were found to be the most depressed (1.94, SD = 1.80). Binge drinkers were most likely to be Hispanic (26.16\%), male (97.93\%), unmarried (98.09\%) elders. Additionally, binge drinkers were the youngest group of respondents (60.88, SD = 7.98) and had the least amount of education (11.81 years, SD = 2.86). The findings of this study once again suggest further research into the affects of drinking behavior on health in old age is needed to better serve this population}, keywords = {Aging, Binge drinking, Gerontology, health conditions, Social work}, url = {https://scholars.unh.edu/cgi/viewcontent.cgi?article=2199\&context=thesis}, author = {Knapp, Kaleigh} } @article {8508, title = {Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 04 16}, pages = {655-665}, abstract = {

Objectives: Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time.

Method: Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012).

Results: Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking.

Discussion: The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Family Conflict, Female, Humans, Longitudinal Studies, Male, Marriage, Middle Aged, Sex Factors, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbw073}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27353031}, author = {Kira S. Birditt and James A. Cranford and Jasmine A Manalel and Toni C Antonucci} } @mastersthesis {10322, title = {Driving and Expectation to Age in Place for Older Adults along the Urbanicity Continuum}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-01-31}, pages = {108}, school = {University of Massachusetts Boston}, type = {phd}, abstract = {Many older adults would like to age in place. Expectations can be important and valid predictors of whether an older adult actually does remain in place. Along with health declines that may initiate unwanted relocation, additional factors influence expectation and ability to age in place. Driving is an important factor in aging in place. Many issues (e.g., unsafe driving, safety concerns, financial or physical burden of tending to a car, etc.) may lead to voluntary or involuntary driving cessation. Without access to public transit or access to adequate informal caregiver transportation (i.e., rides from family or friends) to reach target destinations, driving cessation may ultimately initiate unwanted relocation to a supportive housing environment or nursing home. An unwanted move may diminish quality of life among older adults and furthermore, aging in place is typically less expensive than moves to supportive housing. The purpose of this dissertation is to evaluate driving status as a factor in expectation to age in place. It also investigates how expectations to age in place as well as driving behaviors differ for older adults along the urbanicity continuum. Additionally, the impact of health status and physical mobility on the relationship between driving and expectation to age in place is examined. These relationships are evaluated using ordered logistic regression. The sample includes 8,046 older adults in the Health and Retirement Study database. Findings from the ordinal logistic regression indicate that non-drivers are significantly more likely to expect to age in place. The relationship between driving and expectation to age in place is not moderated by urbanicity status in the regression results. Driving represents a mediating factor in the link between health and expectation to age in place. Supplemental analyses mirror similar results to the ordinal logistic regression results. Relocation is a process triggered by a series of events and likely preceded by expectation to age in place. There are many factors related to driving and aging place. Though expectations may be a mainspring for planning, understanding what individuals anticipate regarding their future living situation is an important area of study.}, keywords = {0351:Gerontology, 0493:Aging, 0630:Public policy, Aging, Aging in place, Driving, Gerontology, Health and environmental sciences, Older Adults, Public Policy, Social Sciences, Urbanicity}, isbn = {9780438807549}, url = {https://scholarworks.umb.edu/doctoral_dissertations/434/}, author = {Richardson,Lorilei M.} } @article {9408, title = {Dyadic Effects of Depressive Symptoms on Medical Morbidity in Middle-Aged and Older Couples.}, journal = {Health Psychology}, volume = {37}, year = {2018}, pages = {28-36}, keywords = {Couples, Depressive symptoms, Disease}, issn = {0278-6133}, doi = {10.1037/hea0000573}, url = {http://doi.apa.org/getdoi.cfm?doi=10.1037/hea0000573http://psycnet.apa.org/psycarticles/2017-52080-001.pdf}, author = {Courtney A Polenick and Brenna N Renn and Kira S. Birditt} } @article {8592, title = {Death across the lifespan: Age differences in death-related thoughts and anxiety.}, journal = {Death Stud}, volume = {41}, year = {2017}, month = {2017 02}, pages = {69-77}, abstract = {

Many studies have found age-related declines in death-related anxiety. Why do death-related thoughts and anxiety decline across the lifespan when exposure to, and likelihood of, death increase over time? In Study 1, a cross-sectional survey of 2,363 adults, death-related thoughts declined across the lifespan. In Study 2, a longitudinal study of 9,815 adults followed over a 4-year period, death anxiety declined across the lifespan. Further, greater social support predicted lower levels of death anxiety over time, after controlling for self-rated health and chronic illnesses. Close relationships serve emotion regulation functions to decrease death anxiety and thoughts across the lifespan.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Aging, Anxiety, Attitude to Death, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Thinking, Young Adult}, issn = {1091-7683}, doi = {10.1080/07481187.2016.1206997}, url = {https://www.tandfonline.com/doi/full/10.1080/07481187.2016.1206997}, author = {William J. Chopik} } @article {8895, title = {Death of family members as an overlooked source of racial disadvantage in the United States.}, journal = {Proceedings of the National Academy of Sciences of the United States of America}, volume = {114}, year = {2017}, month = {2017 Jan 31}, pages = {915-920}, abstract = {

Long-standing racial differences in US life expectancy suggest that black Americans would be exposed to significantly more family member deaths than white Americans from childhood through adulthood, which, given the health risks posed by grief and bereavement, would add to the disadvantages that they face. We analyze nationally representative US data from the National Longitudinal Study of Youth (n = 7,617) and the Health and Retirement Study (n = 34,757) to estimate racial differences in exposure to the death of family members at different ages, beginning in childhood. Results indicate that blacks are significantly more likely than whites to have experienced the death of a mother, a father, and a sibling from childhood through midlife. From young adulthood through later life, blacks are also more likely than whites to have experienced the death of a child and of a spouse. These results reveal an underappreciated layer of racial inequality in the United States, one that could contribute to the intergenerational transmission of health disadvantage. By calling attention to this heightened vulnerability of black Americans, our findings underscore the need to address the potential impact of more frequent and earlier exposure to family member deaths in the process of cumulative disadvantage.

}, keywords = {Bereavement, Death \& Dying, Disadvantage, Loss, Older Adults, Racial/ethnic differences}, issn = {1091-6490}, doi = {10.1073/pnas.1605599114}, author = {Debra Umberson and Olson, Julie Skalamera and Crosnoe, Robert and Hui Liu and Tetyana Pudrovska and Rachel Donnelly} } @article {9259, title = {Debt and Financial Vulnerability on the Verge of Retirement}, number = {Working Paper No. 23664}, year = {2017}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {We analyze older individuals{\textquoteright} debt and financial vulnerability using data from the Health and Retirement Study (HRS) and the National Financial Capability Study (NFCS). Specifically, in the HRS we examine three different cohorts (individuals age 56-61) in 1992, 2004, and 2010 to evaluate cross-cohort changes in debt over time. We also use two waves of the NFCS (2012 and 2015) to gain additional insights into debt management and older individuals{\textquoteright} capacity to shield themselves against shocks. We show that recent cohorts have taken on more debt and face more financial insecurity, mostly due to having purchased more expensive homes with smaller down payments.}, keywords = {Consumption and Savings, Debt, Retirement Planning and Satisfaction}, doi = {10.3386/w23664}, url = {http://www.nber.org/papers/w23664.pdf}, author = {Annamaria Lusardi and Olivia S. Mitchell and Oggero, Noemi} } @article {8921, title = {The Decline in Earnings Prior to Application for Disability Insurance Benefits}, volume = {77}, year = {2017}, pages = {1-15}, publisher = {Social Security Bulletin}, edition = {1}, keywords = {Disabilities, Income, Medicare/Medicaid/Health Insurance, Older Adults, Social Security}, url = {https://www.ssa.gov/policy/docs/ssb/v77n1/v77n1p1.html}, author = {Costa, Jackson} } @article {8849, title = {Dementia rates are declining, and education could have a lot to do with it}, journal = {Stateside}, volume = {2017}, number = {01/10/2017}, year = {2017}, publisher = {Michigan Radio}, address = {Ann Arbor, MI}, keywords = {Dementia, Education, Health Conditions and Status, Interviews, Local news, Older Adults}, url = {http://michiganradio.org/post/dementia-rates-are-declining-and-education-could-have-lot-do-it}, author = {Stateside Staff} } @mastersthesis {11079, title = {Dementia Risk in Elders with Anxiety and Insomnia}, volume = {Doctor of Philosophy}, year = {2017}, school = {The University of Texas, Medical Branch at Galveston}, address = {Galveston, TX}, abstract = {Current evidence suggests that there is an association between benzodiazepinereceptor-agonist medications (BZRA) and subsequent dementia. Expert opinions differ regarding whether the association indicates a causal relationship. There is sufficient evidence that neuropsychiatric symptoms, such as anxiety and insomnia, are indicators of prodromal dementia which may lead to treatment with benzodiazepine-receptor agonist medications. Therefore, the association between BZRAs and subsequent dementia may be a spurious correlation for which the prodromal onset is responsible. This study proposed to test the postulate that the anxiety and insomnia symptom cluster (A/I) is a predictor of dementia. A retrospective data analysis was conducted on the Aging, Demographics, and Memory Study (ADAMS) dataset in order to determine whether A/I symptoms or treatment were associated with subsequent dementia or cognitive impairment (DOCI). The study controlled for gender and comorbid depression. The study excluded BZRA usage and medical comorbidities that were either confounding variables in assessment or alternative explanations of cognitive decline. The study used chi-square analysis, comparison of incidence rates, odds ratios, relative risk, and logistic regression to investigate the idea that the A/I symptom cluster indicates developing prodromal dementia. The study failed to find an association between A/I symptoms and subsequent DOCI in the total sample. However, there was a significant relationship between A/I symptoms and subsequent DOCI in the male gender that was not found in females. No association was found for the A/I medications in any of the analyses. Further investigation of the ADAMS dataset without removing the exclusion variables also showed that BZRA usage was not associated with subsequent DOCI. The gender differences identified suggest prodromal dementia phenotypes that are differentially expressed in males and females. The lack of association between A/I medications and subsequent DOCI in this study is validated by the lack of association between BZRA medications and subsequent DOCI in the larger ADAMS dataset. While it is unlikely that a single reliable predictor of subsequent dementia exists, by triangulating the approaches between multiple disciplines{\textemdash}such as biomarkers and neurological studies{\textemdash}with neuropsychiatric manifestations of prodromal dementia, it is possible that reliable early prediction may be accomplished. Earlier identification would then lead to effective treatments and ultimately prevention.}, keywords = {ADAMS, Dementia, Medication}, url = {https://www.researchgate.net/profile/Richard_Wallis/publication/344360789_Dementia_Risk_in_Elders_with_Anxiety_and_Insomnia/links/5f6c36f8a6fdcc00863859c6/Dementia-Risk-in-Elders-with-Anxiety-and-Insomnia.pdf}, author = {Wallis, Richard David} } @article {6455, title = {Depression and Frailty: Concurrent Risks for Adverse Health Outcomes}, journal = {Aging and Mental Health}, volume = {21}, year = {2017}, pages = {399-408}, abstract = {Objectives: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury. Methods: Data come from five waves (2004 2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury. Results: Prevalence of frailty increased over the study period (24.1 32.1 ), while the prevalence of depression was relatively constant over time (approximately 13 ). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursing home = 1.33, 95 CI: 1.09 1.66; ORFall = 1.52, 95 CI: 1.12 2.08; Depression: ORNursing home = 3.63, 95 CI: 1.29 9.97; ORFall = 1.16, 95 CI: 1.01 1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression. Conclusion: Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the frailty index which confer most risk for poor health outcomes.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.1080/13607863.2015.1102199}, url = {http://dx.doi.org/10.1080/13607863.2015.1102199}, author = {Matthew C. Lohman and Briana Mezuk and Dumenci, Levent} } @article {9055, title = {Depression symptoms in older adults with cancer: A multilevel longitudinal study}, journal = {Journal of Psychosocial Oncology}, volume = {35}, year = {2017}, pages = {260-277}, abstract = {Objective: Data from the Health and Retirement Study were used to test a conceptual model integrating stress and coping, conservation of resources, and life-course theories, to investigate predictors of depression symptoms over 8 years among a nationally representative sample of older adults aged 50{\textendash}91 years. The main investigative questions were: (1) Do older adults with cancer have a different 8-year symptomatic depression trajectory than those without cancer? (2) Do the differences in life-course factors, internal, external, and health-related resources within and between older adults have a differential effect on 8-year symptomatic depression trajectories for individuals with and without a cancer diagnosis? Methods: We used a two-level longitudinal panel design to test a multilevel growth model. We examined individual differences in depression symptoms between 2000 and 2008, and tested multiple potential predictors. All those with a first diagnosis of cancer in 1998{\textendash}2000 were included in the study (n = 200) together with a representative subsample of all noncancer cases (n = 1,190). Results: Significant two-way interaction effects were detected between having cancer and the absence of spouse/partner in the home, and cancer and lower life expectancy; each resulted in higher probabilities of depression. A significant three-way interaction effect was detected between cancer, gender, and social support; women with a cancer history and low social support had the highest probability of depression. Conclusion: Assessment and intervention in the {\textquotedblleft}survivorship{\textquotedblright} phase of cancer should target older adults with higher levels of depression early in the cancer experience, those with no partner present in home, those with lower life expectancy, and women with low social support.}, keywords = {Cancer screenings, Depressive symptoms}, issn = {0734-7332}, doi = {10.1080/07347332.2017.1286698}, url = {https://www.tandfonline.com/doi/full/10.1080/07347332.2017.1286698}, author = {Tara J Schapmire and Anna C. Faul} } @article {8963, title = {Depressive symptomatology and fall risk among community-dwelling older adults.}, journal = {Social Science \& Medicine}, volume = {178}, year = {2017}, month = {04/2017}, pages = {206-213}, abstract = {

RATIONALE: Falls are common among older adults and may be related to depressive symptoms (DS). With advancing age, there is an onset of chronic conditions, sensory impairments, and activity limitations that are associated with falls and with depressive disorders. Prior cross-sectional studies have observed significant associations between DS and subsequent falls as well as between fractures and subsequent clinical depression and DS.

OBJECTIVE: The directionality of these observed relationship between falls and DS is in need of elaboration given that cross-sectional study designs can yield biased estimates of the DS-falls relationship.

METHODS: Using 2006-2010 Health and Retirement Study data, cross-lagged panel structural equation models were used to evaluate associations between falls and DS among 7233 community-dwelling adults ages >=65. Structural coefficients between falls and DS (in 2006{\textrightarrow}2008, 2008{\textrightarrow}2010) were estimated.

RESULTS: A good-fitting model was found: Controlling for baseline (2006) physical functioning, vision, chronic conditions, and social support and neighborhood social cohesion, falls were not associated with subsequent DS, but a 0.5 standard deviation increase in 2006 DS was associated with a 30\% increase in fall risk two years later. This DS-falls relationship was no longer significant when use of psychiatric medications, which was positively associated with falls, was included in the model.

CONCLUSION: Using sophisticated methods and a large U.S. sample, we found larger magnitudes of effect in the DS-falls relationship than in prior studies-highlighting the risk of falls for older adults with DS. Medical providers might assess older individuals for DS as well as use of psychotropic medications as part of a broadened falls prevention approach. National guidelines for fall risk assessments as well as quality indicators for fall prevention should include assessment for clinical depression.

}, keywords = {Community-dwelling, Depressive symptoms, Falls, Health Shocks, Older Adults, Restricted data}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2017.02.020}, author = {Geoffrey J Hoffman and Hays, Ron D and Steven P Wallace and Martin F Shapiro and Susan L Ettner} } @article {8829, title = {Depressive Symptoms and Salivary Telomere Length in a Probability Sample of Middle-Aged and Older Adults.}, journal = {Psychosom Med}, volume = {79}, year = {2017}, month = {2017 Feb/Mar}, pages = {234-242}, abstract = {

OBJECTIVE: To examine the association between depressive symptoms and salivary telomere length in a probability sample of middle-aged and older adults, and to evaluate age and sex as potential moderators of this association and test whether this association was incremental to potential confounds.

METHODS: Participants were 3,609 individuals from the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction on DNA extracted from saliva samples. Depressive symptoms were assessed via interview, and health and lifestyle factors, traumatic life events, and neuroticism were assessed via self-report. Regression analyses were conducted to examine the associations between predictor variables and salivary telomere length.

RESULTS: After adjusting for demographics, depressive symptoms were negatively associated with salivary telomere length (b = -.003; p = .014). Furthermore, this association was moderated by sex (b = .005; p = .011), such that depressive symptoms were significantly and negatively associated with salivary telomere length for men (b = - .006; p < .001) but not for women (b = - .001; p = .644). The negative association between depressive symptoms and salivary telomere length in men remained statistically significant after additionally adjusting for cigarette smoking, body mass index, chronic health conditions, childhood and lifetime exposure to traumatic life events, and neuroticism.

CONCLUSIONS: Higher levels of depressive symptoms were associated with shorter salivary telomeres in men, and this association was incremental to several potential confounds. Shortened telomeres may help account for the association between depression and poor physical health and mortality.

}, keywords = {Aged, Anxiety Disorders, Body Mass Index, Chronic disease, depression, Female, Humans, Life Style, Male, Middle Aged, Neuroticism, Psychological Trauma, Saliva, Sex Factors, Smoking, Telomere Shortening}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000383}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00006842-900000000-98910}, author = {Mark A Whisman and Emily D Richardson} } @mastersthesis {9283, title = {Depressive Symptoms Association With Health Outcomes And Treatment In Older Americans With Diabetes}, volume = {Public Health Doctorate}, year = {2017}, school = {University of South Carolina}, type = {Dissertation}, address = {Columbia, SC}, abstract = {Introduction: Diabetes remains the 7th leading cause of death in the United States. Diabetes is a major public health concern of its own, but when you add the comorbidity of depression, diabetes outcomes are amplified. This dissertation examines how depressive symptomatology and treatment for depression are associated with selfreported health (SRH) and diabetes control. Methods: Chi-square and logistic regression were used to analyze data from the Health and Retirement Study (2012). We assessed the associations between SRH and diabetes control with depressive symptomatology data. Results: In our sample (n=4374), 19\% of respondents reported high depressive symptomatology and 59\% self-reported {\textquotedblleft}good{\textquotedblright} health compared to 41\% self-reported {\textquotedblleft}bad{\textquotedblright} health. Associated with {\textquotedblleft}bad{\textquotedblright} SRH were psychiatric medication or psychotherapy treatment (p=.0211), education (p=<.0001), insulin usage (<.0001), diabetes control (p=<.0001), depressive symptomatology (p=<.0001), and clinical diagnosis for depression (p=.0005). For the second outcome, only 9\% of the sample reported no diabetes control. Insulin usage (p=<.0001), SRH (p=<.0001), depressive symptoms (p=.0039), sex (p=.0363) and age (p=.0015) were associated with no diabetes control. Conclusion: Depressive symptomatology is associated with SRH and diabetes control. Treatment is moderately significant with SRH, but not significant with diabetes control. A depression diagnosis was not significantly associated with diabetes control.}, keywords = {Depressive symptoms, Diabetes, Health Conditions and Status}, url = {http://scholarcommons.sc.edu/etd/4019/}, author = {Williams, Lashonda Javon} } @article {9250, title = {Depressive symptoms in recipients of home- and community-based services in the United States: Are older adults receiving the care they need?}, journal = {American Journal of Geriatric Psychiatry}, volume = {25}, year = {2017}, pages = {1351-1360}, abstract = {

OBJECTIVE: To understand unmet depression needs of older adults, the current study investigates depressive symptoms, psychiatric treatment, and home- and community-based service (HCBS) use in a nationally representative sample of older adults in the United States.

METHODS: Participants included 5,582 adults aged 60 and over from the 2010-2012 waves of the nationally representative Health and Retirement Study. Weighted bivariate analyses were used to examine the frequency of depressive symptoms (Center for Epidemiologic Studies Depression Scale) and psychiatric treatment among HCBS recipients compared with non-HCBS recipients. Weighted logistic regression models were used to evaluate the effect of depressive symptoms on HCBS use.

RESULTS: HCBS recipients had a higher frequency of depressive symptoms compared with nonrecipients (27.5\% versus 10.4\%, respectively). In particular, transportation service recipients had the highest frequency of depressive symptoms (37.5\%). HCBS recipients with depressive symptoms were no more likely than nonrecipients to receive psychiatric services. Depressive symptoms were associated with HCBS use, above and beyond sociodemographic and health risk factors.

CONCLUSION: Depressive symptoms are more frequent among HCBS recipients compared with nonrecipients; however, depressed HCBS recipients are no more likely to receive psychiatric services, suggesting unmet depression needs. HCBS may be a key setting for depression detection and delivery of mental health interventions.

}, keywords = {Caregiving, Community-based services, Depressive symptoms}, issn = {1545-7214}, doi = {10.1016/j.jagp.2017.05.021}, author = {Renee Pepin and Amanda N Leggett and Amanda Sonnega and Shervin Assari} } @article {8582, title = {Development and Validation of a 10-Year Mortality Prediction Model: Meta-Analysis of Individual Participant Data From Five Cohorts of Older Adults in Developed and Developing Countries.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 03 01}, pages = {410-416}, abstract = {

Background: Existing mortality prediction models for older adults have been each developed using a single study from the United States or Western Europe. We aimed to develop and validate a 10-year mortality prediction model for older adults using data from developed and developing countries.

Methods: We used data from five cohorts, including data from 16 developed and developing countries: ELSA (English Longitudinal Study of Aging), HRS (Health and Retirement Study), MHAS (Mexican Health and Aging Study), SABE-Sao Paulo (The Health, Well-being and Aging), and SHARE (Survey on Health, Ageing and Retirement in Europe). 35,367 older adults were split into training (two thirds) and test (one third) data sets. Baseline predictors included age, sex, comorbidities, and functional and cognitive measures. We performed an individual participant data meta-analysis using a sex-stratified Cox proportional hazards model, with time to death as the time scale. We validated the model using Harrell{\textquoteright}s C statistic (discrimination) and the estimated slope between observed and predicted 10-year mortality risk across deciles of risk (calibration).

Results: During a median of 8.6 years, 8,325 participants died. The final model included age, sex, diabetes, heart disease, lung disease, cancer, smoking, alcohol use, body mass index, physical activity, self-reported health, difficulty with bathing, walking several blocks, and reporting date correctly. The model showed good discrimination (Harrell{\textquoteright}s C = 0.76) and calibration (slope = 1.005). Models for developed versus developing country cohorts performed equally well when applied to data from developing countries.

Conclusion: A parsimonious mortality prediction model using data from multiple cohorts in developed and developing countries can be used to predict mortality in older adults in both settings.

}, keywords = {Aged, Aged, 80 and over, Developed Countries, Developing Countries, Female, Humans, Male, Meta-Analysis as Topic, Middle Aged, Models, Statistical, Mortality, Prognosis, Time Factors}, issn = {1758-535X}, doi = {10.1093/gerona/glw166}, url = {http://biomedgerontology.oxfordjournals.org/cgi/pmidlookup?view=long\&pmid=27522061}, author = {Suemoto, Claudia Kimie and Ueda, Hiroshi and Hiram Beltr{\'a}n-S{\'a}nchez and Lebr{\~a}o, Maria Lucia and Duarte, Yeda Aparecida and Rebeca Wong and Danaei, Goodarz} } @article {9270, title = {Diabetes and labor market exits: Evidence from the Health \& Retirement Study (HRS)}, journal = {The Journal of the Economics of Ageing}, volume = {9}, year = {2017}, pages = {100-110}, abstract = {The objective of this paper is to estimate the effect of diabetes on labor market exit using longitudinal data from the 1992-2010 Health and Retirement Study (HRS). We estimate a discrete time hazard model to test whether diabetes affects the hazard of leaving employment among individuals who were working for pay at the age of 55-56. Using a probit model, we also estimate the effect of having undiagnosed or poorly controlled diabetes on the probability of labor market exit two years later. Our results indicate that diabetes is associated with an increased hazard of exiting the labor market for males, but not for females. This effect for males persists when we include controls for onset of other health conditions, two of which are documented complications of diabetes (stroke and heart conditions). We also find that diagnosed diabetes with medication use, regardless of whether or not it is under control, is associated with large negative effects on the likelihood of employment two years later. (C) 2016 Elsevier B.V. All rights reserved.}, keywords = {Chronic disease, Diabetes, Employment and Labor Force, Retirement Planning and Satisfaction}, issn = {2212828X}, doi = {10.1016/j.jeoa.2016.08.005}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2212828X16300639http://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/plain}, author = {Chatterji, Pinka and Heesoo Joo and Kajal Chatterji Lahiri} } @article {9414, title = {Differential Changes in Health Measures by Caregiving Status: Hierarchical Models}, journal = {Work, Aging and Retirement}, volume = {3}, year = {2017}, pages = {393-402}, abstract = {The purpose of this study is to compare the health trajectories/trends of caregivers and non-caregivers before and after the caregivers begin to provide informal services. In this case we focus on caregiving services provided to parents/parents-in-law. The study uses a sample of N = 19,943 observations (drawn from 1,813 unique individuals) observed over 11 waves of the Health and Retirement Study. Using Hierarchical Linear Model (HLM) Methods, the trajectories of health outcomes for caregivers are compared to those of non-caregivers. We examined trajectories related to general health, measures of mobility, motor skills, cognition and measures of depression. We control for education, wealth, occupation, gender, marital status, and race. For caregivers, there is a 0.027 (0.014 per year) increase in the mobility difficulty index and a 0.020 (0.010 per year) increase in large muscle movement difficulty index for every year after the commencement of caregiving, compared to non-caregivers. There is also a significant 0.7 percentage point increase in the probability of reporting a stroke and a 0.118 (0.059 per year) drop in the cognition summary score for each additional year after the start of caregiving. These findings provide evidence of the adverse health effects of caregiving on its providers, particularly with regard to the physical and mental well-being of caregivers.}, keywords = {Caregiving, Health Trajectories}, issn = {2054-4642}, doi = {10.1093/workar/wax005}, url = {http://academic.oup.com/workar/article/3/4/393/3101301/Differential-Changes-in-Health-Measures-byhttp://academic.oup.com/workar/article-pdf/3/4/393/19644858/wax005.pdf}, author = {Unuigbe, Aig and Lee, Yeonjung and Vaughon, Wendy and Jennifer Kaufman and William T Gallo} } @article {9005, title = {Difficulty managing medications and finances in older adults: A 10-year cohort study.}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {1455-1461}, abstract = {

BACKGROUND: Difficulty managing medicines and finances becomes increasingly common with advanced age, and compromises the ability to live safely and independently. Remarkably little is known how often this occurs.

OBJECTIVES: To provide population-based estimates of the risk of developing incident difficulty managing medications and finances in older adults.

DESIGN: A prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of older adults.

PARTICIPANTS: 9,434 participants aged 65 and older who did not need help in managing medications or managing finances in 2002. Follow-up assessments occurred every 2 years until 2012.

MEASUREMENTS: The primary outcomes were time to difficulty managing medications and time to difficulty managing finances. Risk factors such as demographics, comorbidities, functional status, and cognitive status were assessed at baseline. Hazard models that considered the competing risk of death were used to estimate both the cumulative incidence of developing difficulty managing medications and finances and to identify potential risk factors. Analyses were adjusted for age, gender, race, marital status, wealth and education.

RESULTS: The 10 years incidence of difficulty increased markedly with age, ranging from 10.3\% (95\% CI 9.3-11.6) for managing medications and 23.1\% (95\% CI 21.6-24.7) for managing finances in those aged 65-69, to 38.2\% (95\% CI 33.4-43.5) for medicines and 69\% (95\% CI 63.7-74.3) for finances in those over age 85. Women had a higher probability of developing difficulty managing medications and managing finances than men.

CONCLUSION: This study highlights the importance of preparing older adults for the likelihood they will need assistance with managing their medicines and finances as the risk for having difficulty with these activities over time is substantial.

}, keywords = {Financial literacy, Older Adults, Prescription Medication, Risk Factors}, issn = {1532-5415}, doi = {10.1111/jgs.14819}, author = {Bleijenberg, Nienke and Sei J. Lee and Irena Cenzer and W John Boscardin and Kenneth E Covinsky} } @article {9212, title = {Disability rises gradually for a cohort of older Americans}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {72}, year = {2017}, pages = {151-161}, abstract = {Objectives: We study changes in average disability over nearly two decades for a large epidemiological cohort of older Americans. As some people exit by mortality, do average disability levels for the living cohort rise rapidly, rise gradually, stay steady, or decline? Method: Data are from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort for 1993-2010. Cohort members are aged 70+ in 1993 (mean = 77.5 years), and the survivors are aged 87+ in 2010 (mean = 90.2 years). Personal care disability (activities of daily living), household management disability (instrumental activities of daily living), and physical limitations are studied. We study average disability for the living cohort over time and the disability histories for decedent and survivor groups. Results: Average disability rises gradually over time for the living cohort. Earlier decedent groups have higher average disability than later ones. Near death, disability rises sharply for all decedent groups. Longer surviving groups have less average disability, and slower disability increases, than shorter surviving groups. All results are repeated for younger cohort members (baseline age = 70-79 years), older ones (baseline age = 80+ years), women, and men. Discussion: As a cohort ages, average disability among living members increases gradually, signaling behavioral, psychological, and biological fitness in very old persons.}, keywords = {Disabilities, Mortality, Women and Minorities}, issn = {1079-5014}, doi = {10.1093/geronb/gbw002}, url = {https://academic.oup.com/psychsocgerontology/article-lookup/doi/10.1093/geronb/gbw002https://academic.oup.com/psychsocgerontology/article/2632051/Disability-Rises-Gradually-for-a-Cohort-of-Older}, author = {Verbrugge, Lois M. and Dustin C. Brown and Zajacova, Anna} } @article {12136, title = {Discovery and fine-mapping of adiposity loci using high density imputation of genome-wide association studies in individuals of African ancestry: African Ancestry Anthropometry Genetics Consortium.}, journal = {PLoS Genetics}, volume = {13}, year = {2017}, pages = {e1006719}, abstract = {

Genome-wide association studies (GWAS) have identified >300 loci associated with measures of adiposity including body mass index (BMI) and waist-to-hip ratio (adjusted for BMI, WHRadjBMI), but few have been identified through screening of the African ancestry genomes. We performed large scale meta-analyses and replications in up to 52,895 individuals for BMI and up to 23,095 individuals for WHRadjBMI from the African Ancestry Anthropometry Genetics Consortium (AAAGC) using 1000 Genomes phase 1 imputed GWAS to improve coverage of both common and low frequency variants in the low linkage disequilibrium African ancestry genomes. In the sex-combined analyses, we identified one novel locus (TCF7L2/HABP2) for WHRadjBMI and eight previously established loci at P < 5{\texttimes}10-8: seven for BMI, and one for WHRadjBMI in African ancestry individuals. An additional novel locus (SPRYD7/DLEU2) was identified for WHRadjBMI when combined with European GWAS. In the sex-stratified analyses, we identified three novel loci for BMI (INTS10/LPL and MLC1 in men, IRX4/IRX2 in women) and four for WHRadjBMI (SSX2IP, CASC8, PDE3B and ZDHHC1/HSD11B2 in women) in individuals of African ancestry or both African and European ancestry. For four of the novel variants, the minor allele frequency was low (<5\%). In the trans-ethnic fine mapping of 47 BMI loci and 27 WHRadjBMI loci that were locus-wide significant (P < 0.05 adjusted for effective number of variants per locus) from the African ancestry sex-combined and sex-stratified analyses, 26 BMI loci and 17 WHRadjBMI loci contained <= 20 variants in the credible sets that jointly account for 99\% posterior probability of driving the associations. The lead variants in 13 of these loci had a high probability of being causal. As compared to our previous HapMap imputed GWAS for BMI and WHRadjBMI including up to 71,412 and 27,350 African ancestry individuals, respectively, our results suggest that 1000 Genomes imputation showed modest improvement in identifying GWAS loci including low frequency variants. Trans-ethnic meta-analyses further improved fine mapping of putative causal variants in loci shared between the African and European ancestry populations.

}, keywords = {Adiposity, Anthropometry, Blacks, Body Mass Index, Chromosome Mapping, Female, Gene Frequency, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Linkage Disequilibrium, Male, Obesity, Polymorphism, Single Nucleotide, Serine Endopeptidases, Transcription Factor 7-Like 2 Protein, Waist-Hip Ratio, Whites}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1006719}, author = {Ng, Maggie C Y and Graff, Mariaelisa and Lu, Yingchang and Justice, Anne E and Mudgal, Poorva and Liu, Ching-Ti and Young, Kristin and Yanek, Lisa R and Feitosa, Mary F and Wojczynski, Mary K and Rand, Kristin and Brody, Jennifer A and Brian E Cade and Dimitrov, Latchezar and Duan, Qing and Guo, Xiuqing and Leslie A Lange and Michael A Nalls and Okut, Hayrettin and Tajuddin, Salman M and Bamidele O Tayo and Vedantam, Sailaja and Bradfield, Jonathan P and Chen, Guanjie and Chen, Wei-Min and Chesi, Alessandra and Irvin, Marguerite R and Padhukasahasram, Badri and Smith, Jennifer A and Zheng, Wei and Matthew A. Allison and Ambrosone, Christine B and Bandera, Elisa V and Traci M Bartz and Berndt, Sonja I and Bernstein, Leslie and Blot, William J and Erwin P Bottinger and John Carpten and Chanock, Stephen J and Chen, Yii-Der Ida and Conti, David V and Cooper, Richard S and Myriam Fornage and Freedman, Barry I and Garcia, Melissa and Phyllis J Goodman and Hsu, Yu-Han H and Hu, Jennifer and Huff, Chad D and Ingles, Sue A and John, Esther M and Rick A Kittles and Eric A Klein and Li, Jin and McKnight, Barbara and Nayak, Uma and Nemesure, Barbara and Ogunniyi, Adesola and Olshan, Andrew and Press, Michael F and Rohde, Rebecca and Rybicki, Benjamin A and Babatunde Salako and Sanderson, Maureen and Shao, Yaming and David S Siscovick and Stanford, Janet L and Stevens, Victoria L and Stram, Alex and Strom, Sara S and Vaidya, Dhananjay and Witte, John S and Yao, Jie and Zhu, Xiaofeng and Ziegler, Regina G and Alan B Zonderman and Adeyemo, Adebowale and Ambs, Stefan and Cushman, Mary and Jessica Faul and Hakonarson, Hakon and Levin, Albert M and Nathanson, Katherine L and Erin B Ware and David R Weir and Zhao, Wei and Zhi, Degui and Donna K Arnett and Grant, Struan F A and Sharon L R Kardia and Oloapde, Olufunmilayo I and Rao, D C and Charles N Rotimi and Sale, Michele M and L Keoki Williams and Zemel, Babette S and Becker, Diane M and Ingrid B Borecki and Michele K Evans and Tamara B Harris and Hirschhorn, Joel N and Li, Yun and Patel, Sanjay R and Psaty, Bruce M and Rotter, Jerome I and Wilson, James G and Bowden, Donald W and Cupples, L Adrienne and Christopher A Haiman and Ruth J F Loos and Kari E North} } @article {8907, title = {Discrimination and Telomere Length Among Older Adults in the United States.}, journal = {Public Health Reports}, year = {2017}, month = {2017 Jan 01}, abstract = {

OBJECTIVES: Chronic stress from experiencing discrimination can lead to long-term changes in psychological and physiologic responses, including shorter leukocyte telomere length. We examined the association between leukocyte telomere length and variations in the association by race or type of discrimination.

METHODS: Our study consisted of 3868 US-born non-Hispanic black (hereinafter, black) and non-Hispanic white (hereinafter, white) adult participants from the 2008 Health and Retirement Study biomarker sample with complete sociodemographic and discrimination information. We examined major lifetime unfair treatment and everyday discrimination. Coarsened exact matching matched exposed and unexposed participants on several sociodemographic factors. Coarsened exact matching creates analytic weights for the matched data sets. We applied weighted linear regression to the matched data sets. We conducted 2 subanalyses in which we matched on potential mediators-physical activity, smoking status, and obesity-and examined if racism was associated with shorter telomere length compared with other attributes. All analyses were stratified by race.

RESULTS: We found no difference in telomere length for black and white participants reporting major lifetime unfair treatment (β = 0.09; 95\% CI, -0.33 to 0.15) or everyday discrimination (β = 0.04; 95\% CI, -0.12 to 0.40). Everyday discrimination was associated with shorter leukocyte telomere length among black people (β = -0.23; 95\% CI, -0.44 to -0.01) but not among white people (β = 0.05; 95\% CI, -0.01 to 0.10). Matching on potential mediators generally decreased the effect estimate among black people.

CONCLUSIONS: Experiencing everyday discrimination was associated with shortened telomere length among older black adults. Further research is needed to understand the adverse physiologic effects of discrimination to create effective interventions.

}, keywords = {Discrimination, Older Adults, Racial/ethnic differences, Telomeres}, issn = {1468-2877}, doi = {10.1177/0033354916689613}, author = {Sze Y Liu and Ichiro Kawachi} } @mastersthesis {9434, title = {Disparities Between Patients{\textquoteright} End-of-Life Care Preferences and Actual End-of-Life Care Received}, volume = {Ph.D.}, year = {2017}, month = {2017}, school = {University of California, San Francisco}, type = {Dissertation}, address = {San Francisco, CA}, abstract = {Background: Data suggest that patients{\textquoteright} end-of-life (EOL) care preferences are not consistently followed. Based on these data, in 2015, the IOM called for research to identify the prevalence of the problem of EOL care preferences not honored. The current study used an ethical framework to study this problem. Objective: The purpose was to identify the prevalence of patient{\textquoteright}s not having their EOL care preferences followed using data from an existing nationally representative study. Methods: A secondary analysis of data from seven biennial waves (2002-2014) of the Health and Retirement Study (HRS) was performed. A cross-sectional analysis was accomplished using primarily the HRS exit interview. All respondents indicating that a written EOL preference had been documented were included. Deceased patients{\textquoteright} proxies provided the information about the patient{\textquoteright}s preferred EOL care and the actual care received. Because proxies could select more than one EOL care option, both a sample and a subsample of proxies who only selected one option were evaluated. Associations between mismatched EOL preferred vs. EOL received care options and respondent characteristics were also evaluated. Results: 3,754 respondents died during the study period, of who 3,660 met the inclusion criteria of having written EOL care instructions. The subsample included 212 respondents. Analysis of the sample found that the most preferred type of EOL care was comfort care, followed by limit care. The frequencies of both samples revealed that in the four EOL care types for which HRS collects data (all care possible, limit care, withhold treatment, comfort care), patient preferences were not followed 53-72\% of the time. A question about providers verbally offering EOL care treatments to the patient{\textquoteright}s proxy were asked and nearly 17\% of the time those instructions were not followed. Discussion: Using data from a nationally representative study, this study confirms that regardless of the type of EOL care patients{\textquoteright} prefer, and the presence of written instructions, patients do not receive that care greater than 50\% of the time, and a significant number are receiving unwanted EOL care. Further data are needed to ascertain why patients{\textquoteright} autonomous preferences are not followed at the EOL.}, keywords = {End-of-life care, Nursing homes, Patient-physician Relationship}, url = {https://search.proquest.com/docview/1984355653/abstract/850FAF56564645A4PQ/1?accountid=14667}, author = {Wishner, Denise} } @article {8899, title = {Disparity in dental out-of-pocket payments among older adult populations: a comparative analysis across selected European countries and the USA.}, journal = {International Dental Journal}, volume = {67}, year = {2017}, pages = {157-171}, abstract = {

BACKGROUND: The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods.

METHOD: We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents >=51 years of age. We estimated the impacts of dental-care coverage and of demographic, socio-economic and health status on the likelihood and amount of dental OOP payments.

RESULTS: In the USA, older persons with the least education, lowest income and worst health are most likely to pay nothing OOP for their dental care and, for persons with an OOP payment, the amount of this payment increases with income and education and is higher for persons who are uninsured and in fair or poor health. However, these results were not consistently found in the 10 European countries we studied.

CONCLUSIONS: European countries classified according to social welfare state or the presence of social health insurance (SHI) showed no effect on the likelihood of making payments OOP for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within countries with SHI, as well as differing needs, tastes and access to care across countries, contribute to this finding.

}, keywords = {Cross-National, Dental Care, Older Adults, Out-of-pocket payments, SHARE}, issn = {1875-595X}, doi = {10.1111/idj.12284}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Widstrom, Eeva and Listl, Stefan} } @article {9321, title = {Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.}, journal = {American Journal of Geriatric Psychiatry}, volume = {25}, year = {2017}, month = {2017 Oct}, pages = {1074-1082}, abstract = {

OBJECTIVES: Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.

DESIGN/SETTING/PARTICIPANTS: Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.

MEASUREMENTS: BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.

RESULTS: Fifty-eight (15\%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95\% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95\% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95\% CI: 1.12-3.59; p = 0.02).

CONCLUSIONS: A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.

}, keywords = {Dementia, Depressive symptoms, Healthcare, Stress}, issn = {1545-7214}, doi = {10.1016/j.jagp.2017.02.025}, author = {Donovan T Maust and Helen C Kales and Ryan J McCammon and Frederic C. Blow and Amanda N Leggett and Kenneth M. Langa} } @article {9264, title = {Distribution of lifetime nursing home use and of out-of-pocket spending}, journal = {Proceedings of the National Academy of Sciences}, volume = {114}, year = {2017}, pages = {9838{\textendash}9842}, keywords = {Consumption and Savings, Medical Expenses, Nursing homes, Spending}, issn = {0027-8424}, doi = {10.1073/pnas.1700618114}, url = {http://www.pnas.org/lookup/doi/10.1073/pnas.1700618114https://syndication.highwire.org/content/doi/10.1073/pnas.1700618114http://www.pnas.org/syndication/doi/10.1073/pnas.1700618114}, author = {Michael D Hurd and Pierre-Carl Michaud and Susann Rohwedder} } @article {9372, title = {Do Financial Constraints Affect Depressive Symptomatology Among Mid-Aged and Older Adults?}, journal = {The International Journal of Aging and Human Development}, volume = {85}, year = {2017}, pages = {438-455}, abstract = {The relationship between financial constraints and depressive symptomatology among adults aged 50 and greater was examined. The mediating effect of perceived control over one{\textquoteright}s financial circumstances on this relationship was assessed. Ordinary least square hierarchical regression models were estimated using data from the Health and Retirement Study. As an aggregated measure, financial constraints were positively associated with depression in mid-age and late life, and this relationship was partially accounted for by the pathway of perceived control over one{\textquoteright}s financial circumstances. When disaggregated as a measure, financial constraints at the individual level had a significant effect on depression, while financial constraints at the family and public levels did not have a significant effect. When added to the model, perceived control over one{\textquoteright}s financial circumstances had a significant effect on depressive symptomatology, financial constraints remained significant at the individual level.}, keywords = {Depressive symptoms, Financial literacy, Socioeconomic factors, Well-being}, issn = {0091-4150}, doi = {10.1177/0091415017697724}, url = {http://journals.sagepub.com/doi/10.1177/0091415017697724http://journals.sagepub.com/doi/pdf/10.1177/0091415017697724}, author = {Gillen, Martie and Karen A. Zurlo and Hyungsoo Kim} } @article {9012, title = {Do multiple health events reduce resilience when compared with single events?}, journal = {Health Psychology}, volume = {36}, year = {2017}, pages = {721-728}, abstract = {

OBJECTIVE: The impact of multiple major life stressors is hypothesized to reduce the probability of resilience and increase rates of mortality. However, this hypothesis lacks strong empirical support because of the lack of prospective evidence. This study investigated whether experiencing multiple major health events diminishes rates of resilience and increases rates of mortality using a large population-based prospective cohort.

METHOD: There were n = 1,395 individuals sampled from the Health and Retirement Study (HRS) and examined prospectively from 2 years before 4 years after either single or multiple health events (lung disease, heart disease, stroke, or cancer). Distinct depression and resilience trajectories were identified using latent growth mixture modeling (LGMM). These trajectories were compared on rates of mortality 4 years after the health events.

RESULTS: Findings indicated that 4 trajectories best fit the data including resilience, emergent postevent depression, chronic pre-to-post depression, and depressed prior followed by improvement. Analyses demonstrate that multiple health events do not decrease rates of resilience but do increase the severity of symptoms among those on the emergent depression trajectory. Emergent depression increased mortality compared with all others but among those in this class, rates were not different in response to single versus multiple health events.

CONCLUSIONS: Multiple major stressors do not reduce rates of resilience. The emergence of depression after health events does significantly increase risk for mortality regardless of the number of events. (PsycINFO Database Record

}, keywords = {Health Shocks, Older Adults, Resilience}, issn = {1930-7810}, doi = {10.1037/hea0000481}, author = {Ruth T Morin and Isaac R Galatzer-Levy and Maccallum, Fiona and George A. Bonanno} } @article {9052, title = {Do personality traits influence investors{\textquoteright} portfolios?}, journal = {Journal of Behavioral and Experimental Economics}, volume = {68}, year = {2017}, month = {Jan-06-2017}, pages = {1 - 12}, abstract = {Based on large-scale survey data from the 2006{\textendash}2012 waves of the US Health and Retirement Study (HRS), we show that individual portfolio decisions are influenced by a variety of stable traits and facets traditionally investigated in the field of personality psychology. Three personality traits have a significant negative correlation with financial risk taking, as measured by the holding and the amount of stock assets: Agreeableness, Cynical Hostility and Anxiety. For Cynical Hostility a belief-based mechanism seems to be at work, whereas the impact of all the other traits seems to pass through the preferences {\textendash} rather than the beliefs {\textendash} channel. Our findings shed new light on the determinants of individuals{\textquoteright} risk taking in the financial domain. {\textcopyright} 2017 Elsevier Inc.}, keywords = {Economics, Investing, Personality, Portfolios}, issn = {22148043}, doi = {10.1016/j.socec.2017.03.001}, author = {Alessandro Bucciol and Luca Zarri} } @article {6503, title = {Do Regular Cholesterol Screenings Lead to Lower Cholesterol Levels and Better Health Behaviors for All? Spotlight on Middle-Aged and Older Adults in the United States.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 Apr}, pages = {389-414}, abstract = {

OBJECTIVE: This study investigates how the causal effects of cholesterol screening differ by likelihood of using this preventive care service in terms of accessibility gaps and effects on health-related outcomes across groups with advantaged and disadvantaged backgrounds.

METHOD: We use propensity score matching to analyze a nationally representative sample using data from 2008, 2010, and 2012 waves of the Health and Retirement Study ( N = 3,907).

RESULTS: We find that respondents who are least likely to get their cholesterol tested benefit most from the use of cholesterol screening when they do use it, while its effects are smallest for those who are most likely to use this service.

DISCUSSION: Understanding the heterogeneous effects of preventive health service has important policy implications, particularly in terms of how to maximize the public health benefits of preventive care.

}, keywords = {Aged, Aged, 80 and over, Cholesterol, Female, Health Behavior, Humans, Longitudinal Studies, Male, Mass Screening, Middle Aged, Preventive Health Services, United States}, issn = {1552-6887}, doi = {10.1177/0898264316635588}, url = {http://europepmc.org/abstract/MED/26921271}, author = {Choi, Yool and Lee, Hyo Jung} } @article {9621, title = {Do State Laws Protecting Older Workers from Discrimination Reduce Age Discrimination in Hiring? Experimental (and Nonexperimental) Evidence}, number = {WP 2017-360}, year = {2017}, pages = {1-79}, institution = {Michigan Retirement Research Center}, address = {Ann Arbor, MI}, abstract = {We provide evidence from a field experiment {\textemdash} a correspondence study {\textemdash} on age discrimination in hiring for retail sales jobs. We collect experimental data in all 50 states and then relate measured age discrimination {\textemdash} the difference in callback rates between old and young applicants {\textemdash} to variation across states in antidiscrimination laws offering protections to older workers that are stronger than the federal age and disability discrimination laws. We do a similar analysis for nonexperimental data on differences across states in hiring rates of older versus younger workers. The experimental evidence points consistently to evidence of hiring discrimination against older men and, more so, against older women. However, the evidence on the relationship between hiring discrimination against older workers and state variation in age and disability discrimination laws is not so clear; at a minimum, there is not a compelling case that stronger state protections reduce hiring discrimination against older workers. In contrast, the non-experimental evidence suggests that stronger disability discrimination protections increase the relative hiring of older workers.}, keywords = {Ageism, Discrimination, Labor force participation}, url = {http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp360.pdf}, author = {David Neumark and Ian Burn and Patrick Button and Nanneh Chehras} } @article {9387, title = {Documentation of Blood-Based Biomarkers in the 2014 Health and Retirement Study}, year = {2017}, month = {12/2017}, institution = {Survey Research Center, Institute for Social Research, University of Michigan}, address = {Ann Arbor, MI}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and David R Weir} } @article {9325, title = {Does a Sense of Benevolence Influence Volunteering and Caregiving among Older People?}, journal = {Social Work Research}, volume = {41}, year = {2017}, pages = {155-166}, abstract = {Volunteering and caregiving are both helping behaviors, but they take place in different social contexts. Although personal resources and networks are important factors in understanding whether older people volunteer and provide family care, studies of the psychological factors influencing these behaviors are rare. Using theoretical guidance of the resource and strategic mobilization model, this study aims to construct a psychological factor-sense of benevolence (SBEN)-and elucidate the effects of SBEN on volunteering and caregiving among older adults when personal resources and networks are controlled. Authors, using data from the 2000 Health and Retirement Study, included 939 community-dwelling older adults age 55 years and older in the study. Using principal component analysis, authors retained 10 items to construct the SBEN scale (Cronbach{\textquoteright}s alpha =.86). Two separate logistic regression models were used to assess the relationships between SBEN and volunteering and SBEN and caregiving. Findings show that higher SBEN increased the likelihood for older people to give care but was not related to volunteering. SBEN may be used as a construct to help understand the psychological factors behind older individuals{\textquoteright} helping behaviors to family. Further research identifying mechanisms of engaging older volunteers-that is, psychological and institutional motivating factors-is needed.}, keywords = {Activity engagement, Caregiving, Volunteerism}, issn = {1070-5309}, doi = {10.1093/swr/svx012}, url = {http://academic.oup.com/swr/article/41/3/155/4080844/Does-a-Sense-of-Benevolence-Influence-Volunteeringhttp://academic.oup.com/swr/article-pdf/41/3/155/19658245/svx012.pdf}, author = {Shen, Huei-Wern and Delston, J. B. and Wang, Yi} } @article {9018, title = {Does Caring for a Spouse With Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study.}, journal = {The Gerontologist}, volume = {57}, year = {2017}, pages = {319}, abstract = {

PURPOSE OF THE STUDY: The purpose of this study is to expand our recent work, which showed that spousal dementia caregivers compared to spousal nondementia caregivers experience an accelerated rate of frailty over time, by exploring cognitive health outcomes between dementia and nondementia caregivers.

DESIGN AND METHODS: Using 8 biannual waves of the Health and Retirement Study data and performance on the modified Telephone Interview for Cognitive Status, we examined changes in cognitive health among surviving spousal caregivers (N = 1,255) of individuals with dementia (n = 192) and without dementia (n = 1,063), 2 waves prior and 2 waves following the death of the care recipient.

RESULTS: Controlling for baseline health and contextual factors (e.g., frailty status, age, education), results revealed that dementia caregivers had significantly greater cognitive decline (p < .01) compared to nondementia caregivers. Relative to 2 waves prior to the death of their spouse, dementia caregivers declined by 1.77 points relative to nondementia caregivers (0.87 points) at the time their spouses{\textquoteright} deaths were reported and 1.89 relative to the 1.18 points at the wave following these deaths, respectively.

IMPLICATIONS: The findings from this study show that spousal caregivers of persons with dementia experience accelerated cognitive decline themselves compared to nondementia caregivers. These results, along with our previous study findings, suggest that this vulnerable group could benefit from early cognitive screening and psychosocial interventions designed to help dementia caregivers better maintain their cognitive and physical health during and following their intensive caregiving responsibilities.

}, keywords = {Caregiving, Cognitive Ability, Dementia, Older Adults}, issn = {1758-5341}, doi = {10.1093/geront/gnv148}, author = {Kara B. Dassel and Dawn C Carr and Vitaliano, Peter} } @article {9214, title = {Does everyone use probabilities? The role of cognitive skills}, journal = {European Economic Review}, volume = {98}, year = {2017}, month = {Jan-09-2017}, pages = {73-85}, abstract = {What is the role of cognitive skills in decision making under uncertainty? We address this question by examining the relationship between responses to survey questions about subjective probabilities of stock market returns and stock holding decisions. Based on data from the Health and Retirement Study (HRS), we find that for individuals with lower cognitive skills the association between measured probabilities and decisions is weaker than for individuals with higher cognitive skills. Additional evidence suggests that individuals with lower cognitive skills are more likely to give heuristic answers to questions about stock return probabilities. A likely explanation is that individuals with lower cognitive skills have a fuzzier mental representation of stock returns that cannot be captured by a unique well-defined probability distribution. In contrast, individuals with higher cognitive skills are more likely to act as if subjective probabilities are meaningful measures of uncertainty. We discuss whether or not the behavior of the latter can be seen as more {\textquotedblleft}rational{\textquotedblright}.}, keywords = {Cognitive Ability, Probability}, issn = {00142921}, doi = {10.1016/j.euroecorev.2017.06.009}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0014292117301101http://api.elsevier.com/content/article/PII:S0014292117301101?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0014292117301101?httpAccept=text/plain}, author = {Binswanger, Johannes and Salm, Martin} } @article {9320, title = {Does How We Feel About Financial Strain Matter for Mental Health?}, journal = {Journal of Financial Therapy}, volume = {8}, year = {2017}, pages = {63-78}, abstract = {This study investigated how stress responses to financial strain are related to mental health (i.e., depression) to answer the question: Does how we feel about financial strain matter? Informed by the ABC-X model of family stress and analyzed with data from the Health and Retirement Study (HRS), results reveal that financial strain is significantly related to increased depression; however, financial stress was found to moderate this relationship. Financially strained respondents without a stress response did not have significantly different depression scores than those who were not experiencing financial strain; however, depression scores increased as the stress response to financial strain increased. Consistent with the ABC-X model, results suggest that financial strain is a neutral event until it is processed and interpreted by an individual, with subjective perceptions a more powerful predictor of mental health than objective financial circumstances. These results emphasize an area of synergy for financial and mental health researchers and professionals.}, keywords = {Depressive symptoms, Financial burden, Mental Health, Stress}, issn = {19457774}, doi = {10.4148/1944-9771.1130}, url = {http://newprairiepress.org/jft/vol8/iss1/5}, author = {Asebedo, Sarah D. and Wilmarth, Melissa J.} } @article {9623, title = {Does Religiosity Account for Lower Rates of Advance Care Planning by Older African Americans?}, journal = {The Journals of Gerontology: Series B}, volume = {73}, year = {2017}, month = {Jan-02-2017}, pages = {687 - 695}, abstract = {Objectives Advance care planning (ACP) is associated with higher quality care at the end of life and increased odds of receiving hospice care and of dying at home. Older African Americans are less likely to complete advance directives (ADs) or discuss life-sustaining treatment preferences. This study examined whether religiosity accounts for race disparities. Method Analyses were conducted with Health and Retirement Study data (1,180 African Americans, 5,681 Whites). Two forms of ACP were regressed on race, five measures of religiosity, and demographic, health, and health care covariates. Results Whites were twice as likely to engage in ACP. Including religiosity predictors did not close these gaps. Frequency of service attendance was positively associated with AD completion for both White and African American participants. Relationships between religious affiliation and advance care discussion varied by race. For White participants only, more frequent prayer was associated with higher odds of advance care discussion. Discussion Although religiosity is often proposed as a reason for low rates of ACP among African Americans, religiosity measures did not explain race differences. Distinct aspects of religiosity were associated with ACP both negatively and positively, and these relationships varied by type of ACP and by race. {\textcopyright} 2017 The Author(s). }, keywords = {African Americans, Death \& Dying, Hospice, Religion}, issn = {1079-5014}, doi = {10.1093/geronb/gbw155}, url = {https://academic.oup.com/psychsocgerontology/article/73/4/687/2965389http://academic.oup.com/psychsocgerontology/article-pdf/73/4/687/24627052/gbw155.pdf}, author = {Catheryn S Koss} } @article {6511, title = {Dog Walking, the Human-Animal Bond and Older Adults{\textquoteright} Physical Health.}, journal = {Gerontologist}, volume = {57}, year = {2017}, month = {2017 Oct 01}, pages = {930-939}, abstract = {

PURPOSE OF THE STUDY: This study explored the associations between dog ownership and pet bonding with walking behavior and health outcomes in older adults.

DESIGN AND METHODS: We used data from the 12th wave (2012) of the Health and Retirement Study which included an experimental human-animal interaction module. Ordinary least squares regression and binary logistic regression models controlling for demographic variables were used to answer the research questions.

RESULTS: Dog walking was associated with lower body mass index, fewer activities of daily living limitations, fewer doctor visits, and more frequent moderate and vigorous exercise. People with higher degrees of pet bonding were more likely to walk their dog and to spend more time walking their dog each time, but they reported walking a shorter distance with their dog than those with weaker pet bonds. Dog ownership was not associated with better physical health or health behaviors.

IMPLICATIONS: This study provides evidence for the association between dog walking and physical health using a large, nationally representative sample. The relationship with one{\textquoteright}s dog may be a positive influence on physical activity for older adults.

}, keywords = {Aged, Animals, Dogs, Female, Health Status, Human-Animal Bond, Humans, Least-Squares Analysis, Linear Models, Logistic Models, Male, Middle Aged, Ownership, Walking}, issn = {1758-5341}, doi = {10.1093/geront/gnw051}, url = {http://gerontologist.oxfordjournals.org/content/early/2016/03/18/geront.gnw051.abstract}, author = {Angela L Curl and Bibbo, Jessica and Rebecca A Johnson} } @article {9149, title = {Drawing down retirement wealth: Interactions between Social Security wealth and private retirement savings}, number = {WR-1165}, year = {2017}, month = {01/2017}, institution = {RAND Corporation}, address = {Santa Monica, CA}, keywords = {Consumption and Savings, Retirement Planning and Satisfaction, Social Security}, doi = {10.7249/WR1165}, url = {http://www.rand.org/pubs/working_papers/WR1165.html}, author = {Philip Armour and Hung, Angela} } @mastersthesis {9522, title = {Durable Disparity: The Emergence and Entrenchment of the Great American Smoking Gap}, volume = {Ph.D.}, year = {2017}, pages = {165}, school = {University of Michigan}, type = {Dissertation}, address = {Ann Arbor, MI}, abstract = {This dissertation consists of three chapters that investigate how inequalities in health behaviors originate and how they are maintained, using cigarette smoking as a case. In Chapter II, I examine the associations between parental and adult child smoking and consider how they may be modified by the adult child{\textquoteright}s socioeconomic attainment and social mobility. Using data collected by the Panel Study of Income Dynamics in 1968, 1986, and 2011, I find that having a smoking parent as a child is associated with a 9 percent to 10 percentage point increase in the probability of smoking as an adult in 1986 and 2011, respectively. However, the parental contribution to an adult child{\textquoteright}s smoking likelihood decreased to 7 and 5 percentage point and is no longer statistically significant in 2011 after accounting for the adult child{\textquoteright}s own socioeconomic attainment. Children of 1968 parents (themselves interviewed in 1986) are more likely to reproduce their parents{\textquoteright} smoking behavior if they maintain their parents{\textquoteright} economic position or are downwardly mobile than if they are upwardly mobile. For children of 1986 parents (interviewed in 2011), adult children who are downwardly mobile with respect to parental education show a larger effect of parental smoking on their own behavior than those who maintain their parents{\textquoteright} education or are upwardly mobile. x In Chapter III, I evaluate the contribution of smoke-free laws to the socioeconomic inequality in smoking. Using a state-level dataset constructed from multiple sources, I show that states with lower smoking rates are more likely to adopt smoke-free laws. Lower unemployment rates and higher educational attainment in a state are positively associated with smoke-free workplace and bar laws, respectively. I then use a personlevel survey dataset, the Behavioral Risk Factor Surveillance Survey, to estimate the effect of the laws{\textquoteright} implementation on individuals{\textquoteright} probability of smoking. Smoke-free laws are associated with a decline in smoking among women. The decline is concentrated among women who have high school diplomas or are college graduates. Taken together, the results suggest that smoke-free laws may contribute to betweenstate smoking inequalities and that they may contribute to gender disparities. In Chapter IV, I examine the associations between tobacco control policy change and smoking cessation and smoking intensity of older adults, and how they vary by education and race. I use geocoded longitudinal data from the 1992 to 2014 waves of the Health and Retirement Study including smokers 51 and older to assess the relationship between the implementation of 100 percent smoke-free nonhospitality and hospitality workplace laws at local and state levels, average cigarette pack price at the state level, and the likelihood of an individual{\textquoteright}s smoking cessation or change in the number of cigarettes smoked daily. The implementation of a non-hospitality workplace law was associated with an increased likelihood of cessation among men, but not among women. Implementation of restaurant and bar smoke-free laws was not associated with increased cessation or lowered intensity. White men, nonwhite women, xi and high school graduates decreased their smoking intensity in response to cigarette price change more than others. These results suggest that the sensitivity of older U.S. adults to changes in smoke-free laws and cigarette prices is limited. I close the dissertation by discussing promising future research direction on health behavior disparities and smoking}, keywords = {Family Roles/Relationships, Health Conditions and Status, Smoking}, url = {https://deepblue.lib.umich.edu/bitstream/handle/2027.42/140926/luciekal_1.pdf?sequence=1\&isAllowed=y}, author = {Lucie Kalousova} } @article {8826, title = {Data Resource Profile: Cross-national and cross-study sociodemographic and health-related harmonized domains from SAGE plus ELSA, HRS and SHARE (SAGE+, Wave 1)}, journal = {International Journal of Epidemiology}, volume = {45}, year = {2016}, month = {Aug-10-2016}, pages = {1403 - 1403j}, abstract = {Four longitudinal studies were included in this rigorous harmonization process: the Study on global AGEing and adult health (SAGE); English Longitudinal Study on Ageing (ELSA); US Health and Retirement Study (HRS); and Survey of Health, Ageing and Retirement in Europe (SHARE). An ex-post harmonized process was applied to nine health-related thematic domains (socio-demographic and economic, health states, overall self-report of health and mental state, health examinations, physical and mental performance tests, risk factors, chronic conditions, social network and subjective well-being) for data from the 2004 wave of each study. Large samples of adults aged 50 years and older were available from each study: SAGE, n = 18 886; ELSA, n = 9181; HRS, n = 19 303; and SHARE, n = 29 917. The microdata, along with further details about the harmonization process and all metadata, are available through the World Health Organization (WHO) data archive at [http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog]. Further information and enquiries can be made to [sagesurvey@who.int] or the corresponding author. The data resource will continue to be updated with data across additional waves of these surveys and new waves.}, keywords = {Cross-National, ELSA, Older Adults, SAGE, SHARE}, issn = {0300-5771}, doi = {10.1093/ije/dyw181}, url = {http://ije.oxfordjournals.org/lookup/doi/10.1093/ije/dyw181}, author = {Minicuci, Nadia and Naidoo, Nirmala and Chatterji, Somnath and Kowal, Paul} } @article {8364, title = {Depressed Mood in Middle-Aged and Older Adults in Europe and the United States: A Comparative Study Using Anchoring Vignettes.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 Feb}, pages = {95-117}, publisher = {28}, abstract = {

OBJECTIVE: To compare self-ratings of depressed mood in middle-aged and older adults in the United States and nine European countries after adjustment by anchoring vignettes.

METHOD: Samples were drawn from three large surveys of middle-aged and older adults: the U.S. Health and Retirement Study, the English Longitudinal Study of Aging (ELSA), and the Survey of Health, Ageing and Retirement in Europe. Self-ratings of depressed mood were compared across countries before and after adjustment by anchoring vignettes depicting cases with different levels of depressed mood.

RESULTS: Compared with Europeans as a group, Americans rated both the cases presented in the vignettes and themselves as more depressed. However, after adjustment by vignette ratings, Americans appeared to be less depressed than their counterparts in all but two European countries.

DISCUSSION: Cultural differences in mental health norms reflected in vignette rating may partly explain between-country differences in self-reported depressive symptoms and perhaps other psychiatric complaints.

}, keywords = {Aged, Cross-Cultural Comparison, depression, Europe, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, United States}, issn = {1552-6887}, doi = {10.1177/0898264315585506}, url = {http://jah.sagepub.com/content/early/2015/04/22/0898264315585506.abstract}, author = {Ramin Mojtabai} } @article {8478, title = {Depression and Frailty in Late Life: Evidence for a Common Vulnerability.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 07}, pages = {630-40}, abstract = {

OBJECTIVES: The study purpose is to estimate the correlation between depression and competing models of frailty, and to determine to what degree the comorbidity of these syndromes is determined by shared symptomology.

METHODS: Data come from the 2010 Health and Retirement Study. Analysis was limited to community-dwelling participants 65 and older (N = 3,453). Depressive symptoms were indexed by the 8-item Centers for Epidemiologic Studies Depression (CESD) scale. Frailty was indexed by 3 alternative conceptual models: (a) biological syndrome, (b) frailty index, and (c) functional domains. Confirmatory factor analysis (CFA) was used to estimate the correlation between depression and each model of frailty.

RESULTS: Each of the 3 frailty latent factors was significantly correlated with depression: biological syndrome (ρ = .68, p < .01), functional domains (ρ = .70, p < .01), and frailty index (ρ = .61, p < .01). Substantial correlation remained when accounting for shared symptoms between depression and the biological syndrome (ρ = .45) and frailty index (ρ = .56) models.

DISCUSSION: Results indicate that the correlation of frailty and depression in late life is substantial. The association between the two constructs cannot be fully explained by symptom overlap, suggesting that psychological vulnerability may be an important component of frailty.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, depression, Female, Frail Elderly, Geriatric Assessment, Humans, Independent Living, Interview, Psychological, Male}, issn = {1758-5368}, doi = {10.1093/geronb/gbu180}, url = {http://www.ncbi.nlm.nih.gov/pubmed/25617399}, author = {Matthew C. Lohman and Dumenci, Levent and Briana Mezuk} } @article {8806, title = {Desire for predictive testing for Alzheimer{\textquoteright}s disease and impact on advance care planning: a cross-sectional study.}, journal = {Alzheimers Res Ther}, volume = {8}, year = {2016}, month = {2016 12 13}, pages = {55}, abstract = {

BACKGROUND: It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer{\textquoteright}s disease, or whether testing would change behavior. Using a nationally representative sample, we explored who would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease, and examined how using such a test may impact advance care planning.

METHODS: A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65~years or older asked questions about a test predictive of Alzheimer{\textquoteright}s disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer{\textquoteright}s disease. Then, imagining they knew they would develop Alzheimer{\textquoteright}s disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer{\textquoteright}s disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones.

RESULTS: Overall, 75\% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be <=75~years old (odds ratio 0.71 (95\% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer{\textquoteright}s, 81\% would be likely to complete an advance directive, although only 15\% had done so already.

CONCLUSIONS: In this nationally representative sample, 75\% of older adults would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer{\textquoteright}s disease and suggests this may be an opportunity to engage patients in advance care planning discussions.

}, keywords = {Advance care planning, Aged, Aged, 80 and over, Alzheimer disease, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Patient Acceptance of Health Care}, issn = {1758-9193}, doi = {10.1186/s13195-016-0223-9}, url = {http://alzres.biomedcentral.com/articles/10.1186/s13195-016-0223-9http://link.springer.com/content/pdf/10.1186/s13195-016-0223-9.pdf}, author = {Sheffrin, Meera and Stijacic-Cenzer, Irena and Michael A Steinman} } @article {8376, title = {The determinants of presenteeism: a comprehensive investigation of stress-related factors at work, health, and individual factors among the aging workforce.}, journal = {J Occup Health}, volume = {58}, year = {2016}, month = {2016}, pages = {25-35}, publisher = {58}, abstract = {

OBJECTIVES: The aim of this study was to identify the determinants of presenteeism, taking health and individual factors into account.

METHODS: A quantitative analysis applying structural equation modelling analysis was conducted on the basis of secondary data from the Health and Retirement Survey (2008 wave), which measured presenteeism and its determinants.

RESULTS: Stress-related factors at work (β =-0.35, p<0.001), individual factors (α =-0.27, p<0.001), and health (β =0.24, p<0.001) were significantly related to presenteeism. Individual factors were found to be directly correlated with stress-related factors at work (β =0.22, p<0.001). Significant indirect effects between stress-related factors at work and presenteeism (Sobel z=-6.61; p<0.001) and between individual factors and presenteeism (Sobel z=-4.42; p<0.001), which were mediated by health, were also found. Overall, the final model accounted for 37\% (R(2)=0.37) of the variance in presenteeism.

CONCLUSIONS: Our study indicates some important and practical guidelines for employers to avoid the burdens of stress-related presenteeism among their employees. These findings could help select target factors in the design and implementation of effective presenteeism interventions in the aging working population.

}, keywords = {Age Factors, Aged, Aging, Female, Health Surveys, Humans, Male, Middle Aged, Occupational Diseases, Presenteeism, Stress, Psychological, United States, Workplace}, issn = {1348-9585}, doi = {10.1539/joh.15-0114-OA}, url = {https://www.jstage.jst.go.jp/article/joh/58/1/58_15-0114-OA/_article}, author = {Tianan Yang and Zhu, Mingjing and Xiyao Xie} } @article {8367, title = {Determinants of Private Long-Term Care Insurance Purchase in Response to the Partnership Program.}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 Apr}, pages = {687-703}, publisher = {51}, abstract = {

OBJECTIVE: To assess three possible determinants of individuals{\textquoteright} response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness.

DATA SOURCES: The health and retirement study (HRS) merged with data on states{\textquoteright} implementation of the PLTC program.

STUDY DESIGN: Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression.

DATA EXTRACTION METHODS: Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations.

PRINCIPAL FINDINGS: We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness.

CONCLUSIONS: Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program{\textquoteright}s existence and increased education about the program{\textquoteright}s benefits, and more generally, about long-term care risks and needs.

}, keywords = {Aged, Awareness, Costs and Cost Analysis, Decision making, Female, Humans, Insurance, Long-Term Care, Male, Middle Aged, Socioeconomic factors}, issn = {1475-6773}, doi = {10.1111/1475-6773.12353}, url = {http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12353/abstract}, author = {Lin, Haizhen and Jeffrey T Prince} } @article {8401, title = {Diabetic Phenotypes and Late-Life Dementia Risk: A Mechanism-specific Mendelian Randomization Study.}, journal = {Alzheimer Dis Assoc Disord}, volume = {30}, year = {2016}, month = {2016 Jan-Mar}, pages = {15-20}, publisher = {30}, abstract = {

BACKGROUND: Mendelian Randomization (MR) studies have reported that type 2 diabetes (T2D) was not associated with Alzheimer disease (AD). We adopted a modified, mechanism-specific MR design to explore this surprising result.

METHODS: Using inverse-variance weighted MR analysis, we evaluated the association between T2D and AD using data from 39 single nucleotide polymorphisms (SNPs) significantly associated with T2D in DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) and the corresponding associations of each SNP with AD risk obtained from the International Genomics of Alzheimer{\textquoteright}s Project (IGAP, n=17,008 AD cases and n=37,154 controls). We evaluated mechanism-specific genetic subscores, including β-cell function, insulin sensitivity, and adiposity, and repeated analyses in 8501 Health and Retirement Study participants for replication and model validation.

RESULTS: In IGAP, the overall T2D polygenic score did not predict AD [odds ratio (OR) for the T2D polygenic score=1.01; 95\% confidence interval (CI), 0.96, 1.06] but the insulin sensitivity polygenic score predicted higher AD risk (OR=1.17; 95\% CI, 1.02, 1.34). In the Health and Retirement Study, polygenic scores were associated with T2D risk; the associations between insulin sensitivity genetic polygenic score and cognitive phenotypes were not statistically significant.

CONCLUSIONS: Evidence from polygenic scores suggests that insulin sensitivity specifically may affect AD risk, more than T2D overall.

}, keywords = {Alzheimer disease, Diabetes Mellitus, Type 2, Genetic Predisposition to Disease, Humans, Insulin, Mendelian Randomization Analysis, Phenotype, Polymorphism, Single Nucleotide, Risk Factors}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000128}, url = {http://europepmc.org/abstract/MED/26650880}, author = {Stefan Walter and Jessica R Marden and Laura D Kubzansky and Elizabeth R Mayeda and Paul K Crane and Chang, Shun-Chiao and Marilyn C Cornelis and David Rehkopf and Mukherjee, Shubhabrata and M. Maria Glymour} } @article {8499, title = {Differences Among Older Adults in the Types of Dental Services Used in the United States.}, journal = {Inquiry}, volume = {53}, year = {2016}, month = {2016}, abstract = {

The purpose of this article is to explore differences in the socioeconomic, demographic characteristics of older adults in the United States with respect to their use of different types of dental care services. The 2008 Health and Retirement Study (HRS) collected information about patterns of dental care use and oral health from individuals aged 55 years and older in the United States. We analyze these data and explore patterns of service use by key characteristics before modeling the relationship between service use type and those characteristics. The most commonly used service category was fillings, inlays, or bonding, reported by 43.6\% of those with any utilization. Just over one third of those with any utilization reported a visit for a crown, implant, or prosthesis, and one quarter reported a gum treatment or tooth extraction. The strongest consistent predictors of use type are denture, dentate, and oral health status along with dental insurance coverage and wealth. Our results provide insights into the need for public policies to address inequalities in access to dental services among an older US population. Our findings show that lower income, less wealthy elderly with poor oral health are more likely to not use any dental services rather than using only preventive dental care, and that cost prevents most non-users who say they need dental care from going to the dentist. These results suggest a serious access problem and one that ultimately produces even worse oral health and expensive major procedures for this population in the future.

}, keywords = {Aged, Dental Care, Female, Humans, Insurance, Dental, Male, Middle Aged, Surveys and Questionnaires, United States}, issn = {1945-7243}, doi = {10.1177/0046958016652523}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27284127}, author = {Richard J. Manski and Jody Schimmel Hyde and Haiyan Chen and John F Moeller} } @article {8410, title = {Differences between Subjective and Predicted Survival Probabilities and Their Relation to Preventive Care Use}, journal = {B.E. Journal of Economic Analysis and Policy}, volume = {16}, year = {2016}, pages = {807-835}, publisher = {16}, abstract = {I analyse how differences between subjective and predicted survival probabilities are related to preventive healthcare use. Based on the Health and Retirement Study, I find that private information inherent in subjective survival probability affects the decisions on preventive care use: positive and negative deviations between the subjective and predicted survival probabilities both imply lower likelihood of use, the relations with negative deviations being stronger. These results are driven by perceptions verified by later survival and health outcomes. A theoretical model provides explanation for the empirical results, in which preventive care increases the chances of survival, but the benefits of preventive care also vary with the survival probability.}, keywords = {Mortality, Older Adults, Preventative Care}, issn = {1935-1682}, doi = {10.1515/bejeap-2015-0154}, url = {https://www.degruyter.com/view/j/bejeap.2016.16.issue-2/bejeap-2015-0154/bejeap-2015-0154.xml}, author = {Anik{\'o} Bir{\'o}} } @article {8413, title = {Differences in Out-of-Pocket Health Care Expenses of Older Single and Couple Households}, journal = {EBRI Notes}, volume = {37}, year = {2016}, publisher = {37}, abstract = {This paper examines in detail the differences in out-of-pocket health care spending between couple and single older households. The data for this paper come from the Health and Retirement Study (HRS), a study of a nationally representative sample of U.S. households with individuals over age 50. Throughout the paper participants are classified into three different age groups: ages 65-74 (Age Group I), ages 75-84 (Age Group II), and ages 85 and above (Age Group III). All the numbers reported are for a two-year period between 2010 and 2012. This paper also includes total recurring and total non-recurring expenses for the households studied. It should be noted that health insurance premiums and spending on over-the-counter drugs are not included in this study. The average per-person out-of-pocket spending for households ages 65 and above during a two-year period on doctor visits, dentist visits, and prescription drugs (referred to collectively as recurring health care services) is roughly 2,500 for both single and couple households. This amount does not change with age. There are large differences in non-recurring health care spending (which includes overnight hospital stays, outpatient surgery, home health care, nursing home stays, and other services) between older singles and older couples, and these differences increase with age. For Age Group I, the average total non-recurring expenses were 2,790 for singles and 2,024 for couples, a difference of 766. For Age Group II, the average total non-recurring expenses went up to 5,502 and 3,930 for singles and couples, respectively, a difference of 1,572. For the oldest age group (those 85 and above), the difference went up to 4,825 ( 13,355 for singles and 8,530 for couples). Some of the largest differences in non-recurring health care spending between older singles and older couples are in home health care and nursing home expenses. This suggests that couples benefit from their spouses or partners acting as their caregivers.}, keywords = {Health Expenses, Healthcare, Medicare/Medicaid/Health Insurance, Older Adults, Prescription Medication}, url = {http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2723591}, author = {Sudipto Banerjee} } @inbook {5264, title = {Disability Insurance Incentives and the Retirement Decision: Evidence from the United States}, booktitle = {Social Security Programs and Retirement Around the World: Disability INsurance Programs and Retirement}, year = {2016}, pages = {45-80}, publisher = {Chicago University Press}, organization = {Chicago University Press}, address = {Chicago}, abstract = {Public programs that benefit older individuals, such as Social Security and Medicare, may be changed in the future in ways that reflect an expectation of longer work lives. But do older Americans have the health capacity to work longer? This paper explores this question by asking how much older individuals could work if they worked as much as those with the same mortality rate in the past or as much as their younger counterparts in similar health. Using both methods, we estimate that there is significant additional capacity to work at older ages. We also explore whether there are differences in health capacity across education groups and whether health has improved more over time for the highly educated, using education quartiles to surmount the challenge of changing levels of education over time.}, keywords = {Employment and Labor Force, Insurance, Older Adults, Public Policy, Retirement Planning and Satisfaction}, author = {Courtney Coile}, editor = {David A Wise} } @article {12183, title = {Disability Measurement in the Health and Retirement Study}, year = {2016}, publisher = {National Institute on Aging}, address = {Bethesda, MD}, keywords = {Disability}, author = {Emily M. Agree and Douglas A. Wolf} } @article {8377, title = {Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA.}, journal = {Int Dent J}, volume = {66}, year = {2016}, month = {2016 Feb}, pages = {36-48}, publisher = {66}, abstract = {

BACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries.

METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents>=51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use.

RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance.

CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.

}, keywords = {Aged, Aged, 80 and over, Demography, Dental Care, Europe, Female, Humans, Insurance Coverage, Interviews as Topic, Male, Middle Aged, Oral Health, Patient Acceptance of Health Care, United States}, issn = {0020-6539}, doi = {10.1111/idj.12190}, url = {http://onlinelibrary.wiley.com/doi/10.1111/idj.12190/epdf}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Widstrom, Eeva and Listl, Stefan} } @article {8500, title = {Dispositional Optimism and Incidence of Cognitive Impairment in Older Adults.}, journal = {Psychosom Med}, volume = {78}, year = {2016}, month = {2016 09}, pages = {819-28}, abstract = {

OBJECTIVE: Higher levels of optimism have been linked with positive health behaviors, biological processes, and health conditions that are potentially protective against cognitive impairment in older adults. However, the association between optimism and cognitive impairment has not been directly investigated. We examined whether optimism is associated with incident cognitive impairment in older adults.

METHODS: Data are from the Health and Retirement Study. Optimism was measured by using the Life Orientation Test-R and cognitive impairment with a modified version of the Telephone Interview for Cognitive Status derived from the Mini-Mental State Examination. Using multiple logistic regression models, we prospectively assessed whether optimism was associated with incident cognitive impairment in 4624 adults 65 years and older during a 4-year period.

RESULTS: Among participants, 312 women and 190 men developed cognitive impairment during the 4-year follow-up. Higher optimism was associated with decreased risk of incident cognitive impairment. When adjusted for sociodemographic factors, each standard deviation increase in optimism was associated with reduced odds (odds ratio [OR] = 0.70, 95\% confidence interval [CI] = 0.61-0.81) of becoming cognitively impaired. A dose-response relationship was observed. Compared with those with the lowest levels of optimism, people with moderate levels had somewhat reduced odds of cognitive impairment (OR = 0.78, 95\% CI = 0.59-1.03), whereas people with the highest levels had the lowest odds of cognitive impairment (OR = 0.52, 95\% CI = 0.36-0.74). These associations remained after adjusting for health behaviors, biological factors, and psychological covariates that could either confound the association of interest or serve on the pathway.

CONCLUSIONS: Optimism was prospectively associated with a reduced likelihood of becoming cognitively impaired. If these results are replicated, the data suggest that potentially modifiable aspects of positive psychological functioning such as optimism play an important role in maintaining cognitive functioning.

}, keywords = {Aged, Aged, 80 and over, Cognitive Dysfunction, Female, Humans, Incidence, Male, Optimism, Protective factors, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000345}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27284699}, author = {Katerina A B Gawronski and Eric S Kim and Kenneth M. Langa and Laura D Kubzansky} } @article {5847, title = {Distributional Effects of Means Testing Social Security: An Exploratory Analysis}, number = {Working Paper No. 22424}, year = {2016}, pages = {1-28}, institution = {Cambridge, MA, National Bureau of Economic Research}, abstract = {This paper examines the distributional implications of introducing additional means testing of Social Security benefits where proceeds are used to help balance Social Security{\textquoteright}s finances. Benefits of the top quarter of households ranked according to the relevant measure of means are reduced using a modified version of the Social Security Windfall Elimination Provision (WEP). The replacement rate in the first bracket of the benefit formula, determining the Primary Insurance Amount (PIA), would be reduced from 90 percent to 40 percent of Average Indexed Monthly Earnings (AIME). Four measures of means are considered: total wealth; an annualized measure of AIME; the wealth value of pensions; and a measure of average indexed lifetime W2 earnings. The empirical analysis is based on data from the Health and Retirement Study. These means tests would reduce total lifetime household benefits by 7 to 9 percentage points. We find that the basis for means testing Social Security makes a substantial difference as to which households have their benefits reduced, and that different means tests may have different effects on the benefits of families in similar circumstance. We also find that the measure of means used to evaluate the effects of a means test makes a considerable difference as to how one would view the effects of the means test on the distribution of benefits.}, keywords = {Net Worth and Assets, Public Policy, Social Security}, author = {Alan L Gustman and Thomas L. Steinmeier and N. Tabatabai} } @article {8411, title = {Diverging Fortunes: Racial/Ethnic Inequality in Wealth Trajectories in Middle and Late Life}, journal = {Race and Social Problems}, volume = {8}, year = {2016}, pages = {29-41}, publisher = {8}, abstract = {The primary aim of this study is to examine whether racial/ethnic inequality in wealth dissipates or increases between middle and late life, and by how much. To address this aim, this study draws on critical race and life course perspectives as well as 10 waves of panel data from the Health and Retirement Study and growth curve models to understand racial/ethnic inequality in wealth trajectories among whites, blacks, and Mexican Americans (N = 8337). Findings show that, by midlife, significant inequalities in net worth emerge between whites and their black and Mexican American counterparts. On average, white households have amassed a net worth of 105k by midlife, compared to less than 5k and 39k among black and Mexican American families, respectively. Moreover, whites experience much more rapid rates of wealth accumulation during their 50s and 60s than their minority counterparts, resulting in increasing wealth disparities with age, consistent with a process of cumulative disadvantage. At the peak of their wealth trajectory (at age 66), whites have approximately 245k more than blacks and 219k more than Mexican Americans. A wide range of socioeconomic, behavioral, and health factors account for a portion, but not all, of racial/ethnic inequality in wealth, suggesting that unobserved factors such as parental wealth, segregation, and discrimination may play a role in the production and maintenance of wealth inequality.}, keywords = {Event History/Life Cycle, Health Conditions and Status, Inequality, Net Worth and Assets, Older Adults, Racial/ethnic differences}, doi = {10.1007/s12552-016-9160-2}, url = {http://dx.doi.org/10.1007/s12552-016-9160-2}, author = {Tyson H Brown} } @article {8530, title = {Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life?}, journal = {Gerontologist}, volume = {56}, year = {2016}, month = {2016 06}, pages = {514-24}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Chronic disease, Disability Evaluation, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Middle Aged, Resilience, Psychological, Retirement, Surveys and Questionnaires}, issn = {1758-5341}, doi = {10.1093/geront/gnu068}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25063353}, author = {Lydia K Manning and Dawn C Carr and Ben Lennox Kail} } @article {10766, title = {Do Households Save More When the Kids Leave Home?}, number = {IB$\#$16-8}, year = {2016}, institution = {Center for Retirement Research at Boston College}, abstract = {Kids are expensive. As a result, when children become financially independent, parents often have a substantial amount of extra money on hand. In this case, they have two basic choices: spend more on themselves or increase their saving for retirement. What they actually do is an open question. }, keywords = {401(k), Family, Family Characteristics}, url = {https://crr.bc.edu/briefs/do-households-save-more-when-the-kids-leave-home/}, author = {Alicia H. Munnell and Irena Dushi and Geoffrey T. Sanzenbacher and Anthony Webb and Anqi Chen} } @article {9030, title = {Do Late-Career Wages Boost Social Security More for Women than Men?}, number = {WP$\#$2016-13}, year = {2016}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {Any worker who delays claiming Social Security receives a larger monthly benefit due to the actuarial adjustment. Some claimants {\textendash} particularly women, who are more likely to take time out of the labor force early in their careers {\textendash} can further increase their benefits if the extra years of work raise their career average earnings by displacing lower-earning years. This study uses the Health and Retirement Study linked to earnings records to quantify the impact of women{\textquoteright}s late-career earnings on Social Security benefits relative to men{\textquoteright}s. It also compares the impact on women, depending on their marital status and education.}, url = {http://crr.bc.edu/working-papers/do-late-career-wages-boost-social-security-more-for-women-than-men/}, author = {Matthew S. Rutledge and John E. Lindner} } @article {8824, title = {Do working conditions at older ages shape the health gradient?}, journal = {J Health Econ}, volume = {50}, year = {2016}, month = {2016 12}, pages = {183-197}, abstract = {

This study examines whether working conditions at the end of workers{\textquoteright} careers impact health and contribute to health disparities across occupations. A dynamic panel correlated random effects model is used in conjunction with a rich data set that combines information from the Health and Retirement Study (HRS), expert ratings of job demands from the Occupational Information Network (O*NET), and mid-career earnings records from the Social Security Administration{\textquoteright}s (SSA) Master Earnings File (MEF). Results reveal a strong relationship between positive aspects of the psychosocial work environment and improved self-reported health status, blood pressure, and cognitive function. However, there is little evidence to suggest that working conditions shape observed health disparities between occupations in the years leading up to retirement.

}, keywords = {Aged, Female, Health Status, Humans, Income, Male, Middle Aged, Occupations, Retirement, Workplace}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2016.10.002}, url = {http://linkinghub.elsevier.com/retrieve/pii/S016762961630337Xhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/plain}, author = {Lauren L Schmitz} } @article {6477, title = {Does Dementia Caregiving Accelerate Frailty? Findings From the Health and Retirement Study}, journal = {The Gerontologist}, volume = {56}, year = {2016}, pages = {444-450}, chapter = {444}, abstract = {Purpose of the Study: Numerous studies have discovered negative health consequences associated with spousal caregiving at the end of life; however, little is known about how care-recipient cognitive status impacts caregiver health outcomes, specifically in the area of frailty, and whether health consequences remain over time. This study examines differences in frailty between spousal caregivers of persons with and without a dementia diagnosis. Design and Methods: Using 7 biannual waves of the Health and Retirement Study data (1998 2010), we examined odds of becoming frailer among surviving spouses of individuals who died between 2000 and 2010 (N = 1,246) with and without dementia. To assess increased frailty, we used a Frailty Index, which assesses chronic diseases, mobility, functional status, depressive symptoms, and subjective health. Logistic regression was used to examine the relationship between care-recipient cognitive status and whether, compared with the wave prior to death of the care-recipient, spousal caregivers were frailer: (1) in the wave the death was reported and (2) 2 years after the death was reported.Results: Dementia caregivers had 40.5 higher odds of experiencing increased frailty by the time the death was reported and 90 higher odds in the following wave compared with non-dementia caregivers.Implications: Given our findings, we discuss public health implications regarding the health and well-being of caregivers of persons with dementia. Given projected increases in dementia diagnoses as the population ages, we propose a need for interventions that provide enhanced support for dementia caregivers.}, keywords = {Adult children, End of life decisions, Health Conditions and Status, Healthcare, Public Policy}, doi = {10.1093/geront/gnu078}, url = {http://gerontologist.oxfordjournals.org/content/early/2014/08/25/geront.gnu078.abstract}, author = {Kara B. Dassel and Dawn C Carr} } @article {8710, title = {Does retirement mean more physical activity? A longitudinal study}, journal = {BMC Public Health}, volume = {16}, year = {2016}, month = {Jan-12-2016}, pages = {1-7}, abstract = {Background: Evidence on physical activity (PA) and transitions out of full-time employment in middle-to-older age is mainly cross-sectional and focused upon retirement. The purpose was to examine trajectories in PA before and after transitions out of full-time employment. Methods: Data were obtained for 5,754 people in full-time employment aged 50-75 from the US Health and Retirement Survey. Logistic regression was used to examine trajectories in twice-weekly participation in light, moderate and vigorous PA among those transitioning to part-time work, semi-retirement, full retirement, or economic inactivity due to disability, in comparison to those remaining in full-time employment. Results: Twice weekly participation in vigorous and light physical activity changed little for those who remained in full-time employment, while moderate physical activity decreased between baseline and follow-up (OR 0.95, 95 \% CI 0.91, 0.99). Differences in physical activity according to transitional categories at follow-up were evident. Baseline differences in physical activity across all intensities were greatest among participants transitioning from full-time to part-time employment compared to those who remained in full-time employment throughout the study period (vigorous OR 1.41 95 \% CI 1.23, 1.61; moderate OR 1.28 95 \% CI 1.12, 1.46; light OR 1.29 95 \% CI 1.12, 1.49). Those transitioning to unemployment were already among the least physically active at baseline, irrespective of intensity (albeit, with 95 \% CIs spanning unity). Those transitioning to full-time retirement were also among the least active (e.g. vigorous OR 0.71 95 \% CI 0.61, 0.81; moderate OR 0.80 95 \% CI 0.71, 0.90). Declines in physical activity were reported for those transitioning to economic inactivity due to a disability (vigorous OR 0.29 95 \% CI 0.14, 0.64; moderate OR 0.56 95 \% CI 0.33, 0.95; light OR 0.34 95 \% CI 0.19, 0.63). Physical activity increased regardless of intensity among participants transitioning to semi-retirement (p > 0.05) and full retirement (e.g. vigorous OR 1.28 95 \% CI 1.09, 1. 51; moderate OR 1.24 95 \% CI 1.07, 1.43). Light physical activity increased for those transitioning to unemployment (OR 1.40 95 \% CI 1.02, 1.93), though less change was evident in moderate or vigorous physical activity. Conclusions: The amount and intensity of PA varies by the type of transition out of full-time employment among people in middle-to-older age.}, keywords = {Aging, Health Conditions and Status, Older Adults, Physical activity, Retirement Planning and Satisfaction}, doi = {10.1186/s12889-016-3253-0}, url = {http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3253-0http://link.springer.com/content/pdf/10.1186/s12889-016-3253-0}, author = {Feng, Xiaoqi and Croteau, Karen and Kolt, Gregory S. and Astell-Burt, Thomas} } @article {10759, title = {Does Socioeconomic Status Lead People to Retire Too Soon?}, number = {IB$\#$16-14}, year = {2016}, institution = {Center for Retirement Research at Boston College}, abstract = {Working longer is a powerful lever to enhance retirement security. Individuals, on average, are healthier, live longer, and face less physically demanding jobs, so they should be able to extend the number of years worked. But averages are misleading when differences in health, job prospects, and life expectancy have widened between individuals with low and high socioeconomic status (SES). Thus, a single prescription for all no longer seems appropriate. Rather, it is important to know: 1) how long individuals in different SES groups have to work to maintain their preretirement standard of living; 2) how long they plan to work; and 3) what explains any gap between the two. }, keywords = {Retirement, socioeconomic status}, url = {https://crr.bc.edu/briefs/does-socioeconomic-status-lead-people-to-retire-too-soon/}, author = {Alicia H. Munnell and Anthony Webb and Anqi Chen} } @article {9390, title = {Does the Option of Continued Work Later in Life Result in a More Optimistic View of Retirement?}, number = {$\#$8}, year = {2016}, month = {05/2016}, abstract = {This paper explores the link between work options and individuals{\textquoteright} views about retirement and overall well-being. Data for this paper come from 133 qualitative interviews of older individuals in the United States, United Kingdom, and Italy that were conducted in 2014 and from the Health and Retirement Study (HRS). Results from the qualitative interviews reveal that respondents in the US, relative to those in the UK and Italy, reported both a higher frequency of expecting to work in retirement and a more positive outlook for their retirement years. An examination of interview transcripts suggested a bifurcation among those who planned to work in retirement between: 1) those who viewed work as a contingency plan, for whom the outlook was generally positive; and 2) those who viewed work as a necessity for financial reasons, for whom the outlook was generally negative. This explanation was partly supported using data from the HRS. In both a descriptive and multivariate context, career wage-and-salary male respondents who reported some chance of working past age 65 had better retirement experiences and better mental health outcomes compared with those who expected to work past age 65 with certainty, while among women differences were not statistically significant. The findings from this paper suggest that optimism about retirement is related to the optionality of work in the years ahead. }, keywords = {Bridge employment, Optimism, Retirement Planning and Satisfaction}, url = {https://scholar.google.com/scholar_url?url=http://workandretirement.uk/wp-content/uploads/2017/06/Cahill-et-al-Optionality-of-Work-in-Retirement-working-paper-8.docx\&hl=en\&sa=X\&scisig=AAGBfm0CmMKDSLAvhfZvJhg6KbUDVh0ohg\&nossl=1\&oi=scholaralrt}, author = {Kevin E. Cahill and Smeaton, Deborah and Principi, Andrea and Socci, Marco and Santini, Sara} } @article {8551, title = {Does the Relationship of the Proxy to the Target Person Affect the Concordance between Survey Reports and Medicare Claims Measures of Health Services Use?}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 Feb}, pages = {314-27}, abstract = {

OBJECTIVES: To compare concordance of survey reports of health service use versus claims data between self respondents and spousal and nonspousal relative proxies.

DATA SOURCES: 1995-2010 data from the Survey on Assets and Health Dynamics among the Oldest Old and 1993-2010 Medicare claims for 3,229 individuals (13,488 person-years).

STUDY DESIGN: Regression models with individual fixed effects were estimated for discordance of any hospitalizations and outpatient surgery and for the numbers of under- and over-reported physician visits.

PRINCIPAL FINDINGS: Spousal proxies were similar to self respondents on discordance. Nonspousal proxies, particularly daughters/daughters-in-law and sons/sons-in-law, had less discordance, mainly due to reduced under-reporting.

CONCLUSIONS: Survey reports of health services use from nonspousal relatives are more consistent with Medicare claims than spousal proxies and self respondents.

}, keywords = {Ambulatory Surgical Procedures, Female, Hospitalization, Humans, Insurance Claim Review, Male, Medicare, Patient Acceptance of Health Care, Proxy, Self Report, Socioeconomic factors, Spouses, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12321}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26059195}, author = {George L Wehby and Michael P Jones and Fred A Ullrich and Yiyue Lou and Frederic D Wolinsky} } @article {8681, title = {Does Volunteering Experience Influence Advance Care Planning in Old Age?}, journal = {J Gerontol Soc Work}, volume = {59}, year = {2016}, month = {2016 07}, pages = {423-438}, abstract = {

Advance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010. The sample is derived from seven waves (1998-2010) of data from the Health and Retirement Study. Logistic regression results showed that overall ACP and durable power of attorney for health care (DPAHC) were both higher (OR~=~1.61 and 1.71, respectively) for older adults with volunteering experience in the past 10~years than those without such experience. Available social support (relatives and friends living nearby) was not associated with the relationship between volunteering and ACP. Other factors related to ACP included poorer health, death being expected, death due to cancer, older age, and being a racial minority. Involving older people in volunteer work may help to increase ACP. Future research is encouraged to identify reasons for the association between volunteering and ACP.

}, keywords = {Advance care planning, Aged, Aging, Female, Humans, Income, Logistic Models, Male, Middle Aged, Social Support, Socioeconomic factors, Terminal Care, Volunteers}, issn = {1540-4048}, doi = {10.1080/01634372.2016.1230567}, author = {Shen, Huei-Wern and Khosla, Nidhi} } @article {8932, title = {Dynamic aspects of family transfers}, journal = {Journal of Public Economics}, volume = {137}, year = {2016}, month = {Jan-05-2016}, pages = {1 - 13}, abstract = {Parents transfer a great deal to their adult children, and we have rich theoretical models providing a framework for these transfers. However, both the models and existing empirical work typically examine behavior in the cross section. To date, we know little about the dynamic aspects of family transfers. Here I examine transfers over a span of 17 years and find substantial changes in recipiency over time and a strong negative correlation between transfers and transitory income. I also find that events such as job loss and divorce are strong predictors of parental transfers and, although rare, are typically associated with larger transfers than income alone might predict. Finally, transfers are distributed unequally across siblings, and perhaps surprisingly, the distribution of transfers becomes even more unequal when examined over an extended period of time than in any single year. The evidence presented here thus suggests that dynamic analyses can provide insights into behavior that are impossible to obtain in a static context.}, keywords = {Adult children, Divorce, Job loss, Marriage, Older Adults}, issn = {00472727}, doi = {10.1016/j.jpubeco.2016.03.008}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0047272716300147http://api.elsevier.com/content/article/PII:S0047272716300147?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0047272716300147?httpAccept=text/plain}, author = {Kathleen McGarry} } @article {8541, title = {Dynamic modelling of long-term care decisions}, journal = {Review of Economics of the Household}, volume = {14}, year = {2016}, month = {Jan-06-2016}, pages = {463 - 488}, abstract = {This paper describes and analyzes research on the dynamics of long-term care and the policy relevance of identifying the sources of persistence in caregiving arrangements (including the effect of dynamics on parameter estimates, implications for family welfare, parent welfare, child welfare, and cost of government programs). We discuss sources and causes of observed persistence in caregiving arrangements including inertia/state dependence (confounded by unobserved heterogeneity) and costs of changing caregivers. We comment on causes of dynamics including learning/human capital accumulation; burnout; and game-playing. We suggest how to deal with endogenous geography; dynamics in discrete and continuous choices; and equilibrium issues (multiple equilibria, dynamic equilibria). We also present an overview of commonly used longitudinal data sets and evaluate their relative advantages/disadvantages. We also discuss other data issues related to noisy measures of wealth and family structure. Finally, we suggest some methods to handle econometric problems such as endogeneous geography.}, keywords = {Caregiving, Economics, Healthcare, Older Adults}, issn = {1569-5239}, doi = {10.1007/s11150-013-9236-3}, url = {http://link.springer.com/10.1007/s11150-013-9236-3http://link.springer.com/content/pdf/10.1007/s11150-013-9236-3http://link.springer.com/content/pdf/10.1007/s11150-013-9236-3.pdfhttp://link.springer.com/article/10.1007/s11150-013-9236-3/fulltext.html}, author = {Sovinsky, Michelle and Steven N. Stern} } @article {8266, title = {Debt literacy, financial experiences, and overindebtedness}, journal = {Journal of Pension Economics and Finance}, volume = {14}, year = {2015}, pages = {332}, publisher = {14}, abstract = {We analyze a national sample of Americans with respect to their debt literacy, financial experiences, and their judgments about the extent of their indebtedness. Debt literacy is a component of broader financial understanding that measures knowledge about debt and self-assessed financial knowledge. Financial experiences are the participants{\textquoteright} reported experiences with traditional borrowing, alternative borrowing, and investing. Overindebtedness is a self-reported measure. Debt literacy is low, with only about one-third of the population grasping the basics of interest compounding. Even after controlling for demographics, we find a relationship between debt literacy and both financial experiences and debt loads. Individuals with lower levels of debt literacy tend to transact in high-cost manners, incurring higher fees and using high-cost borrowing. We provide a rough estimate of the national implications of debt ignorance on credit card costs by consumers. Less knowledgeable individuals also report that their debt loads are excessive or that they are unable to judge their debt position.}, keywords = {Healthcare, Methodology, Net Worth and Assets, Other}, author = {Annamaria Lusardi and Peter Tufano} } @article {5881, title = {Declining Wealth and Work Among Male Veterans in the Health and Retirement Study}, year = {2015}, institution = {Cambridge, MA, National Bureau of Economic Research}, abstract = {The composition, wealth and employment of male veterans and nonveterans are analyzed for four cohorts from the Health and Retirement Study, ages 51 to 56 in 1992, 1998, 2004 and 2010. Half of the men in the two oldest cohorts served in the military. Only 16 percent of the men in the youngest cohort, the only cohort subject to the All-Volunteer Military, served. One fifth to one third of the members of each cohort who served saw combat, mainly in Viet Nam and in the First Gulf War. Among those 51 to 56 in 1992, veterans were better educated, healthier, wealthier, and more likely to be working than nonveterans. By the 2010 cohort, 51 to 56 year old veterans had lost their educational advantage over nonveterans, were less healthy, less wealthy and less likely to be working. After standardizing in multiple regressions for the influence of major observable characteristics, for the original 1992 HRS cohort the wealth of veterans is no longer higher than the wealth of nonveterans. In contrast, the wealth of veterans from the youngest cohort, those 51 to 56 in 2010, remains about 10 to 13 percent below the wealth of nonveterans from that cohort. There also is a decline from older to younger cohorts of veterans compared to nonveterans in the probability of being not retired, of working more than 35 hours per week, and in the likelihood of holding a job for more than 10 years. Comparisons are made within the group of veterans by years of service, officer rank and other covariates.}, keywords = {Demographics, Net Worth and Assets}, author = {Alan L Gustman and Thomas L. Steinmeier and N. Tabatabai} } @mastersthesis {6276, title = {Demand for Long-Term Care and Long-Term Care Insurance -- A Human Capital Perspective}, volume = {3714584}, year = {2015}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-27 First page - n/a}, month = {2015}, pages = {119}, school = {State University of New York at Buffalo}, type = {Ph.D.}, address = {Buffalo, NY}, abstract = {The dissertation examines several aspects of the demand for long-term care and long-term care insurance. It develops and applies a comprehensive "full insurance" model analytically in order to empirically estimate the pattern of relationship between private long-term care insurance and other non-marketable alternatives: self-insurance, self-protection, family insurance and safety-net insurance. It therefore allows us to estimate the degree to which demand for private long-term care insurance is substituted or complemented by its non-marketable alternatives. We explicitly explore the crowding out of private long-term care insurance by Medicaid. The role of education and health in the demand for long-term care and long-term care insurance is the primary focus of this study. Individuals with better education and health expect to live longer; they can purchase this insurance product in better health during their late middle age and get rewarded by insurance companies in the form of lower premiums. Medicaid turns out to be an expensive insurance option for them as it carries a high deductible for people with high income and wealth, and an educated person is aware of the potential financial risk associated with future utilization of long-term care services. While conventional wisdom would suggest that the primary effect of education on demand for long-term care insurance operates through an income effect, the paper carefully shows, both theoretically and empirically that it is the knowledge effect and an independent health effect that have the most influence. The spectrum of knowledge effect goes beyond its immediate relevance for the labor market. The paper tries to provide a complex analysis of interactions of different forms of insurances from a broader human capital perspective. The dissertation carefully explores the primary statistically significant determinants of demand for long-term care with the specific focus on the role of private LTCI coverage in determining the choice of mode of care. The dissertation also delves into an empirical investigation to understand the relationship between private insurance coverage and ultimate utilization of long-term care services in different specific caregiving institutional frameworks. The thesis pays explicit attention to different arguments of demand function of private LTCI and future utilization of long-term care. We explore the decision taken by an individual to purchase private long-term care insurance in different strata of wealth distribution. Our comprehensive analysis provides a useful instrument to develop business strategies regarding forecasting future demand for private long-term care insurance for the firms operating in long-term care insurance industry. Our analysis can also be utilized to evaluate implications of any changes in public policies.}, keywords = {Healthcare, Insurance, Medicare/Medicaid/Health Insurance, Methodology, Net Worth and Assets}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1700219388?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+Full+Text\&rft_val_fmt=info:ofi/}, author = {Dey, Sanjoy} } @article {8192, title = {Dental use and expenditures for older uninsured Americans: the simulated impact of expanded coverage.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Feb}, pages = {117-35}, publisher = {50}, abstract = {

OBJECTIVE: To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans.

DATA SOURCES/STUDY SETTING: We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS).

STUDY DESIGN: We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured.

DATA COLLECTION/EXTRACTION METHODS: The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ).

PRINCIPAL FINDINGS: We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older.

CONCLUSIONS: Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users.

}, keywords = {Aged, Dental Health Services, Female, Health Expenditures, Humans, Insurance, Dental, Male, Medically Uninsured, Middle Aged, Surveys and Questionnaires, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12205}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and John V Pepper and Patricia A St Clair} } @article {6478, title = {Depression and anxiety symptoms in male veterans and non-veterans: The Health and Retirement Study}, journal = {International Journal of Geriatric Psychiatry}, volume = {30}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, pages = {623-630}, chapter = {623}, abstract = {Objectives: We examined whether veteran status was associated with elevated depression and anxiety symptoms in men aged 50 and older after adjusting for sociodemographic factors. Methods: Participants were 6577 men aged 50years and older who completed the 2006 wave of the Health and Retirement Study (HRS). Forty-nine percent of participants were veterans. A randomly selected subset of participants completed the HRS Psychosocial Questionnaire (N=2957), which contained the anxiety items. Elevated depression and anxiety symptoms were determined based on brief versions of Center for Epidemiologic Studies-Depression Scale (CES-D total score 4) and Beck Anxiety Inventory (BAI total score 12). Results: Elevated depression and anxiety symptoms were found in 11.0 and 9.9 of veterans, respectively, compared with 12.8 and 12.3 of non-veterans. Veteran status was not associated with increased odds of anxiety or depression symptoms in the multivariable-adjusted logistic regression analyses. Additional analyses indicated that Vietnam War veterans were more than twice as likely as World War II or Korean War veterans to have elevated depression symptoms (OR=2.15, 95 CI: 1.54-3.00) or anxiety symptoms (OR=2.12, 95 CI: 1.28-3.51). Conclusions: In a community-based sample of men aged 50 and older, veteran status was not associated with the presence of elevated depression and anxiety symptoms. Rather, these symptoms were associated with age, ethnicity, education, and medical conditions. Among veterans, cohort effects accounted for differences in psychiatric symptoms. Including younger cohorts from the Global War on Terror may yield different results in future studies.}, keywords = {Demographics, Health Conditions and Status}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84906295551andpartnerID=40andmd5=4ec6b4f1c99e0f3fd36effe28a7f26c2}, author = {Christine E Gould and Rideaux, T. and Adam P Spira and Sherry A. Beaudreau} } @article {8283, title = {Depression and onset of cardiovascular disease in the US middle-aged and older adults}, journal = {Aging and Mental Health}, volume = {19}, year = {2015}, pages = {1084-1092}, publisher = {19}, abstract = {Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults. Methods: The study sample came from 1992-2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51-61 years old in 1992 with no CVD history. A score of 3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity. Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27 (hazard ratio HR = 1.27, 95 confidence interval = 1.17-1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose-response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant. Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.}, keywords = {Health Conditions and Status, Healthcare, Risk Taking}, doi = {10.1080/13607863.2014.1003281}, author = {Xiang, Xiaoling and An, Ruopeng} } @article {8161, title = {Depressive Symptoms and Disability Risk Among Older White and Latino Adults by Nativity Status}, journal = {Journal of Aging and Health}, volume = {27}, year = {2015}, pages = {1286-1305}, publisher = {27}, abstract = {Objective:To examine how the relationship between depressive symptoms and disability may vary by nativity status in later life. Method: This nationally representative prospective study of community-dwelling adults age 51 years and older in the Health and Retirement Study (1998-2010) used hierarchical linear modeling to examine how depressive symptoms (Center for Epidemiological Symptoms of Depression) and disability (instrumental activities of daily living IADL ; activities of daily living ADL ) vary by nativity status (U.S.- vs. foreign-born), accounting for changes in social support, health behaviors, and health conditions. Results: Depressive symptoms were associated with increased IADL and ADL disability among Latinos compared with Whites; foreign-born Latinos had lower than expected depressive symptom related IADL and ADL (0.82; p .001) disability. Discussion: Given that U.S.-born Latinos had similar or poorer depressive symptom related disability outcomes than Whites, interventions focused on early detection and treatment of depressive symptoms for this group are warranted and may improve disablement outcomes.}, keywords = {Health Conditions and Status, Public Policy, Women and Minorities}, doi = {10.1177/0898264315580121}, url = {http://jah.sagepub.com/content/early/2015/04/22/0898264315580121.abstract}, author = {Mary E Bowen and Ruch, Alexandra} } @article {8207, title = {Depressive symptoms, psychiatric medication use, and risk of type 2 diabetes: results from the Health and Retirement Study.}, journal = {Gen Hosp Psychiatry}, volume = {37}, year = {2015}, month = {2015 Sep-Oct}, pages = {420-6}, publisher = {37}, abstract = {

OBJECTIVE: This prospective study investigates the relationships between depressive symptoms, psychiatric medication use, and their interaction on risk of developing type 2 diabetes.

METHOD: Data come from the 1998-2010 waves of the Health and Retirement Study, a US nationally representative cohort of adults aged 51 years and older. Analysis is restricted to participants <65 years old who did not have diabetes in 1998 (N=8704). Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies-Depression Scale. Risk of diabetes over the 12-year follow-up period was assessed using Cox proportional hazard models with time-varying covariates.

RESULTS: After adjusting for covariates, both depressive symptoms [hazard ratio (HR): 1.06, 95\% confidence interval (CI): 1.02-1.09] and psychiatric medication use (HR: 1.57, 95\% CI: 1.25-1.96) were associated with development of diabetes. The interaction between depressive symptoms and medication use was significant (beta=-0.240, P=.049), indicating that the association between elevated depressive symptoms and diabetes was higher among respondents not taking medications. The associations between depressive symptoms and medication use were also attenuated by increasing body mass index.

CONCLUSION: Findings highlight the complex relationship between depressive symptoms and psychiatric medications on diabetes risk and the need for a nuanced understanding of these factors.

}, keywords = {Antidepressive Agents, Cohort Studies, depression, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Risk Assessment, Surveys and Questionnaires}, issn = {1873-7714}, doi = {10.1016/j.genhosppsych.2015.05.008}, url = {http://www.sciencedirect.com/science/article/pii/S0163834315001334}, author = {Scott M Ratliff and Briana Mezuk} } @mastersthesis {6397, title = {Determinants of labor market choices: age differentials and family circumstances}, volume = {3709636}, year = {2015}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-22 First page - n/a}, month = {2015}, pages = {164}, school = {University of California, San Diego}, type = {Ph.D.}, address = {San Diego}, abstract = {My research explores the interactions between labor market choices, public programs, and family circumstances. In the following three chapters, I study the relationship between labor market conditions and job search behavior of workers of differing ages, the effect of children{\textquoteright}s events on parental retirement timing, as well as the impact of UI extensions on recipients{\textquoteright} spouses.}, keywords = {Employment and Labor Force, Methodology, Public Policy}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1699088591?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+Full+Text\&rft_val_fmt=info:ofi/}, author = {Kutyavina, Marina} } @article {8271, title = {Development and demonstration of a state model for the estimation of incidence of partly undetected chronic diseases}, journal = {BMC MEDICAL RESEARCH METHODOLOGY}, volume = {15}, year = {2015}, pages = {98}, publisher = {15}, abstract = {Background: Estimation of incidence of the state of undiagnosed chronic disease provides a crucial missing link for the monitoring of chronic disease epidemics and determining the degree to which changes in prevalence are affected or biased by detection. Methods: We developed a four-part compartment model for undiagnosed cases of irreversible chronic diseases with a preclinical state that precedes the diagnosis. Applicability of the model is tested in a simulation study of a hypothetical chronic disease and using diabetes data from the Health and Retirement Study (HRS). Results: A two dimensional system of partial differential equations forms the basis for estimating incidence of the undiagnosed and diagnosed disease states from the prevalence of the associated states. In the simulation study we reach very good agreement between the estimates and the true values. Application to the HRS data demonstrates practical relevance of the methods. Discussion: We have demonstrated the applicability of the modeling framework in a simulation study and in the analysis of the Health and Retirement Study. The model provides insight into the epidemiology of undiagnosed chronic diseases.}, keywords = {Health Conditions and Status, Methodology}, author = {Ralph Brinks and Barbara H. Bardenheier and Annika Hoyer and Ji Lin and Sandra Landwehr and Edward W Gregg} } @article {8661, title = {Diagnosis and control of hypertension in the elderly populations of Japan and the United States}, journal = {International Journal of Population Studies}, volume = {1}, year = {2015}, month = {Jul-01-2016}, pages = {19-28}, abstract = {The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system con-tributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in se-niors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years old or older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n = 2,309) and the U.S. Health and Retirement (HRS) Study (n = 3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hyperten-sion is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medi-cation is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S. }, keywords = {Blood pressure, Cross-National, Health Conditions and Status, Heart disease, Hypertension, Older Adults}, issn = {2424-8150}, doi = {10.18063/IJPS.2015.01.008}, url = {http://ijps.whioce.com/index.php/ijps/article/view/01008}, author = {Saito, Yasuhiko and Davarian, Shieva and Takahashi, Atsuhiko and Schneider, Edward and Eileen M. Crimmins} } @article {8253, title = {Did the Great Recession Influence Retirement Plans?}, journal = {Research on Aging}, volume = {37}, year = {2015}, pages = {275-305}, publisher = {37}, abstract = {The recent recession constitutes one of the macro forces that may have influenced workers retirement plans. We evaluate a multilevel model that addresses the influence of macro-, meso-, and micro-level factors on retirement plans, changes in these plans, and expected retirement age. Using data from Waves 8 and 9 of the Health and Retirement Study (N = 2,618), we find that individuals with defined benefit plans are more prone to change toward plans to stop work before the stock market declined, whereas the opposite trend holds for those without pensions. Debts, ability to reduce work hours, and firm unionization also influenced retirement plans. Findings suggest retirement planning education may be particularly important for workers without defined pensions, especially in times of economic volatility.}, keywords = {Employment and Labor Force, Health Conditions and Status, Pensions, Retirement Planning and Satisfaction}, doi = {10.1177/0164027514530171}, url = {http://roa.sagepub.com/content/early/2014/04/22/0164027514530171.abstract}, author = {Maximiliane E Szinovacz and Adam Davey and Lauren Martin} } @article {8177, title = {Dimensions of Subjective Well-Being.}, journal = {Soc Indic Res}, volume = {123}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, month = {2015}, pages = {625-660}, publisher = {123}, abstract = {

We use two waves of a population based survey (the RAND American Life Panel) to investigate the relations between various evaluative and experienced well-being measures based on the English Longitudinal Study of Aging, the Gallup Wellbeing Index, and a 12-item hedonic well-being module of the Health and Retirement Study. In a randomized set-up we administered several versions of the survey with different response scales. Using factor analysis, we find that all evaluative measures load on the same factor, but the positive and negative experienced affect measures load on different factors. We find evidence of an effect of response scales on both the estimated number of underlying factors and their relations with demographics. We conclude that finer response scales allowing more nuanced answers offer more reliability. The relation of evaluative and experienced measures with demographics are very different; perhaps the most striking aspect is the lack of a consistent relation of experienced well-being measures with income, while evaluative well-being is strongly positively related with income.

}, issn = {0303-8300}, doi = {10.1007/s11205-014-0753-0}, author = {Arie Kapteyn and Jinkook Lee and Caroline Tassot and Hana Vonkova and Gema Zamarro} } @article {8884, title = {Directional dominance on stature and cognition in~diverse human populations.}, journal = {Nature}, volume = {523}, year = {2015}, month = {2015 Jul 23}, pages = {459-62}, abstract = {

Homozygosity has long been associated with rare, often devastating, Mendelian disorders, and Darwin was one of the first to recognize that inbreeding reduces evolutionary fitness. However, the effect of the more distant parental relatedness that is common in modern human populations is less well understood. Genomic data now allow us to investigate the effects of homozygosity on traits of public health importance by observing contiguous homozygous segments (runs of homozygosity), which are inferred to be homozygous along their complete length. Given the low levels of genome-wide homozygosity prevalent in most human populations, information is required on very large numbers of people to provide sufficient power. Here we use runs of homozygosity to study 16 health-related quantitative traits in 354,224 individuals from 102 cohorts, and find statistically significant associations between summed runs~of homozygosity and four complex traits: height, forced expiratory lung volume in one second, general cognitive ability and educational attainment (P < 1 {\texttimes} 10(-300), 2.1 {\texttimes} 10(-6), 2.5 {\texttimes} 10(-10) and 1.8 {\texttimes} 10(-10), respectively). In each case, increased homozygosity was associated with decreased trait value, equivalent to the offspring of first cousins being 1.2 cm shorter and having 10 months{\textquoteright} less education. Similar effect sizes were found across four continental groups and populations with different degrees of genome-wide homozygosity, providing evidence that homozygosity, rather than confounding, directly contributes to phenotypic variance. Contrary to earlier reports in substantially smaller samples, no evidence was seen of an influence of genome-wide homozygosity on blood pressure and low density lipoprotein cholesterol, or ten other cardio-metabolic traits. Since directional dominance is predicted for traits under directional evolutionary selection, this study provides evidence that increased stature and cognitive function have been positively selected in human evolution, whereas many important risk factors for late-onset complex diseases may not have been.

}, keywords = {Biological Evolution, Blood pressure, Body Height, Cholesterol, Cognitive Ability, Cohort Studies, Education, Female, Forced Expiratory Volume, Genome, Homozygote, Humans, Lung Volume Measurements, Male, Phenotype}, issn = {1476-4687}, doi = {10.1038/nature14618}, author = {Joshi, Peter K and T{\~o}nu Esko and Mattsson, Hannele and Eklund, Niina and Gandin, Ilaria and Nutile, Teresa and Jackson, Anne U and Schurmann, Claudia and Albert Vernon Smith and Zhang, Weihua and Okada, Yukinori and Stan{\v c}{\'a}kov{\'a}, Alena and Jessica Faul and Wei Zhao and Traci M Bartz and Maria Pina Concas and Franceschini, Nora and Enroth, Stefan and Vitart, Veronique and Trompet, Stella and Guo, Xiuqing and Daniel I Chasman and Jeff O{\textquoteright}Connell and Corre, Tanguy and Nongmaithem, Suraj S and Chen, Yuning and Mangino, Massimo and Ruggiero, Daniela and Traglia, Michela and Farmaki, Aliki-Eleni and Kacprowski, Tim and Bjonnes, Andrew and van der Spek, Ashley and Wu, Ying and Giri, Anil K and Yanek, Lisa R and Wang, Lihua and Edith Hofer and Cornelius A Rietveld and McLeod, Olga and Marilyn C Cornelis and Pattaro, Cristian and Verweij, Niek and Baumbach, Clemens and Abdel Abdellaoui and Warren, Helen R and Vuckovic, Dragana and Mei, Hao and Bouchard, Claude and Perry, John R B and Cappellani, Stefania and Saira S Mirza and Benton, Miles C and Broeckel, Ulrich and Sarah E Medland and Penelope A Lind and Malerba, Giovanni and Alexander W Drong and Yengo, Loic and Bielak, Lawrence F and Zhi, Degui and van der Most, Peter J and Daniel Shriner and M{\"a}gi, Reedik and Hemani, Gibran and Karaderi, Tugce and Wang, Zhaoming and Tian Liu and Demuth, Ilja and Jing Hua Zhao and Meng, Weihua and Lataniotis, Lazaros and van der Laan, Sander W and Bradfield, Jonathan P and Andrew R Wood and Bonnefond, Amelie and Ahluwalia, Tarunveer S and Hall, Leanne M and Salvi, Erika and Yazar, Seyhan and Carstensen, Lisbeth and de Haan, Hugoline G and Abney, Mark and Afzal, Uzma and Matthew A. Allison and Amin, Najaf and Asselbergs, Folkert W and Bakker, Stephan J L and Barr, R Graham and Baumeister, Sebastian E and Daniel J. Benjamin and Bergmann, Sven and Boerwinkle, Eric and Erwin P Bottinger and Campbell, Archie and Chakravarti, Aravinda and Chan, Yingleong and Chanock, Stephen J and Chen, Constance and Yii-Der I Chen and Collins, Francis S and Connell, John and Correa, Adolfo and Cupples, L Adrienne and Gail Davies and D{\"o}rr, Marcus and Georg B Ehret and Ellis, Stephen B and Feenstra, Bjarke and Feitosa, Mary F and Ford, Ian and Caroline S Fox and Timothy M Frayling and Friedrich, Nele and Geller, Frank and Scotland, Generation and Gillham-Nasenya, Irina and Gottesman, Omri and Graff, Misa and Grodstein, Francine and Gu, Charles and Haley, Chris and Hammond, Christopher J and Sarah E Harris and Tamara B Harris and Nicholas D Hastie and Heard-Costa, Nancy L and Heikkil{\"a}, Kauko and Lynne J Hocking and Homuth, Georg and Jouke-Jan Hottenga and Huang, Jinyan and Huffman, Jennifer E and Hysi, Pirro G and Mohammed Arfan Ikram and Ingelsson, Erik and Joensuu, Anni and Johansson, {\r A}sa and Jousilahti, Pekka and Jukema, J Wouter and K{\"a}h{\"o}nen, Mika and Kamatani, Yoichiro and Kanoni, Stavroula and Kerr, Shona M and Khan, Nazir M and Philipp D Koellinger and Koistinen, Heikki A and Kooner, Manraj K and Kubo, Michiaki and Kuusisto, Johanna and Lahti, Jari and Lenore J Launer and Lea, Rodney A and Lehne, Benjamin and Lehtim{\"a}ki, Terho and David C Liewald and Lars Lind and Loh, Marie and Lokki, Marja-Liisa and London, Stephanie J and Loomis, Stephanie J and Loukola, Anu and Lu, Yingchang and Lumley, Thomas and Lundqvist, Annamari and M{\"a}nnist{\"o}, Satu and Marques-Vidal, Pedro and Masciullo, Corrado and Matchan, Angela and Mathias, Rasika A and Matsuda, Koichi and Meigs, James B and Meisinger, Christa and Meitinger, Thomas and Menni, Cristina and Mentch, Frank D and Mihailov, Evelin and Lili Milani and Montasser, May E and Grant W Montgomery and Alanna C Morrison and Myers, Richard H and Nadukuru, Rajiv and Navarro, Pau and Nelis, Mari and Nieminen, Markku S and Ilja M Nolte and O{\textquoteright}Connor, George T and Ogunniyi, Adesola and Padmanabhan, Sandosh and Walter R Palmas and Pankow, James S and Patarcic, Inga and Pavani, Francesca and Peyser, Patricia A and Pietilainen, Kirsi and Neil Poulter and Prokopenko, Inga and Ralhan, Sarju and Redmond, Paul and Rich, Stephen S and Rissanen, Harri and Robino, Antonietta and Rose, Lynda M and Rose, Richard and Cinzia Felicita Sala and Babatunde Salako and Veikko Salomaa and Sarin, Antti-Pekka and Saxena, Richa and Schmidt, Helena and Scott, Laura J and Scott, William R and Sennblad, Bengt and Seshadri, Sudha and Peter Sever and Shrestha, Smeeta and Smith, Blair H and Jennifer A Smith and Soranzo, Nicole and Sotoodehnia, Nona and Southam, Lorraine and Stanton, Alice V and Stathopoulou, Maria G and Strauch, Konstantin and Strawbridge, Rona J and Suderman, Matthew J and Tandon, Nikhil and Tang, Sian-Tsun and Kent D Taylor and Bamidele O Tayo and T{\"o}glhofer, Anna Maria and Tomaszewski, Maciej and T{\v s}ernikova, Natalia and Tuomilehto, Jaakko and Andr{\'e} G Uitterlinden and Vaidya, Dhananjay and van Hylckama Vlieg, Astrid and van Setten, Jessica and Vasankari, Tuula and Vedantam, Sailaja and Vlachopoulou, Efthymia and Vozzi, Diego and Vuoksimaa, Eero and Waldenberger, Melanie and Erin B Ware and Wentworth-Shields, William and Whitfield, John B and Sarah Wild and Gonneke Willemsen and Yajnik, Chittaranjan S and Yao, Jie and Zaza, Gianluigi and Zhu, Xiaofeng and Salem, Rany M and Melbye, Mads and Bisgaard, Hans and Nilesh J Samani and Cusi, Daniele and Mackey, David A and Cooper, Richard S and Froguel, Philippe and Pasterkamp, Gerard and Grant, Struan F A and Hakonarson, Hakon and Luigi Ferrucci and Scott, Robert A and Morris, Andrew D and Palmer, Colin N A and George Dedoussis and Deloukas, Panos and Bertram, Lars and Lindenberger, Ulman and Berndt, Sonja I and Lindgren, Cecilia M and Nicholas J Timpson and T{\"o}njes, Anke and Munroe, Patricia B and Thorkild I. A. S{\o}rensen and Charles N Rotimi and Donna K Arnett and Oldehinkel, Albertine J and Sharon L R Kardia and Balkau, Beverley and Gambaro, Giovanni and Morris, Andrew P and Johan G Eriksson and Margaret J Wright and Nicholas G Martin and Hunt, Steven C and John M Starr and Ian J Deary and Griffiths, Lyn R and Henning Tiemeier and Nicola Pirastu and Kaprio, Jaakko and Wareham, Nicholas J and P{\'e}russe, Louis and Wilson, James G and Giorgia G Girotto and Caulfield, Mark J and Olli T Raitakari and Dorret I Boomsma and Gieger, Christian and van der Harst, Pim and Hicks, Andrew A and Kraft, Peter and Sinisalo, Juha and Knekt, Paul and Johannesson, Magnus and Patrik K E Magnusson and Hamsten, Anders and Schmidt, Reinhold and Ingrid B Borecki and Vartiainen, Erkki and Becker, Diane M and Bharadwaj, Dwaipayan and Mohlke, Karen L and Boehnke, Michael and Cornelia M van Duijn and Sanghera, Dharambir K and Teumer, Alexander and Zeggini, Eleftheria and Andres Metspalu and Paolo P. Gasparini and Ulivi, Sheila and Ober, Carole and Toniolo, Daniela and Rudan, Igor and David J Porteous and Ciullo, Marina and Timothy Spector and Caroline Hayward and Dupuis, Jos{\'e}e and Ruth J F Loos and Alan F Wright and Chandak, Giriraj R and Vollenweider, Peter and Alan R Shuldiner and Ridker, Paul M and Rotter, Jerome I and Sattar, Naveed and Gyllensten, Ulf and Kari E North and Pirastu, Mario and Psaty, Bruce M and David R Weir and Laakso, Markku and Gudnason, Vilmundur and Takahashi, Atsushi and Chambers, John C and Kooner, Jaspal S and David P Strachan and Campbell, Harry and Joel N Hirschhron and Markus Perola and Polasek, Ozren and James F Wilson} } @article {8237, title = {Disability Trajectories at the End of Life: A "Countdown" Model.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {745-52}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Death, Disabled Persons, Female, Humans, Male, Time Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu182}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/23/geronb.gbu182.abstract}, author = {Douglas A. Wolf and Vicki A Freedman and Jan I Ondrich and Christopher L Seplaki and Brenda C Spillman} } @article {6459, title = {Disability-Free Life-Years Lost Among Adults Aged >=50 Years, With and Without Diabetes}, journal = {Diabetes Care}, year = {2015}, abstract = {OBJECTIVE Quantify the impact of diabetes status on healthy and disabled years of life for older adults in the U.S. and provide a baseline from which to evaluate ongoing national public health efforts to prevent and control diabetes and disability.RESEARCH DESIGN AND METHODS Adults (n = 20,008) aged 50 years and older were followed from 1998 to 2012 in the Health and Retirement Study, a prospective biannual survey of a nationally representative sample of adults. Diabetes and disability status (defined by mobility loss, difficulty with instrumental activities of daily living IADL , and/or difficulty with activities of daily living ADL ) were self-reported. We estimated incidence of disability, remission to nondisability, and mortality. We developed a discrete-time Markov simulation model with a 1-year transition cycle to predict and compare lifetime disability-related outcomes between people with and without diabetes. Data represent the U.S. population in 1998.RESULTS From age 50, adults with diabetes died 4.6 years earlier, developed disability 6 7 years earlier, and spent about 1 2 more years in a disabled state than adults without diabetes. With increasing baseline age, diabetes was associated with significant (P 0.05) reductions in the number of total and disability-free life-years, but the absolute difference in years between those with and without diabetes was less than at younger baseline age. Men with diabetes spent about twice as much of their remaining years disabled (20 24 of remaining life across the three disability definitions) as men without diabetes (12 16 of remaining life across the three disability definitions). Similar associations between diabetes status and disability-free and disabled years were observed among women.CONCLUSIONS Diabetes is associated with a substantial reduction in nondisabled years, to a greater extent than the reduction of longevity.}, keywords = {Health Conditions and Status, Methodology}, doi = {10.2337/dc15-1095}, url = {http://care.diabetesjournals.org/content/early/2015/12/17/dc15-1095.abstract}, 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 {8296, title = {Disaggregating activities of daily living limitations for predicting nursing home admission.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {560-78}, publisher = {50}, abstract = {

OBJECTIVE: To examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts.

DATA SOURCES: We used panel data from the Health and Retirement Study (HRS) for years 1998-2010. The HRS is a nationally representative survey of adults older than 50 years (n = 18,801).

STUDY DESIGN: We fitted Cox regressions in a continuous time survival model with age at first nursing home admission as the outcome. Time-varying ADL disability types were the key explanatory variables.

PRINCIPAL FINDINGS: Of the six ADL limitations, bathing difficulty emerged as the strongest predictor of subsequent nursing home placement across cohorts. Eating and dressing limitations were also influential in driving admissions among more recent cohorts. Using simple ADL counts for analysis yielded similar adjusted R(2) s; however, the amount of explained variance doubled when we allowed the ADL disability measures to time-vary rather than remain static.

CONCLUSIONS: Looking beyond simple ADL counts can provide health professionals insights into which specific disability types trigger long-term nursing home use. Functional disabilities measured closer in time carry more prognostic power than static measures.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Female, Geriatric Assessment, Homes for the Aged, Humans, Male, Middle Aged, Nursing homes, Patient Admission, Residence Characteristics, Risk Factors, Sex Factors, Socioeconomic factors}, issn = {1475-6773}, doi = {10.1111/1475-6773.12235}, author = {Joelle H Fong and Olivia S. Mitchell and Benedict S K Koh} } @article {8224, title = {Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Oct}, pages = {1413-20}, publisher = {30}, abstract = {

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Ageism, Aging, Disabled Persons, Female, Follow-Up Studies, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Surveys and Questionnaires}, issn = {1525-1497}, doi = {10.1007/s11606-015-3233-6}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff}, author = {Stephanie E Rogers and Angela D Thrasher and Yinghui Miao and W John Boscardin} } @article {8668, title = {Disease incidence and mortality among older Americans and Europeans.}, journal = {Demography}, volume = {52}, year = {2015}, month = {2015 Apr}, pages = {593-611}, abstract = {

Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.

}, keywords = {Age Distribution, Aged, Chronic disease, Europe, Health Behavior, Humans, Incidence, Middle Aged, Neoplasms, Prevalence, Risk Factors, Sex Distribution, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1007/s13524-015-0372-7}, author = {Sole-Auro, Aida and Pierre-Carl Michaud and Michael D Hurd and Eileen M. Crimmins} } @article {6482, title = {Disparity in dental coverage among older adult populations: a comparative analysis across selected European countries and the USA}, journal = {International Dental Journal}, volume = {65}, year = {2015}, month = {04/2015}, pages = {77-88}, chapter = {77}, abstract = {Background Insurance against the cost of preventing and treating oral diseases can reduce inequities in dental-care use and oral health. The purpose of this study was to examine the extent of variation in dental insurance coverage for older adult populations within and between the USA and various European countries. Method The analyses relied on 2006 2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and on 2004 2006 data from the Health and Retirement Study (HRS) in the USA for respondents 51 years of age and older. A series of logistic regression models was estimated to identify disparities in dental coverage. Results The highest extent of significant insurance differences between various population subgroups was found for the USA. In comparison with southern and eastern European countries, a lower number of significant differences in coverage was found for Scandinavian countries. Countries categorised as having comprehensive public insurance coverage showed a tendency towards less insurance variation within their populations than did countries categorised as not having comprehensive public coverage. The exceptions were Poland and Switzerland. Conclusions The findings of the present study suggest that significant variations in dental coverage exist within all elderly populations examined and that the extent of inequalities also differs between countries. By and large, the observed variations corroborate the perception that population dental coverage is more equally distributed under public subsidy. This could be relevant information for decision makers who seek to improve policies in order to provide more equitable dental coverage.}, keywords = {Cross-National, Healthcare, Insurance, Public Policy}, doi = {10.1111/idj.12139}, url = {http://dx.doi.org/10.1111/idj.12139}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Widstrom, Eeva and Jinkook Lee and Listl, Stefan} } @article {8286, title = {Divorce/Separation in Later-Life: A Fixed Effects Analysis of Economic Well-Being by Gender}, journal = {Journal of Family and Economic Issues}, volume = {36}, year = {2015}, pages = {299-306}, publisher = {36}, abstract = {With the on-going aging of the United States population and an increase in the number of older men and women living in a divorced/separated state, examining the economic security of this group is a worthwhile undertaking. Utilizing the 2004 and 2010 waves of the RAND Health and Retirement Study, this study employed fixed effects (FE) regression to examine the effects of divorce/separation on total wealth for older men and women. Results suggested older divorced/separated individuals endured a significant loss in total wealth due to a martial disruption and women fared worse than men. However, older adults can take proactive steps to ease this financial setback.}, keywords = {Adult children, Methodology, Net Worth and Assets, Public Policy}, doi = {10.1007/s10834-014-9432-1}, url = {http://dx.doi.org/10.1007/s10834-014-9432-1}, author = {Sharma, Andy} } @article {6453, title = {Do Grandchildren Influence How Old You Feel?}, journal = {Journal of Aging and Health}, year = {2015}, month = {12/2015}, abstract = {Objectives: Guided by the acknowledged importance of measures of aging alternative to chronological age, we explored the association between subjective age, on the one hand, and having grandchildren and provision of grandchild care, on the other, by gender and age groups. Method: Data from the Health and Retirement Study (HRS; N = 1,701 men and 2,395 women aged 50-85) and linear regression models were used to test two hypotheses. Results: Grandparents feel older than their grandchildless counterparts at younger ages, but such association is reversed in later life if they look after their grandchildren. A cumulative negative association between subjective age and both having grandchildren and providing grandchild care holds for older women. Discussion: This study extends prior research by examining age and gender differences in factors associated with subjective age. The findings suggest that grandparenthood is central in shaping the personal experience of aging. Future studies should address the causality of the factors analyzed.}, keywords = {Adult children, Expectations, Healthcare}, doi = {10.1177/0898264315618920}, url = {http://jah.sagepub.com/content/early/2015/12/08/0898264315618920.abstract}, author = {Valeria Bordone and Bruno Arpino} } @article {5854, title = {Do Households Increase Their Savings When the Kids Leave Home?}, year = {2015}, institution = {Boston College}, abstract = {Much of the disagreement over whether households are adequately prepared for retirement reflects differences in assumptions regarding the extent to which consumption declines when the kids leave home. If consumption declines substantially when the kids leave home, as some life-cycle models of retirement saving assume, households need to achieve lower replacement rates in retirement and need to accumulate less wealth. Using administrative tax data from the Health and Retirement Study (HRS), as well as the Survey of Income and Program Participation (SIPP), this paper investigates whether household consumption declines when kids leave the home and, if so, by how much. Because consumption data are noisy and savings is the flip side of consumption, this paper examines whether savings in 401(k) plans increase when the kids leave home. The paper also investigates alternative methods of saving, including non-401(k) savings and increased mortgage payments.}, keywords = {Consumption and Savings, Event History/Life Cycle, Net Worth and Assets, Pensions, Retirement Planning and Satisfaction}, author = {Irena Dushi and Alicia H. Munnell and Geoffrey T. Sanzenbacher and Anthony Webb} } @article {6483, title = {Do Physical Activity, Smoking, Drinking, or Depression Modify Transitions from Cognitive Impairment to Functional Disability?}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {44}, year = {2015}, pages = {1171-1180}, chapter = {1171}, abstract = {Background: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. Objectives: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. Methods: Health and Retirement Study participants aged 65 without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. Results: Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95 CI: 0.28 0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95 CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. Conclusion: Physical activity may protect against IADL limitations while smoking, alcohol consumption, and depression do not afford substantial protection among the cognitively impaired. Results highlight the need for extra support for IADLs among individuals with cognitive losses.}, keywords = {Disabilities, Health Conditions and Status, Healthcare}, doi = {10.3233/JAD-141866}, url = {http://dx.doi.org/10.3233/JAD-141866}, author = {Pamela M. Rist and Jessica R Marden and Benjamin D Capistrant and Bei Wu and M. Maria Glymour} } @article {8626, title = {Do Retired Americans Annuitize Too Little? Trends in the Share of Annuitized Income}, number = {CRR WP 2015-9}, year = {2015}, month = {06/2015}, pages = {1-49}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {This paper examines the importance of annuity-like income as a share of total money income received by aged families. The analysis considers the aged (62+) population as a whole as well as different parts of the aged families{\textquoteright} income distribution during the period from the early 1980s through 2009. We use survey data from 1983 through 2009 from the March Current Population Survey (March CPS) and the Survey of Consumer Finances (SCF). The total income amounts reported in the files are compared with data in the National Income and Product Accounts (NIPA). We calculate the family income consisting of annuitized income flows (primarily Social Security and pensions) and measure it as a share of families{\textquoteright} total money income. We also expand the definition of both annuitized and non-annuitized income to include income flows not captured in the surveys, namely, health insurance subsidies and the housing services received by homeowners. Finally, we consider the potential impact on aged families if they were to convert their wealth into private annuities.}, keywords = {Annuitization, Income, Older Adults, Retirement Planning and Satisfaction}, url = {http://crr.bc.edu/wp-content/uploads/2015/06/wp_2015-9.pdf}, author = {Barry Bosworth and Gary T. Burtless and Mattan Alalouf} } @article {10902, title = {Do Statins Reduce the Health and Health Care Costs of Obesity?}, journal = {Pharmacoeconomics}, volume = {33}, year = {2015}, month = {2015 Jul}, pages = {723-34}, abstract = {

CONTEXT: Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae.

METHODS: Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50~years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins.

RESULTS: Life expectancy gains of statins are estimated to be 5-6~\% greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and~2 obesity (body mass index [BMI] >=30 and >=35~kg/m(2), respectively) and they increase the costs of class~3 obesity (BMI >=40~kg/m(2)) by 1.2~\%.

CONCLUSIONS: Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

}, keywords = {Aged, Computer Simulation, Cost-Benefit Analysis, Health Care Costs, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Life Expectancy, Markov chains, Models, Economic, Obesity, Quality-Adjusted Life Years}, issn = {1179-2027}, doi = {10.1007/s40273-014-0234-y}, author = {Gaudette, {\'E}tienne and Dana P Goldman and Messali, Andrew and Sood, Neeraj} } @article {8519, title = {Documentation of Biomarkers in the 2010 and 2012 Health and Retirement Study}, number = {DR-031}, year = {2015}, month = {04/2015}, pages = {15}, institution = {Survey Research Center, University of Michigan}, address = {Ann Arbor, Michigan}, keywords = {Biomarkers, Meta-analyses, Survey Methodology}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and David R Weir} } @article {8625, title = {Does Age-Related Decline in Ability Correspond with Retirement Age?}, number = {CRR WP 2015-24}, year = {2015}, pages = {1-39}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {While declines in physical and mental performance are inevitable as workers age, they are not uniform across the various systems of the body {\textendash} some physical and cognitive abilities decline much earlier than others. This variance implies that workers in occupations that rely on skills that decline early may be unable to work until late ages, even as policy changes like increases in the Full Retirement Age (FRA) encourage them to. Researchers often estimate models of early retirement that include a control for whether a worker is in a blue-collar job {\textendash} basically assuming that less-physical white-collar work allows longer careers. But this assumption ignores the fact that even workers in white-collar occupations may find themselves relying on skills that have declined. This paper instead reviews the literature on aging and constructs a Susceptibility Index meant to reflect how susceptible an occupation is to declines in ability, regardless of whether the occupation relies on physical abilities (as blue-collar occupations do) or cognitive ones.}, keywords = {Bridge employment, Cognitive Ability, Health Conditions and Status, Older Adults, Physical Ability, Retirement Planning and Satisfaction}, url = {http://crr.bc.edu/wp-content/uploads/2015/09/wp_2015-24.pdf}, author = {Belbase, Anek and Geoffrey T. Sanzenbacher and Gillis, Christopher M.} } @article {9099, title = {Does eliminating the earnings test increase the incidence of low income among older women?}, number = {Working Paper No. 21601}, year = {2015}, month = {10/2015}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Reducing or eliminating Social Security{\textquoteright}s Retirement Earnings Test (RET) can encourage labor supply of older individuals receiving benefits. However, these reforms can encourage earlier claiming of Social Security benefits, permanently lowering future benefits. We explore the consequences, for older women, of eliminating the RET from the Full Retirement Age to age 69 (in 2000), relying on the inter-cohort variation in exposure to changes in the RET to estimate these effects. The evidence is consistent with the conclusion that eliminating the RET increased the likelihood of having very low incomes among women in their mid-70s and older {\textendash} ages at which the lower benefits from claiming earlier could outweigh higher income in the earlier period when women or their husbands increased their labor supply.}, keywords = {Income inequality, Restricted data, Women and Minorities}, doi = {10.3386/w21601}, url = {http://www.nber.org/papers/w21601.pdf}, author = {Theodore F. Figinski and David Neumark} } @article {5887, title = {Does Investors{\textquoteright} Personality Influence Their Portfolios?}, year = {2015}, institution = {Tilburg, Netherlands, Netspar}, abstract = {Based on large-scale survey data from the 2006-2012 waves of the US Health and Retirement Study (HRS) we show that individual portfolio decisions are influenced by a variety of traits and facets traditionally investigated in the field of personality psychology. Two personality traits that taken together depict a self-centered personality profile have the most significant impact on financial risk taking: lower Agreeableness and higher Cynical Hostility predict higher willingness to take risks. The effects of Agreeableness seem to pass through the preferences rather than the beliefs channel. Our findings shed new light on the non-cognitive side of individuals risk taking.}, keywords = {Health Conditions and Status, Methodology, Net Worth and Assets, Risk Taking}, author = {Alessandro Bucciol and Luca Zarri} } @article {8267, title = {Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey}, journal = {Journal of the American Geriatrics Society}, volume = {63}, year = {2015}, pages = {2014}, publisher = {63}, abstract = {ObjectivesTo determine associations between use of three different modes of social contact (in person, telephone, written or e-mail), contact with different types of people, and risk of depressive symptoms in a nationally representative, longitudinal sample of older adults. DesignPopulation-based observational cohort. SettingUrban and suburban communities throughout the contiguous United States. ParticipantsIndividuals aged 50 and older who participated in the Health and Retirement Survey between 2004 and 2010 (N = 11,065). MeasurementsFrequency of participant use of the three modes of social contact with children, other family members, and friends at baseline were used to predict depressive symptoms (measured using the eight-item Center for Epidemiologic Studies Depression Scale) 2 years later using multivariable logistic regression models. ResultsProbability of having depressive symptoms steadily increased as frequency of in-personbut not telephone or written or e-mail contactdecreased. After controlling for demographic, clinical, and social variables, individuals with in-person social contact every few months or less with children, other family, and friends had a significantly higher probability of clinically significant depressive symptoms 2 years later (11.5 ) than those having in-person contact once or twice per month (8.1 ; P .001) or once or twice per week (7.3 ; P .001). Older age, interpersonal conflict, and depression at baseline moderated some of the effects of social contact on depressive symptoms. ConclusionFrequency of in-person social contact with friends and family independently predicts risk of subsequent depression in older adults. Clinicians should consider encouraging face-to-face social interactions as a preventive strategy for depression.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Methodology, Retirement Planning and Satisfaction}, author = {Alan R Teo and Choi, Hwajung and Sarah B. Andrea and Marcia A. Valenstein and Jason T Newsom and Dobscha, Steven K. and Zivin, Kara} } @article {8278, title = {Does Neighborhood Disorder Predict Recovery From Mobility Limitation? Findings From the Health and Retirement Study}, journal = {Journal of Aging and Health}, volume = {27}, year = {2015}, pages = {1415}, publisher = {27}, abstract = {Objective: This research explores whether perceptions of physical neighborhood disorder predict recovery from mobility limitation over a 2-year period and examines whether psychosocial factors (i.e., depressive symptomology and mastery) and physical activity are salient mediators. Method: Using data from the Health and Retirement Study (HRS): Participant Lifestyle Questionnaire (2008-2010), odds ratio estimates of recovery were ascertained using binary logistic regression, and post hoc Sobel tests were conducted to formally assess mediation. Results: Net of demographic characteristics and socioeconomic status, increased neighborhood disorder was associated with lower odds of recovery. However, both psychosocial indicators and physical activity were significant individual partial mediators, which suggest neighborhood disorder influences recovery from physical impairment via psychosocial processes and barriers to physical activity. Discussion: Reducing neighborhood disorder may enhance older residents{\textquoteright} psychosocial well-being and improve participation in physical activity, thus increasing recovery from mobility limitation and preventing subsequent disability.}, keywords = {Demographics, Disabilities, Health Conditions and Status, Other, Public Policy}, doi = {10.1177/0898264315584328}, author = {Kenzie Latham and Monica M Williams} } @article {8321, title = {Does prescription drug coverage improve mental health? Evidence from Medicare Part D}, journal = {Journal of Health Economics}, volume = {41}, year = {2015}, note = {Times Cited: 0 0}, pages = {46-58}, publisher = {41}, abstract = {The introduction of the Medicare Prescription Drug program (Part D) in 2006 resulted in a significant increase in access to coverage for older adults in the U.S. Several studies have documented the impact of this program on prescription drug utilization, expenditures and medication adherence among older adults. However, few studies have evaluated the extent to which these changes have affected the health of seniors. In this study we use data from the Health and Retirement Study to identify the impact of the Medicare Part D program on mental health. Using a difference-in-difference approach, we find that the program significantly reduced depressive symptoms among older adults. We explore the mechanisms through which this effect operates and evaluate heterogeneity in impact. (C) 2015 Elsevier B.V. All rights reserved.}, keywords = {Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance}, author = {Padmaja Ayyagari and Dan M. Shane} } @article {8635, title = {Does Protecting Older Workers from Discrimination Make It Harder to Get Hired? Evidence from Disability Discrimination Laws}, journal = {National Bureau of Economic Research Working Paper Series}, volume = {No. 21379}, year = {2015}, month = {2015}, abstract = {We explore the effects of disability discrimination laws on hiring of older workers. A concern with anti-discrimination laws is that they may reduce hiring by raising the cost of terminations and {\textendash} in the specific case of disability discrimination laws {\textendash} raising the cost of employment because of the need to accommodate disabled workers. Moreover, disability discrimination laws can affect non-disabled older workers because they are fairly likely to develop work-related disabilities, yet are not protected by these laws. Using state variation in disability discrimination protections, we find little or no evidence that stronger disability discrimination laws lower the hiring of non-disabled older workers. We similarly find no evidence of adverse effects of disability discrimination laws on hiring of disabled older workers.}, keywords = {Ageism, Aging Workforce, Bridge employment, Disabilities, Older Adults}, url = {http://www.nber.org/papers/w21379}, author = {David Neumark and Joanne Song and Patrick Button} } @article {5872, title = {Does Retirement Impact Health Care Utilization?}, year = {2015}, institution = {Los Angeles, CA, Center for Economic and Social Research, University of Southern California}, abstract = {The objective of this paper is to estimate the causal effect of retirement on health care utilization. To do so, we use data from the 1992-2008 waves of the Health and Retirement Study (HRS) and the 2004-2006 waves of the Survey of Health, Aging, and Retirement in Europe (SHARE).In particular, we estimate the causal impact of retirement on health care utilization as measured by: doctor visits, visits to a general practitioner, nights in the hospital, and preventative care use. This paper uses panel data and instrumental variable methods, exploiting variation in statutory retirement ages across countries, to estimate the causal effects. Cross-country comparisons allow us to examine the role of a health care system s use of the general practitioner as a gate keeper to specialists in this relationship. We find that while retirement is associated with increased health care use, our causal estimates show that retirement leads to fewer doctor visits in both the US and continental Europe. Nights in the hospital are unaffected by retirement status. Further we find that health care systems with primary care physicians who act as gatekeepers are particularly effective at decreasing doctor visits at retirement. Therefore, we conclude that increasing the statutory retirement age to help the solvency of the retirement systems will also increase doctor visits as individuals continue to work longer. In the US, the burden of this increased utilization will likely be borne by private insurance companies and public insurance to the extent it covers working individuals in their 60 s. European evidence suggests that this increase in doctor visits due to delayed retirement will be particularly evident in health systems without strong gatekeeper roles for general practitioners.}, keywords = {Health Conditions and Status, Healthcare, Retirement Planning and Satisfaction}, author = {Norma B Coe and Gema Zamarro} } @article {5856, title = {Does Retirement Improve Health and Life Satisfaction?}, year = {2015}, abstract = {We utilize panel data from the Health and Retirement Study to investigate the impact of retirement on physical and mental health, life satisfaction, and health care utilization. Because poor health can induce retirement, we instrument for retirement using eligibility for Social Security and employer sponsored pensions and coverage by the Social Security earnings test. We find strong evidence that retirement improves both health and life satisfaction. While the impact on life satisfaction occurs within the first 4 years of retirement, many of the improvements in health show up 4 or more years later, consistent with the view that health is a stock that evolves slowly. We find little evidence that retirement influences health care utilization.}, keywords = {Health Conditions and Status, Pensions, Public Policy, Retirement Planning and Satisfaction, Social Security}, url = {http://www.nber.org/papers/w21326.pdf}, author = {Gorry, Aspen and Gorry, Devon and Sita Nataraj Slavov} } @article {8648, title = {Does Social Security Continue to Favor Couples?}, number = {CRR WP 2015-11}, year = {2015}, month = {06/2015}, pages = {1-44}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hills, MA}, abstract = {While dramatic increases in women{\textquoteright}s labor supply and earnings have led to a substantial decline in the fraction of women eligible for spouse benefits at retirement, most wives still receive a survivor benefit, as wives still typically have lower earnings than their husbands and live longer. Using the MINT microsimulation model and the HRS data linked with Social Security administrative earnings records, this paper examines the extent to which Social Security continues to favor couples and will do so in the future. The paper finds that while the OASI program still distributes lifetime income from singles to couples, the transfers appear to be shrinking over time. Nevertheless, couples are still projected to have a higher benefit/tax ratio, a lower median net tax rate, and a higher share of them will be receiving positive net transfers from the system as compared to those who are never married or divorced. The increased labor force participation and earnings of women have contributed significantly to the decline in redistribution from men to women, and from singles to couples, while the effect of declining marriage rates has only a modest effect. }, keywords = {Divorce, Marriage, Older Adults, Retirement Planning and Satisfaction, Social Security, Women and Minorities}, url = {http://crr.bc.edu/wp-content/uploads/2015/06/wp_2015-111.pdf}, author = {Nadia S. Karamcheva and April Yanyuan Wu and Alicia H. Munnell} } @article {8289, title = {Does Stroke Contribute to Racial Differences in Cognitive Decline?}, journal = {Stroke}, volume = {46}, year = {2015}, month = {2015 Jul}, pages = {1897-902}, publisher = {46}, abstract = {

BACKGROUND AND PURPOSE: It is unknown whether blacks{\textquoteright} elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition.

METHODS: Among 4908 black and white participants aged >=65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time.

RESULTS: We identified 34 of 453 (7.5\%) blacks and 300 of 4455 (6.7\%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95\% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black-white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; P<0.001) corresponding to ≈7.9 years of cognitive aging. The effect of incident stroke on cognition did not statistically differ by race (P=0.52).

CONCLUSIONS: In this population-based cohort of older adults, incident stroke did not explain black-white differences in cognitive decline or impact cognition differently by race.

}, keywords = {African Continental Ancestry Group, Aged, Aged, 80 and over, Cognition Disorders, European Continental Ancestry Group, Female, Humans, Longitudinal Studies, Male, Risk Factors, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.114.008156}, url = {http://stroke.ahajournals.org/content/early/2015/05/20/STROKEAHA.114.008156.abstract}, author = {Deborah A Levine and Mohammed U Kabeto and Kenneth M. Langa and Lynda D Lisabeth and Mary A M Rogers and Andrzej T Galecki} } @mastersthesis {6359, title = {Dynamic models of health and labor supply in later life}, volume = {3708322}, year = {2015}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-27 First page - n/a}, month = {2015}, pages = {193}, school = {The University of Wisconsin - Madison}, type = {Ph.D.}, address = {Madison, WI}, abstract = {In these essays, I develop and estimate life-cycle models aimed at explaining various patterns in labor supply behavior at older ages. The first study measures the extent to which later-life differences in health and disability risks across occupations affect retirement behavior and how these risks influence initial career choice. In the second essay, I look at the degree to which the changing composition of occupations over time--from more to less physically demanding--has contributed to the increase in labor force participation at older ages. The final study examines the effects of wage and health transition processes as well as the role of accrued work-related strain on the labor force participation decisions of older males, aimed particularly at accounting for the high rates of "reverse retirement" seen in the data.}, keywords = {Disabilities, Employment and Labor Force, Methodology, Retirement Planning and Satisfaction}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1697922475?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/Dissertations+\%26+Theses+\%40+CIC+Institutions\&rft_val_fmt=info:of}, author = {Lindsay Jacobs} } @article {8104, title = {Death certificates underestimate infections as proximal causes of death in the U.S.}, journal = {PLoS One}, volume = {9}, year = {2014}, note = {Times Cited: 0}, month = {2014}, pages = {e97714}, publisher = {9}, abstract = {

BACKGROUND: Death certificates are a primary data source for assessing the population burden of diseases; however, there are concerns regarding their accuracy. Diagnosis-Related Group (DRG) coding of a terminal hospitalization may provide an alternative view. We analyzed the rate and patterns of disagreement between death certificate data and hospital claims for patients who died during an inpatient hospitalization.

METHODS: We studied respondents from the Health and Retirement Study (a nationally representative sample of older Americans who had an inpatient death documented in the linked Medicare claims from 1993-2007). Causes of death abstracted from death certificates were aggregated to the standard National Center for Health Statistics List of 50 Rankable Causes of Death. Centers for Medicare and Medicaid Services (CMS)-DRGs were manually aggregated into a parallel classification. We then compared the two systems via 2{\texttimes}2, focusing on concordance. Our primary analysis was agreement between the two data sources, assessed with percentages and Cohen{\textquoteright}s kappa statistic.

RESULTS: 2074 inpatient deaths were included in our analysis. 36.6\% of death certificate cause-of-death codes agreed with the reason for the terminal hospitalization in the Medicare claims at the broad category level; when re-classifying DRGs without clear alignment as agreements, the concordance only increased to 61\%. Overall Kappa was 0.21, or "fair." Death certificates in this cohort redemonstrated the conventional top 3 causes of death as diseases of the heart, malignancy, and cerebrovascular disease. However, hospitalization claims data showed infections, diseases of the heart, and cerebrovascular disease as the most common diagnoses for the same terminal hospitalizations.

CONCLUSION: There are significant differences between Medicare claims and death certificate data in assigning cause of death for inpatients. The importance of infections as proximal causes of death is underestimated by current death certificate-based strategies.

}, keywords = {Cause of Death, Death Certificates, Hospitalization, Humans, Infections, Medicare, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0097714}, author = {Govindan, Sushant and Shapiro, Letitia and Kenneth M. Langa and Theodore J Iwashyna} } @article {6475, title = {Dementia and dependence: Do Modifiable Risk Factors Delay Disability?}, journal = {Neurology}, volume = {82}, year = {2014}, month = {04/2014}, pages = {1543-1550}, chapter = {1543}, abstract = {Objective: To identify modifying factors that preserve functional independence among individuals at high dementia risk. Methods: Health and Retirement Study participants aged 65 years or older without baseline activities of daily living (ADL) limitations (n = 4,922) were interviewed biennially for up to 12 years. Dementia probability, estimated from direct and proxy cognitive assessments, was categorized as low (i.e., normal cognitive function), mild, moderate, or high risk (i.e., very impaired) and used to predict incident ADL limitations (censoring after limitation onset). We assessed multiplicative and additive interactions of dementia category with modifiers (previously self-reported physical activity, smoking, alcohol consumption, depression, and income) in predicting incident limitations. Results: Smoking, not drinking, and income predicted incident ADL limitations and had larger absolute effects on ADL onset among individuals with high dementia probability than among cognitively normal individuals. Smoking increased the 2-year risk of ADL limitations onset from 9.9 to 14.9 among the lowest dementia probability category and from 32.6 to 42.7 among the highest dementia probability category. Not drinking increased the 2-year risk of ADL limitations onset by 2.1 percentage points among the lowest dementia probability category and 13.2 percentage points among the highest dementia probability category. Low income increased the 2-year risk of ADL limitations onset by 0.4 among the lowest dementia probability category and 12.9 among the highest dementia probability category. Conclusions: Smoking, not drinking, and low income predict incident dependence even in the context of cognitive impairment. Regardless of cognitive status, reducing these risk factors may improve functional outcomes and delay institutionalization.}, keywords = {Health Conditions and Status, Income}, doi = {10.1212/WNL.0000000000000357}, author = {Pamela M. Rist and Benjamin D Capistrant and Bei Wu and Jessica R Marden and M. Maria Glymour} } @article {8063, title = {Dental Care Coverage and Use: Modeling Limitations and Opportunities}, journal = {American Journal of Public Health}, volume = {104}, year = {2014}, pages = {e80-e87}, publisher = {104}, abstract = {Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage. Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.}, keywords = {Healthcare, Insurance, Public Policy}, doi = {10.2105/AJPH.2013.301693}, url = {http://dx.doi.org/10.2105/AJPH.2013.301693}, author = {Richard J. Manski and John F Moeller and Haiyan Chen} } @article {7992, title = {Dental usage under changing economic conditions.}, journal = {J Public Health Dent}, volume = {74}, year = {2014}, note = {Times Cited: 1}, month = {2014 Winter}, pages = {1-12}, publisher = {74}, abstract = {

OBJECTIVE: The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans.

METHODS: Data from the Health and Retirement Study (HRS) were analyzed for U.S. individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of (a) starting and (b) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates.

RESULTS: We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population.

CONCLUSIONS: Older Americans{\textquoteright} dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health-care services that are preventive, routine, and relatively inexpensive.

}, keywords = {Dental Health Services, Financing, Personal, Humans, Middle Aged, United States}, issn = {1752-7325}, doi = {10.1111/j.1752-7325.2012.00370.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {8061, title = {Dependence in binary outcomes: A quadratic exponential model approach}, journal = {Bulletin of the Malaysian Mathematical Sciences Society}, volume = {37}, year = {2014}, note = {Export Date: 29 January 2014 Source: Scopus}, pages = {129-137}, publisher = {37}, abstract = {Repeated measurements data appear in many applications of study subjects such as correlated binary data. Most of studies often focus on the dependence of marginal response probabilities. There is a lack of study based on joint probability distributions that yield estimation and test procedure using conditional probabilities, marginal means and correlated binary data. In this paper, the quadratic exponential form model has been extended for a Markov chain framework. This study extends the quadratic exponential model for displaying the estimation procedure for the nature and extent of dependence among the binary outcomes. In addition, a test procedure is extended to test for the goodness of fit of the model as well as for testing the order of the underlying Markov chain. The proposed model and the test procedures have been examined thoroughly with an application to elderly population data from the Health and Retirement Study (HRS) data.}, keywords = {Methodology, Other}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84890077284andpartnerID=40andmd5=b5707512075fa6411d8415bdec6bf441}, author = {Maboobeh Zangeneh Sirdari and M. Ataharul Islam and Norhashidah Awang} } @mastersthesis {6209, title = {Depression and older, community-dwelling, African American women}, volume = {3626229}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-09-09 First page - n/a}, month = {2014}, pages = {96}, school = {Morgan State University}, type = {Ph.D.}, address = {Baltimore, MD}, abstract = {Using data from the Health and Retirement Study (HRS) 2010 wave, this research examined depression among community-dwelling, African American women, age 50 and over. Depression among this population was examined in relation to age, social support, religion, caregiving, and physical health. Intersectionality and social construction were used as theoretical frameworks for the study. Drawn from an original sample of 22,034 individuals, the sample for this research consisted of 2,249 respondents. Multiple logistic regression was used to predict depression among community-dwelling African American women. Findings indicated significant relationships between depression and age, social support, and physical health. However, religion and caregiving were not found to be significant predictors of depression among this population. Implications for future research, practice and policy are also discussed.}, keywords = {Adult children, Health Conditions and Status, Healthcare, Methodology, Women and Minorities}, author = {Tamika C. Baldwin} } @article {8142, title = {Depression and risk of hospitalization for pneumonia in a cohort study of older Americans.}, journal = {J Psychosom Res}, volume = {77}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {528-34}, publisher = {77}, abstract = {

OBJECTIVE: The aim of this study is to determine if depression is independently associated with risk of hospitalization for pneumonia after adjusting for demographics, medical comorbidity, health-risk behaviors, baseline cognition and functional impairments.

METHODS: This secondary analysis of prospectively collected data examined a population-based sample of 6704 Health and Retirement Study (HRS) (1998-2008) participants>50years old who consented to have their interviews linked to their Medicare claims and were without a dementia diagnosis. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. ICD-9-CM diagnoses were used to identify hospitalizations for which the principal discharge diagnosis was for bacterial or viral pneumonia. The odds of hospitalization for pneumonia for participants with depression relative to those without depression were estimated using logistic regression models. Population attributable fractions were calculated to determine the extent that hospitalizations for pneumonia could be attributable to depression.

RESULTS: After adjusting for demographic characteristics, clinical factors, and health-risk behaviors, depression was independently associated with increased odds of hospitalization for pneumonia (odds ratio [OR]: 1.28, 95\% confidence interval [95\%CI]: 1.08, 1.53). This association persisted after adjusting for baseline cognition and functional impairments (OR: 1.24, 95\%CI: 1.03, 1.50). In this cohort, 6\% (95\%CI: 2\%, 10\%) of hospitalizations for pneumonia were potentially attributable to depression.

CONCLUSION: Depression is independently associated with increased odds of hospitalization for pneumonia. This study provides additional rationale for integrating mental health care into medical settings in order to improve outcomes for older adults.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Comorbidity, depression, Depressive Disorder, Female, Hospitalization, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Pneumonia, Risk Assessment, Risk Factors, United States}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2014.08.002}, author = {Dimitry S Davydow and Catherine L Hough and Zivin, Kara and Kenneth M. Langa and Wayne J Katon} } @article {8011, title = {Determinants of socioeconomic inequalities in subjective well-being in later life: a cross-country comparison in England and the USA}, journal = {Quality of Life Research}, volume = {23}, year = {2014}, note = {Export Date: 6 August 2014 Article in Press}, pages = {2545-2558}, publisher = {23}, abstract = {Purpose To explore country-specific influences on the determinants of two forms of subjective well-being (life satisfaction and quality of life) among older adults in England and the USA. Methods Harmonised data from two nationally representative panel studies of individuals aged 50 and over, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), are used. Linear regression models are fitted separately for life satisfaction and quality of life scales using cross-sectional samples in 2004. The ELSA sample was 6,733, and the HRS sample was 2,300. Standardised coefficients are reported to determine the country-specific importance of explanatory variables, and predicted values are shown to highlight the relative importance of statistically significant country-level interaction effects. Results Having a disability, been diagnosed with a chronic conditions or having low household wealth are strongly associated with poorer life satisfaction and quality of life. These statistical effects are consistent in England and the USA. The association of years spent in education, however, varied between the two countries: educational inequalities have a greater adverse effect on subjective well-being in the USA compared with England. Conclusion Interventions are required to counterbalance health and socioeconomic inequalities that restrict sections of the population from enjoying satisfying and meaningful lives in older age. The differential association between education and well-being in England and the USA suggests that the provision of welfare benefits and state-funded public services in England may go some way to protect against the subsequent adverse effect of lower socioeconomic status on subjective well-being.}, keywords = {Cross-National, Expectations, Health Conditions and Status, Net Worth and Assets, Public Policy, Retirement Planning and Satisfaction}, doi = {10.1007/s11136-014-0694-8}, author = {Jivraj, S. and James Nazroo} } @mastersthesis {6141, title = {Determinants of spouse/partner informal caregiving and its impacts on informal caregivers{\textquoteright} physical, psychological health and economic well-being: evidence from the health and retirement study}, year = {2014}, school = {University of Illinois at Urbana-Champaign}, address = {Champaign, IL}, abstract = {State policies have recently trended towards encouraging home and community-based services (HCBS) over institutionalized care because of the relative higher costs and lower quality in institutions. Studies suggest, however, that this cost-saving strategy has hidden individual and societal costs that may only surface when the informal caregivers grow older themselves. For example, intense caregiving can negatively impact the caregivers{\textquoteright} long-term physical, mental/psychological, and economic well-being. However, the determinants of caregiving duration and their impacts on caregivers{\textquoteright} later physical health and psychological health and economic well-being have never been examined holistically. Prior studies touching on these issues have narrowly emphasized the influence of either the elderly recipients{\textquoteright} or caregivers{\textquoteright} characteristics on informal caregiving and caregivers{\textquoteright} outcomes. To address these limitations, this study examined the following questions: Q1) What are the determinants of informal caregivers{\textquoteright} time spent on caregiving? Q2) How do caregiving hours impact informal caregivers{\textquoteright} later physical health, psychological health, and economic well-being? Furthermore, this study examined the associations between predisposing, enabling, and need factors from the viewpoints of both care recipients and caregivers. It also examines differing lengths of caregiver commitments and how they impact the caregivers{\textquoteright} outcomes (physical health, psychological health, and economic well-being) in the future across various caregiver characteristics. Using longitudinal, nationally representative data of the Health and Retirement Study from two waves (2008 and 2010), I looked at 496 dyad units (including care recipients and couples/partners as caregivers) of community-dwelling elderly to evaluate the impact of relative factors on the length of informal caregiving hours and whether providing more caregiving hours cause greater negative impacts on caregivers{\textquoteright} later physical health, psychological health, and economic well-being. To answer Q1, I used a hierarchical ordinal logistic regression model to identify predisposing, enabling, and need factors from both care recipients and care recipients{\textquoteright} and their impacts on caregiving hours. For Q2, multivariate ordinal logistic regression or ordinal least square (OLS) regression models were separately used to examine the impact of three durations of caregiving hours (providing fewer, medium, and longer caregiving hours) at Time 1 on caregivers{\textquoteright} physical, psychological, and economic well-being at Time 2. Findings indicate that recipients with higher functional impairment (activities of daily living (ADL) and instrument activities of daily living (IADL)) and usage of home care service by caregivers have a significant, negative impact on caregivers{\textquoteright} length of caregiving hours. In addition, caregivers who are older and employed are more likely to provide a greater number of hours. Furthermore, caregivers who provide more hours are more likely to have a higher level of chronic illness (objective physical health). On the other hand, I found no significant associations between caregiving intensity and self-rated health (subjective physical health), psychological health, or household wealth (including assets and income). The analysis considering predisposing, enabling, and need factors from both care recipients and caregivers to unravel the complicated caregiving phenomena are presented. Implications for research, practice, and policy are drawn based on the results.}, keywords = {Healthcare, Methodology, Public Policy}, author = {Wang, Ming Sheng} } @article {7996, title = {Development and validation of a brief dementia screening indicator for primary care.}, journal = {Alzheimers Dement}, volume = {10}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Nov}, pages = {656-665.e1}, publisher = {10}, abstract = {

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12~years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5~kg/m(2) (8 points), requiring assistance with money or medications (10 points), and~depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell{\textquoteright}s C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

}, keywords = {Aged, Cohort Studies, Dementia, Female, Humans, Male, Mass Screening, Predictive Value of Tests, Primary Health Care, Proportional Hazards Models, Risk Assessment}, issn = {1552-5279}, doi = {10.1016/j.jalz.2013.11.006}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1}, author = {Deborah E Barnes and Alexa S. Beiser and Anne Lee and Kenneth M. Langa and Alain Koyama and Sarah R Preis and John Neuhaus and Ryan J McCammon and Kristine Yaffe and Seshadri, Sudha and Mary Haan and David R Weir} } @article {8042, title = {Diabetes associated with early labor-force exit: A comparison of sixteen high-income countries}, journal = {Health Affairs}, volume = {33}, year = {2014}, note = {Export Date: 29 January 2014 Source: Scopus}, pages = {110-115}, publisher = {33}, abstract = {The economic burden of diabetes and the effects of the disease on the labor force are of substantial importance to policy makers. We examined the impact of diabetes on leaving the labor force across sixteen countries, using data about 66,542 participants in the Survey of Health, Ageing and Retirement in Europe; the US Health and Retirement Survey; or the English Longitudinal Study of Ageing. After matching people with diabetes to those without the disease in terms of age, sex, and years of education, we used Cox proportional hazards analyses to estimate the effect of diabetes on time of leaving the labor force. Across the sixteen countries, people diagnosed with diabetes had a 30 percent increase in the rate of labor-force exit, compared to people without the disease. The costs associated with earlier labor-force exit are likely to be substantial. These findings further support the value of greater public- and privatesector investment in preventing and managing diabetes. 2014 Project HOPE- The People-to-People Health Foundation, Inc. A.}, keywords = {Employment and Labor Force, Healthcare}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84891794055andpartnerID=40andmd5=6065e630ae9199c709499cf87070f6fa}, author = {Juliet Rumball-Smith and Douglas Barthold and Nandi, Arijit and Jody Heymann} } @article {8130, title = {Diabetes diagnosis and exercise initiation among older Americans}, journal = {Preventive Medicine}, volume = {65}, year = {2014}, note = {Export Date: 6 August 2014}, pages = {128-132}, publisher = {65}, abstract = {Objective: To determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. Methods: We used data from the 2004-2010 Health and Retirement Study in a pre-post study design. Individuals newly-diagnosed with diabetes (N. = 635) were propensity score matched to a comparison group with no diabetes. Results: In the year following a reported diagnosis, 35.7 (95 confidence interval 32.0 to 39.5) of those newly diagnosed with diabetes initiated exercise as compared with 31.4 (95 confidence interval 27.9 to 35.1) for the matched cohort with no diabetes, with a between-group difference of 4.3 percentage points (95 confidence interval -0.9 to 9.4). Among individuals with fewer health risk factors at baseline, the between-group difference was 15.6 percentage points (95 confidence interval 1.58 to 29.5). Conclusion: Over 35 of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis. Among individuals with fewer health risk factors at baseline, those newly-diagnosed with diabetes were more likely to begin exercise than those without diabetes. 2014 Elsevier Inc.}, keywords = {Demographics, Health Conditions and Status, Healthcare}, doi = {10.1016/j.ypmed.2014.05.001}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84901829825andpartnerID=40andmd5=4961de60a077ce36676e9d5c53632ed9}, author = {Leigh Ann Leung and Shailender Swaminathan and Amal Trivedi} } @article {8020, title = {Diabetes risk, diagnosis, and control: Do psychosocial factors predict hemoglobin A1C defined outcomes or accuracy of self-reports?}, journal = {Ethnicity and Disease}, volume = {24}, year = {2014}, note = {Times Cited: 0}, pages = {19-27}, publisher = {24}, abstract = {Objective: To evaluate the accuracy of self-reported diabetes among multi-ethnic older adults by psychosocial factors and assess predictors of diabetes risk, diagnosis, and control. Design and Methods: The 2006 Health and Retirement Study (N=5,594) was used to determine agreement between self-reported diabetes and measured diabetes (HbA1c = 6.5 ) by age, sex, race/ethnicity, nativity, education, health insurance coverage, body mass index, depressive symptoms, and prior report of racial discrimination. We also examined associations between these factors and pre-diabetes (HbA1c = 6.0- 6.5 ) among individuals without diabetes, and those with undiagnosed and poorly controlled (HbA1c = 8.0 ) diabetes. Results: Accuracy of self-reported diabetes was good (ie, sensitivity = 80 and specificity = 95 ) among all demographic subgroups and across most social strata. Among those who reported racial discrimination, sensitivity of self-reported diabetes was lower among Blacks who reported racial discrimination in comparison to Blacks who did not report racial discrimination (82.7 vs 89.0 ) an association that was marginally statistically significant (P=.05). Blacks and Hispanics had higher odds of pre-diabetes, undiagnosed diabetes, and poor glycemic control. Conclusions: Self-reported diabetes corresponded well with HbA1c assessed disease for all social strata examined in this sample of multi-ethnic older adults. Blacks with a history of racial discrimination may be less likely to know diabetes status.}, keywords = {Demographics, Health Conditions and Status, Other}, author = {White, Kellee and Mondesir, Favel L. and Lisa M. Bates and M. Maria Glymour} } @article {9143, title = {The difference-in-difference method: assessing the selection bias in the effects of neighborhood environment on health.}, journal = {Economics and Human Biology}, volume = {13}, year = {2014}, month = {2014 Mar}, pages = {20-33}, abstract = {This paper uses the difference-in-difference estimation approach to explore the self-selection bias in estimating the effect of neighborhood economic environment on self-assessed health among older adults. The results indicate that there is evidence of downward bias in the conventional estimates of the effect of neighborhood economic disadvantage on self-reported health, representing a lower bound of the true effect.}, keywords = {Neighborhoods}, issn = {1873-6130}, doi = {10.1016/j.ehb.2013.03.007}, author = {Irina B Grafova and Vicki A Freedman and Lurie, Nicole and Kumar, Rizie and Jeannette Rogowski} } @mastersthesis {6045, title = {Differential Aging-In-Place}, year = {2014}, school = {University of Michigan}, address = {Ann Arbor}, abstract = {This three-essay dissertation explores components of aging{\textendash}in-place among adults living alone aged 65 and older using nationally representative data from the Health and Retirement Study (HRS). Drawing on the Person-Environment Fit and Person-Centered perspectives, the overall goal is to examine the extent to which three dimensions of aging-in-place, namely the environment, the older individual, and individual agency (efficacy), are inter-related in order to enable independent living among this subgroup of older persons. Together, these three components help to characterize the heterogeneity of the life contexts and personal resources of older adults who live alone and are aging-in-place. The first paper explored to what degree the environment and health subgroups are associated with subjective well-being among older adults living alone. Through clustering analysis, the four health subgroups of sensory-cognitive impaired, physically impaired, frail, and healthy were identified. The intersection of these health subgroups with three environmental contexts that reflect different levels of physical and social support were examined. The frail group was more likely to show depressive symptoms if they lived in a physically average and socially unsupported environment. The sensory-cognitive impaired group was more likely to report depressive symptoms when they lived in a physically-unsupported but socially-supported environment. The second paper asked if changes in depressive symptomatology over time are mediated by changes in perceived control. The findings confirm a stronger negative influence of membership in a vulnerable health subgroup on perceived control, which in turn affects depressive symptoms over time. Among the environmental contexts, only greater social support was associated with a decrease in depressive symptoms over time via perceived control. The third paper extended the empirical examination of proposals drawn from the Person-Environment Fit perspective. I asked how much environments moderate the effects of health profiles and low socioeconomic status on mortality risk. The results show that for individuals in the sensory-cognitive impaired and physically impaired groups, broader social network was associated with an increased risk of death. In addition, the study revealed that older adults living alone with low socioeconomic status who live in a senior housing environment had a reduced risk of death.}, keywords = {Demographics, Health Conditions and Status, Retirement Planning and Satisfaction}, author = {So Jung Park} } @article {7995, title = {The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jul}, pages = {860-70}, publisher = {69}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Disabled Persons, Female, Humans, Male, Prospective Studies, Stroke, United States, White People}, issn = {1758-535X}, doi = {10.1093/gerona/glt191}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract}, author = {Benjamin D Capistrant and Nicte I Mejia and Sze Y Liu and Qianyi Wang and M. Maria Glymour} } @article {5838, title = {Do Homeowners Mark to Market? A Comparison of Self-reported and Estimated Market Home Values During the Housing Boom and Bust}, year = {2014}, institution = {New York, NYU Wagner School}, abstract = {This paper examines homeowners self-reported values in the American Housing Survey and the Health and Retirement Study from the start of the recent housing price run-ups through recent price declines. We compare zip code level market-based estimates of housing prices to those derived from homeowners self-reported values. We show that there are systematic differences which vary with market conditions and the amount of equity owners hold in their homes. When prices have fallen, homeowners systematically state that their homes are worth more than market estimates suggest, and homeowners with little or no equity in their homes state values above the market estimates to a greater degree. Over time, homeowners appear to adjust their assessments to be more in line with past market trends, but only slowly. Our results suggest that underwater borrowers are likely to understate their losses and either may not be aware that their mortgages are underwater or underestimate the degree to which they are.}, keywords = {Demographics, Housing, Net Worth and Assets, Public Policy}, url = {https://ideas.repec.org/a/bla/reesec/v44y2016i3p627-657.html}, author = {Sewin Chan and Sastrup, Samuel R. and Ellen, Ingrid Gould} } @article {6465, title = {Does Becoming an ADL Spousal Caregiver Increase the Caregiver{\textquoteright}s Depressive Symptoms?}, journal = {Research on Aging}, volume = {36}, year = {2014}, pages = {655-682}, chapter = {655}, abstract = {This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents depressive symptoms at follow-up, controlling for other factors identified in Pearlin s stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers. Furthermore, wives continuing as caregivers have more follow-up depressive symptoms than wives who do not provide care. Finally, the physical health of the spousal caregiver is related to depressive symptoms at follow-up. We conclude with policy and practice implications of these three main findings.}, keywords = {Adult children, Health Conditions and Status, Healthcare, Public Policy}, doi = {10.1177/0164027513516152}, url = {http://roa.sagepub.com/content/early/2013/12/22/0164027513516152.abstract}, author = {Ruth E Dunkle and Sheila Feld and Amanda J Lehning and Kim, Hyunjee and Shen, Huei-Wern and Kim, Min Hee} } @article {8055, title = {Does brain reserve protect older women from vascular depression?}, journal = {The journals of gerontology. Series B, Psychological sciences and social sciences}, volume = {69}, year = {2014}, note = {Times Cited: 0}, pages = {157-67}, publisher = {69}, abstract = {OBJECTIVES: Brain reserve theory, typically discussed in relation to dementia, was examined with regard to late-life depression symptomatology and cerebrovascular burden (CVB) in older-old women. METHOD: It was predicted that in a 6-year longitudinal sample (Health and Retirement Study) of 1,355 stroke-free women aged 80 years and older, higher levels of depressive symptomatology (8-item Center for Epidemiologic Studies-Depression score) would be predicted by high CVB, less educational attainment, and the education CVB interaction after controlling for age and cognitive functioning (Telephone Interview for Cognitive Status). A latent growth curve model was used to identify differences in depression symptomatology at baseline and over time. Logistic regression analyses were used to predict clinically significant depressive symptomatology at each wave based on CVB, education, and the education CVB interaction. RESULTS: Results indicate that among older women, greater educational attainment predicted fewer depression symptoms at baseline, but this advantage was partially eroded over time. The education CVB interaction predicted clinically significant depressive symptoms at baseline when the benefits of education were most robust. DISCUSSION: Brain reserve, characterized by educational attainment, may counterbalance the effect of high CVB with respect to depressive symptoms, thereby preserving mood in late life. These findings support the application of brain reserve theory to late-life depression.}, keywords = {Demographics, Health Conditions and Status}, doi = {10.1093/geronb/gbt007}, author = {Daniel Paulson and Mary E Bowen and Peter A Lichtenberg} } @article {7982, title = {Does duration of spousal caregiving affect risk of depression onset? Evidence from the Health and Retirement Study.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, note = {Times Cited: 0}, month = {2014 Aug}, pages = {766-70}, publisher = {22}, abstract = {

OBJECTIVES: To assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults.

METHODS: We studied married and depression-free Health and Retirement Study respondents aged 50 years and older (n~= 9,420) at baseline from 2000 to 2010. Current (>=14 hours per week of help with instrumental/activities of daily living for a spouse in the most recent biennial survey) and long-term caregiving (care at two consecutive surveys) were used to predict onset of elevated depressive symptoms (>=3 on a modified Centers for Epidemiologic Studies Depression scale) with discrete-time hazards models and time-updated exposure and covariate information.

RESULTS: Current caregiving was associated with significant elevations in risk of depression onset (hazard ratio: 1.64; Wald χ(2), 1 df: 28.34; p~<0.0001). Effect estimates for long-term caregiving were similar (hazard ratio: 1.52, Wald χ(2), 1 df: 3.63; p~= 0.06).

CONCLUSIONS: Current spousal caregiving significantly predicted onset of depression; the association was not exacerbated by longer duration of caregiving.

}, keywords = {Aged, Caregivers, depression, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Risk Factors, Spouses, Time Factors, United States}, issn = {1545-7214}, doi = {10.1016/j.jagp.2013.01.073}, author = {Benjamin D Capistrant and Lisa F Berkman and M. Maria Glymour} } @article {10989, title = {Does Retirement Make You Happy? A Simultaneous Equations Approach}, number = {2014-310}, year = {2014}, institution = {Michigan Retirement Research Center, University of Michigan}, address = {Ann Arbor}, abstract = {Continued improvements in life expectancy and fiscal insolvency of public pensions have led to increased pension entitlement ages in several countries, but its consequences for subjective well-being are largely unknown. Financial consequences of retirement complicate the estimation of effects of retirement on well-being as financial circumstances may influence well-being, so the effects of retirement may be confounded by income changes. Also, unobservable determinants of income are probably related with unobservable determinants of well-being, making income possibly endogenous if used as control in well-being regressions. To address these issues, we estimate a simultaneous model of retirement, income, and subjective well-being while accounting for time effects and unobserved individual effects. Public pension arrangements (replacement rates, eligibility rules for early and full retirement) serve as instrumental variables. We use data from HRS and SHARE from 2004 to 2010. We find that depressive symptoms are negatively related to retirement while life satisfaction is positively related. Remarkably, income does not seem to affect depression or life satisfaction. This contrasts with correlations in the raw data showing significant relations between income and depression and life satisfaction. This suggests that accounting for the endogeneity of income in equations explaining depression or life satisfaction is important. }, keywords = {Depressive symptoms, Income, Life Satisfaction, Retirement}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp310.pdf}, author = {Raquel Fonseca and Arie Kapteyn and Jinkook Lee and Gema Zamarro} } @article {8024, title = {Does Sequence Matter in Multi-Mode Surveys: Results from an Experiment.}, journal = {Field methods}, volume = {26}, year = {2014}, month = {2014 May 01}, pages = {141-155}, publisher = {26}, abstract = {

Interest in a multi-mode approach to surveys has grown substantially in recent years, in part due to increased costs of face-to-face interviewing and the emergence of the internet as a survey mode. Yet, there is little systematic evidence of the impact of a multimode approach on survey costs and errors. This paper reports the results of an experiment designed to evaluate whether a mixed-mode approach to a large screening survey would produce comparable response rates at a lower cost than a face-to-face screening effort. The experiment was carried out in the Health and Retirement Study (HRS), an ongoing panel study of Americans over age 50. In 2010, HRS conducted a household screening survey to recruit new sample members to supplement the existing sample. The experiment varied the sequence of modes with which the screening interview was delivered. One treatment offered mail first, followed by face-to-face interviewing; the other started with face-to-face and then mail. A control group was offered only face-to-face interviewing. Results suggest that the mixed mode options reduced costs without reducing response rates to the screening interview. There is some evidence, however, that the sequence of modes offered may impact the response rate for a follow-up in-depth interview.

}, issn = {1525-822X}, doi = {10.1177/1525822X13491863}, url = {http://fmx.sagepub.com/content/early/2013/07/24/1525822X13491863.abstract}, author = {James Wagner and Arrieta, Jennifer and Heidi M Guyer and Mary Beth Ofstedal} } @article {8066, title = {Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability?}, journal = {Population Research and Policy Review}, volume = {33}, year = {2014}, pages = {81-96}, publisher = {33}, abstract = {Studies consistently document a Hispanic paradox in U.S. adult mortality, whereby Hispanics have similar or lower mortality rates than non-Hispanic whites despite lower socioeconomic status. This study extends this line of inquiry to disability, especially among foreign-born Hispanics, since their advantaged mortality seemingly should be paired with health advantages more generally. We also assess whether the paradox extends to U.S.-born Hispanics to evaluate the effect of nativity. We calculate multistate life tables of life expectancy with disability to assess whether racial/ethnic and nativity differences in the length of disability-free life parallel differences in overall life expectancy. Our results document a Hispanic paradox in mortality for foreign-born and U.S.-born Hispanics. However, Hispanics low mortality rates are not matched by low disability rates. Their disability rates are substantially higher than those of non-Hispanic whites and generally similar to those of non-Hispanic blacks. The result is a protracted period of disabled life expectancy for Hispanics, both foreign- and U.S.-born.}, keywords = {Demographics, Disabilities, Health Conditions and Status, Women and Minorities}, doi = {10.1007/s11113-013-9312-7}, url = {http://dx.doi.org/10.1007/s11113-013-9312-7}, author = {Mark D Hayward and Robert A Hummer and Chi-Tsun Chiu and C{\'e}sar Gonz{\'a}lez-Gonz{\'a}lez and Rebeca Wong} } @article {8097, title = {Does the Widowhood Effect Precede Spousal Bereavement? Results from a Nationally Representative Sample of Older Adults}, journal = {American Journal of Geriatric Psychiatry}, year = {2014}, note = {Export Date: 6 August 2014 Article in Press}, abstract = {Objective: Increased mortality risk following spousal bereavement (often called the widowhood effect ) is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. Design: Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. Method: Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: recent widows (N = 396) were bereaved between 2004 and 2006, before outcomes were assessed; near widows (N = 380) were bereaved between 2006 and 2008, after outcomes were assessed; married individuals (N = 7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. Results: Compared to married individuals, recent widows had worse depressive symptoms ( = 0.71, 95 confidence interval (CI): 0.57, 0.85 ). Near widows had worse depressive symptoms ( = 0.21, 95 CI: 0.08, 0.34 ), mobility ( = 0.14, 95 CI: 0.01, 0.26 ), and word recall ( = -0.13, 95 CI: -0.23, -0.02 ) compared to married individuals. Conclusions: Health declines before spousal death suggests some portion of the widowhood effect may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse. 2014 American Association for Geriatric Psychiatry.}, keywords = {Adult children, Health Conditions and Status, Net Worth and Assets}, doi = {10.1016/j.jagp.2014.05.004}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84902947790andpartnerID=40andmd5=a8046d229a07ff2a9286365ad66a8086}, author = {Anusha M Vable and S. V. Subramanian and Pamela M. Rist and M. Maria Glymour} } @article {8137, title = {Does Working for Oneself, not Others, Improve Older Adults Health? An Investigation on Health Impact of SelfEmployment}, journal = {American Journal of Entrepreneurship}, volume = {1}, year = {2014}, pages = {142-180}, publisher = {1}, abstract = {This paper examines the health impact of being self-employed versus working for others among older adults (aged 50 ) and its implications. Facing an aging workforce, self-employment at older ages may provide an economic benefit via an alternative to retirement. However, little research has examined the health effects of self-employment in later life. Relying on the latest 7 waves of data from the Health and Retirement Study, this study comprehensively examines health using a 29-item index to measure the impact of self-employment status on changes in older adults overall health. We conduct a 2-stage generalized panel data instrument variables regression model, with lagged values to control potential endogeneity and simultaneity issues. We find self-employment compared to wage-and-salary jobs result in better health, controlling for job stress and work intensity, cognitive performance, prior health conditions, socioeconomic and demographic factors. This positive self-employment impact stands our in knowledge-based industry sectors. In labor intensive industry sectors such as Durable Goods Manufacturing, self-employed older adults{\textquoteright} more gradual retirement seems to result in a health advantage over wage-and-salary employees. Limitations of the study and future research directions are discussed.}, keywords = {Employment and Labor Force, Health Conditions and Status, Other, Retirement Planning and Satisfaction}, author = {Zhang, Ting} } @mastersthesis {6126, title = {Dyadic analyses of chronic conditions and distress within marriage : a gendered perspective}, year = {2014}, school = {University of Texas, Austin}, address = {Austin, TX}, abstract = {Chronic conditions negatively impact well-being, and the negative impact of a chronic condition can extend beyond the diagnosed person to his or her spouse. This association may be further influenced by gender, as gender can shape how individuals experience their own chronic conditions-- including what conditions they develop-- and how they react to the conditions and distress of their spouses. In my dissertation, I examine how one spouse{\textquoteright}s chronic conditions are related to the other spouse{\textquoteright}s psychological distress over time. I address this using quantitative analysis of the Health and Retirement Study and qualitative analysis of in-depth interviews. In my quantitative analysis, I find that the association between one spouse{\textquoteright}s chronic conditions and the other spouse{\textquoteright}s distress differs by gender, number of conditions, whether one or both spouses have chronic conditions, and type of condition. Regarding number of conditions, a husband{\textquoteright}s number of chronic conditions increases his wife{\textquoteright}s distress more so than a wife{\textquoteright}s number of chronic conditions increases her husband{\textquoteright}s. These associations are mitigated by the chronically ill spouse{\textquoteright}s own distress and functional limitations. Additionally, this gender difference is more pronounced if both spouses have chronic conditions compared to if only one has chronic conditions. Regarding type of condition, lung disease and stroke are the most negatively impactful for spouses{\textquoteright} distress, whereas high blood pressure, cancer, and arthritis are not related to spouses{\textquoteright} distress. All conditions, except for stroke, relate to husbands{\textquoteright} and wives{\textquoteright} distress similarly, but a husband{\textquoteright}s stroke increases a wife{\textquoteright}s distress initially whereas the wife{\textquoteright}s stroke increases the husband{\textquoteright}s distress over time. In my qualitative analysis, I find that when women are chronically ill, they continue to emotionally care for their husbands, which likely protects their husbands from psychological distress but exacerbates women{\textquoteright}s own distress. My results point to the importance of promoting the psychological well-being of both spouses during periods of chronic conditions. This is especially critical for spouses of people with more than one condition, chronically ill women whose husbands are also chronically ill, and spouses of people experiencing stroke and lung disease.}, keywords = {Demographics, Health Conditions and Status, Healthcare}, author = {Thomeer, Mieke Beth} } @book {5293, title = {Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life}, year = {2014}, publisher = {National Academies Press}, organization = {National Academies Press}, address = {Washington, DC}, keywords = {End of life decisions, Health Conditions and Status, Healthcare, Public Policy, Retirement Planning and Satisfaction} } @article {8064, title = {Dynamic Implications of Subjective Expectations: Evidence from Adult Smokers}, journal = {American Economic Journal: Applied Economics}, volume = {6}, year = {2014}, pages = {1-37}, publisher = {6}, abstract = {We set up a dynamic discrete choice model with subjective expectations data to explain adult smokers{\textquoteright} find important differences between subjective survival probabilities and those estimated using observed mortality data. Subjectively, individuals attach less weight to their health conditions and smoking choices and more weight to such factors as age, race, and parents{\textquoteright} longevity. Moreover, adult smokers are found to care more about their health and to be more forward-looking than predicted by a rational expectations framework. We further show the importance of unobserved heterogeneity in agents{\textquoteright} subjective survival probabilities, and discuss policy implications of subjective expectations.}, keywords = {Consumption and Savings, Expectations, Health Conditions and Status, Methodology, Other}, doi = {10.1257/app.6.1.1}, url = {http://www.aeaweb.org/articles.php?doi=10.1257/app.6.1.1}, author = {Wang, Yang} } @mastersthesis {6003, title = {Dynamic models of individual and household retirement behavior}, volume = {3629292}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-09-20 First page - n/a}, month = {2014}, pages = {159}, school = {The University of Wisconsin - Madison}, type = {Ph.D.}, address = {Madison, WI}, abstract = {Chapter 1: Estimating the Returns of Attending a Selective University on Earnings using Regression Discontinuity with Multiple Admission Cutoffs. Abstract: The first chapter estimates the effect attending a selective university has on earnings. I show that using the admission cutoffs of two related majors offered by selective universities is enough to identify the isolated "university effect" on wages. To do so, I propose a novel identification framework using the cutoffs of two related majors in a regression discontinuity design that distinguishes the effect of graduating from a selective university from the effects of the confounding factors correlated with the student application and enrollment decision. This design requires a system with strict cutoffs and simultaneous decision making of university and major upon application. The university admission system in Chile has a strict admission criteria based solely on the university selection test and high school grades, and has students choose their school and major simultaneously. This admission system leads naturally to a regression discontinuity design because we can compare the earnings of those above and below the cutoff to estimate the "university effect". My main findings suggest that, on average, attending a selective university in Chile significantly increases earnings, that is, selective universities not only select the best students, but also play a role increasing their future earnings. Chapter 2: The Effects of Private High Schools, University Rankings and Employer Learning on Wages in Chile. Abstract: The second chapter studies the effects of attending a private high school, university ranking and employer learning on wages. My empirical strategy is based on the Mincer-type wage regressions. I carry out my analysis using individual-level data from Chile. I find a large and significant effect on wages at the beginning of workers{\textquoteright} careers from attending a private high school and from attending a highly ranked university. These findings can be rationalized by the statistical discrimination and employer learning model since the effects of attending a private high school or highly ranked university decrease with experience. I construct an employer learning model to explain these decreases and find employers decrease by fifty percent the weight they place on university ranking when setting wages in three years. My findings further indicate that incorporating university admission test percentile rankings in employment applications can significantly improve the market{\textquoteright}s ability to appropriately assign wages by decreasing the information gap between potential employees and employers. Chapter 3: College-Major Choice to College-Then-Major Choice. Abstract: Many countries use college-major-specific admissions policies that require a student to choose a college-major pair jointly. Motivated by potential student-major mismatches, we explore the equilibrium effects of postponing student choice of major. We develop a sorting equilibrium model under the college-major-specific admissions regime, allowing for match uncertainty and peer effects. We estimate the model using Chilean data. We introduce the counterfactual regime as a Stackelberg game in which a social planner chooses college-specific admissions policies and students make enrollment decisions, learn about their fits to various majors before choosing one. We compare outcomes and welfare under the two different regimes.}, keywords = {Adult children, Cross-National, Employment and Labor Force, Methodology, Other, Public Policy, Retirement Planning and Satisfaction}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1561545905?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/Dissertations+\%26+Theses+\%40+CIC+Institutions\&rft_val_fmt=info:of}, author = {Merkurieva, Irina S.} } @article {8105, title = {Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, note = {Times Cited: 0}, month = {2014 Jun}, pages = {606-13}, publisher = {22}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Aged, Aged, 80 and over, Anhedonia, depression, Disabled Persons, Female, Humans, Interview, Psychological, Longitudinal Studies, Male, Middle Aged, Mortality, Risk Factors}, issn = {1545-7214}, doi = {10.1016/j.jagp.2012.12.001}, author = {Kenneth E Covinsky and Irena Cenzer and Kristine Yaffe and Sarah O{\textquoteright}Brien and Dan G. Blazer} } @article {7914, title = {Dementia and out-of-pocket spending on health care services.}, journal = {Alzheimers Dement}, volume = {9}, year = {2013}, note = {Times Cited: 0}, month = {2013 Jan}, pages = {19-29}, publisher = {9}, abstract = {

BACKGROUND: High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods. Because it leads to disability and the loss of independence, dementia may put patients and their families at risk for high OOP spending, especially for long-term care services.

METHODS: We used data from the Aging, Demographics, and Memory Study, a nationally representative subsample (n = 743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared with those with cognitive impairment without dementia and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications-two types of health care that are frequently paid for OOP. Multivariate and logistic regression models were used to adjust for the influence of potential confounders.

RESULTS: After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared with those with normal cognition ($8216 for those with dementia vs. $2570 for those with normal cognition, P < .01). Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (P < .01). Dementia was not associated with the likelihood of visiting the dentist (P = .76) or foregoing prescription medications owing to cost (P = .34).

CONCLUSIONS: Dementia is associated with high levels of OOP spending but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not "crowd out" spending on these other health care services.

}, keywords = {Aged, Dementia, Female, Financing, Personal, Health Expenditures, Humans, Male}, issn = {1552-5279}, doi = {10.1016/j.jalz.2011.11.003}, author = {Delavande, Adeline and Michael D Hurd and Martorell, Paco and Kenneth M. Langa} } @article {8946, title = {Dementia Risk and Financial Decision Making by Older Households: The Impact of Information.}, journal = {Journal of Human Capital}, year = {2013}, month = {2013 Apr 01}, pages = {45}, abstract = {

The knowledge and reasoning ability needed to manage one{\textquoteright}s finances is a form of human capital. Alzheimer{\textquoteright}s disease and other dementias cause progressive declines in cognition that lead to a complete loss of functional capacities. In this paper we analyze the impact of information about cognitive decline on the choice of household financial decision-maker. Using longitudinal data on older married couples in a novel application of survival analysis, we find that as the financial decision maker{\textquoteright}s cognition declines, the management of finances is eventually turned over to his cognitively intact spouse, often well after difficulties handling money have already emerged. However, a memory disease diagnosis increases the hazard of switching the financial respondent by over 200 percent for couples who control their retirement accounts, like 401(k) accounts, relative to those who passively receive retirement income. This finding is consistent with a model of the value of information: households with the most to gain financially from preparation are most responsive to information about cognitive decline.

}, keywords = {Decision making, Dementia, Finances, Older Adults}, issn = {1932-8575}, doi = {10.2139/ssrn.2339225}, author = {Joanne W. Hsu and Robert J. Willis} } @article {8931, title = {Depression, antidepressant medications, and risk of Clostridium difficile infection.}, journal = {BMC Medicine}, volume = {11}, year = {2013}, month = {2013 May 07}, pages = {121}, abstract = {

BACKGROUND: An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.

METHODS: In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.

RESULTS: The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95\% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95\% CI 168.0 to 226.1). The odds of CDI were 36\% greater in persons with major depression (95\% CI 1.06 to 1.74), 35\% greater in individuals with depressive disorders (95\% CI 1.05 to 1.73), 54\% greater in those who were widowed (95\% CI 1.21 to 1.95), and 25\% lower in adults who did not live alone (95\% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.

CONCLUSIONS: Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

}, keywords = {Antidepressants, Clostridium, Depressive symptoms, Infection, Older Adults}, issn = {1741-7015}, doi = {10.1186/1741-7015-11-121}, author = {Mary A M Rogers and M. Todd Greene and Vincent B Young and Sanjay Saint and Kenneth M. Langa and John Y Kao and David M. Aronoff} } @article {7904, title = {Development of a Modified BODE Index as a Mortality Risk Measure Among Older Adults With and Without Chronic Obstructive Pulmonary Disease}, journal = {American Journal of Epidemiology}, volume = {178}, year = {2013}, pages = {1150-1160}, publisher = {178}, abstract = {The BODE index was developed as a prognostic mortality risk tool for persons with chronic obstructive pulmonary disease (COPD). It incorporates 4 measures: body mass index, lung obstruction, dyspnea, and exercise capacity. The intent of this study was to examine how well a BODE-like index constructed using a simpler lung function measure, peak expiratory flow, in combination with physical functioning and symptom information more readily found in survey data (a quasi-BODE index), performs in identifying persons at higher risk of mortality and whether it may be extended as an assessment of mortality risk to persons without diagnosed COPD. Using US national survey data from the Health Retirement Study for 2006 2010, each unit increase in the quasi-BODE index score was associated with a multiplicative 50 increase in mortality risk (odds ratio = 1.50, 95 confidence interval: 1.41, 1.59). The quasi-BODE index is a multidimensional health status instrument based on the BODE index, which is a good predictor of mortality. The quasi-BODE index was compiled using simple measures of physical and respiratory function. It is a potentially useful prognostic instrument for older adult populations with or without COPD, including those with severe physical limitations, particularly when combined with demographic factors and comorbid conditions.}, keywords = {Demographics, Health Conditions and Status}, doi = {10.1093/aje/kwt087}, url = {http://aje.oxfordjournals.org/content/178/7/1150.abstract}, author = {Melissa H. Roberts and Douglas W Mapel and Bruse, Shannon and Petersen, Hans and Nyunoya, Toru} } @article {7891, title = {Diabetes is associated with cognitive impairment no dementia in the aging, demographics, and memory study (ADAMS)}, journal = {International Psychogeriatrics}, volume = {25}, year = {2013}, pages = {167-168}, publisher = {25}, abstract = {Individuals with diabetes mellitus have a 1.39 times increased risk of Alzheimer{\textquoteright}s disease, a 2.38 times increased risk of vascular dementia, and a faster rate of cognitive decline compared to individuals without diabetes (Lu et al., 2009). In a study, over a 9-year follow-up diabetes was associated with accelerated progression from mild cognitive impairment (MCI) to dementia, but was not associated with progression from no impairment to MCI (Xu et al., 2010). Many previous studies on cognitive impairment and diabetes are limited by the use of cognitive screens to diagnose and assess cognitive impairment. A few studies diagnosing cognitive impairment with comprehensive neuropsychological batteries provide mixed results. For instance, Luchinger et al. (2007) found that diabetes was correlated with the presence of MCI, whereas diabetes was not associated with the presence of dementia versus no dementia in the Aging, Demographics, and Memory Study ADAMS; (Llewellyn et al., 2010).}, keywords = {Health Conditions and Status, Methodology, Risk Taking}, doi = {10.1017/S1041610212001196}, url = {http://dx.doi.org/10.1017/S1041610212001196}, author = {Christine E Gould and Sherry A. Beaudreau and Salman, Huma} } @article {7874, title = {Differences in diabetes mellitus onset for older Black, White, and Mexican Americans}, journal = {Ethnicity and disease}, volume = {23}, year = {2013}, note = {Times Cited: 0}, pages = {310-5}, publisher = {23}, abstract = {OBJECTIVES: Our research examines the differences in estimated odds of developing diabetes mellitus for White, Black, and Mexican Americans age 51 and over for a period of 11 years. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal data came from 14,783 respondents of the Health and Retirement Study (1995-2006) who reported being diabetes-free at the first time period. Discrete-time survival models were used to analyze ethnic variations in the probability of developing diabetes. MAIN OUTCOME MEASURE: Estimated odds of developing diabetes mellitus. RESULTS: The odds of newly diagnosed diabetes increased between 1995 and 2006, with 11 cumulative incidence for all study participants. The probability of incident diabetes among Black Americans was .01 during the period of 1995/96-1998, which increased to .03 during 1998-2000 and remained at .03 throughout subsequent periods, with cumulative incidence over the 11 years at 12 . In contrast, for Mexican Americans the probability more than doubled from .02 in 1995/ 96-1998 to .05 in 2004-2006, with cumulative incidence at 19 . White Americans had 11 cumulative incidence during the 11 year period. CONCLUSIONS: Relative to White Americans, Mexican Americans had significantly elevated odds of developing diabetes throughout the 11-year period of observation even after controlling for differences in demographic, socioeconomic, and time-varying health characteristics.}, keywords = {Health Conditions and Status, Methodology, Women and Minorities}, author = {A. R. Quinones and Jersey Liang and Wen Ye} } @proceedings {10623, title = {Differential Mortality and Retirement Benefits in the Health and Retirement Study}, journal = {15th Annual Joint Conference of the Retirement Research Consortium}, year = {2013}, address = {Washington, D.C.}, abstract = {The objective of this study is to investigate the magnitude of the increase in differential mortality and its impact on the progressivity of the retirement system. Several studies have incorporated differential mortality in constructed measures of lifetime contributions and benefits; and they frequently conclude that mortality differences are sufficient to offset large portions of the progressivity that was originally built into the Social Security system. However, most of those studies were limited to the retirement portion of the OASDI program. Less account has been taken of disability and survivor benefits. As highlighted by a recent CBO (2006) report, most of the lifetime progressivity flows from the disability and survivor portions of the program. }, keywords = {Mortality, retirement benefits}, url = {https://mrdrc.isr.umich.edu/publications/conference/pdf/2013_RRC_A2C_BosworthBurkeDifferentialMortality.pdf}, author = {Barry Bosworth and Burke, Kathleen} } @article {7954, title = {Direct Social Support and Long-term Health Among Middle-Aged and Older Adults With Type 2 Diabetes Mellitus}, journal = {Journals of Gerontology Series B-Psychological Sciences and Social Sciences}, volume = {68}, year = {2013}, note = {Times Cited: 0}, pages = {933-943}, publisher = {68}, abstract = {Objectives. This study examined whether or not direct social support is associated with long-term health among middle-aged and older adults with diabetes mellitus. Method. Direct social support was assessed at baseline (2003) for 1,099 adults with type 2 diabetes mellitus from the Health and Retirement Study. Self-reported health status was examined at baseline and in 4 biennial survey waves (2003-2010). A series of ordinal logistic regression models examined whether or not the 7-item Diabetes Care Profile scale was associated with a subsequent change in health status over time. Additional analyses examined whether or not individual components of direct social support were associated with health status change. Results. After adjusting for baseline covariates, greater direct social support as measured by the Diabetes Care Profile was associated with improved health outcomes over time; however, this trend was not significant (p = .06). The direct social support measures that were associated with improved health over follow-up were support for taking medicines (odds ratio OR = 1.22), physical activity (OR = 1.26), and going to health care providers (OR = 1.22; all p .05). Discussion. Interventions that specifically target improving specific aspects of diabetes social support may be more effective in improving long-term health than less targeted efforts.}, keywords = {Adult children, Health Conditions and Status, Other}, doi = {10.1093/geronb/gbt100}, author = {Emily J Nicklett and Michele M Heisler and Spencer, Michael S. and Ann Marie Rosland} } @inbook {5254, title = {Disability and Subjective Well-being}, booktitle = {Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health}, year = {2013}, pages = {280-300}, publisher = {Stanford University Press}, organization = {Stanford University Press}, address = {Stanford, CA}, abstract = {The authors examine the relationship between disability, its onset, and subjective well-being in Chapter 15. Individuals with a work-limitating disability self-reported lower levels of life satisfaction. Consistent with previous studies, the authors find a negative relationship between disability status and subjective well-being. Employment status, income, and wealth, mitigates this negative relationship, but disability still emerges as a salient determinant of subjective well-being throughout the analysis.}, keywords = {Employment and Labor Force, Expectations, Health Conditions and Status, Healthcare, Income, Retirement Planning and Satisfaction}, author = {Mary C. Daly and Gardiner, Colin S.}, editor = {Kenneth A. Couch and Mary C. Daly and Julie M Zissimopoulos} } @article {7789, title = {Disability during the last two years of life.}, journal = {JAMA Intern Med}, volume = {173}, year = {2013}, note = {Copyright - Copyright American Medical Association Sep 9, 2013 Last updated - 2013-09-18 SubjectsTermNotLitGenreText - United States--US}, month = {2013 Sep 09}, pages = {1506-13}, publisher = {173}, abstract = {

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

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

DESIGN: Prospective cohort study.

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Disabled Persons, Educational Status, Female, Frail Elderly, Humans, Income, Longitudinal Studies, Male, Marital Status, Middle Aged, Prospective Studies, Sex Distribution, Socioeconomic factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2013.8738}, author = {Alexander K Smith and Louise C Walter and Yinghui Miao and W John Boscardin and Kenneth E Covinsky} } @article {7886, title = {Disability Shocks Near Retirement Age and Financial Well-Being}, journal = {Social security bulletin}, volume = {73}, year = {2013}, pages = {23-43}, publisher = {73}, abstract = {Using Health and Retirement Study data, the authors examine three groups of adults aged 51 56 in 1992 with different disability experiences over the following 8 years. Our analysis reveals three major findings. First, people who started and stayed nondisabled experienced stable financial security, with substantial improvement in household wealth despite substantial labor force withdrawal. Second, people who started as nondisabled but suffered a disability shock experienced a substantial increase in poverty rates and a sharp decline in median incomes. Average earnings loss was the greatest for that group, with public and private benefits replacing less than half of the loss, whereas the reduction in private health insurance coverage was more than alleviated by the increase in public health insurance coverage. Third, people who started and stayed disabled were behind at the baseline and have fallen further behind on most measures. An important exception is substantial improvement in health insurance coverage because of public safety nets.}, keywords = {Employment and Labor Force, Health Conditions and Status, Income, Medicare/Medicaid/Health Insurance, Net Worth and Assets, Public Policy, Retirement Planning and Satisfaction}, author = {Irena Dushi and Rupp, Kalman} } @mastersthesis {6295, title = {D{\'\i}vida das fam{\'\i}lias : uma analise para a Europa (HRS) e EUA (SHARE) para 2006 e 2010}, year = {2013}, school = {University of Lisbon}, address = {Lisbon}, abstract = {This dissertation investigates the evolution and determinants of the household debts in the United States of America (USA) and also in Europe (EU), before and after the beginning of the financial crises. The amounts and the debt incidence (mortgage and nonmortgage) were compared for the two years observed (2006/07 and 2010). After the presentation and discussion of the relevant literature, the determinants that had influence on the indebtedness in the USA and the EU were empirically tested based on the data from Health And Retirement Study (HRS) wave 8 (2006) and wave 10 (2010) and Survey of Health, Ageing and Retirement in Europe (SHARE) wave 2 (2006) and wave 4 (2010). As the objective is to verify alterations in the individual behavior in the periods pre and post crises, this alteration was analyzed through the observation of the same individual on both moments in time. Various specifications of the Probit model were tested where the dependent variable assumed the value of "one" or "zero" corresponding to the exist of debt or not. The study was conducted taking under consideration the whole set of debts (liability) and also for each type of debt in the European.( Overdue bills, Debt on cars and other vehicles, Debt on credit cards, Loans, Debts to relatives or friends and Student loans ) and the north American case (mortgage and nonmortgage). The EU average debt amount is higher than the USA in both years, suffering an increase from 2006 to 2010, while in the USA it stayed constant, however, the percentage of individuals with any kind of debt stayed similar in both years and both analyzed regions. The results suggest that in the EU, after the crises, was verified a change on the weight of each debt source, with a trade off between the decreasing search of formal financial institutions and the rise of informal debt, obtained from family and friends. The estimated model results show that the age, the in log wealth, the financial risk aversion, marriage and financial savings in general have a negative effect in debt acquirement. On the other hand, having a mortgage, the education (number of years) and having children has a positive effect on debt acquirement. The factors that explain different kinds of debt differ in the analyzed regions and years, noticing that the children"s variable, the health state, education and marriage are exclusively meaningful and present in the EU, opposing the USA, where they show no statistical relevance.}, keywords = {Cross-National, Net Worth and Assets, Public Policy, SHARE}, author = {Ferr{\~a}o, Filipe Ant{\'o}nio da Cunha} } @article {7888, title = {Do wealth disparities contribute to health disparities within racial/ethnic groups?}, journal = {Journal of Epidemiology and Community Health}, volume = {67}, year = {2013}, pages = {439-445}, publisher = {67}, abstract = {Background Though wide disparities in wealth have been documented across racial/ethnic groups, it is largely unknown whether differences in wealth are associated with health disparities within racial/ethnic groups. Methods Data from the Survey of Consumer Finances (2004, ages 25 64) and the Health and Retirement Survey (2004, ages 50 ), containing a wide range of assets and debts variables, were used to calculate net worth (a standard measure of wealth). Among non-Hispanic black, Hispanic and non-Hispanic white populations, we tested whether wealth was associated with self-reported poor/fair health status after accounting for income and education. Results Except among the younger Hispanic population, net worth was significantly associated with poor/fair health status within each racial/ethnic group in both data sets. Adding net worth attenuated the association between education and poor/fair health (in all racial/ethnic groups) and between income and poor/fair health (except among older Hispanics). Conclusions The results add to the literature indicating the importance of including measures of wealth in health research for what they may reveal about disparities not only between but also within different racial/ethnic groups.}, keywords = {Demographics, Health Conditions and Status, Net Worth and Assets}, doi = {10.1136/jech-2012-200999}, author = {Craig E Pollack and Cubbin, Catherine and Sania, Ayesha and Mark D Hayward and Donna M. Vallone and Flaherty, Brian and Paula Braveman} } @article {5954, title = {Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study}, year = {2013}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions.}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and Heidi M Guyer and Kenneth M. Langa and Mary Beth Ofstedal and Amanda Sonnega and Robert B Wallace and David R Weir} } @article {10492, title = {Does Household Debt Influence the Labor Supply and Benefit Claiming Decisions of Older Americans?}, number = {CRR WP 2013-22}, year = {2013}, month = {12/2013}, institution = {Boston College}, abstract = {Americans{\textquoteright} indebtedness has increased dramatically since the 1980s {\textendash} a trend likely to have important implications for retirement security. This study finds that older adults with debt are 8 percentage points more likely to work and 2 percentage points less likely to receive Social Security benefits than those without debt. Not only does the presence of debt influence older adults{\textquoteright} behavior, but so do the amount and type of debt {\textendash} particularly outstanding mortgages. Increasingly, retirement security will depend on having enough income and assets to pay for basic living expenses and to service debt.}, keywords = {Debt, Labor, Social Security, Social Security Benefits, Social Security linkage}, url = {https://crr.bc.edu/working-papers/does-household-debt-influence-the-labor-supply-and-benefit-claiming-decisions-of-older-americans-2/}, author = {Barbara A Butrica and Nadia S. Karamcheva} } @article {5975, title = {Does Retirement Induced through Social Security Pension Eligibility Influence Subjective Well-being? A Cross-Country Comparison}, year = {2013}, institution = {Ann Arbor, MI, University of Michigan Retirement Research Center}, abstract = {How does retirement influence subjective well-being? Some studies suggest retirement does not affect subjective well-being or may improve it. Others suggest it adversely affects it. This paper aims at advancing our understanding of the effect of retirement on subjective well-being by (1) using longitudinal data to tease out the retirement effect from age and cohort differences; (2) using instrumental variables to address potential reverse causation of subjective well-being on retirement decisions; and (3) conducting cross-country analyses, exploiting differences in eligibility ages for retirement benefits across countries and within countries. We use panel data from the US Health and Retirement Study and the Survey of Health, Ageing, and Retirement in Europe. This allows us to use a quasi-experimental approach where variations in public pension eligibility due to country and cohort specific retirement ages help identify retirement effects. For both the U.S. and Europe we find that retirement is associated with higher levels of depression. However, when we use instrumental variables we find the opposite result. Retirement induced through Social Security pension eligibility is found to have a positive effect, reducing depression symptoms, although only marginally significant for the U.S. when considering the depression indicator. Retirement is not found to have a significant effect on life satisfaction measures for either the U.S. or Europe.}, keywords = {Cross-National, Expectations, Health Conditions and Status, Retirement Planning and Satisfaction, SHARE}, url = {https://mrdrc.isr.umich.edu/pubs/does-retirement-induced-through-social-security-pension-eligibility-influence-subjective-well-being-a-cross-country-comparison-3/}, author = {Arie Kapteyn and Jinkook Lee and Gema Zamarro} } @article {7796, title = {Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study.}, journal = {Ethn Dis}, volume = {23}, year = {2013}, month = {2013 Spring}, pages = {155-60}, publisher = {23}, abstract = {

OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.

DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years.

OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages.

METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale).

RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95\% CI: 1.33, 1.61; Blacks: HR=1.42, 95\% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13\% excess hazard of CVD mortality (HR=1.13, 95\% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95\% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65.

CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.

}, keywords = {Aged, Black or African American, Cardiovascular Diseases, depression, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Risk Assessment, Risk Factors, White People}, issn = {1049-510X}, author = {Benjamin D Capistrant and Paola Gilsanz and J Robin Moon and Anna Kosheleva and Kristen K Patton and M. Maria Glymour} } @article {5927, title = {The Decision to Delay Social Security Benefits: Theory and Evidence}, number = {17866}, year = {2012}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Social Security benefits may be commenced at any time between age 62 and age 70. As individuals who claim later can, on average, expect to receive benefits for a shorter period, an actuarial adjustment is made to the monthly benefit amount to reflect the age at which benefits are claimed. We investigate the actuarial fairness of this adjustment. Our simulations suggest that delaying is actuarially advantageous for a large subset of people, particularly for real interest rates of 3.5 percent or below. The gains from delaying are greater at lower interest rates, for married couples relative to singles, for single women relative to single men, and for two-earner couples relative to one-earner couples. In a two-earner couple, the gains from deferring the primary earner{\textquoteright}s benefit are greater than the gains from deferring the secondary earner{\textquoteright}s benefit. We then use panel data from the Health and Retirement Study to investigate whether individuals{\textquoteright} actual claiming behavior appears to be influenced by the degree of actuarial advantage to delaying. We find no evidence of a consistent relationship between claiming behavior and factors that influence the actuarial advantage of delay, including gender and marital status, interest rates, subjective discount rates, or subjective assessments of life expectancy.}, keywords = {Consumption and Savings, Employment and Labor Force, Public Policy, Social Security}, doi = {10.3386/w17866}, author = {John B. Shoven and Sita Nataraj Slavov} } @article {7771, title = {Depressive symptoms and psychosocial stress at work among older employees in three continents.}, journal = {Global Health}, volume = {8}, year = {2012}, month = {2012 Jul 20}, pages = {27}, publisher = {8}, abstract = {

BACKGROUND: To assess whether an association of psychosocial stress at work with depressive symptoms among older employees is evident in a set of comparable empirical studies from Europe, North America and Asia.

METHODS: Cross-sectional and longitudinal multivariate regression analyses of data from 4 cohort studies with elder workers (2004 and 2006) testing associations of psychosocial stress at work ({\textquoteright}effort-reward imbalance{\textquoteright}; {\textquoteright}low control{\textquoteright}) with depressive symptoms.

RESULTS: Cross-sectional analyses from 17 countries with 14.236 participants reveal elevated odds ratios of depressive symptoms among people experiencing high work stress compared to those with low or no work stress. Adjusted odds ratios vary from 1.64 (95\% CI 1.02-2.63) in Japan to 1.97 (95\% CI 1.75-2.23) in Europe and 2.28 (95\% CI 1.59-3.28) in the USA. Odds ratios from additional longitudinal analyses (in 13 countries) controlling for baseline depression are smaller, but remain in part significant.

CONCLUSION: Findings indicate that psychosocial stress at work might be a relevant risk factor for depressive symptoms among older employees across countries and continents. This observation may call for global policy efforts to improve quality of work in view of a rapidly aging workforce, in particular in times of economic globalization.

}, keywords = {Asia, Cross-Sectional Studies, Data collection, depression, Europe, Female, Humans, Longitudinal Studies, Male, Middle Aged, North America, Prevalence, Regression Analysis, Risk Factors, Stress, Psychological, Work}, issn = {1744-8603}, doi = {10.1186/1744-8603-8-27}, author = {Johannes Siegrist and Lunau, T. and Morten Wahrendorf and Dragano, N.} } @article {7709, title = {Depressive symptoms in spouses of older patients with severe sepsis.}, journal = {Crit Care Med}, volume = {40}, year = {2012}, month = {2012 Aug}, pages = {2335-41}, abstract = {

OBJECTIVE: To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse{\textquoteright}s presepsis history, whether this risk differs by sex, and is associated with a sepsis patient{\textquoteright}s disability after hospitalization.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008).

PATIENTS: Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis.

MEASUREMENTS AND MAIN RESULTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20\% at a median of 1.1 yrs presepsis to 34\% at a median of 1 yr postsepsis) with an odds ratio of 3.74 (95\% confidence interval: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (odds ratio 1.90, 95\% confidence interval 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (odds ratio 2.86, 95\% confidence interval 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (odds ratio 1.35 per activities of daily living limitation of sepsis survivor, 95\% confidence interval 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives{\textquoteright} depression (odds ratio 2.61, 95\% confidence interval 0.93, 7.38).

CONCLUSIONS: Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their loved one dies and when their loved one survives.

}, keywords = {Age Factors, Aged, depression, Female, Hospitalization, Humans, Male, Multivariate Analysis, Prospective Studies, Psychiatric Status Rating Scales, Sepsis, Sex Factors, Spouses, Time Factors, United States}, issn = {1530-0293}, doi = {10.1097/CCM.0b013e3182536a81}, author = {Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Theodore J Iwashyna} } @article {7727, title = {Despite {\textquoteright}welcome to Medicare{\textquoteright} benefit, one in eight enrollees delay first use of part B services for at least two years.}, journal = {Health Aff (Millwood)}, volume = {31}, year = {2012}, month = {2012 Jun}, pages = {1260-8}, publisher = {31}, abstract = {

Much research has focused on the possible overuse of health care services within Medicare, but there is also substantial evidence of underuse. In recent years, Congress has added a "welcome to Medicare" physician visit and a number of preventive services with no cost sharing to the Medicare benefit package to encourage early and appropriate use of services. We examined national longitudinal data on first claims for Part B services-the portion of Medicare that covers physician visits-to learn how people used these benefits. We found that 12 percent of people, or about one in eight, who enrolled in Medicare at age sixty-five waited more than two years before making their first use of care covered by Part B. In part, this delay reflected patterns of use before enrollment, in that people who sought preventive care before turning sixty-five continued to do so after enrolling in Medicare. Enrollees with Medigap coverage, higher household wealth, and a higher level of education typically received care under Part B sooner than others, whereas having greater tolerance for risk was more likely to lead enrollees to delay use of Part B services. Men had a lower probability of using Part B services early than women; blacks and members of other minority groups were less likely to use services early than whites. Although the "welcome to Medicare" checkup does not appear to have had a positive effect on use of services soon after enrollment, the percentage of beneficiaries receiving Part B services in the first two years after enrollment has steadily increased over time. Whether or not delays in receipt of care should be a considerable public policy concern may depend on what factors are leading specific categories of enrollees to delay care and how such delays affect health.

}, keywords = {Aged, Female, Humans, Insurance Claim Review, Male, Medicare Part B, Time Factors, United States}, issn = {1544-5208}, doi = {10.1377/hlthaff.2011.0479}, author = {Frank A Sloan and Kofi F Acquah and Paul P Lee and Devdutta G. Sangvai} } @article {7743, title = {Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions.}, journal = {J Aging Soc Policy}, volume = {24}, year = {2012}, month = {2012}, pages = {291-308}, publisher = {24}, abstract = {

Data from the U.S. Health and Retirement Study (N = 2,589) and the Australian Household Income and Labour Dynamics survey (N = 1,760) were used to compare the macro-level policy frameworks on individual retirement timing expectations for pre-baby boomers (61+ years) and early baby boomers (45 to 60 years). Australian workers reported younger expected age of retirement compared to the U.S. sample. Reporting poor health was more strongly associated with younger expected retirement age in the United States than in Australia. Cohort and gender differences in the United States were found for the effect of private health insurance on younger expected age at retirement. Our results draw attention to how cross-national comparisons can inform us on the effects of policies on retirement expectations among older workers.

}, keywords = {Activities of Daily Living, Age Factors, Australia, Cross-Cultural Comparison, Florida, Health Benefit Plans, Employee, Health Status, Humans, Job Satisfaction, Middle Aged, Pensions, Public Policy, Retirement, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {1545-0821}, doi = {10.1080/08959420.2012.676324}, author = {K. A. Sargent-Cox and Kaarin J. Anstey and Kendig, H. and Skladzien, E.} } @mastersthesis {6169, title = {Determinants of the retirement assets and the amount in stock within retirement assets: Evidence from the Survey of Consumer Finances and the Health and Retirement Study}, volume = {Ph.D.}, year = {2012}, school = {Purdue University}, address = {West Lafayette, IN}, abstract = {The purpose of this research was to investigate the determinants of the retirement assets held in Individual Retirement Accounts, Keogh accounts, and current and future pensions. A second purpose was to investigate the determinants of the amount in stock within those retirement assets. Building upon the theory of human capital, the theory of planned behavior, and the bargaining power model, this study proposed that human capital, attitudes related to finances, and the relative bargaining power of the spouse would influence an individual{\textquoteright}s retirement assets and the amount in stocks within the retirement assets. Using data from the Survey of Consumer Finances, Study 1 explored the relationship between the three proposed domains and the amount in retirement assets and the amount in stock within the retirement assets. In Study 2, the relationship between the proposed domains was examined using similar variables but with a relatively older sample (e.g., the Health and Retirement Study). The results of both studies supported the theory of human capital and the theory of health capital. Those who had higher education and those who had better health were more likely to have more in retirement assets, and they have more in the amount of stock within retirement assets. Those who saved regularly and were more likely to take risk when saving and investing had more retirement assets and they have more in the amount of stock within retirement assets. The results on the influence of the spouse on retirement assets and the amount in stock within retirement assets showed some support for the bargaining power model. The retirement assets and the amount in stocks within retirement assets were influenced by the spouse. Age, education, working status of the spouse, and who was the more financial knowledgeable person among the two would influence the retirement assets and the amount in stock within retirement assets of the household head. The results of the study supported the existing literature on human capital and health capital. There was some support for the bargaining power model. The results suggest that educators and financial advisors should encourage couples to discuss their plans about saving for retirement with each other and their advisors. However, many people will be single during some or all of their retirement so individual plans for retirement savings should also be carefully developed. This is an important role for educators and financial advisors. However, older adults with fewer resources (e.g. education, employer-sponsored pension plans) will continue to need the support of Social Security.}, keywords = {Health Conditions and Status, Methodology, Net Worth and Assets, Other, Pensions, Retirement Planning and Satisfaction}, author = {Ting-Ying Yang and Feinberg, Richard A.} } @article {7703, title = {Disability and decline in physical function associated with hospital use at end of life.}, journal = {J Gen Intern Med}, volume = {27}, year = {2012}, month = {2012 Jul}, pages = {794-800}, publisher = {27}, abstract = {

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

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

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

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

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

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

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

}, keywords = {Aged, Cost of Illness, Disabled Persons, Employment, Female, Humans, Income, Insurance, Disability, Likelihood Functions, Logistic Models, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Social Security, United States}, issn = {1541-2563}, doi = {10.3109/15412555.2012.696159}, author = {Thornton Snider, Julia and J. A. Romley and Ken S Wong and Zhang, Jie and Eber, Michael and Dana P Goldman} } @mastersthesis {6142, title = {Disability Insurance in General Equilibrium}, volume = {Ph.D.}, year = {2012}, school = {University of Virginia}, address = {Charlottesville, VA}, abstract = {The Social Security Disability Insurance (DI) Program, which provides income protection to qualified workers who suffer from disabilities, is now facing rapid growth in the number of recipients. The DI program also discourages exit by workers whose health improves by penalizing work heavily. In the first chapter, I build a dynamic general equilibrium model to provide a quantitative analysis of the welfare effects of the DI program and the impact of DI policy reforms on the program{\textquoteright}s financial health and on worker behavior and welfare. A recently proposed policy to provide two extra years of partial benefits for DI beneficiaries returning to work would reduce the size of the DI beneficiary population, lowering total DI payments and the tax rate and raising welfare of a healthy newborn by 0.33\%. Increasing the Social Security Normal Retirement Age from 65 to 67 raises the number of DI recipients by 8.9\%. Policy changes strengthening the strictness of disability criteria increase social welfare mainly due to the reduction in the tax rate. Lastly, simulation results for the case of eliminating the DI program shows a large welfare gain in the new steady state, implying that the distortionary effects of taxation outweigh the gains from providing insurance. The second chapter takes into consideration that people can also obtain financial protection from public and private health insurance programs to have medical costs covered when they suffer health problems. I build a dynamic general equilibrium model to quantitatively analyze the impact of policy reforms on the DI program and on workers{\textquoteright} behavior and welfare when Medicare, Medicaid, and employer-sponsored health insurance programs interact with the DI program. A policy change strengthening the strictness of the DI admission process increases social welfare mainly due to the reduction in the tax rate and the increase in the wage level. Expanding Medicaid eligibility, which is a provision in the Affordable Care Act, reduces the number of DI recipients by 4.0\% and increases general equilibrium welfare by 0.1\%. However, the welfare effects differ by education.}, keywords = {Disabilities, Event History/Life Cycle, Methodology, Other, Public Policy, Social Security}, author = {Wang, Ruwei} } @mastersthesis {6319, title = {Disease as a predictor of depression in aging adults}, volume = {M.A.}, year = {2012}, school = {California State University, Los Angeles}, address = {Los Angeles, CA}, abstract = {The purpose of this study is to examine the effects of self-reported chronic health conditions and functional status on the Center for Epidemiologic Studies depression scale using data from the Health and Retirement Study (HRS). The analysis consisted of fitting multivariate adaptive regression splines (MARS) modes to the extant data. Possible covariates included: age, gender, being white, being Hispanic, high blood pressure, heart disease, arthritis, lung disease, back pain, diabetes, stroke, cancer, ADL and IADL functional limitations. Data included 27,461 respondent{\textquoteright}s longitudinal data, which was collected on eight test occasions. Four hypotheses were formed. Results indicated that back pain and lung disease predicted depression scores which support the second hypothesis. ADL and IADL functional limitations were the most important predictors of depression score, confirming the third and fourth predictions. While chronic disease can lead to elevated depression scores, it appears that functional limitations may be more strongly related to depression.}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Gray, Mikea R.} } @article {8954, title = {The Displacement Effect of Public Pensions on the Accumulation of Financial Assets.}, journal = {Fiscal Studies}, volume = {33}, year = {2012}, pages = {107-128}, abstract = {

The generosity of public pensions may depress private savings and provide incentives to retire early. While there is plenty of evidence supporting the latter effect, there remains considerable controversy whether public pensions crowd out private savings. This paper uses international micro-datasets collected over recent years to investigate whether public pensions displace private savings. The identification strategy relies not only on cross-country differences in generosity but also on differences in the progressivity or non-linearity of pension formulas across countries. We estimate that an extra dollar of pension wealth depresses accumulated financial assets around the time of retirement by 22 cents. An extra ten thousand dollars in public pension wealth reduces the average retirement age by roughly one month which implies an elasticity of retirement years with respect to pension wealth of -0.15.

}, keywords = {Finances, Older Adults, Pensions, Retirement Planning and Satisfaction}, issn = {0143-5671}, doi = {10.1111/j.1475-5890.2012.00154.x}, author = {Michael D Hurd and Pierre-Carl Michaud and Susann Rohwedder} } @article {7728, title = {Do discriminatory attitudes to older workers at work affect their retirement intentions?}, journal = {International Journal of Manpower}, volume = {33}, year = {2012}, pages = {405-423}, publisher = {33}, abstract = {Purpose - The purpose of this paper is to investigate whether employers{\textquoteright} attitudes towards older workers, especially regarding promotions, really affect their retirement intentions, distinguishing between men and women. Design/methodology/approach - First, the author uses the 1992 wave of the Health and Retirement Study to estimate, through a Fields decomposition, the relative contribution of the feeling of an older worker to be discriminated against regarding promotions; and to explain the self-reported probability to work full time after 62, decomposing by gender. Second, using the two first waves of HRS, the author removes any bias due to time-constant unobserved heterogeneity, to test whether the individual feeling of being passed over for promotion may be misreported, owing to a strong preference for leisure. Finally, the author examines the effect of a change in this variable over time on the intentions to exit early. Findings - The Fields decomposition shows that feeling passed over for promotion plays a non-negligible role to predict retirement plans but only for women. In addition, using panel data allows a misreporting bias to be exhibited that may lead to underestimating of the negative effect of discriminatory practices towards older workers on their retirement plans. Lastly, an increase between 1992 and 1994 in the age-discrimination towards older workers encouraged women to leave their job early, while it had no effect on retirement plans of men. Practical implications - Empirical results put forward the idea that retirement intentions may differ across gender, owing to the different nature of the employer-employee relation. While for men, this relation is characterized by delayed-payment arrangements signed ex ante with the employer, as already shown by Adams, it is not true for women. Consequently, the age-based preference of employers for promotion, leading to a lower probability of promotion for older workers, is treated by men as a consequence of ex ante arrangements and does not affect their retirement plans. However, women can attribute such attitudes of their employer to a kind of blatant discrimination, reducing therefore their attachment to their job. Originality/value - The paper presents a longitudinal approach towards the determinants of retirement intentions that allows the unobserved heterogeneity constant over time to be removed and to estimate to what extent the feeling of being passed over for promotion may be attributed, for each gender, to some arrangements signed ex ante with the employer.}, keywords = {Employment and Labor Force, Net Worth and Assets, Retirement Planning and Satisfaction, Women and Minorities}, doi = {10.1108/01437721211243769}, author = {Pierre-Jean, Messe} } @article {10756, title = {Do Income Taxes Affect the Progressivity of Social Security?}, number = {IB$\#$12-3}, year = {2012}, institution = {Center for Retirement Research at Boston College}, address = {Boston, MA}, abstract = {Policymakers have designed Social Security to be a progressive retirement program that replaces a larger share of monthly earnings for low- and middleincome workers than for high earners. However, previous research has found that, although the Disability Insurance (DI) component of Social Security is very progressive, the Old-Age and Survivors Insurance (OASI) component may be less progressive than intended. One reason is that high earners tend to live longer than low earners. Since Social Security pays an annuity that lasts throughout retirement, it benefits high earners with greater longevity. Social Security{\textquoteright}s progressivity may also be }, keywords = {Income taxes, Social Security}, url = {https://crr.bc.edu/briefs/do-income-taxes-affect-the-progressivity-of-social-security/}, author = {Norma B Coe and Karamcheva, Zhenya and Richard W Kopcke and Alicia H. Munnell} } @article {7679, title = {Does health insurance reduce illness-related worker absenteeism?}, journal = {Applied Economics}, volume = {44}, year = {2012}, pages = {4591-4603}, publisher = {44}, abstract = {The objective of this article is to examine whether having health insurance reduces illness-related absenteeism among older workers. A nationally representative sample of 1780 workers in the United States, aged 52-64, are drawn from the 2004-2006 Health and Retirement Study (HRS). Binary logistic regressions and censored Tobit models are estimated for workers{\textquoteright} likelihood of missing work days due to illness and the number of illness-related work days missed, respectively, while explicitly addressing the possibility of insurance-selection effects. The findings suggest that over a 12-month period, older workers without health insurance are as likely as insured workers to miss work days due to illness and there are no differences in the number of days missed between insured and uninsured workers. However, there is strong evidence that poor baseline health, onset of new diseases and longer hospitalization significantly increase an older worker{\textquoteright}s absenteeism at work. These results suggest that having health insurance does not affect illness-related absenteeism among older workers in the US. Future research examining other aspects of worker productivity, such as {\textquoteright}presenteeism{\textquoteright}, and the longer term effects of insurance on productivity can extend our understanding of the role of health insurance in the workplace. PUBLICATION ABSTRACT}, keywords = {Employment and Labor Force, Medicare/Medicaid/Health Insurance, Methodology, Other}, doi = {10.1080/00036846.2011.593498}, author = {Xu Xu and Gail A Jensen} } @article {7755, title = {Does retirement trigger ill health?}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Mar}, pages = {282-300}, publisher = {21}, abstract = {

This paper investigates the effects of retirement on various health outcomes. Data stem from the first three waves of the English Longitudinal Study of Ageing (ELSA). With these informative data, non-parametric matching and instrumental variable (IV) methods are applied to identify causal effects. It is found that retirement significantly increases the risk of being diagnosed with a chronic condition. In particular, it raises the risk of a severe cardiovascular disease and cancer. This is also reflected in increased risk factors (e.g. BMI, cholesterol, blood pressure) and increased problems in physical activities. Furthermore, retirement worsens self-assessed health and an underlying health stock.

}, keywords = {Activities of Daily Living, Cardiovascular Diseases, Chronic disease, England, Health Status, Humans, Longitudinal Studies, Models, Econometric, Neoplasms, Quality of Life, Retirement, Risk Factors}, issn = {1099-1050}, doi = {10.1002/hec.1712}, author = {Stefanie Behncke} } @article {7776, title = {Does stock market performance influence retirement intentions?}, journal = {Journal of Human Resources}, volume = {47}, year = {2012}, pages = {1055-1081}, publisher = {47}, abstract = {Media reports predicted that the stock market decline in October 2008 would cause changes in retirement intentions, due to declines in retirement assets. We use panel data from the Health and Retirement Study to investigate the relationship between stock market performance and retirement intentions during 1998-2008, a period that includes the recent crisis. While we find a weak negative correlation between stock returns and retirement intentions, further investigation suggests that this relationship is not driven by wealth shocks brought about by stock market fluctuations, but by other factors that are correlated with both the stock market and retirement intentions. PUBLICATION ABSTRACT}, keywords = {Methodology, Net Worth and Assets, Public Policy, Retirement Planning and Satisfaction}, doi = { 10.3368/jhr.47.4.1055}, author = {Gopi Shah Goda and John B. Shoven and Sita Nataraj Slavov} } @article {5903, title = {Dynamic Aspects of Family Transfers}, number = {18446}, year = {2012}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Each year parents transfer a great deal of money to their adult children. While intuition might suggest that these transfers are altruistic and made out of concern for the well-being of the children, empirical tests of the model have consistently yielded negative results. However, an important limitation in these sorts of studies and of our understanding of transfers in general has stemmed our inability to observe transfers over time. Estimates of patterns in a single cross section necessarily miss important aspects of behavior. In this paper I expand on the static altruistic model and posit a dynamic model in which parents use current observations on the incomes of their children to update their expectations regarding future incomes and desired future transfers. I then draw on data spanning a 17 year period to examine the dynamic aspects of transfer behavior. I find substantial change across periods in recipiency, large differences across children within the family, and a strong negative correlation between inter vivos transfers and the transitory incomes of the recipients. This evidence suggests that dynamic models can provide insights into transfer behavior that are impossible to obtain in a static context.}, keywords = {Adult children}, doi = {10.3386/w18446}, author = {Kathleen McGarry} } @mastersthesis {6291, title = {Dynamic Models of Labor Supply and Retirement}, volume = {3524349}, year = {2012}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2012 Last updated - 2013-04-18 First page - n/a}, month = {2012}, pages = {113}, school = {The University of Wisconsin - Madison}, type = {Ph.D.}, abstract = {This dissertation contains three separate essays on the dynamic models of labor supply and retirement. The first essay documents "sharp retirement"--retirement accompanied by a discontinuous decline in labor supply--across three data sets, which previous literature found difficult to explain. I propose and estimate a life-cycle labor supply model with habit persistence wherein sharp retirement can be explained by workers quitting "cold turkey." In much the same way that one might quit smoking, workers with accumulated "working habit" exit the labor force with a pronounced, discontinuous decline in labor supply. The working habit model is consistent with the data, where workers reduce yearly labor supply by scaling back more in hours worked per week (over 50\% reduction) than in weeks worked per year (20\% reduction). The fixed costs approach, which has been the standard model used to understand sharp retirement, cannot explain these trends. After estimating the model, counterfactuals show that reducing Social Security benefits by 20\% causes individuals work an additional 8.6 months. Individuals choosing sharp retirement respond mostly on the extensive margin by delaying retirement eight months, while individuals choosing smooth retirement respond mostly on the intensive margin by increasing yearly labor supply and delaying retirement only one month. The second essay develops and estimates a Ben-Porath human capital model in which individuals make decisions on consumption, human capital investment, labor supply, and retirement. The model allows both an endogenous wage process (which is typically assumed exogenous in the retirement literature) and an endogenous retirement decision (which is typically assumed exogenous in the human capital literature). This integration is important to obtain unbiased estimates, which are critical for most counterfactual analysis. For instance, when evaluating the effect of increasing the Social Security Normal Retirement Age (NRA) on workers{\textquoteright} labor supply and retirement decisions, not only does one have to consider how the policy change affects the retirement decision directly, one also needs to consider how it affects the wage process and therefore affects retirement indirectly. We estimate the model using the Method of Simulated Moments to match the life-cycle profiles of wages and hours from the PSID data. Counterfactuals of delaying NRA and removing Social Security earnings test are conducted. We find significant increases in one individual{\textquoteright}s human capital investment at old ages, which leads to over 20\% increase in the wage profile near retirement. Finally, the third essay tests for asymmetric employer learning in the labor market using a three-period model with a match component of wages. When a worker makes her quit/stay decision in a labor market with three periods, she must consider the signaling effect of her decision in subsequent periods. This breaks down some implications derived from two-period models, which are mostly used in the empirical literature. The unconditional quit rate is not necessarily negatively connected with ability in this three-period asymmetric learning model. I suggest two alternative hypothesis tests for asymmetric employer learning in the model. The first test scrutinizes the negative relationship between conditional quit rates and abilities. The second test examines the evolution of weighted average within-group ability variation. Under this model, the variation should decrease over one worker{\textquoteright}s career history due to sorting on ability. I use the NLSY79 Work-History data and find evidence of asymmetric employer learning from these tests.}, keywords = {Employment and Labor Force, Methodology, Net Worth and Assets, Other, Retirement Planning and Satisfaction, Social Security}, author = {Fan, Xiaodong} } @article {5934, title = {Dynamic Wage and Employment Effects of Elder Parent Care}, year = {2012}, note = {Boston College Department of Economics, Boston College Working Papers in Economics: 792, 2012 Working Paper}, institution = {Boston College}, abstract = {This paper formulates and estimates a dynamic discrete choice model of elder parent care and work to analyze how caregiving affects a woman{\textquoteright}s current and future labor force participation and wages. Intertemporal tradeoffs, such as decreased future earning capacity due to a current reduction in labor market work, are central to the decision to provide care. The existing literature, however, overlooks such long-term considerations. I depart from the previous literature by modeling caregiving and work decisions in an explicitly intertemporal framework. The model incorporates dynamic elements such as the health of the elderly parent, human capital accumulation and job offer availability. I estimate the model on a sample of women from the Health and Retirement Study by efficient method of moments. The estimates indicate that intertemporal tradeoffs matter considerably. In particular, women face low probabilities of returning to work or increasing work hours after a caregiving spell. Using the estimates, I simulate several government sponsored elder care policy experiments: a longer unpaid leave than currently available under the Family and Medical Leave Act of 1993; a paid work leave; and a caregiver allowance. The leaves encourage more work among intensive care providers since they guarantee a woman can return to her job, while the caregiver allowance discourages work. A comparison of the welfare gains generated by the policies shows that half the value of the paid leave can be achieved with the unpaid leave, and the caregiver allowance generates gains comparable to the unpaid leave.}, keywords = {Consumption and Savings, Employment and Labor Force, Healthcare, Methodology, Public Policy, Time Use, Women and Minorities}, url = {URL:http://fmwww.bc.edu/EC-P/WP792.pdf URL}, author = {Meghan M. Skira and Department of Economics} } @mastersthesis {6231, title = {Debt and negative net worth among near-retirees}, volume = {Ph.D.}, year = {2011}, note = {ISBN 9781124618456}, pages = {164}, school = {Utah State University}, address = {Logan, UT}, abstract = {Going into retirement, near-retirees are looking at increased debt levels, which can offset any asset accumulations and reduce retirement income. By using data from the 2008 Health and Retirement Study (HRS), this study examines the debt and negative net worth of near-retirees. This study further investigates what factors are associated with the likelihood of holding consumer debt, holding mortgage debt, and holding home equity debt over holding no debt, and what factors are associated with the likelihood of holding negative net worth over holding a high level of net worth among near-retirees. The study sample includes 3,745 individuals between the ages of 51 and 64. The results of the multinomial logistic regression analysis indicate that, all else being equal, human capital factors such as education, physical health problems, and depression symptoms play a significant role in predicting the likelihood of holding debt and negative net worth. In particular, education is positively associated with the likelihood of holding consumer, mortgage, and home equity debt over holding no debt, while it is negatively associated with the likelihood of having negative net worth over having a high level of net worth. Among the socioeconomic characteristics that influence the likelihood of near-retirees holding debt and negative net worth are household income, working in the labor force, and race. In particular, household income positively influences the likelihood of holding mortgage debt over holding no mortgage debt as well as the likelihood of holding home equity debt over holding no home equity debt. However, household income negatively influences the likelihood of having negative net worth over having a higher level of net worth. The findings of this study could help financial educators, financial planners, and policymakers understand the differences in human capital and socioeconomic characteristics of near-retirees who hold some levels of debt over no debt and who hold no net worth or a lower level of net worth over a higher level of net worth. This study concludes that it is important for professionals, consumer educators, and financial planners to provide those who hold higher levels of debt and lower levels of net worth with financial literacy education; therefore, these individuals might be able to attain economic well-being in retirement.}, keywords = {Adult children, Methodology, Net Worth and Assets, Other, Retirement Planning and Satisfaction}, url = {https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1937\&context=etd}, author = {Brown, Susan M. E.} } @article {7665, title = {Depression and the onset of chronic illness in older adults: a 12-year prospective study.}, journal = {J Behav Health Serv Res}, volume = {38}, year = {2011}, month = {2011 Jul}, pages = {373-82}, publisher = {38}, abstract = {

The relationship between depression and development of chronic illness among older adults is not well understood. This study uses data from the Health and Retirement Study to evaluate the relationship between depression at baseline and new onset of chronic illnesses including cancer, heart problems, arthritis, and diabetes. Analysis controlling for demographics (age, gender, race, education), health risk indicators (BMI and smoking), functional limitations (gross motor index, health limitations for work), and income show that working-age older people (ages 50-62) with depression at baseline are at significantly higher risk to develop diabetes, heart problems, and arthritis during the 12-year follow-up. No significant association was found between depression and cancer. Prevention efforts aimed at chronic illnesses among the elderly should recognize the mind-body interaction and focus on preventing or alleviating depression.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Chronic disease, depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Sex Distribution, Socioeconomic factors, United States}, issn = {1556-3308}, doi = {10.1007/s11414-011-9234-2}, author = {Mustafa C. Karakus and Lisa C Patton} } @article {7624, title = {Determinants of death in the hospital among older adults.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, note = {Kelley, Amy S Ettner, Susan L Wenger, Neil S Sarkisian, Catherine A United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2321-5. doi: 10.1111/j.1532-5415.2011.03718.x. Epub 2011 Nov 8.}, month = {2011 Dec}, pages = {2321-5}, publisher = {59}, abstract = {

OBJECTIVES: To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics.

DESIGN: Using multivariable regression, the relationship between in-hospital death and participants{\textquoteright} social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care.

SETTING: The Health and Retirement Study, a longitudinal nationally representative cohort of older adults.

PARTICIPANTS: People aged 67 and older who died between 2,000 and 2,006 (N~=~3,539) were sampled.

MEASUREMENTS: In-hospital death.

RESULTS: Thirty-nine percent (n~=~1,380) of participants died in the hospital (range 34\% in Midwest to 45\% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death.

CONCLUSION: Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.

}, keywords = {Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Male, Multivariate Analysis, Risk Factors, Socioeconomic factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03718.x}, author = {Amy Kelley and Susan L Ettner and Neil S. Wenger and Catherine A Sarkisian} } @article {10887, title = {Determinants of medical expenditures in the last 6 months of life.}, journal = {Annals of Internal Medicine}, volume = {154}, year = {2011}, pages = {235-242}, abstract = {

BACKGROUND: End-of-life medical expenditures exceed costs of care during other years, vary across regions, and are likely to be unsustainable. Identifying determinants of expenditure variation may reveal opportunities for reducing costs.

OBJECTIVE: To identify patient-level determinants of Medicare expenditures at the end of life and to determine the contributions of these factors to expenditure variation while accounting for regional characteristics. It was hypothesized that race or ethnicity, social support, and functional status are independently associated with treatment intensity and controlling for regional characteristics, and that individual characteristics account for a substantial proportion of expenditure variation.

DESIGN: Using data from the Health and Retirement Study, Medicare claims, and The Dartmouth Atlas of Health Care, relationships were modeled between expenditures and patient and regional characteristics.

SETTING: United States, 2000 to 2006.

PARTICIPANTS: 2394 Health and Retirement Study decedents aged 65.5 years or older.

MEASUREMENTS: Medicare expenditures in the last 6 months of life were estimated in a series of 2-level multivariable regression models that included patient, regional, and patient and regional characteristics.

RESULTS: Decline in function (rate ratio [RR], 1.64 [95\% CI, 1.46 to 1.83]); Hispanic ethnicity (RR, 1.50 [CI, 1.22 to 1.85]); black race (RR, 1.43 [CI, 1.25 to 1.64]); and certain chronic diseases, including diabetes (RR, 1.16 [CI, 1.06 to 1.27]), were associated with higher expenditures. Nearby family (RR, 0.90 [CI, 0.82 to 0.98]) and dementia (RR, 0.78 CI, 0.71 to 0.87]) were associated with lower expenditures, and advance care planning had no association. Regional characteristics, including end-of-life practice patterns (RR, 1.09 [CI, 1.06 to 1.14]) and hospital beds per capita (RR, 1.01 [CI, 1.00 to 1.02]), were associated with higher expenditures. Patient characteristics explained 10\% of overall variance and retained statistically significant relationships with expenditures after regional characteristics were controlled for.

LIMITATION: The study limitations include the decedent sample, proxy informants, and a large proportion of unexplained variation.

CONCLUSION: Patient characteristics, such as functional decline, race or ethnicity, chronic disease, and nearby family, are important determinants of expenditures at the end of life, independent of regional characteristics.

PRIMARY FUNDING SOURCE: The Brookdale Foundation.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Ethnic Groups, Female, Health Expenditures, Humans, Income, Independent Living, Male, Medicare, Regression Analysis, Social Support, Socioeconomic factors, Terminal Care, United States}, issn = {1539-3704}, doi = {10.7326/0003-4819-154-4-201102150-00004}, author = {Amy Kelley and Susan L Ettner and R Sean Morrison and Qingling Du and Neil S. Wenger and Catherine A Sarkisian} } @article {7529, title = {Development and validation of a brief cognitive assessment tool: the sweet 16.}, journal = {Arch Intern Med}, volume = {171}, year = {2011}, month = {2011 Mar 14}, pages = {432-7}, publisher = {171}, abstract = {

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80\% and a specificity of 70\%, whereas an MMSE score of less than 24 showed a sensitivity of 64\% and a specificity of 86\% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99\% and a specificity of 72\% in contrast to an MMSE score with a sensitivity of 87\% and a specificity of 89\%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, Female, Humans, Male, Neuropsychological tests, Surveys and Questionnaires}, issn = {1538-3679}, doi = {10.1001/archinternmed.2010.423}, author = {Tamara G Fong and Richard N Jones and James L Rudolph and Frances Margaret Yang and Tommet, Douglas and Habtemariam, Daniel and Edward R Marcantonio and Kenneth M. Langa and Sharon K Inouye} } @article {7645, title = {Is diabetes-specific health literacy associated with diabetes-related outcomes in older adults?}, journal = {J Diabetes}, volume = {3}, year = {2011}, note = {Yamashita, Takashi Kart, Cary S Australia Journal of diabetes J Diabetes. 2011 Jun;3(2):138-46. doi: 10.1111/j.1753-0407.2011.00112.x.}, month = {2011 Jun}, pages = {138-46}, publisher = {3}, abstract = {

BACKGROUND: The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults.

METHODS: Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean ({\textpm}SD) 67.96 {\textpm} 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927).

RESULTS: Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care (R2 = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week.

CONCLUSIONS: No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients{\textquoteright} assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy.

}, keywords = {Adult, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Health Literacy, Humans, Logistic Models, Middle Aged, Multivariate Analysis, Self Care, Socioeconomic factors, Surveys and Questionnaires, United States}, issn = {1753-0407}, doi = {10.1111/j.1753-0407.2011.00112.x}, author = {Takashi Yamashita and Cary S Kart} } @article {7675, title = {Differences in health between Americans and Western Europeans: Effects on longevity and public finance.}, journal = {Soc Sci Med}, volume = {73}, year = {2011}, month = {2011 Jul}, pages = {254-63}, publisher = {73}, abstract = {

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

}, keywords = {Activities of Daily Living, Adult, Aged, Body Mass Index, Cross-Cultural Comparison, Disabled Persons, Europe, Female, Health Expenditures, health policy, Health Status Disparities, Health Surveys, Humans, Internationality, Life Expectancy, Male, Middle Aged, Models, Economic, Models, Statistical, Mortality, Public Health, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.05.027}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {7598, title = {The Disability Screening Process and the Labor Market Behavior of Accepted and Rejected Applicants: Evidence from the Health and Retirement Study}, journal = {Journal of Labor Research}, volume = {32}, year = {2011}, pages = {237-253}, publisher = {32}, abstract = {This paper uses Social Security earnings records linked to data from the Health and Retirement Study to examine the labor market behavior of rejected and accepted disability applicants prior to their application. We find that rejected applicants have substantially lower earnings and labor force participation rates during the decade prior to application than beneficiaries. Also, we find some evidence of a divergence between these groups, with rejected applicants leaving the labor force at a faster rate than beneficiaries as their application date approaches. One interpretation of these results is that the disability screening process on average separates those who are at least partially motivated by adverse economic circumstances when applying for disability benefits from other applicants. PUBLICATION ABSTRACT}, keywords = {Disabilities, Employment and Labor Force, Social Security}, doi = {10.1007/s12122-011-9110-0}, author = {Seth Hyland Giertz and Kubik, J.} } @article {7641, title = {Dispositional optimism protects older adults from stroke: the Health and Retirement Study.}, journal = {Stroke}, volume = {42}, year = {2011}, note = {Kim, Eric S Park, Nansook Peterson, Christopher Research Support, Non-U.S. Gov{\textquoteright}t United States Stroke; a journal of cerebral circulation Stroke. 2011 Oct;42(10):2855-9. Epub 2011 Jul 21.}, month = {2011 Oct}, pages = {2855-9}, publisher = {42}, abstract = {

BACKGROUND AND PURPOSE: Although higher optimism has been linked to an array of positive health outcomes, the association between optimism and incidence of stroke remains unclear, especially among older adults. We examined whether higher optimism was associated with a lower incidence of stroke.

METHOD: Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults aged>50 years--were used. Analyses were conducted for a 2-year follow-up on the subset of 6044 adults (2542 men, 3502 women) who were stroke-free at baseline. Analyses adjusted for chronic illnesses, self-rated health, and relevant sociodemographic, behavioral, biological, and psychological factors.

RESULTS: Higher optimism was associated with a lower risk of stroke. On an optimism measure ranging from 3 to 18, each unit increase in optimism was associated with an age-adjusted OR of 0.90 for stroke (95\% CI, 0.84 to 0.97; P<0.01). The effect of optimism remained significant even after fully adjusting for a comprehensive set of sociodemographic, behavioral, biological, and psychological stroke risk factors.

CONCLUSIONS: Optimism may play an important role in protecting against stroke among older adults.

}, keywords = {Affect, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Personality, Prospective Studies, Risk Factors, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.111.613448}, author = {Eric S Kim and Nansook Park and Christopher Peterson} } @article {7561, title = {Do biological measures mediate the relationship between education and health: A comparative study.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Jan}, pages = {307-15}, publisher = {72}, abstract = {

Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets - the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA - in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.

}, keywords = {Biomarkers, Blood pressure, Body Mass Index, Cholesterol, Costa Rica, Educational Status, Female, Health Status Disparities, Health Status Indicators, Health Surveys, Humans, Male, Middle Aged, Qualitative Research, Taiwan, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.11.004}, author = {Goldman, Noreen and Cassio M. Turra and Rosero-Bixby, Luis and David R Weir and Eileen M. Crimmins} } @article {7597, title = {Do Market Returns Influence Risk Tolerance? Evidence from Panel Data}, journal = {Journal of Family and Economic Issues}, volume = {32}, year = {2011}, pages = {532-544}, publisher = {32}, abstract = {This study used the 1992-2006 waves of the Health and Retirement Study (HRS) to investigate changes in risk tolerance levels over time in response to stock market returns. Findings indicate that risk tolerance tends to increase when market returns increase and decrease when market returns decrease. Individuals who change their risk tolerance in this manner are likely to invest in stocks when prices are high and sell when prices are low. Researchers, employers, financial educators and practitioners should help investors overcome the bias of overweighting recent news of market performance. PUBLICATION ABSTRACT}, keywords = {Consumption and Savings, Other, Retirement Planning and Satisfaction, Risk Taking}, doi = {https://doi.org/10.1007/s10834-010-9223-2}, author = {Yao, R. and Angela L Curl} } @article {5909, title = {Do Stronger Age Discrimination Laws Make Social Security Reforms More Effective?}, number = {WP 2011-249}, year = {2011}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {Supply-side Social Security reforms to increase employment and delay benefit claiming among older individuals may be frustrated by age discrimination. We test for policy complementarities between supply-side Social Security reforms and demand-side efforts to deter age discrimination, specifically studying whether stronger state-level age discrimination protections enhanced the impact of the increases in the Social Security Full Retirement Age (FRA) that occurred in the past decade. The evidence indicates that, for older individuals who were caught by the increase in the FRA, benefit claiming reductions and employment increases were sharper in states with stronger age discrimination protections.}, keywords = {Employment and Labor Force, Public Policy, Retirement Planning and Satisfaction, Social Security}, url = {https://mrdrc.isr.umich.edu/pubs/do-stronger-age-discrimination-laws-make-social-security-reforms-more-effective-3/}, author = {David Neumark and Joanne Song} } @article {7587, title = {Does fall history influence residential adjustments?}, journal = {Gerontologist}, volume = {51}, year = {2011}, month = {2011 Apr}, pages = {190-200}, publisher = {51}, abstract = {

PURPOSE OF THE STUDY: To determine whether reported falls at baseline are associated with an older adult{\textquoteright}s decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years.

DESIGN AND METHODS: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.e., moving, home modifications, increased use of adaptive equipment, family support, or personal care assistance) during the subsequent 2 years.

RESULTS: Compared with those with no history of falls, individuals with a history of falls had higher odds of making any RA. Among those making an RA, individuals with an injurious fall were more likely than those with no history of a fall to start using adaptive equipment or increase their use of personal care assistance.

IMPLICATIONS: The higher initiation of RAs among fallers may indicate proactive steps to prevent future falls and may be influenced by interactions with the health care system. To optimize fall prevention efforts, older adults would benefit from education and interventions addressing optimal use of RAs before falls occur.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Decision making, Environment Design, Female, Geriatric Assessment, Humans, Male, Residential Facilities, Risk Factors}, issn = {1758-5341}, doi = {10.1093/geront/gnq086}, author = {Leland, Natalie and Frank Porell and Susan L Murphy} } @article {7608, title = {Does informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Sep}, pages = {585-94}, publisher = {66B}, abstract = {

OBJECTIVE: Prior studies have extensively examined the reciprocal relation between disability and depressive symptoms in late life, but little is known about whether informal care attenuates the reciprocal relation over time. This study examined whether disability and depressive symptoms mobilize informal care and whether informal care, once mobilized, protects older adults against the progression of disability and depressive symptoms.

METHODS: The analysis was based on 6,454 community-dwelling older adults who were interviewed in one or more waves of the Health and Retirement Study between 1998 and 2006. Extending an autoregressive cross-lagged model, we constructed 3 cycles of the relations among disability, depressive symptoms, and informal care. Comparing the relations across 3 cycles informs us about the attenuating effect of informal care on the relation between disability and depressive symptoms over time.

RESULTS: Although older adults{\textquoteright} disability and depressive symptoms mobilized informal care initially, worsening disability and depressive symptoms often exhausted support. Receipt of care generally increased, rather than decreased, disability and depressive symptoms, and the detrimental effects remained the same over time.

DISCUSSION: We need to better understand the linkage between disability and depressive symptoms and seek effective interventions to reduce caregiver strain and enhance care receivers{\textquoteright} well-being.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Cohort Studies, Cost of Illness, depression, Disability Evaluation, Female, Humans, Longitudinal Studies, Male, Models, Psychological, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr060}, author = {Lin, I-Fen and Wu, Hsueh-Sheng} } @article {7601, title = {Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {478-89}, publisher = {66B}, abstract = {

OBJECTIVES: Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression).

METHOD: Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent{\textquoteright}s rating of each vignette character{\textquoteright}s health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent{\textquoteright}s cut-points from the vignettes and the severity of the respondent{\textquoteright}s own health problems based on these vignette cut-points.

RESULTS: We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity.

DISCUSSION: These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.

}, keywords = {Adult, Aged, Aged, 80 and over, Attitude to Health, Bias, Black People, Disability Evaluation, Educational Status, Female, Geriatric Assessment, Health Status Indicators, Health Surveys, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Socioeconomic factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbr050}, author = {Jennifer B Dowd and Todd, Megan} } @article {7604, title = {Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey.}, journal = {J Aging Health}, volume = {23}, year = {2011}, month = {2011 Aug}, pages = {806-21}, publisher = {23}, abstract = {

OBJECTIVE: To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults.

METHOD: Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods.

RESULTS: Over the follow-up periods, 38.6\% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged >=65 years. Other drinking patterns were not associated with lower odds of incident functional limitation.

DISCUSSION: Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Alcohol Drinking, Female, Humans, Logistic Models, Male, Middle Aged, Retirement}, issn = {1552-6887}, doi = {10.1177/0898264310397541}, author = {James C. Lin and Guerrieri, Joy Gioia and Alison A . Moore} } @article {7660, title = {Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence.}, journal = {Am Econ Rev}, volume = {101}, year = {2011}, month = {2011 Dec}, pages = {3047-77}, publisher = {101}, abstract = {

We investigate the effects of the institutional settings of the US health care system on individuals{\textquoteright} life-cycle medical expenditures. Health is a form of general human capital; labor turnover and labor-market frictions prevent an employer-employee pair from capturing the entire surplus from investment in an employee{\textquoteright}s health. Thus, the pair underinvests in health during working years, thereby increasing medical expenditures during retirement. We provide empirical evidence consistent with the comparative statics predictions of our model using the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). Our estimates suggest significant inefficiencies in health investment in the United States.

}, keywords = {Employment, Health Benefit Plans, Employee, Health Expenditures, Health Status, Humans, Income, Personnel Turnover, Retirement, United States}, issn = {0002-8282}, doi = {10.1257/aer.101.7.3047}, author = {Fang, H. and Alessandro Gavazza} } @article {7605, title = {Dynamic links between memory and functional limitations in old age: longitudinal evidence for age-based structural dynamics from the AHEAD study.}, journal = {Psychol Aging}, volume = {26}, year = {2011}, month = {2011 Sep}, pages = {546-58}, publisher = {26}, abstract = {

This study examined competing substantive hypotheses about dynamic (i.e., time-ordered) links between memory and functional limitations in old age. We applied the Bivariate Dual Change Score Model to 13-year longitudinal data from the Asset and Health Dynamics Among the Oldest Old Study (AHEAD; N = 6,990; ages 70 - 95). Results revealed that better memory predicted shallower increases in functional limitations. Little evidence was found for the opposite direction that functional limitations predict ensuing changes in memory. Spline models indicated that dynamic associations between memory and functional limitations were substantively similar between participants aged 70-79 and those aged 80-95. Potential covariates (gender, education, health conditions, and depressive symptoms) did not account for these differential lead-lag associations. Applying a multivariate approach, our results suggest that late-life developments in two key components of successful aging are intrinsically interrelated. Our discussion focuses on possible mechanisms why cognitive functioning may serve as a source of age-related changes in health both among the young-old and the old-old.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cognition, depression, Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Memory, Memory Disorders, Memory, Episodic, Models, Statistical, Neuropsychological tests}, issn = {1939-1498}, doi = {10.1037/a0023023}, author = {Frank J Infurna and Denis Gerstorf and Lindsay H Ryan and Jacqui Smith} } @mastersthesis {6156, title = {The Dynamics of Living Arrangements Among the Elderly}, volume = {Ph.D.}, year = {2011}, pages = {175}, school = {The University of North Carolina at Chapel Hill}, address = {Chapel Hill, NC}, abstract = {Combining care arrangements and whom the elderly live with, I study the mechanisms behind changes in living arrangements. I estimate a dynamic model of living arrangements, savings, intergenerational transfers and health outcomes. I use the nonlinear discrete factor random effects estimation method to control for unobserved heterogeneity. I use the rich data available in the 1995 - 2006 waves of the Health and Retirement Study (HRS) and supplement them with data on Medicaid and costs of care, resulting in a unique data set. I find that living arrangements are strongly influenced by health and savings. In particular, functional health is the strongest predictor of living arrangements. Inter vivos transfers and bequest intent affect living arrangements only to the extent that they impact the distribution of unobserved heterogeneity, indicating the absence of the exchange hypothesis as far as living arrangements are concerned. Public policies have a small but significant effect in the determination of living arrangements. For example, a twofold increase in the probability of receiving nursing home benefits among Medicaid eligibles increases the use of nursing home only by a 0.1 percentage point. The effects of public policies are more pronounced among elderly individuals with poor initial health and low initial wealth.}, keywords = {Healthcare, Methodology, Public Policy}, doi = {https://doi.org/10.17615/g4eg-0w45}, author = {Witvorapong, Nopphol} } @article {7655, title = {Dynamics of self-rated health and selective mortality.}, journal = {Empir Econ}, volume = {40}, year = {2011}, note = {P01 AG005842-24/NIA NIH HHS/United States Empirical economics Nihms264233 Empir Econ. 2011 Feb 1;40(1):119-140.}, month = {2011 Feb 01}, pages = {119-140}, publisher = {40}, abstract = {

Self-rated health status (SRHS) is one of the most frequently used health measures in empirical health economics. This article analyzes the first seven waves of the Health and Retirement Study (HRS) and finds that (1) all available lags have decreasing but significant predictive power for current SRHS and (2) SRHS and future mortality are strongly related which leads to a specific selection problem known as survivorship bias. A parsimonious joint model with an autocorrelated latent health component in both the SRHS and the mortality equation is suggested. It is better able to capture the empirical facts than commonly used models including random effects and/or state dependence and better able to correct the survivorship bias than commonly used strategies such as inverse probability weighting.

}, issn = {0377-7332}, doi = {10.1007/s00181-010-0422-3}, author = {Florian Heiss} } @article {7515, title = {Data sets on pensions and health: Data collection and sharing for policy design.}, journal = {Int Soc Secur Rev}, volume = {63}, year = {2010}, month = {2010 Jul}, pages = {197-222}, publisher = {63}, abstract = {

A growing number of countries are developing or reforming pension and health policies in response to population ageing and to enhance the welfare of their citizens. The adoption of different policies by different countries has resulted in several natural experiments. These offer unusual opportunities to examine the effects of varying policies on health and retirement, individual and family behaviour, and well-being. Realizing these opportunities requires harmonized data-collection efforts. An increasing number of countries have agreed to provide data harmonized with the Health and Retirement Study in the United States. This article discusses these data sets, including their key parameters of pension and health status, research designs, samples, and response rates. It also discusses the opportunities they offer for cross-national studies and their implications for policy evaluation and development.

}, issn = {0020-871X}, doi = {10.1111/j.1468-246X.2010.01375.x}, author = {Jinkook Lee} } @article {7526, title = {Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries.}, journal = {BMC Health Serv Res}, volume = {10}, year = {2010}, month = {2010 Jun 21}, pages = {173}, publisher = {8}, abstract = {

BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.

RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).

CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Emergency Service, Hospital, Humans, Insurance Claim Review, Medicare, Prospective Studies, Severity of Illness Index, United States}, issn = {1472-6963}, doi = {10.1186/1472-6963-10-173}, author = {Kaskie, Brian and Maksym Obrizan and Elizabeth A Cook and Michael P Jones and Li Liu and Suzanne E Bentler and Robert B Wallace and John F Geweke and Kara B Wright and Elizabeth A Chrischilles and Claire E Pavlik and Robert L. Ohsfeldt and Gary E Rosenthal and Frederic D Wolinsky} } @mastersthesis {6061, title = {The demand for preventive activities among older adults and its association with Medicare expenditures}, volume = {PhD}, year = {2010}, pages = {282}, school = {University of Pennsylvania}, type = {Dissertation}, address = {Philadelphia, PA}, abstract = {In recent years, certain health policy makers have emphasized the need for an increase in preventive services interventions as means to improve health outcomes and cut health care costs. Oftentimes, the debate around the purported benefits of prevention centers on the need to cut the costs of highly costly systems such as Medicare. However, little is known about the factors that might actually influence the demand for preventive services among older adults, neither do we know much about how the dynamic for the demand for prevention plays out among older adults within the context of a household. Moreover, there is little evidence to support the belief that all preventive activities necessarily translate in cost savings. This dissertation examines the theoretical and empirical factors that influence the demand for prevention at the individual and household level. It also analyzes the associations between a diverse set of preventive services and Medicare expenditures in older adults. Using a panel data set from the Health and Retirement study linked to Medicare claims data, I find evidence that while lifestyle prevention such as physical activity, non-smoking and normal weight status maintenance are negatively associated with Medicare expenditures at ages 65-69, clinical preventive activities such as flu shot, cholesterol screening, mammography, Pap smears test and prostate cancer screening have at best no effect on expenditures, at worst they are positively associated; yet these findings may be biased due to uncontrolled unobservables. Also, I find that education, risk aversion, and long term planning are significantly associated with a higher demand for all preventive services. Finally, I find large bargaining effects between household members whereby spouses initiate and terminate preventive activities together. This result leaves room for policy makers to take advantage of spillover effects in the design of interventions designed with the purpose of increasing the demand for prevention.}, keywords = {Consumption and Savings, Demographics, Health Conditions and Status, Medicare/Medicaid/Health Insurance}, url = {https://repository.upenn.edu/edissertations/281/}, author = {Puig de la Parra, Andrea} } @inbook {NBERc8416, title = {Demographic Trends, Housing Equity, and the Financial Security of Future Retirees}, booktitle = {Demography and the Economy}, year = {2010}, pages = {227-287}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, abstract = {About 80 percent of households with heads at retirement age own a home. Aside from Social Security and dedicated retirement saving, home equity is the primary asset of a large fraction of these homeowners. Thus, the fi nancial security of many older households depends importantly on the value of their homes. Venti and Wise (1990, 2001, 2004); Megbolugbe, Sa- Aadu, and Shilling (1997); and Banks et al. (2010) show that housing equity tends to be withdrawn when households experience shocks to family status like entry to a nursing home or death of a spouse. If, as these analyses suggest, housing equity is conserved for a {\textquotedblleft}rainy day,{\textquotedblright} then the value of housing can have important implications for the reserve of wealth in the event of such shocks}, keywords = {Demography, Financial security, Housing}, isbn = {0-226-75472-3}, url = {http://www.nber.org/chapters/c8416}, author = {James M. Poterba and Steven F Venti and David A Wise} } @article {7536, title = {Dental care coverage and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, month = {2010 Winter}, pages = {1-12}, publisher = {70}, abstract = {

OBJECTIVES: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS).

METHODS: We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage.

CONCLUSIONS: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.

}, keywords = {Aged, Employment, ethnicity, Female, Humans, Income, Insurance, Dental, Male, Middle Aged, Models, Statistical, Multivariate Analysis, Retirement, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00137.x}, author = {Richard J. Manski and John F Moeller and Jody Schimmel and Patricia A St Clair and Haiyan Chen and Larry S. Magder and John V Pepper} } @article {7535, title = {Dental care expenditures and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, month = {2010 Spring}, pages = {148-55}, publisher = {70}, abstract = {

OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS).

METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status.

CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

}, keywords = {Age Factors, Aged, Dental Care, Educational Status, ethnicity, Female, Financing, Personal, Humans, Income, Insurance Coverage, Insurance, Dental, Male, Marital Status, Middle Aged, Mouth, Edentulous, Retirement, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00156.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7545, title = {Dental care utilization and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, note = {Manski, Richard J Moeller, John Chen, Haiyan St Clair, Patricia A Schimmel, Jody Magder, Larry Pepper, John V R01 AG026090-01A2/AG/NIA NIH HHS/United States R01 AG026090-03/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Nihms172468 J Public Health Dent. 2010 Winter;70(1):67-75.}, month = {2010 Winter}, pages = {67-75}, publisher = {70}, abstract = {

OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).

METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.

CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.

}, keywords = {Aged, Confounding Factors, Epidemiologic, Dental Care, Employment, ethnicity, Female, health policy, Humans, Income, Insurance, Dental, Leisure activities, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Retirement, Socioeconomic factors, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00145.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7428, title = {Dentistry; Research conducted at University of Maryland has provided new information about dentistry}, journal = {Health Insurance Law Weekly}, year = {2010}, pages = {50}, abstract = {2010 APR 18 - ( http://www.newsrx.com NewsRx.com) -- In this recent study, researchers in the United States conducted a study To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS) (see also http://www.newsrx.com/library/topics/Dentistry.html Dentistry). We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, author = {Anonymous} } @article {7531, title = {Depression among older adults in the United States and England.}, journal = {Am J Geriatr Psychiatry}, volume = {18}, year = {2010}, month = {2010 Nov}, pages = {1036-44}, publisher = {11}, abstract = {

CONTEXT: Depression negatively affects health and well being among older adults, but there have been no nationally representative comparisons of depression prevalence among older adults in England and the United States.

OBJECTIVE: The authors sought to compare depressive symptoms among older adults in these countries and identify sociodemographic and clinical correlates of depression in these countries.

DESIGN AND SETTING: The authors assessed depressive symptoms in non-Hispanic whites aged 65 years and older in 2002 in two nationally representative, population-based studies: the U.S. Health and Retirement Study and English Longitudinal Study of Ageing.

PARTICIPANTS: A total of 8,295 Health and Retirement Study respondents and 5,208 English Longitudinal Study of Ageing respondents.

MAIN OUTCOME MEASURES: The authors measured depressive symptoms using the eight-item Center for Epidemiologic Studies Depression Scale. The authors determined whether depressive symptom differences between the United States and England were associated with sociodemographic characteristics, chronic health conditions, and health behaviors.

RESULTS: Significant depressive symptoms (Center for Epidemiologic Studies Depression Scale score >=4) were more prevalent in English than U.S. adults (17.6\% versus 14.6\%, adjusted Wald test F([1, 1593]) = 11.4, p < 0.001). Adjusted rates of depressive symptoms in England were 19\% higher compared with the United States (odds ratio: 1.19, 95\% confidence interval: 1.01-1.40). U.S. adults had higher levels of education, and net worth, but lower levels of activities of daily living/instrumental activities of daily living impairments, tobacco use, and cognitive impairment, which may have contributed to relatively lower levels of depressive symptoms in the United States.

CONCLUSIONS: Older adults in the United States had lower rates of depressive symptoms than their English counterparts despite having more chronic health conditions. Future cross-national studies should identify how depression treatment influences outcomes in these populations.

}, keywords = {Aged, Aged, 80 and over, depression, England, Female, Health Behavior, Health Status, Health Surveys, Humans, Male, Prevalence, Risk Factors, United States, White People}, issn = {1545-7214}, doi = {10.1097/JGP.0b013e3181dba6d2}, author = {Zivin, Kara and David J Llewellyn and Iain A Lang and Sandeep Vijan and Mohammed U Kabeto and Erin M Miller and Kenneth M. Langa} } @article {7468, title = {Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Mar}, pages = {551-6}, publisher = {58}, abstract = {

OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without.

DESIGN: Prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61.

PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS.

MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves.

RESULTS: Eight hundred eighty-seven (12\%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45\% vs 23\%, Cox hazard ratio (HR)=2.33, 95\% confidence interval (CI)=2.06-2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95\% CI=1.25-1.66).

CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.

}, keywords = {Activities of Daily Living, depression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mobility Limitation, Proportional Hazards Models, Prospective Studies, Risk Factors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.02723.x}, author = {Kenneth E Covinsky and Kristine Yaffe and Lindquist, Karla and Cherkasova, Elena and Yelin, Edward and Dan G. Blazer} } @article {7541, title = {Depressive symptoms predict incident stroke independently of memory impairments.}, journal = {Neurology}, volume = {75}, year = {2010}, note = {Glymour, M M Maselko, J Gilman, S E Patton, K K Avendano, M 1R01MH087544/MH/NIMH NIH HHS/United States 1R21 AG34385-01A1/AG/NIA NIH HHS/United States 1R21AG037889-01/AG/NIA NIH HHS/United States 1R21HD066312-01/HD/NICHD NIH HHS/United States 1RC4MH092707-01/MH/NIMH NIH HHS/United States 5R03MH083335/MH/NIMH NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Neurology Neurology. 2010 Dec 7;75(23):2063-70.}, month = {2010 Dec 07}, pages = {2063-70}, publisher = {75}, abstract = {

BACKGROUND: We evaluated whether depressive symptoms predict the onset of first stroke independently of memory impairment. We conceptualized memory impairment as a marker of preexisting cerebrovascular disease. We hypothesized that if depressive symptoms are causally related to stroke through mechanisms unrelated to cerebrovascular disease, depressive symptoms should predict stroke independently of memory impairment.

METHODS: Incidence of first stroke was assessed with self or proxy reports from 19,087 participants in the Health and Retirement Study cohort (1,864 events). Elevated depressive symptoms (3+ on an 8-item Centers for the Epidemiologic Study of Depression scale) and memory impairment (score of <=6 on a combined immediate and delayed recall of a 10-word list) were used as predictors of incident stroke in Cox survival models with adjustment for sociodemographic and cardiovascular risk factors.

RESULTS: After adjustment for sociodemographic and cardiovascular risk factors, elevated depressive symptoms (hazard ratio = 1.25; 95\% confidence interval 1.12-1.39) and memory impairment (hazard ratio = 1.26; 95\% confidence interval 1.13-1.41) each predicted stroke incidence in separate models. Hazard ratios were nearly unchanged and remained significant (1.23 for elevated depressive symptoms and 1.25 for memory impairment) when models were simultaneously adjusted for both elevated depressive symptoms and memory impairment. Elevated depressive symptoms also predicted stroke when restricting analyses to individuals with median memory score or better.

CONCLUSIONS: Memory impairments and depressive symptoms independently predict stroke incidence. Memory impairment may reflect undiagnosed cerebrovascular disease. These results suggest that depressive symptoms might be directly related to stroke rather than merely indicating preexisting cerebrovascular disease.

}, keywords = {Aged, Aged, 80 and over, depression, Female, Health Surveys, Humans, Incidence, Kaplan-Meier Estimate, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Neuropsychological tests, Predictive Value of Tests, Risk Factors, Statistics, Nonparametric, Stroke, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0b013e318200d70e}, author = {M. Maria Glymour and J Maselko and Gilman, S E and Kristen K Patton and Mauricio Avendano} } @mastersthesis {6160, title = {Determinants and Implications of Mortality Risk at the End of the Life Cycle}, volume = {Ph.D.}, year = {2010}, note = {ISBN: 9781124229829}, month = {2010}, school = {University of Washington}, abstract = {The primary goal of this dissertation is to investigate the impacts of survival uncertainty on outcomes relevant to older Americans. While objective measures of life expectancy are useful in explaining economic outcomes, this dissertation also highlights the importance of subjective measures. In particular, results suggest survival beliefs provide otherwise unobservable information that better predict outcomes. Chapter one employs a Life Cycle model, showing that households smooth consumption and labor supply. Specifically, a longer expected lifetime is associated with the delay of consumption into the future and substitution of hours worked to the present. The second chapter develops a model for purchases of life insurance by older households and tests for the presence of marital bargaining power. Results indicate that increasing the relative bargaining power of the husband reduces the size of the insurance policy taken against the husband{\textquoteright}s life, and increases insurance taken on his wife{\textquoteright}s life. In other words, the household reallocates resources to states of nature that the husband places greater weight, and purchases insurance to guarantee adequate resources for funding optimal consumption in the event of the wife{\textquoteright}s death. Furthermore, results show systematic differences in the effect of survival uncertainty on life insurance purchases. In particular, life insurance purchases are decreasing with objective survival probabilities, but are increasing with subjective measures, suggesting the presence of asymmetric information. The secondary goal of this dissertation is to extend the literature examining the determinants of adult mortality. The third chapter examines the impacts of family characteristics such as parental and sibling on adult mortality at the objective level using survey data from the Health and Retirement Study. Using a competing risk model that controls for correlation between individual death and survey non-response, I find evidence that individuals with longer lived parents exhibit lower mortality risk. Increases in parental age not only affect mortality through increasing the predisposition to survive, but also through positive information from knowledge of extended parental survival and positive social relationships formed. Also, I find individuals with higher vitality and a higher opportunity cost to completing the survey are less likely to respond in future survey waves.}, keywords = {Consumption and Savings, Employment and Labor Force, End of life decisions, Health Conditions and Status, Time Use, Women and Minorities}, author = {Edwin S. Wong} } @mastersthesis {6031, title = {Diabetes Health and Disability Pathways: Racial/Ethnic, Socioeconomic, and Gender Disparities}, volume = {Ph.D.}, year = {2010}, pages = {186}, school = {University of Michigan}, address = {Ann Arbor}, abstract = {This dissertation examines how race/ethnicity, socioeconomic status, and gender relate to longitudinal health outcomes among older adults with type 2 diabetes. Further, this dissertation analyzes the extent to which certain factors, such as social ties and health and illness behaviors, mediate this relationship. The outcomes examined are self-reported health status, adherence, and functional limitations. The hypotheses tested are that individuals with less social support--as well as individuals from socially disadvantaged backgrounds--will report lower health status and greater functional limitations relative to individuals from socially privileged backgrounds and relative to individuals greater amounts of social support. Longitudinal survey data is examined from the Health and Retirement Study (HRS) along with the 2003 HRS Diabetes Supplement. Further, qualitative and quantitative data were collected and analyzed from a small sample (30) of community-dwelling seniors. Multi-level modeling and mixed-method analysis is used to examine individual-level patterns of change. Throughout this series of analyses, race/ethnicity, socioeconomic status, and gender were independent predictors of subsequent health and disability outcomes. However, additional characteristics, such as social support and health characteristics, are important mediators of this relationship. As discussed in the second chapter, diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health. As discussed in the fourth chapter, however, different forms of social support interact strongly with health behaviors to prevent functional decline As diabetes and other chronic illnesses are increasingly recognized as social and public health priorities, it will become more critical to identify proximal and distal mechanisms by which chronic illness trajectories differ. No previous studies have adequately addressed this aim as proposed in this research. The identification of divergent pathways (and in particular, the relationship to mechanisms that can be altered in interventions) over the life course can enable more effective and efficient prevention practices and interventions.}, keywords = {Demographics, Event History/Life Cycle, Health Conditions and Status, Healthcare, Other}, url = {http://proquest.umi.com/pqdweb?index=0\&did=2259687861\&SrchMode=1\&sid=1\&Fmt=6\&VInst=PROD\&VType=PQD\&RQT=309\&VName=PQD\&TS=1298895294\&clientId=17822}, author = {Emily J Nicklett} } @article {7339, title = {Diabetes-related support, regimen adherence, and health decline among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65B}, year = {2010}, month = {2010 May}, pages = {390-9}, publisher = {10}, abstract = {

UNLABELLED: OBJECTIVES. Social support is generally conceptualized as health promoting; however, there is little consensus regarding the mechanisms through which support is protective. Illness support has been proposed to promote regimen adherence and subsequent prevention of health decline. We hypothesize that (a) support for regimen adherence is negatively associated with self-reported health decline among older diabetic adults and that (b) regimen adherence is negatively associated with health decline among older diabetic adults.

METHODS: We used the Health and Retirement Study data on individuals over the age of 60 years with type 2 diabetes mellitus (n = 1,788), examining change in self-reported health status over a 2-year period using binomial and cumulative ordinal logistic regression models.

RESULTS: Diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health.

CONCLUSIONS: Illness-related support appears to be a mechanism through which social support matters in the diabetic population. Although this relationship did not extend to prevention of health status decline among diabetics, the relationship between support and illness management is promising.

}, keywords = {Activities of Daily Living, Aged, Diabetes Mellitus, Type 2, Disability Evaluation, Female, Health Behavior, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Patient Compliance, Quality of Life, Social Support, Surveys and Questionnaires, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp050}, author = {Emily J Nicklett and Jersey Liang} } @article {7464, title = {Differences in functional impairment across subtypes of dementia.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Apr}, pages = {434-41}, publisher = {65A}, abstract = {

BACKGROUND: Dementia is a cause of disability in later life. Despite the importance of functional status to the diagnosis of dementia, limited information exists on differences in functional limitations by dementia subtype. We conducted a cross-sectional analysis using the Aging, Demographics, and Memory Study (ADAMS) to determine the extent of functional impairment among older adults with dementia due to different etiologies.

METHODS: The ADAMS sample consisted of 856 individuals aged 71 years and older originally surveyed as part of the Health and Retirement Study. Based on a comprehensive in-person cognitive evaluation, respondents were assigned to diagnostic categories of normal cognition, cognitive impairment not demented, and demented. Dementia subtypes were grouped into three categories: vascular dementia (VaD), Alzheimer{\textquoteright}s dementia (AD), and dementia due to other etiologies. For 744 of the 856 respondents, a proxy informant completed a questionnaire asking whether the respondent had difficulty completing instrumental activities of daily living and activities of daily living (ADLs).

RESULTS: Of 744 ADAMS participants, 263 had dementia: 199 (70.5\%) with AD, 42 (16.9\%) with VaD, and 22 (12.6\%) were demented due to other etiologies. After adjustment for demographics, chronic illnesses, and dementia severity, participants with VaD (odds ratio [OR] 5.74; 95\% confidence interval [CI] 2.60-12.69) and other etiologies of dementia (OR 21.23; 95\% CI 7.25-62.16) were more likely to have greater than or equal to four ADL limitations compared with those with AD.

CONCLUSIONS: VaD is associated with significantly more ADL limitations than AD. These physical limitations should be considered when designing adult day care programs, which adequately accommodate the needs of non-AD patients.

}, keywords = {Activities of Daily Living, Aged, Alzheimer disease, Dementia, Dementia, Vascular, Humans}, issn = {1758-535X}, doi = {10.1093/gerona/glp197}, author = {Tanya R Gure and Mohammed U Kabeto and Brenda L Plassman and John D Piette and Kenneth M. Langa} } @article {7493, title = {Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults.}, journal = {Soc Sci Med}, volume = {71}, year = {2010}, note = {Using Smart Source Parsing pp. Jul Elsevier Science, Amsterdam The Netherlands}, month = {2010 Jul}, pages = {405-413}, publisher = {71}, abstract = {

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

}, keywords = {Chronic disease, Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Obesity, Retirement, Risk Factors, Sex Factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.03.038}, author = {F. Renna and Thakur, Nidhi} } @mastersthesis {6168, title = {Discrimination and health: A longitudinal study}, volume = {M.S.}, year = {2010}, pages = {59}, school = {Clemson University}, type = {Dissertation}, abstract = {This study examines several questions about discrimination using a longitudinal survey from the 2006 and 2008 waves of the Health and Retirement Study (HRS). Results show that whites are least likely to experience discrimination as we expected. In addition, the data provides support for the hypothesis that people with higher total household assets and higher household total number of members are less likely to experience discrimination. However, contrary to my hypothesis, females have smaller odds of experiencing discrimination compared to males. People with higher education levels are more likely to report major discrimination events compared to those with lower education levels. There is a negative relationship between everyday discrimination and individuals{\textquoteright} change in health, but the relationship between major discrimination events and individuals{\textquoteright} change in health is not significant. Therefore, the hypothesis that perceived discrimination is linked to adverse change in health is partially supported. Moreover, the buffering effect of social support in the relationship between perceived discrimination and change in health is not supported, and the hypothesis that detrimental effect of discrimination is stronger to men than women is partially supported.}, keywords = {Adult children, Demographics, Employment and Labor Force, Healthcare, Net Worth and Assets}, url = {https://tigerprints.clemson.edu/all_theses/933/}, author = {Jun Xu} } @article {7513, title = {Disease prevalence, disease incidence, and mortality in the United States and in England.}, journal = {Demography}, volume = {47 Suppl}, year = {2010}, month = {2010}, pages = {S211-31}, publisher = {47}, abstract = {

We find that both disease incidence and disease prevalence are higher among Americans in age groups 55-64 and 70-80, indicating that Americans suffer from higher past cumulative disease risk and experience higher immediate risk of new disease onset compared with the English. In contrast, age-specific mortality rates are similar in the two countries, with an even higher risk among the English after age 65. We also examine reasons for the large financial gradients in mortality in the two countries. Among 55- to 64-year-olds, we estimate similar health gradients in income and wealth in both countries, but for 70- to 80-year-olds, we find no income gradient in the United Kingdom. Standard behavioral risk factors (work, marriage, obesity, exercise, and smoking) almost fully explain income gradients among those aged 55-64 in both countries and a significant part among Americans 70-80 years old. The most likely explanation of the absence of an English income gradient relates to the English income benefit system: below the median, retirement benefits are largely flat and independent of past income, and hence past health, during the working years. Finally, we report evidence using a long panel of American respondents that their subsequent mortality is not related to large changes in wealth experienced during the prior 10-year period.

}, keywords = {Aged, Aged, 80 and over, England, Health Status, Health Status Disparities, Humans, Incidence, Life Tables, Middle Aged, Morbidity, Mortality, Prevalence, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.2010.0008}, author = {James Banks and Muriel, Alastair and James P Smith} } @article {7444, title = {Do Older Adults Anticipate Relocating?: The Relationship Between Housing Relocation Expectations and Falls}, journal = {The Journal of Applied Gerontology}, volume = {29}, year = {2010}, note = {Using Smart Source Parsing pp. Apr Sage Publications, Thousand Oaks CA}, pages = {231-250}, publisher = {29}, abstract = {The relationship between the occurrence of falls and the expectations older adults have about making future residential moves is examined in this research. Data from the 2002 Health and Retirement Study (HRS) are used to analyze self-reported probabilities of moving among a nationally representative sample of noninstitutionalized adults aged 65 and older. The results show that falls were predictive of anticipation of housing relocation as indicated by more than 50 reported probability of moving within the next 2 years. The results suggest that consideration of housing relocation is greater among older adults who experience tangible events indicative of a trajectory of deteriorating health. Reprinted by permission of Sage Publications Inc., copyright The Southern Gerontological Society.}, keywords = {Demographics, Health Conditions and Status, Housing, Methodology, Retirement Planning and Satisfaction}, doi = {10.1177/0733464809335595}, author = {Stoeckel, Kimberly J. and Frank Porell} } @article {7480, title = {Do wives work hours hurt husbands health? Reassessing the care work deficit thesis}, journal = {Social Science Research}, volume = {39}, year = {2010}, pages = {801-813}, publisher = {39}, abstract = {Life expectancy is an important factor that individuals have to take into account for saving and consumption choices. The life-cycle model of consumption and saving behaviour predicts that consumption growth should decrease with higher mortality rates. The aim of this study is to test this hypothesis based on data about subjective longevity expectations from the Health and Retirement Study merged with detailed consumption data from two waves of the Consumption and Activities Mail Survey. This study finds that an increase in subjective mortality by 1 corresponds to an annual decrease in consumption of non-durable goods of around 1.8 .}, keywords = {Consumption and Savings, Event History/Life Cycle, Health Conditions and Status}, doi = {https://doi.org/10.1016/j.ssresearch.2010.04.008}, author = {Kristen W Springer} } @article {7471, title = {Does consumption buy happiness? Evidence from the United States}, journal = {International Review of Economics}, volume = {57}, year = {2010}, pages = {163-176}, publisher = {57}, abstract = {We examine the association between various components of consumption expenditure and happiness in the Health and Retirement Study (HRS), a nationally representative sample of older Americans. We find that only one component of consumption is positively related to happiness--leisure consumption. In contrast, consumption of durables, charity, personal care, food, health care, vehicles, and housing are not significantly associated with happiness. Second, we find that leisure consumption is associated with higher levels of happiness partially through its effect on social connectedness, as indexed by measures of loneliness and embeddedness in social networks. On one hand, these results counter the conventional wisdom that material goods can{\textquoteright}t buy happiness. One the other hand, they underscore the importance of social goods and social connectedness in the production of happiness.}, keywords = {Consumption and Savings, Demographics, Retirement Planning and Satisfaction}, doi = {https://doi.org/10.1007/s12232-010-0093-6}, author = {Thomas DeLeire and Ariel Kalil} } @article {7474, title = {Does Gender Moderate Factors Associated with Whether Spouses Are the Sole Providers of IADL Care to Their Partners?}, journal = {Res Aging}, volume = {32}, year = {2010}, month = {2010 Jul 01}, pages = {499-526}, publisher = {32}, abstract = {

We explored whether gender moderated the influence of other factors on solo spousal caregiving. The subsample (N = 452) from the AHEAD study included elderly care recipients (CRs) receiving IADL assistance and their spouses. Logistic regression modeled the likelihood of solo spousal IADL care. Gender moderation was tested by product terms between CRs{\textquoteright} gender and measures of partners{\textquoteright} health, potential helpers, and sociodemographic characteristics. As numbers of CRs{\textquoteright} IADLs and couples{\textquoteright} proximate daughters increased, wives less often received care solely from their husbands, but husbands{\textquoteright} receipt of care from their wives was unaffected. Age differences between spouses and CRs affected solo spousal caregiving to wives and husbands in opposite ways. Regardless of gender, CRs{\textquoteright} number of ADL limitations and spouses with IADL or ADL limitations reduced the likelihood of solo spouse care. Identifying circumstances influencing solo spouse caregiving differently among couples with frail wives and husbands facilitates gender sensitive services.

}, issn = {1552-7573}, doi = {10.1177/0164027510361461}, author = {Sheila Feld and Ruth E Dunkle and Tracy Schroepfer and Shen, H.} } @article {7432, title = {Does major illness cause financial catastrophe?}, journal = {Health Serv Res}, volume = {45}, year = {2010}, month = {2010 Apr}, pages = {418-36}, publisher = {45}, abstract = {

OBJECTIVE: We examine the financial impact of major illnesses on the near-elderly and how this impact is affected by health insurance.

DATA SOURCES: We use RAND Corporation extracts from the Health and Retirement Study from 1992 to 2006.(1)

STUDY DESIGN: Our dependent variable is the change in household assets, excluding the value of the primary home. We use triple difference median regressions on a sample of newly ill/uninsured near elderly (under age 65) matched to newly ill/insured near elderly. We also include a matched control group of households whose members are not ill.

RESULTS: Controlling for the effects of insurance status and illness, we find that the median household with a newly ill, uninsured individual suffers a statistically significant decline in household assets of between 30 and 50 percent relative to households with matched insured individuals. Newly ill, insured individuals do not experience a decline in wealth.

CONCLUSIONS: Newly ill/uninsured households appear to be one illness away from financial catastrophe. Newly ill insured households who are matched to uninsured households appear to be protected against financial loss, at least in the near term.

}, keywords = {Bankruptcy, Cost of Illness, Databases as Topic, Financing, Personal, Humans, Medically Uninsured, Middle Aged, Severity of Illness Index}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2009.01049.x}, author = {Keziah Cook and David Dranove and Sfekas, Andrew} } @article {5787, title = {Does Retirement Affect Cognitive Functioning?}, year = {2010}, institution = {Maastricht: METEOR}, abstract = {This paper analyzes the effect of retirement on cognitive functioning using two large scale surveys. On the one hand the HRS, a longitudinal survey among individuals aged 50 living in the United States, allows us to control for individual heterogeneity and endogeneity of the retirement decision by using the eligibility age for Social Security as an instrument. On the other hand, a comparable international European survey, SHARE, allows us to identify the causal effect of retirement on cognitive functioning by using the cross-country differences in the age-pattern of retirement. The results highlight in both cases a significant negative, and quantitatively comparable, effect of retirement on cognitive functioning. Our results suggest that promoting labor force participation of older workers is not only desirable to insure the viability of retirement schemes, but it could also delay cognitive decline, and thus the occurrence of associated impairments at older age.}, keywords = {Cross-National, Employment and Labor Force, Health Conditions and Status, Retirement Planning and Satisfaction}, url = {http://econpapers.repec.org/paper/dgrumamet/2010005.htm}, author = {Bonsang, Eric and Adam, St{\'e}phane and Perelman, Sergio} } @article {5797, title = {Does Stock Market Performance Influence Retirement Expectations?}, number = {16211}, year = {2010}, note = {Using Smart Source Parsing National Bureau of Economic Research, Inc}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {While media reports predicted substantial changes in labor supply behavior due to the sharp decline in the value of the stock market in October 2008, empirical evidence on the relationship between equity markets and retirement is mixed. We use panel data from the Health and Retirement Study to investigate the relationship between stock market performance and plans for retirement during 1998-2008, a period that includes the recent financial crisis, by exploiting within-year variation in the SandP 500 index across plausibly exogenous dates of interview. While we do detect a statistically significant negative relationship between the reported probability of working full-time at age 62 and the SandP 500 index in the most recent years of our study period, we do not find strong evidence that changes in equity markets influence changes in retirement plans over the period as a whole. We conclude that the higher probabilities of working reported in recent years were likely due to factors other than stock market performance, such as pessimism about economic security more generally.}, keywords = {Consumption and Savings, Employment and Labor Force, Net Worth and Assets, Retirement Planning and Satisfaction, Women and Minorities}, doi = {10.3386/w16211}, author = {Gopi Shah Goda and John B. Shoven and Sita Nataraj Slavov} } @article {5796, title = {Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence}, year = {2010}, note = {Duke University, Department of Economics, Working Papers: 10-01}, institution = {Duke University}, abstract = {We investigate the effects of the institutional settings of the U.S. health care system on individuals{\textquoteright} life-cycle medical expenditures. We argue that health is a form of human capital that affects labor productivity, and that the employment-based health insurance system may lead to inefficient investment in individuals{\textquoteright} health care. The reason is that labor turnover and frictions in the labor market prevent an employer-employee pair from capturing the entire surplus from investment in an employee{\textquoteright}s health. Thus, the pair underinvests in health capital, and this underinvestment increases medical expenditures during retirement. We provide extensive empirical evidence consistent with the comparative statics predictions of our model using two datasets, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). The magnitude of our estimates suggests a significant degree of inefficiency in health investment in the U.S.}, keywords = {Consumption and Savings, Event History/Life Cycle, Health Conditions and Status, Healthcare, Other}, author = {Fang, Hanming and Alessandro Gavazza} } @article {7454, title = {Dynamics and heterogeneity in the process of human frailty and aging: evidence from the U.S. older adult population.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65B}, year = {2010}, month = {2010 Mar}, pages = {246-55}, publisher = {CCCB CCCP}, abstract = {

OBJECTIVES: This study investigated the dynamics and heterogeneity of the frailty index (FI) conceived as a systemic indicator of biological aging in the community-dwelling older adult population in the United States.

METHODS: We used panel data on multiple birth cohorts from the Health and Retirement Survey 1993-2006 and growth curve models to estimate age trajectories of the FI and their differences by sex, race, and socioeconomic status (SES) within cohorts.

RESULTS: The FI for cohorts born before 1942 exhibit quadratic increases with age and accelerated increases in the accumulation of health deficits. More recent cohorts exhibit higher average levels of and rates of increment in the FI than their predecessors do at the same ages. Females, non-Whites, and individuals with low education and income exhibit greater degrees of physiological deregulation than their male, White, and high-SES counterparts at any age. Patterns of sex, race, and SES differentials in rates of aging vary across cohorts.

DISCUSSION: Adjusting for social behavioral factors, the analysis provides evidence for physiological differences in the aging process among recent cohorts of older adults, points to the need for biological explanations of female excess in general system damage, and reveals the insufficiency of any single mechanism for depicting the racial and SES differences in the process of physiological deterioration.

}, keywords = {Aged, Aged, 80 and over, Aging, Cohort Studies, Female, Frail Elderly, Humans, Male, Surveys and Questionnaires, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp102}, author = {Yang, Yang and Lee, Linda C} } @article {7376, title = {Dental care coverage transitions.}, journal = {Am J Manag Care}, volume = {15}, year = {2009}, month = {2009 Oct}, pages = {729-35}, publisher = {15}, abstract = {

OBJECTIVE: To examine dental insurance transition dynamics in the context of changing employment and retirement status.

STUDY DESIGN: Data from the Health and Retirement Study (HRS) were analyzed for individuals 51 years and older between the 2004 and 2006 waves of the HRS.

METHODS: The primary focus of the analysis is the relationship between retirement and transitions in dental care coverage. We calculate and present bivariate relationships between dental coverage and retirement status transitions over time and estimate a multivariable model of dental coverage controlling for retirement and other potentially confounding covariates.

RESULTS: Older adults are likely to lose their dental coverage on entering retirement compared with those who remain in the labor force between waves of the HRS. While more than half of those persons in the youngest group (51-64 years) were covered over this entire period, two-thirds of those in the oldest group (>or=75 years) were without coverage over the same period. We observe a high percentage of older persons flowing into and out of dental coverage over the period of our study, similar to flows into and out of poverty.

CONCLUSIONS: Dental insurance is an important factor in the decision to seek dental care. Yet, no dental coverage is provided by Medicare, which provides medical insurance for almost all Americans 65 years and older. This loss of coverage could lead to distortions in the timing of when to seek care, ultimately leading to worse oral and overall health.

}, keywords = {Aged, Career Mobility, Female, Health Benefit Plans, Employee, Humans, Insurance Coverage, Insurance, Dental, Interviews as Topic, Male, Middle Aged, United States}, issn = {1936-2692}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {5753, title = {Determinants and Consequences of Moving Decisions for Older Homeowners}, number = {WP$\#$2009-16}, year = {2009}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {The lore on whether older Americans move is mixed. While the familiar stereotype is that retirees flock to Florida or Arizona, prior studies have found that their home equity rises modestly over time, suggesting that they tend to stay put. This paper examines moving trends, determinants, and consequences using the original cohort of the Health and Retirement Study (HRS). We find that a full 30 percent of homeowners in the HRS cohort move over the 1992-2004 period, but most moves occur close to home. Overall, two types of movers emerge from the analysis those who affirmatively plan to move and those who react to changing circumstances. As proxies for these two types, this study uses the presence or absence of a negative shock, such as death of a spouse or entry into a nursing home. Our results show that the factors that help determine a move are similar for both groups, while the consequences of a move vary. Homeowners with shocks are more likely to discontinue homeownership and reduce net equity, supporting the hypothesis that households may view housing wealth as insurance against catastrophic events. Finally, while movers in both groups of homeowners experience improvements in psychological well-being, movers with shocks are impacted most by the shocks themselves.}, keywords = {Demographics, Housing, Retirement Planning and Satisfaction}, url = {https://crr.bc.edu/working-papers/determinants-and-consequences-of-moving-decisions-for-older-homeowners/}, author = {Calvo, Esteban and Haverstick, Kelly and Natalia A. Zhivan} } @article {7412, title = {Differential Impact of Involuntary Job Loss on Physical Disability Among Older Workers Does Predisposition Matter?}, journal = {Res Aging}, volume = {31}, year = {2009}, month = {2009 May 01}, pages = {345-360}, publisher = {31}, abstract = {

Older workers{\textquoteright} share of involuntary job losses in the United States has grown fairly consistently in recent decades, prompting greater interest in the health consequences of involuntary unemployment among individuals nearing retirement. In this study, the authors applied the multifactorial model of geriatric health to investigate whether late-career involuntary job loss was associated with subsequent physical disability and whether the effect of involuntary job loss on physical disability varied by predisposition. Using data from the first four waves (1992 to 1998) of the Health and Retirement Survey, the authors measured predisposition with individual risk factors for functional disability and indices of aggregate risk. The results of gender-specific models fit with generalized estimating equations revealed that unmarried women and those with low predisplacement incomes had heightened risk for subsequent functional disability. No differential effects of job loss were found for men.

}, issn = {1552-7573}, doi = {10.1177/0164027508330722}, author = {William T Gallo and Jennie E Brand and Teng, Hsun-Mei and Leo-Summers, Linda and Amy L. Byers} } @article {5744, title = {Do Health Problems Reduce Consumption at Older Ages?}, number = {WP$\#$2009-9}, year = {2009}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {High out-of-pocket health care costs may have serious repercussions for older people and their families. If their incomes are not sufficient to cover these expenses, older adults with health problems may have to deplete their savings, turn to family and friends for financial help, or forego necessary care. Or they may be forced to reduce their consumption of other goods and services to pay their medical bills. This paper uses data from the Health and Retirement Study (HRS) and the related Consumption and Activities Mail Survey (CAMS) to examine the impact of health problems at older ages on out-of-pocket health care spending and other types of expenditures. The analysis estimates fixed effects models of total out-of-pocket health care spending, out-of-pocket health care spending exclusive of premiums, total spending on all items except health care, and total spending on all items except health care and housing. The models are estimated separately for households ages 65 and older and those ages 51 to 64. The results show that medical conditions increase health spending, particularly for households ages 51 to 64, but that health conditions do not generally reduce nonhealth spending. Medical conditions do, however, reduce nonhealth spending for low-income households ages 51 to 64, suggesting that holes in the health safety net before the Medicare eligibility age force some low-income people to lower their living standards to cover medical expenses.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance}, url = {https://crr.bc.edu/working-papers/do-health-problems-reduce-consumption-at-older-ages/}, author = {Barbara A Butrica and Richard W. Johnson and Mermin, Gordon B.T.} } @article {5781, title = {Documentation and Benchmarking of Health Insurance Measures in the Health and Retirement Study}, year = {2009}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The Health and Retirement Study (HRS) has asked respondents about their health insurance coverage since the study began in 1992. The study has asked about public and private coverage, including detailed information on the source of coverage. These data can be used to paint a comprehensive picture of insurance coverage among the elderly and near-elderly from 1992 to the present. This documentation provides an overview of the health insurance measures in the HRS and benchmarks HRS estimates of health insurance for 1996 through 2006 to data from the Medical Expenditure Panel Study (MEPS). For selected outcomes, the data are also benchmarked to data from the National Health Interview Survey (NHIS) for 1997 through 2006.}, keywords = {Medicare/Medicaid/Health Insurance, Methodology}, author = {Helen G Levy and Italo Gutierrez} } @article {7324, title = {Does caring for your spouse harm one{\textquoteright}s health? Evidence from a United States nationally-representative sample of older adults.}, journal = {Ageing Soc}, volume = {29}, year = {2009}, month = {2009 Feb}, pages = {277-293}, publisher = {29}, abstract = {

The purpose of this article is to investigate the relationship between spousal care-giving and declines in functioning and self-rated health among older care-givers. The authors used data from the 2000 and 2002 waves of the United States Health and Retirement Study, a biennial longitudinal survey of a nationally representative cohort of adults aged 50 or more years. Two outcomes were examined, declines in functioning and declines in self-rated health. Care-givers were classified into three groups: no care-giving, less than 14 hours of care-giving per week, and 14 or more hours care-giving per week. To assess declines in functioning, two summary scores were created of limitations in basic and instrumental Activities of Daily Living. To assess declines in self-rated health, we compared responses from 2000 and 2002. In the fully adjusted models, care-giving hours did not have an independent effect on declines in functioning or self-rated health. The relationship between care-giving hours and declines in functioning and self-rated health is probably attributable to socio-demographic characteristics, mainly age. The findings suggest that spousal care-giving does not of itself harm functional health or perceived health among older adult care-givers. Understanding the differential effects of these socio-economic characteristics with care-giving hours on health will be useful in promoting the health of older adult care-givers and treating their disorders.

}, issn = {0144-686X}, doi = {10.1017/S0144686X08007824}, author = {Kristi Rahrig Jenkins and Mohammed U Kabeto and Kenneth M. Langa} } @article {7355, title = {Does job loss cause ill health?}, journal = {Health Econ}, volume = {18}, year = {2009}, month = {2009 Sep}, pages = {1075-89}, publisher = {18}, abstract = {

This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers{\textquoteright} business. I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality.

}, keywords = {Activities of Daily Living, Age Factors, Cohort Studies, Cross-Sectional Studies, Employment, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Sex Factors, Smoking, Socioeconomic factors}, issn = {1099-1050}, doi = {10.1002/hec.1537}, author = {Salm, Martin} } @article {7387, title = {Doing well: a SEM analysis of the relationships between various activities of daily living and geriatric well-being.}, journal = {J Genet Psychol}, volume = {170}, year = {2009}, month = {2009 Sep}, pages = {213-26}, publisher = {170}, abstract = {

An existing large data set, the Health and Retirement Study (HRS) with the subsequent addition of the Consumption and Activities Mail Survey (CAMS) data, provides a rich data set for the examination of the activities of older adults. In this study HRS and CAMS data are used to examine relationships between various activities of daily living (ADLs) and well-being in older adults. Using structural equation modeling, influences of direct and indirect factors that affect older individuals{\textquoteright} cognitive and emotional well-being are analyzed. The data suggest ability to perform ADLs has little to do with cognitive well-being, but is an influential factor in determining emotional well-being.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aged, Cognition, depression, Humans, Models, Psychological, Socioeconomic factors, United States}, issn = {0022-1325}, doi = {10.1080/00221320903218190}, author = {James A Katt and Speranza, Linda and Shore, Wendy and Karen H. Saenz and E. Lea Witta} } @inbook {5243, title = {Data sources, Later Life: Health and Retirement Study (HRS)}, booktitle = {Encyclopedia of the Life Course and Human Development}, volume = {3}, year = {2008}, publisher = {Gale}, organization = {Gale}, address = {Farmington Hills, MI}, abstract = {This reference is an entry in Volume 3 of the Encyclopedia of the Life Course and Human Development; it discusses the Health and Retirement Study as a data source for research on the Later Life stage of the life course.}, keywords = {Methodology}, isbn = {978-0-02-866162-9}, author = {Mary Beth Ofstedal}, editor = {Deborah Carr and Crosnoe, Robert and Mary Elizabeth Hughes and Pienta, Amy M.} } @article {7214, title = {Declines in late-life disability: the role of early- and mid-life factors.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Apr}, pages = {1588-602}, publisher = {66}, abstract = {

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Coronary Disease, Cross-Sectional Studies, Disabled Persons, Female, Health Surveys, Heart Failure, Hospitalization, Humans, Male, Nursing homes, United States}, issn = {1525-1497}, doi = {10.1007/s11606-007-0456-1}, author = {Tanya R Gure and Mohammed U Kabeto and Caroline S Blaum and Kenneth M. Langa} } @article {7225, title = {Depression and retirement in late middle-aged U.S. workers.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Apr}, pages = {693-713}, publisher = {43}, abstract = {

OBJECTIVE: To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement.

DATA SOURCE: Six biennial waves (1992-2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61-year-olds and their spouses started in 1992.

STUDY DESIGN: Workers aged 53-58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N=2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N=2,288).

PRINCIPAL FINDINGS: In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men.

CONCLUSIONS: Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression.

}, keywords = {Activities of Daily Living, Comorbidity, depression, Employment, Female, Humans, Male, Middle Aged, Retirement, Severity of Illness Index, Sex Factors, Socioeconomic factors, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00782.x}, author = {Jalpa A Doshi and Cen, Liyi and Daniel Polsky} } @article {7249, title = {Depressive Symptoms Among Grandparents Raising Grandchildren: The Impact of Participation in Multiple Roles.}, journal = {J Intergener Relatsh}, volume = {6}, year = {2008}, month = {2008 Sep 01}, pages = {285-304}, publisher = {6}, abstract = {

Using the Health and Retirement Study, this research examines well-being among grandparents raising grandchildren during middle to late life, specifically looking at how other roles in which a grandparent is participating (such as worker, volunteer, parent or caregiver) may influence depressive symptoms among grandparent caregivers. Results indicate that grandparents who have recently begun raising a grandchild experience lower levels of well-being when compared to grandparents who are not raising a grandchild regardless of the grandparent{\textquoteright}s level of participation in roles beyond that of grandparent caregiver, while grandparents who have been raising a grandchild for longer periods of time seem to benefit from their participation in multiple roles. However, a higher level of participation in outside roles is associated with a decline in well-being among grandparents who stopped raising a grandchild, suggesting that, for these grandparents, participation in multiple roles acted mainly as a stressor, rather than as a resource.

}, issn = {1535-0770}, doi = {10.1080/15350770802157802}, author = {Lindsey A Baker and Merril Silverstein} } @article {8787, title = {Differential Mortality in Europe and the U.S.: Estimates Based on Subjective Probabilities of Survival}, journal = {SSRN Electronic Journal}, year = {2008}, abstract = {Estimates of differential mortality by socioeconomic status play an important role in several domains: in public policy for assessing distributional effects of public programs; in financial markets for the design of life insurance and annuities; and in individual decision making when figuring out how much to save for retirement. Traditionally, reliable estimates of differential mortality require rich panel data with large sample size. This paper proposes a new, less data-intensive approach relying on just a single cross-section of data. Rather than using observations on actual mortality in panel over time, the authors propose relating individuals{\textquoteright} subjective probabilities of survival to variables of socioeconomic status in cross-section. They formulate the method in a model of survey response and provide an empirical validation based on data from the Health and Retirement Study comparing the alternative estimates to the traditional estimates of differential mortality for the same sample of baseline respondents. They present two applications. First, they document an increase in differential mortality in the U.S. over time, and second, they produce comparable estimates of differential mortality for 10 European countries and the U.S. based on subjective probabilities of survival.}, keywords = {Cross-National, Longevity, Mortality, NDI, Older Adults, Survival}, doi = {10.2139/ssrn.1265705}, author = {Delavande, Adeline and Susann Rohwedder} } @article {7238, title = {Divergent pathways? Racial/ethnic differences in older women{\textquoteright}s labor force withdrawal.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 May}, pages = {S122-34}, publisher = {63B}, abstract = {

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

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

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

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

}, keywords = {Aged, Black People, Demography, Disability Evaluation, Disabled Persons, Employment, ethnicity, Hispanic or Latino, Humans, Middle Aged, Retirement, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.3.s122}, author = {Tyson H Brown and David F Warner} } @mastersthesis {6232, title = {Divergent Pathways: Racial/ethnic inequalities in wealth and health trajectories}, year = {2008}, month = {2008}, pages = {Ph.D.}, school = {The University of North Carolina at Chapel Hill}, type = {3315689}, address = {United States -- North Carolina}, abstract = {Extensive empirical evidence documents racial/ethnic disparities in both wealth and health: compared to Whites, Hispanics and Blacks have considerably less wealth and worse health. However, it remains unclear why racial/ethnic inequalities in wealth and health emerge, and whether these inequalities decrease, remain stable, or increase with age. This dissertation aims to fill these gaps in the literature by drawing on life course perspectives and methods to investigate racial/ethnic differences in wealth and health trajectories (i.e., long-term patterns of intra-individual change and stability in wealth and health with age) and how social disadvantage contributes to racial/ethnic wealth and health disparities. The first empirical chapter utilizes panel data from the National Longitudinal Study of Youth (NLSY), a nationally representative survey, and growth curve models to examine racial/ethnic differences in wealth trajectories between ages 21 and 45. Findings reveal that relatively small wealth gaps between Whites, Blacks and Hispanics exist in their early 20s, but these initial inequalities are magnified with age. In the second substantive chapter, data from the Health and Retirement Study (HRS), a nationally representative, longitudinal dataset is used to examine whether racial/ethnic wealth gaps narrow, remain stable, or widen between during the years leading up to retirement (ages 51 and 73). Results show that Whites experience more rapid rates of wealth accumulation than their minority counterparts during middle and later life, resulting in accelerating wealth disparities with age, consistent with a process of cumulative disadvantage. At age 73, the average White household has a net worth of approximately $122,000, whereas both Hispanic and Black household have less than $5,000. Substantial racial/ethnic disparities in wealth trajectories persist after controlling for group differences in life course capital suggesting that other factors such as racial/ethnic differences in portfolio composition, financial transfers, and exposure to discrimination may contribute to wealth disparities. The third substantive chapter uses HRS data to examine racial/ethnic differences in health trajectories. Results indicate that there are dramatic racial/ethnic disparities in both the levels and rates of change in health. Overall, findings from this study show that racial/ethnic inequalities result in divergent aging experiences for Black, Hispanic, and White Americans.}, keywords = {Demographics, Methodology, Women and Minorities}, doi = {https://doi.org/10.17615/31nz-pn49}, author = {Tyson H Brown} } @article {7230, title = {Division of Parent Care Between Spouses}, journal = {Ageing and Society}, volume = {28}, year = {2008}, pages = {571-97}, publisher = {28}, abstract = {Research on the division of family work has focused on household work and child-care to the exclusion of other domains, whereas studies on care-giving for older people typically ignore spouses support to care-givers. In this paper we apply an approach that is typical of research on spouses division of family work in caring for parents, in that the theoretical model focuses on the cultural mandates that guide spouses division of care, namely gender ideologies about appropriate roles, kinship obligations, and taboos against cross-gender personal care. Other predictors of the spousal division of care drawn from economic and health-care utilisation models are also examined. The analyses use pooled data on 1,449 care occasions from the first five waves of the US Health and Retirement Study. It was found that most couples to some extent share parent care, and that the involvement of husbands depended on a complex interplay of cultural mandates and contexts. Husbands participated most in personal care for parents if the care was mandated by kinship obligations (they cared more for their own than their wife s parents), and by cross-gender care taboos (they cared more for fathers than mothers). Other cultural contexts (such as race), a spouse s other commitments, health-related ability, resources (including support from the parents other children), and care-burden also played a role. The findings demonstrate that decisions to care for parents emerge from complex negotiations among spouses and their children and siblings or, in other words, that parental care is a family endeavour.}, keywords = {Adult children, Demographics, Healthcare}, doi = {https://doi.org/10.1017/S0144686X07006915[Opens in a new window]}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {5736, title = {Documentation of Health Behaviors and Risk Factors Measured in the Health and Retirement Study (HRS/AHEAD)}, year = {2008}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The two most important negative behaviors for population health are smoking, which is declining over time, and obesity, which is on the rise. Recognizing the important role of health behaviors and risk factors with respect to issues of key importance to the HRS (health, employment, wealth, timing of retirement), the original designers of the HRS incorporated a set of core measures of health behaviors at the outset. These measures have been expanded over time. The health behaviors and risk factors that are covered in the HRS include: Cigarette smoking (current and past behavior); Alcohol consumption (current behavior and past drinking problems); Body mass index (derived from self-reports of height and weight); Exercise (current level); Preventive health screenings. This report is organized as follows. Section II provides an inventory of the measures of health behaviors and risk factors that are covered in HRS, noting additions and changes that have occurred across waves. Special methodological issues that must be considered when using these data are covered in Section III. Section IV (and corresponding Tables 2-28) presents prevalence estimates and frequency counts for each of the health behavior and risk factor measures over time. Lastly, Section V addresses data quality by comparing HRS prevalence estimates with those from other surveys, reviewing results from some of the studies that have used HRS data to study health behaviors and risk factors, and investigating the level of missing data for these measures.}, keywords = {Health Conditions and Status, Methodology}, author = {Kristi Rahrig Jenkins and Mary Beth Ofstedal and David R Weir} } @article {5734, title = {Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study}, year = {2008}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Eileen M. Crimmins and Heidi M Guyer and Kenneth M. Langa and Mary Beth Ofstedal and Robert B Wallace and David R Weir} } @article {10810, title = {Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments.}, journal = {J Epidemiol Community Health}, volume = {62}, year = {2008}, month = {2008 Jun}, pages = {532-7}, abstract = {

BACKGROUND: The association between schooling and old age cognitive outcomes such as memory disorders is well documented but, because of the threat of reverse causation, controversy persists over whether education affects old age cognition. Changes in state compulsory schooling laws (CSL) are treated as natural experiments (instruments) for estimating the effect of education on memory and mental status among the elderly. Changes in CSL predict changes in average years of schooling completed by children who are affected by the new laws. These educational differences are presumably independent of innate individual characteristics such as IQ.

METHODS: CSL-induced changes in education were used to obtain instrumental variable (IV) estimates of education{\textquoteright}s effect on memory (n = 10,694) and mental status (n = 9751) for white, non-Hispanic US-born Health and Retirement Survey participants born between 1900 and 1947 who did not attend college.

RESULTS: After adjustment for sex, birth year, state of birth and state characteristics, IV estimates of education{\textquoteright}s effect on memory were large and statistically significant. IV estimates for mental status had very wide confidence intervals, so it was not possible to draw meaningful conclusions about the effect of education on this outcome.

CONCLUSIONS: Increases in mandatory schooling lead to improvements in performance on memory tests many decades after school completion. These analyses condition on individual states, so differences in memory outcomes associated with CSL changes cannot be attributed to differences between states. Although unmeasured state characteristics that changed contemporaneously with CSL might account for these results, unobserved genetic variation is unlikely to do so.

}, keywords = {Aged, Aging, Censuses, Child, Cognition, Education, Educational Status, Female, Health Status, Humans, Least-Squares Analysis, Male, Massachusetts, Memory, Schools, Socioeconomic factors}, issn = {1470-2738}, doi = {10.1136/jech.2006.059469}, author = {M. Maria Glymour and Ichiro Kawachi and Jencks, Christopher and Lisa F Berkman} } @article {5737, title = {Does the Rise in the Full Retirement Age Encourage Disability Benefits Applications? Evidence from the Health and Retirement Study}, year = {2008}, institution = {Ann Arbor, University of Michigan}, abstract = {As the Social Security full retirement age rises, the relative generosity of Social Security retirement benefits compared to disability benefits is declining, raising the incentive for insured people to apply for disability benefits. After controlling for other differences in observable characteristics, such as life-time earnings, we find that an average four month increase in the FRA slightly increases the two-year DI application rate by 0.04-0.30 percentage points. The effect is greater among those with a work limiting health problem (0.22-0.89 percentage points)}, keywords = {Disabilities, Public Policy, Retirement Planning and Satisfaction, Social Security}, url = {https://mrdrc.isr.umich.edu/pubs/does-the-rise-in-the-full-retirement-age-encourage-disability-benefits-applications-evidence-from-the-health-and-retirement-study/}, author = {Xiaoyan Li and Nicole Maestas} } @article {7227, title = {Downward Trend in Dementia Linked to Better Education and Personal Wealth}, journal = {British Medical Journal (International Edition)}, volume = {336}, year = {2008}, pages = {466-7}, publisher = {336}, abstract = {Cognitive decline is declining among Americans older than 70, a study of 11,000 elderly US residents carried out at the University of Michigan Medical School has found. The study showed that higher education and higher net financial worth protected against cognitive impairment. The authors used data from the Health and Retirement Study, a nationally representative, population based longitudinal study of US adults.}, keywords = {Demographics, Health Conditions and Status, Net Worth and Assets}, author = {Hopkins Tanne, Janice} } @article {7228, title = {Dynamics of work disability and pain.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 Mar}, pages = {496-509}, publisher = {27}, abstract = {

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

}, keywords = {Aged, Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Models, Statistical, pain, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2007.05.002}, author = {Arie Kapteyn and James P Smith and Arthur H.O. vanSoest} } @article {8460, title = {Dear Graduate, Please Keep The Change}, journal = {New York Times}, year = {2007}, month = {June 2, 2007}, edition = {Late Edition (East Coast)}, chapter = {C.1}, abstract = {There may be another compelling reason to save and that is that while many aspects of retirement savings are predictable, the big unknowable is health care costs. {\textquoteright}{\textquoteright}If you believe in the logic of the life cycle model, then once you get used to peanut butter, all else follows,{\textquoteright}{\textquoteright} said Jonathan Skinner, a economics professor at Dartmouth College who has studied retirement issues and recently wrote a paper titled {\textquoteright}{\textquoteright}Are You Sure You{\textquoteright}re Saving Enough for Retirement?{\textquoteright}{\textquoteright} for the National Bureau of Economic Research. {\textquoteright}{\textquoteright}That{\textquoteright}s the assumption that I am questioning: Do people want to be stuck in peanut butter in retirement?{\textquoteright}{\textquoteright} [Skinner is referencing projections of increased out-of-pocket medical expenses that are based on Health and Retirement Study data.]}, keywords = {Consumption and Savings, Event History/Life Cycle, Retirement Planning and Satisfaction}, author = {Darlin, Damon} } @article {7172, title = {DEFINED CONTRIBUTION PLANS, DEFINED BENEFIT PLANS, AND THE ACCUMULATION OF RETIREMENT WEALTH.}, journal = {J Public Econ}, volume = {91}, year = {2007}, month = {2007 Nov 01}, pages = {2062-2086}, publisher = {91}, abstract = {

The private pension structure in the United States, once dominated by defined benefit (DB) plans, is currently divided between defined contribution (DC) and DB plans. Wealth accumulation in DC plans depends on the participant{\textquoteright}s contribution behavior and on financial market returns, while accumulation in DB plans is sensitive to a participant{\textquoteright}s labor market experience and to plan parameters. This paper simulates the distribution of retirement wealth under representative DB and DC plans. It uses data from the Health and Retirement Study (HRS) to explore how asset returns, earnings histories, and retirement plan characteristics contribute to the variation in retirement wealth outcomes. We simulate DC plan accumulation by randomly assigning individuals a share of wages that they and their employer contribute to the plan. We consider several possible asset allocation strategies, with asset returns drawn from the historical return distribution. Our DB plan simulations draw earnings histories from the HRS, and randomly assign each individual a pension plan drawn from a sample of large private and public defined benefit plans. The simulations yield distributions of both DC and DB wealth at retirement. Average retirement wealth accruals under current DC plans exceed average accruals under private sector DB plans, although DC plans are also more likely to generate very low retirement wealth outcomes. The comparison of current DC plans with more generous public sector DB plans is less definitive, because public sector DB plans are more generous on average than their private sector counterparts.

}, issn = {0047-2727}, doi = {10.1016/j.jpubeco.2007.08.004}, author = {James M. Poterba and Joshua Rauh and Steven F Venti and David A Wise} } @article {7183, title = {Disease prevalence and survey design effects: A response to Weir and Smith}, journal = {Social Science and Medicine}, volume = {65}, year = {2007}, pages = {1078}, publisher = {65}, abstract = {Evidence provided by Weir and Smith, particularly the findings from the National Health and Nutrition Examination Survey (NHANES), leads us to conclude that an increase in arthritis prevalence during the 1990s in the United States is probable, but the trend is likely overstated in the Health and Retirement Study (HRS). We show that a mistake in our earlier method does not change substantively our previous conclusion that survey duration effects are occurring in the HRS, a finding that is also supported by a variety of regression models (including that of Weir and Smith). Furthermore, very little evidence exists for an upward trend among self-reporters in the National Health Interview Survey (NHIS), and less than 25 of the increase in the HRS over the 1990s can be attributed to increases in obesity.}, keywords = {Health Conditions and Status, Methodology}, doi = {https://doi.org/10.1016/j.socscimed.2007.04.039}, author = {Sven E. Wilson and Benjamin L. Howell} } @inbook {5221, title = {Division of Care Among Adult Children}, booktitle = {Caregiving Contexts: Cultural, familial, and societal implications}, year = {2007}, note = {ProCite field 6 : In ProCite field 8 : eds}, pages = {133-159}, publisher = {Springer}, organization = {Springer}, address = {New York}, abstract = {Adult children play a central role within the family context of care for frail elders. As the preceding chapter by Stoller and Miklowski indicated, older married adults turn first to a spouse for assistance. However, rising divorce rates during the past decades may decrease the availability of spouses as caregivers in the future, and, as the gender gap in longevity closes and more couples age together, both spouses may experience frailty or cognitive decline and thus require support from other family members. After spouses, the next preferred group of potential family caregivers is adult children (Cantor, 1975). Today{\textquoteright}s cohort of older adults is unique with regard to their high fertility, which produced the baby boom cohorts. As a result, these parents have, on average, more children than generations that precede or follow them. While children of today{\textquoteright}s older adults tend to have more siblings than older and younger cohorts, they also have more parents who survived into old age than earlier cohorts, and thus more potential occasions to provide care. Both the availability of multiple adult children as potential caregivers and the potential care needs of multiple parents or parents-in-law likely heighten the complexity of care networks and the need to negotiate and navigate multiple relationships, requiring greater coordination of care activities and enhancing opportunities for conflict over the allocation of care responsibilities.}, keywords = {Adult children, Healthcare}, author = {Adam Davey and Maximiliane E Szinovacz}, editor = {Adam Davey and Maximiliane E Szinovacz} } @article {5683, title = {Do Households Have Enough Retirement Wealth?}, year = {2007}, institution = {Social Science Research Network}, abstract = {Dramatic structural changes in the U.S. pension system, along with the impending wave of retiring baby boomers, have given rise to a broad policy discussion of the adequacy of household retirement wealth. We construct a uniquely comprehensive measure of wealth for households aged 51 and older in 2004 that includes expected wealth from Social Security, defined benefit pensions, life insurance, annuities, welfare payments, and future labor earnings. Abstracting from the uncertainty surrounding asset returns, length of life and medical expenses, we assess the adequacy of wealth using two expected values: an annuitized value of comprehensive wealth and the ratio of comprehensive wealth to the actuarial present value of future poverty lines. We find that most households in these older cohorts can expect to have sufficient total resources to finance adequate consumption throughout retirement, taking as given expected lifetimes and current Social Security benefits. We find a median annuity value of wealth equal to 32,000 per person per year in expected value and a median ratio of comprehensive wealth to poverty-line wealth of 3.56. About 12 percent of households, however, do not have sufficient wealth to finance consumption equal to the poverty line over their expected lifetimes, even after including the value of Social Security and welfare benefits, and an additional 9 percent can expect to be relatively close to the poverty line.}, keywords = {Income, Net Worth and Assets}, url = {http://ssrn.com/abstract=968412}, author = {Love, David A. and Paul A Smith and McNair, Lucy C.} } @article {7150, title = {Do panel surveys really make people sick? A commentary on Wilson and Howell (60:11, 2005, 2623-2627).}, journal = {Soc Sci Med}, volume = {65}, year = {2007}, month = {2007 Sep}, pages = {1071-7; discussion 1078-81}, publisher = {65}, abstract = {

In a recent article in this journal, Wilson and Howell [2005. Do panel surveys make people sick? US arthritis trends in the Health and Retirement Survey. Social Science \& Medicine, 60(11), 2623-2627.] argue that the sharp trend of rising age-specific arthritis prevalence from 1992 to 2000 in the USA among those in their 50s based on the original Health and Retirement Study (HRS) cohort of respondents is "almost surely spurious." Their reasons are that no such trend is found in the National Health Interview Study (NHIS) over this same time period, and that an introduction of a new birth cohort into HRS in 1998 also indicates no trend. They also claim that there may be an inherent bias in panel surveys leading respondents to report greater levels of disease as the duration of their participation in the panel increases. This bias, which they call "panel conditioning," suggests a tendency for participants in a longitudinal survey to seek out medical care and diagnosis of symptoms asked about in previous waves. In this paper, we show that the evidence presented and the conclusions reached by Wilson and Howell are incorrect. Properly analyzed, three national health surveys--the NHIS, National Health and Nutrition Examination Survey (NHANES), and HRS--all show increases in age-specific arthritis prevalence during the 1990s. Since the new HRS sample cohort introduced in 1998 represents only a part of that birth cohort, we also demonstrate that Wilson and Howell{\textquoteright}s evidence in favor of panel conditioning was flawed. We find little indication of panel conditioning among existing participants in a panel survey.

}, keywords = {Arthritis, Female, Health Surveys, Humans, Male, Middle Aged, Prevalence, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.04.019}, author = {David R Weir and James P Smith} } @article {7159, title = {Do the Sick Retire Early? Chronic illness, asset accumulation and early retirement}, journal = {Applied Economics}, volume = {39}, year = {2007}, pages = {1921}, publisher = {39}, abstract = {Our objective is to determine how chronic illness affects asset accumulation and retirement. Previous studies have found that poor health leads to early retirement, but those studies failed to look at the indirect impact of chronic illness on retirement. Using data from the Health and Retirement Study, we define an illness as chronic if the individual reports having asthma, cancer, heart disease, stroke or diabetes for four or more years. We first estimate how a chronic illness influences asset accumulation. We then estimate how asset accumulation and current poor health influence retirement. We observe that the vast majority of the chronically ill population do not report their general health to be poor nor do they report functional limitations in activities of daily living. Nevertheless, our results indicate that chronic illness leads these people to accumulate fewer assets during their working years and consequently retire later. Neither researchers nor policymakers discussing the many critical issues surrounding illness and retirement have addressed this issue.}, keywords = {Health Conditions and Status, Net Worth and Assets, Retirement Planning and Satisfaction}, url = {https://commons.lib.niu.edu/handle/10843/13288}, author = {Miah, M. Solaiman and Wilcox-G{\"o}k, Virginia} } @article {7135, title = {Do Truly Comparable Public and Private Sector Workers Show Any Compensation Differential?}, journal = {Journal of Labor Research}, volume = {28}, year = {2007}, pages = {117}, publisher = {28}, abstract = {Using data from the Health and Retirement Study, we apply propensity score matching methods to examine evidence on the rent paid to public sector workers in the United States. Traditionally, wage differentials are computed assuming that workers from both public and private sectors are comparable, without actually controlling for the comparability of the units. Using this method, we are able to control for selection bias and, at the same time, select a subsample of comparable workers in terms of their conditional probability of choosing to work in the public sector on which to estimate separate wage equations.}, keywords = {Employment and Labor Force, Income}, url = {https://www.researchgate.net/publication/225573004_Do_Truly_Comparable_Public_and_Private_Sector_Workers_Show_Any_Compensation_Differential}, author = {Ramoni-Perazzi, Josefa and Bellante, Don} } @article {7128, title = {Does money buy better health? Unpacking the income to health association after midlife.}, journal = {Health (London)}, volume = {11}, year = {2007}, month = {2007 Apr}, pages = {199-226}, publisher = {11}, abstract = {

This article estimates the effect of household financial resources on health after midlife using models that minimize health-related selectivity and unobserved heterogeneity bias. I focus on the self-rated health and mobility limitations of adults transitioning into retirement over six panels of the Health and Retirement Study (1992-2002; age 51-61 at wave one; N = 7602). Standard regression models that adjust for health-related selection with prospective and retrospective controls suggest a significant influence of long-term income on health, but an insignificant influence of short-term income. Further adjustment for unobserved fixed effects also suggests that short-term income is insignificant. Sizable recent and long-term health feedbacks to income for a portion of the HRS respondents underscore the need to control for the confounding influence of health over the lifecourse. Together these results suggest that adults after midlife are heterogeneous with respect to the causal and selective processes generating the observed association between income and health.

}, keywords = {Aged, Attitude to Health, Employment, Health Status Indicators, Humans, Income, Middle Aged, Mobility Limitation, Models, Econometric, Retirement, Self Concept, Sociology, Medical, United States}, issn = {1363-4593}, doi = {10.1177/1363459307074694}, author = {Berry, Brent M.} } @article {7177, title = {Does more health care improve health among older adults? A longitudinal analysis.}, journal = {J Aging Health}, volume = {19}, year = {2007}, month = {2007 Dec}, pages = {888-906}, publisher = {19}, abstract = {

OBJECTIVE: This research assesses the association of health services use with subsequent physical health among older Americans, adjusting for the confounding between health care use and prior health.

METHOD: Longitudinal data are from the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Linear and logistic regressions are used to model the linkages between medical care use and health outcomes, including self-rated health, functional limitations, and mortality.

RESULTS: There is limited evidence that increased health care use is correlated with improved subsequent health. Increased use of medical care is largely associated with poorer health outcomes. Moreover, there are no significant interaction effects of health care use and baseline health on Activities of Daily Living and Instrumental Activities of Daily Living, despite the existence of a significant but very small interaction effect on self-rated health.

CONCLUSIONS: The findings have implications for the quality of care delivered by the American health care system.

}, keywords = {Activities of Daily Living, Aged, Health Services, Health Services for the Aged, Health Status, Humans, Longitudinal Studies, United States}, issn = {0898-2643}, doi = {10.1177/0898264307308338}, author = {Ezra Golberstein and Jersey Liang and A. R. Quinones and Frederic D Wolinsky} } @article {7178, title = {Does physician communication influence older patients{\textquoteright} diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS).}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {62}, year = {2007}, month = {2007 Dec}, pages = {1435-42}, publisher = {62A}, abstract = {

BACKGROUND: Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients{\textquoteright} diabetes self-management and glycemic control.

METHODS: We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81\%). Independent associations were examined between patients{\textquoteright} ratings of their physician{\textquoteright}s PCOM and PDM with patients{\textquoteright} reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n=1233), the relationship was assessed between patient self-management and HbA1c values.

RESULTS: In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p<.001) and with all self-management domains (p<.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p=.001) and foot care (p=.002). PDM alone was associated with exercise and blood glucose monitoring (both p<.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B= -.10, p=.005).

CONCLUSION: Among these older adults, both their diabetes providers{\textquoteright} provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.

}, keywords = {Aged, Blood Glucose, Communication, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Male, Multivariate Analysis, Physician-Patient Relations, Self Care}, issn = {1079-5006}, doi = {10.1093/gerona/62.12.1435}, author = {Michele M Heisler and Cole, Ian and David R Weir and Eve A Kerr and Rodney A. Hayward} } @article {5700, title = {Dynamic Inefficiencies in Employment-Based Health Insurance System: Theory and Evidence}, number = {13371}, year = {2007}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {We investigate how the employment-based health insurance system in the U.S. affects individuals{\textquoteright} life-cycle health-care decisions. We take the viewpoint that health is a form of human capital that affects workers{\textquoteright} productivities on the job, and derive implications of employees{\textquoteright} turnover on the incentives to undertake health investment. Our model suggests that employee turnovers lead to dynamic inefficiencies in health investment, and particularly, it suggests that employment-based health insurance system in the U.S. might lead to an inefficient low level of individual health during individuals{\textquoteright} working ages. Moreover, we show that under-investment in health is positively related to the turnover rate of the workers{\textquoteright} industry and increases medical expenditure in retirement. We provide empirical evidence for the predictions of the model using two data sets, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). In MEPS, we find that employers in industries with high turnover rates are much less likely to offer health insurance to their workers. When employers offer health insurance, the contracts have higher deductibles and employers{\textquoteright} contribution to the insurance premium is lower in high turnover industries. Moreover, workers in high turnover industries have lower medical expenditure and undertake less preventive care. In HRS, instead we find that individuals who were employed in high turnover industries have higher medical expenditure when retired. The magnitude of our estimates suggests significant degree of intertemporal inefficiencies in health investment in the U.S. as a result of the employment-based health insurance system. We also evaluate and cast doubt on alternative explanations.}, keywords = {Employment and Labor Force, Healthcare, Medicare/Medicaid/Health Insurance}, doi = {10.3386/w13371}, author = {Fang, Hanming and Alessandro Gavazza} } @mastersthesis {6417, title = {The Demography of Community Based Care: The Late Middle-Aged Versus the Elderly}, year = {2006}, month = {2006}, school = {Brown University}, keywords = {Health Conditions and Status, Healthcare}, author = {Julie C Lima} } @mastersthesis {6356, title = {Depression, activities of daily living, and retirement}, year = {2006}, month = {2006}, school = {University of North Texas}, abstract = {Depression is a common clinical and subclinical psychiatric disorder in the middle-age to older adult population. This study examined the relationship between depression and activities of daily living (ADLs) in middle-age to older adults. This study examined longitudinal data from the 1998, wave 4, and 2000, wave 5, of the Health and Retirement Study (HRS), a National Panel Study sponsored by the National Institute on Aging. A negative cross-sectional and longitudinal relationship between higher ADL scores and depression was hypothesized. A goal of the present study was to determine the temporal precedence of these two constructs using a cross-lag panel design to first examine the cross-sectional relationship between ADLs and depression at time-one and at time-two, and then the time-one to time-two longitudinal relationships to examine temporal precedence possible causal relationships. Finally, differences in these correlational relationships by retirement status and then by marital status were tested. There were several interesting findings, including those who were retired in both 1998 and 2000 reported fewer ADLs (i.e., worse functioning), but also reported better health than those who were working in both 1998 and 2000. Similarly, those people who were not married in both 1998 and 2000 reported fewer ADLs but better health than those who were married in both 1998 and 2000. Married individuals reported fewer depressive symptoms than those who were not married.}, keywords = {Health Conditions and Status, Healthcare}, author = {Jackson, Lauren Innes} } @article {5657, title = {Determinants and Consequences of Bargaining Power in Households}, year = {2006}, institution = {Boston College, Center for Retirement Research at Boston College}, abstract = {A growing literature offers indirect evidence that the distribution of bargaining power within a household influences decisions made by the household. These results undermine the notion that a household can be treated as a unitary decision maker. The indirect evidence links household outcomes to variables that are assumed to influence the distribution of bargaining power within the household. In this paper, we have data on whether a husband or wife in the Health and Retirement Study has the final say when making major decisions in a household. We use this variable to analyze determinants and some consequences of bargaining power. Our analysis overcomes endogeneity problems arising in many earlier studies and constitutes the missing link confirming the importance of household bargaining models.}, keywords = {Adult children, End of life decisions}, url = {http://www.bc.edu//centers/crr}, author = {Friedberg, Leora and Anthony Webb} } @article {7079, title = {Development and Validation of a Prognostic Index for 4-year Mortality in Older Adults}, journal = {Journal of the American Medical Association}, volume = {295}, year = {2006}, note = {Article English}, pages = {801 -808}, publisher = {295}, abstract = {Context: Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment. . Objective To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report. . Design, Setting, and Participants Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index. Main Outcome Measure Death by December 31, 2002. Results: The overall response rate was 81 . During the 4-year follow-up, there were 1361 deaths (12 ) in the development cohort and 1072 deaths (13 ) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, 85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index 25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4 risk, 6 to 9 points predicting a 15 risk, 10 to 13 points predicting a 42 risk, and 14 or more points predicting a 64 risk. The risk index showed excellent discrimination with a c statistic of 0.84 in the development cohort and 0.82 in the validation cohort. Conclusion: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Methodology}, author = {Sei J. Lee and Lindquist, Karla and Mark Segal and Kenneth E Covinsky} } @article {7113, title = {Development and validation of an index to predict activity of daily living dependence in community-dwelling elders}, journal = {Medical Care}, volume = {44}, year = {2006}, pages = {149-157}, publisher = {44}, abstract = {BACKGROUND: Maintaining independence in daily functioning is an important health outcome in older adults. A key measure of functional independence in elders is the ability to do activities of daily living (ADL) without the assistance of another person. However, few prognostic indices have been developed that stratify elders into groups at variable risk for developing ADL dependence. OBJECTIVE: We sought to develop and validate a prognostic index that distinguishes between elders at different risk of ADL dependence. RESEARCH DESIGN, SUBJECTS, AND MEASURES: We studied subjects enrolled in Asset and Health Dynamics Among the Oldest Old (AHEAD), a nationally representative cohort of elders older than the age of 70. We included 5239 subjects (mean age, 77) reporting that they could do each of 5 ADL (bathing, dressing, toileting, transferring, and eating) without the assistance of another person at baseline. Subjects were divided into development (n = 3245) and validation (n = 1994) samples based on region of the United States. Our primary outcome was the need for help (dependence) with at least one ADL at 2 years. We used logistic regression to select among predictor variables encompassing several domains: demographic characteristics, comorbid conditions, functional status, cognitive status, and general health indicators. RESULTS: The 9 independent predictors of 2-year ADL dependence were age older than 80, diabetes, difficulty walking several blocks, difficulty bathing or dressing, need for help with personal finances, difficulty lifting 10 pounds, inability to name the Vice President, history of falling, and low body mass index. We created a risk score by assigning 1 point to each risk factor. In the development sample, rates of 2-year ADL dependence in subjects with 0, 1, 2, 3, 4, and 5 or more risk factors were 1.3 , 2.8 , 3.8 , 10 , 22 , and 33 , respectively (P 0.001, roc area = 0.79). In the validation sample, the rates were 0.7 , 4.3 , 8.7 , 11 , 18 , and 40 (P 0.001, roc area = 0.77). The risk score also discriminated between subjects at variable risk for a combined outcome of either ADL decline or death (4.3 , 7.6 , 15 , 21 , 30 , and 47 ). CONCLUSION: Using data available from patient reports, we validated a simple risk index that distinguished between elders at variable risk of ADL dependence. This index may be useful for identifying elders at high risk of poor outcomes or for risk adjustment.}, keywords = {Health Conditions and Status, Healthcare, Risk Taking}, author = {Kenneth E Covinsky and Hilton, Joan and Lindquist, Karla and Dudley, R. A.} } @article {8785, title = {Differential Mortality, Uncertain Medical Expenses, and the Saving of Elderly Singles}, year = {2006}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {People have heterogenous life expectancies: women live longer than men, rich people live longer than poor people, and healthy people live longer than sick people. People are also subject to heterogenous out-of-pocket medical expense risk. We construct a rich structural model of saving behavior for retired single households that accounts for this heterogeneity, and we estimate the model using AHEAD data and the method of simulated moments. We find that the risk of living long and facing high medical expenses goes a long way toward explaining the elderly{\textquoteright}s savings decisions. Specifically, medical expenses that rise quickly with both age and permanent income can explain why the elderly singles, and especially the richest ones, run down their assets so slowly. We also find that social insurance has a big impact on the elderly{\textquoteright}s savings.}, keywords = {Medical Expenses, Mortality, Older Adults, Savings, Singles}, doi = {10.3386/w12554}, url = {http://www.nber.org/papers/w12554.pdf}, author = {Mariacristina De Nardi and Eric French and John Bailey Jones} } @article {5670, title = {Discouraged Workers? Job Search Outcomes of Older Workers}, year = {2006}, institution = {The University of Michigan, Michigan Retirement Research Center}, abstract = {Many have suggested we adopt policies that explicitly encourage the elderly to work. Behind this suggestion is the assumption that if an older person desires a job, one will be found; however, little is known about the extent to which this is true, and in the Health and Retirement Study, many more respondents say they expect to work after retirement than actually undertake work. This raises an important question: To what extent can the elderly readily find suitable jobs? In the context of a theoretical job search model, we examine the decision to search for a job and the probability of transitioning to employment using a large sample of non-workers from the Health and Retirement Study. The effects of both supply-side factors (individual characteristics) and demand-side factors (local labor market conditions) are estimated. We find employment transition rates are relatively low for older searchers: only half of older searchers successfully attain jobs. We examine various explanations for this result, including variation in search intensity, reservation wages, and the possibility of intervening health shocks. We conclude that about 13 of older job searchers becomes a discouraged worker in the sense of being willing to work at the prevailing wage, but unable to find a job.}, keywords = {Employment and Labor Force}, url = {https://mrdrc.isr.umich.edu/publications/Papers/pdf/wp133.pdf}, author = {Nicole Maestas and Xiaoyan Li} } @article {7068, title = {Disease and Disadvantage in the United States and in England}, journal = {Journal of the American Medical Association}, volume = {295}, year = {2006}, pages = {2037-2045}, publisher = {295}, abstract = {Context The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown. Objective To assess the relative heath status of older individuals in England and the United States, especially how their health status varies by important indicators of socioeconomic position. Design, Setting, and Participants We analyzed representative samples of residents aged 55 to 64 years from both countries using 2002 data from the US Health and Retirement Survey (n=4386) and the English Longitudinal Study of Aging (n=3681), which were designed to have directly comparable measures of health, income, and education. This analysis is supplemented by samples of those aged 40 to 70 years from the 1999-2002 waves of National Health and Nutrition Examination Survey (n=2097) and the 2003 wave of the Health Survey for England (n=5526). These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences. To ensure that health differences are not solely due to health issues in the black or Latino populations in the United States, the analysis is limited to non-Hispanic whites in both countries. Main Outcome Measure Self-reported prevalence rates of several chronic diseases related to diabetes and heart disease, adjusted for age and health behavior risk factors, were compared between the 2 countries and across education and income classes within each country. Results The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middleaged adults, mean levels of C-reactive protein are 20 higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14 lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well. Conclusion Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.}, keywords = {Cross-National, Health Conditions and Status, Methodology}, url = {http://www.jama.com}, author = {James Banks and Michael Marmot and Oldfield, Zo{\"e} and James P Smith} } @mastersthesis {6051, title = {Diverse Pathways in Retirement Transitions: Influences of Family, Work, Wealth, and Health}, year = {2006}, month = {2006}, school = {Oregon State University}, abstract = {Shaped by life course and feminist perspectives, this study investigated the influence of finances, human capital, health, family situations, and work factors on two different retirement transitions among married and partnered men and women. Because women and men arrive at retirement under different life circumstances, logistic regression analyses were conducted separately by gender. Respondents were drawn from Waves 1{\textendash}4 of the biennial, longitudinal Health and Retirement Survey (HRS) and included individuals who retired between Waves 1 and 2 (1992{\textendash}1994), Waves 2 and 3 (1994{\textendash}1996), and Waves 3 and 4 (1996{\textendash}1998). Retirees (n = 1,275) transitioned from the labor force at Time 1 to either a partial or complete retirement at Time 2. Results indicated that, relative to partially retired men, completely retired men had higher earnings at their job, worked for larger companies, were more likely labor union members, were covered in pension plans, started pension incomes at Time 2, had health insurance that continued in retirement, likely covered partners in their health plan, were older, were in poorer health, and had provided 400+ hours of care to a grandchild in the last year. Relative to completely retired men, partially retired men had more wealth, were more likely receiving health insurance coverage from their partners{\textquoteright} health plan, had partners who were working for pay at Time 2, had fewer years at their last job, retired earlier than planned, and perceived their last jobs as important. Relative to partially retired women, completely retired women were more likely covered in pension plans, had health insurance that continued in retirement, were more likely labor union members, were White, were older, were in poorer health, and had grandchildren in the home at the time of retirement. Relative to completely retired women, partially retired women had partners who were working for pay at Time 2, retired earlier than planned, and were providing financial support to another individual. Results suggest that partial retirement is a possible solution for workers trying to negotiate a labor force exit while keeping financial and health benefits. Implications and future directions were explored.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status, Retirement Planning and Satisfaction, Women and Minorities}, author = {Peters, Cheryl L.} } @article {7102, title = {Does Caregiving Increase Poverty among Women in Later Life? Evidence from the Health and Retirement Survey}, journal = {Journal of Health and Social Behavior}, volume = {47}, year = {2006}, pages = {258-74}, publisher = {47}, abstract = {Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women{\textquoteright}s subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women{\textquoteright}s risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women{\textquoteright}s poverty risks in later life by intensifying the negative effects of stopping work and declining health on women{\textquoteright}s economic well-being.}, keywords = {Healthcare, Income, Women and Minorities}, author = {Chizuko Wakabayashi and Donato, Katharine M.} } @article {7063, title = {Does Religion Influence Patient Satisfaction?}, journal = {American Journal of Health Behavior}, volume = {30}, year = {2006}, pages = {85-91}, publisher = {30}, abstract = {Objectives: To determine if patient satisfaction varies by level of individual religiosity. Methods: Data from the Health and Retirement Study (HRS), a nationally representative sample of older adults in the United States, were used to assess the relationship between religious salience (importance) and patients satisfaction with their health care encounters. Results: Higher levels of religious salience are significantly related to being very satisfied with one s health care, even after demographic, social, and health variables are taken into account. Conclusions: Researchers, practitioners, and administrators should be aware that religion may significantly influence how patients rate their health care experiences.}, keywords = {Demographics, Healthcare}, author = {Benjamins, Maureen Reindl} } @article {7093, title = {Does Working Longer Make People Healthier and Happier?}, journal = {Center for Retirement Research Issue Brief}, volume = {Series 2}, year = {2006}, publisher = {Series 2}, abstract = {Financing retirement is one of the major challenges facing an aging U.S. population. If individuals continue to retire in their early 60s, many will be hard pressed to maintain an adequate standard of living throughout retirement due to the declining role of Social Security, the shift to 401(k) plans, and low personal saving rates. Combine the retirement income crunch with the dramatic increase in life expectancy, and continued employment in later life appears to be an attractive option. While it is clear that working longer would benefit older Americans financially, less attention has focused on the non-monetary effects of work at older ages. This brief addresses the impact of late-life paid work on physical and psychological well-being. The first section reviews the literature on work at older ages and elderly well-being. The second section describes the analysis. The third and fourth sections present the results. The fifth section identifies vulnerable groups. A final section offers concluding thoughts.}, keywords = {Employment and Labor Force, Expectations, Health Conditions and Status, Healthcare}, author = {Calvo, Esteban} } @article {7105, title = {Driving cessation and consumption expenses in the later years.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Nov}, pages = {S347-53}, publisher = {61B}, abstract = {

OBJECTIVES: This study examined the association between consumption and driving status among older persons within the context of selected variables, including self-rated health and functional status.

METHODS: The data were from the 1998, 2000, and 2002 Health and Retirement Study and the 2003 Health and Retirement Study Consumption and Activities Mail Survey. We conducted Tobit regression analyses on five consumption categories of basic needs (such as food) and higher order needs (such as trips and dining out).

RESULTS: Consumption and driving status were significantly associated, showing that driving cessation was related to a 46\% to 63\% reduction in spending on trips, tickets, and dining out. Another significant relationship emerged between consumption and having never driven. Driving cessation was minimally related to consumption of basic needs (such as food and clothing) and was more strongly associated with higher order needs (such as trips).

DISCUSSION: The findings demonstrate the association between older people{\textquoteright}s driving status and consumption, specifically higher order activities. Older persons who drive and, presumably, have more opportunities to go to stores, restaurants, and other outside events, spend more on food, tickets, and dining out than those who cease driving or have never driven. Although the direction of causality remains unclear, these findings have implications for those concerned with alternative transportation resources for older adults.

}, keywords = {Aged, Automobile Driving, Economics, Female, Health Status, Humans, Male, Sex Factors, Surveys and Questionnaires, Transportation}, issn = {1079-5014}, doi = {10.1093/geronb/61.6.s347}, author = {Hyungsoo Kim and Virginia E. Richardson} } @article {7116, title = {Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?}, journal = {BMC Health Serv Res}, volume = {6}, year = {2006}, month = {2006 Oct 09}, pages = {131}, publisher = {6}, abstract = {

BACKGROUND: Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.

METHODS: Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.

RESULTS: 96 (11\%) of the veterans were classified as dual users. 766 men (50.3\%) had died by December 31, 2002, including 64.9\% of the dual users and 49.3\% of all others, for an attributable mortality risk of 15.6\% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1\% increased relative risk of mortality (AHR = 1.561; p = .009).

CONCLUSION: An indirect measure of veterans{\textquoteright} dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

}, keywords = {Aged, Aged, 80 and over, Deductibles and Coinsurance, Episode of Care, Health Services Research, Hospitals, Veterans, Humans, Male, Medicare, Mortality, Outcome Assessment, Health Care, Proportional Hazards Models, Quality Indicators, Health Care, Risk Assessment, Selection Bias, Surveys and Questionnaires, United States, United States Department of Veterans Affairs, Veterans}, issn = {1472-6963}, doi = {10.1186/1472-6963-6-131}, author = {Frederic D Wolinsky and Thomas R Miller and An, Hyonggin and Paul R Brezinski and Thomas E Vaughn and Gary E Rosenthal} } @article {5669, title = {A Dynamic Model of Retirement and Social Security Reform Expectations: A Solution to the New Early Retirement Puzzle}, number = {2006-134}, year = {2006}, institution = {Michigan Retirement Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {The need for Social Security Reform in the next years is hardly a matter of debate. Therefore, the widespread believe among Americans that Social Security will not be able to pay benefits in the long run at the level that was anticipated, does not come as a surprise. The government acknowledges the situation, and predicts that substantial benefits cuts will be necessary, yet no legislation has been passed to tackle the problem. Researchers, however, have rarely modeled the uncertainty over Social Security reform and benefit levels, and how they affect claiming behavior and retirement. The purpose of this paper is to assess the extent to which these perceptions of future cuts might explain the puzzle of earlier take-up despite bigger penalties to doing so in the presence of increasing longevity. By introducing a small amount of uncertainty (based on self-reported responses to questions regarding expectations over future cuts) of a relatively small cut (compared with what the government reports as necessary to solve the crisis) in a dynamic life-cycle model of retirement, we are able to match the claiming behavior observed in the data, without relying on heterogeneous preferences. Our results support the hypothesis that expectations over future benefits are affecting current behavior. We find that a mis-specified dynamic retirement model would erroneously predict that an increase in the NRA would delay claiming behavior and increase labor supply at older ages. Once the appropriate earnings test incentives are modeled, and we account for the probability of reforms to the system, an increase in the NRA has little effect on claiming behavior, and it can even increase the proportion of individuals claiming before the NRA.}, keywords = {Expectations, Health Conditions and Status, Public Policy, Retirement Planning and Satisfaction, Social Security}, doi = {http://dx.doi.org/10.2139/ssrn.1095253}, author = {Hugo Ben{\'\i}tez-Silva and Debra S. Dwyer and Sanderson, Warren C.} } @article {7016, title = {Depression and Comorbid Pain as Predictors of Disability, Employment, Insurance Status, and Health Care Costs}, journal = {Psychiatric Services}, volume = {56}, year = {2005}, pages = {468-74}, publisher = {56}, abstract = {OBJECTIVE: Individuals with depression commonly experience pain with unclear pathology. This study examined depression and comorbid pain and associated outcomes over six years in a nationally representative cohort of older Americans. METHODS: The Health and Retirement Study began in 1992 and follows 9,825 individuals between the ages of 50 and 61 years. The study reported here used data beginning in 1994 to contrast individuals with depression and those with depression plus comorbid pain. Regression models adjusted for differences in sociodemographic characteristics and health status. RESULTS: Baseline (1994) data were available for 8,280 participants. At baseline, 65.2 percent reported that they did not have pain or depression, 8.1 percent had depression alone, 15.5 percent had mild or moderate pain alone, 2 percent had severe pain alone, 6.6 percent had depression plus mild or moderate pain, and 2.6 percent had depression plus severe pain. Compared with the group with no pain or depression, all the groups with depression, pain, or both had greater decrements in outcomes. Groups tended to have greater decrements in outcomes as levels of pain increased. Overall, no statistically significant differences were found between the groups with depression plus pain and their corresponding groups with pain alone. Two to six years after baseline, compared with participants with depression alone, those with severe pain or depression plus severe pain were more likely to experience new functional limitations and to have higher total health care expenditures. Compared with participants with depression alone, participants with depression plus severe pain were also more likely to lose employment and private health insurance. CONCLUSIONS: Relative to depression alone, depression plus pain and pain alone (particularly severe pain) were associated with significant functional limitations and economic burdens.}, keywords = {Health Conditions and Status}, url = {http://psychservices.psychiatryonline.org/}, author = {Emptage, Nicholas P. and Sturm, Roland and Robinson, Rebecca L.} } @article {7015, title = {Depressive Symptoms of Caregiving Women in Midlife: The role of physical health.}, journal = {Journal of Women and Aging}, volume = {17}, year = {2005}, pages = {115-27}, publisher = {17}, abstract = {This research examined the relationships between providing assistance to aging family members, caregivers{\textquoteright} age, caregivers{\textquoteright} perceptions of their physical health, and caregivers{\textquoteright} depressive symptoms. Several alternative hypotheses were examined. Longitudinal data from 1,898 women from the 1992 and 2000 waves of the Health and Retirement Study (HRS) were used. Results indicate a reciprocal relationship between depression and physical health. These processes were examined using a path analysis. Although the evidence only supported one of the hypotheses, this study clearly demonstrated the importance of physical health for the psychological well-being of women in midlife.}, keywords = {Health Conditions and Status, Healthcare, Women and Minorities}, author = {Timothy S Killian and M Jean Turner and Rebekah Cain} } @article {7036, title = {Diabetes and Urinary Incontinence in 50- to 90-year-old Women: A cross-sectional population-based study}, journal = {American Journal of Obstetrics and Gynecology}, volume = {53}, year = {2005}, pages = {879-885}, publisher = {53}, abstract = {Objective: The purpose of this study was to examine the association between urinary incontinence and diabetes in a large community-based population of women. Study design: The Health and Retirement Study is a large multistage area probability sample of households in the United States. Data were collected from 10,678 women aged 50 to 90 years. Dependent variables were no, mild, and severe incontinence. Independent variables consisted of demographic and health data. Diabetes was dichotomized into insulin-requiring (IRDM) and non insulin-requiring disease (NIRDM). Survey-based ordered logistic regression was used to simultaneously analyze associations between incontinence groups. Results: Urinary incontinence was reported by 22 (2319/10,678) of women. IRDM was associated with urinary incontinence (odds ratio OR 1.63; 95 CI 1.28-2.09), but NIRDM was not (OR 1.20; 95 CI 1.00-1.45). Conclusion: IRDM is independently associated with urinary incontinence in women ages 50 to 90 years, independent of patient body mass index, comorbidities, or age.}, keywords = {Health Conditions and Status, Risk Taking}, url = {https://www.ajog.org/article/S0002-9378(05)01182-8/fulltext}, author = {Cynthia M. Lewis and Ronald M Schrader and Many, Angela and Mackay, Mary and Rebecca G Rogers} } @article {7048, title = {Differences in Amount of Informal Care Received by Non-Hispanic Whites and Latinos in a Nationally Representative Sample of Older Americans}, journal = {Journal of the American Geriatrics Society}, volume = {53}, year = {2005}, pages = {146-151}, publisher = {53}, abstract = {The objective of this study was to evaluate informal (unpaid) care and its broad determinants for Latinos in a nationally representative sample. A cross-sectional analysis of the 1993 Asset and Health Dynamics Study, a national probability sample of 7,443 older adults aged 70 and older, was performed to determine the independent effect of Latino ethnicity on the receipt of informal care by disabled older individuals. Self-reported race/ethnicity was used to predict the mean daily hours of informal care received for activity of daily living (ADL) or instrumental activity of daily living (IADL) assistance after adjustment for predisposing, need, and enabling variables. There was a significant association between informal home care and ethnic group, with 44.3 of Latinos receiving informal care, compared with 33.9 of African Americans and 24.6 of non-Hispanic whites (Po.001). After adjustment, Latinos received 11.0 weekly hours of informal care, compared with 7.5 hours for non-Hispanic whites and 6.3 hours for African Americans (Po.001). The results from this nationally representative sample indicate that Latinos receive significantly more hours of informal care on average than African Americans or non-Hispanic whites for ADL and IADL disability. Clinicians should be alert to the significant amount of informal care and possible associated strain in caregivers of older Latinos.}, keywords = {Healthcare, Women and Minorities}, author = {Weiss, Carlos O. and Hector M Gonz{\'a}lez and Mohammed U Kabeto and Kenneth M. Langa} } @article {8754, title = {Differences in leisure-time, household, and work-related physical activity by race, ethnicity, and education}, journal = {Journal of General Internal Medicine}, volume = {20}, year = {2005}, month = {Jan-03-2005}, pages = {259 - 266}, abstract = {Background: Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. Objective: To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores and strenuous job activities), and total physical activity (TPA) by race, ethnicity, and education. Design, Setting, and Participants: Cross-sectional analyses of data from the 1992 Health and Retirement Study for a nationally representative cohort of 9,621 community-dwelling adults aged 51{\textendash}61 years. Measurements: Physical activity scores for LTPA, WRPA, and TPA based upon self-reported frequency of light or vigorous recreational activities, heavy household chores, and strenuous job-related physical activities. Main Results: LTPA was lower for blacks and Hispanics compared to whites, and LTPA steadily declined with lower levels of education. WRPA showed the reverse pattern, being lowest for whites and persons with greater education. Education was far more important than race/ethnicity as a determinant of LTPA and WRPA in multivariate analyses. After adjusting for differences in overall health and physical functioning, mean TPA scores were similar across racial/ethnic and education categories; blacks (β=1.0; 95\% confidence interval [CI], 0.5 to 1.5) and Spanish-speaking Hispanics (β=1.1; 95\% CI, 0.3 to 1.9) had slightly higher levels of TPA than whites (P<.01 and P=.01, respectively). Conclusions: Differences in educational attainment and health status accounted for virtually all of the racial and ethnic differences in LTPA. After accounting for WRPA, TPA was similar across race, ethnicity, and education subgroups.}, keywords = {Education, Leisure activities, Mortality, Older Adults, Physical activity, Racial/ethnic differences}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2005.40198.x}, url = {http://link.springer.com/10.1111/j.1525-1497.2005.40198.xhttp://www.springerlink.com/index/pdf/10.1111/j.1525-1497.2005.40198.x}, author = {Xiaoxing He and David W. Baker} } @inbook {5227, title = {Discussion of James Poterba, Joshua Rauh, Steven Venti and David Wise, Utility Evaluation of Risk in Retirement Savings Accounts}, booktitle = {Analyses in the Economics of Aging}, year = {2005}, pages = {53}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, address = {Chicago}, keywords = {Net Worth and Assets, Public Policy, Retirement Planning and Satisfaction, Risk Taking}, author = {Robert J. Willis}, editor = {David A Wise} } @inbook {5226, title = {Discussion of Li Gan, Michael Hurd and Daniel McFadden, Individual Subjective Survival Curves}, booktitle = {Analyses in the Economics of Aging}, series = {NBER conference report}, year = {2005}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, address = {Chicago}, keywords = {Expectations, Methodology}, author = {Robert J. Willis}, editor = {David A Wise} } @article {7008, title = {Disparities among older adults in measures of cognitive function by race or ethnicity.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Sep}, pages = {P242-50}, publisher = {60B}, abstract = {

This study examined racial or ethnic differences in cognitive function, cross-sectionally and longitudinally, using survey data from the Asset and Health Dynamics Among the Oldest Old. A version of the Telephone Interview for Cognitive Status (TICS), proxy assessments of cognition, and difficulties in performing daily tasks were assessed. Blacks performed below Whites on the TICS at baseline and on proxy assessments of cognition. TICS score declined with age for Whites and Blacks, with some relative gains for Blacks. At baseline, Blacks more often had difficulties in performing daily tasks, with some increase in difficulties relative to Whites with age. Differences between other groups and Whites were smaller than those between Blacks and Whites.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Case-Control Studies, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Hispanic or Latino, Humans, Linear Models, Longitudinal Studies, Male, Racial Groups, United States}, issn = {1079-5014}, doi = {10.1093/geronb/60.5.p242}, author = {Frank A Sloan and Wang, Jingshu} } @article {7038, title = {Do New Health Conditions Support Mortality-Air Pollution Effects?}, journal = {Journal of Environmental Economics and Management}, volume = {50}, year = {2005}, pages = {496}, publisher = {50}, abstract = {Epidemiological research underlying US air quality regulations documents significant associations between measures of fine particles and premature mortality. Recent studies examine potential mechanistic pathways, related to heart and lung functioning, that may contribute to the observed deaths. Our results support these pathophysiological analyses. We examine whether the onset of serious health conditions, consistent with disease pathways, is related to current and long-term exposure to particulate matter and ozone. Associations between air pollution and alternative indicators of health status are also evaluated. The 1996 wave of the Health and Retirement Study is used with a two-step estimator acknowledging limitations in our ability to measure individual exposures. The findings suggest significant current and long-term effects of particulates on new cases of heart attacks and angina, reinforcing the disease pathways identified in epidemiological studies. Long-term air pollution exposure is also a determinant of recently diagnosed chronic lung conditions and reports of shortness of breath.}, keywords = {Health Conditions and Status}, url = {http://www.elsevier.com/wps/find/journaldescription.cws_home/622870/description description}, author = {Mary F. Evans} } @article {7009, title = {Do Panel Surveys Make People Sick? U.S. Arthritis Trends in the Health and Retirement Study}, journal = {Social Science and Medicine}, volume = {60}, year = {2005}, pages = {2623-7}, publisher = {60}, abstract = {Researchers have long viewed large, longitudinal studies as essential for understanding chronic illness and generally superior to cross-sectional studies. In this study, we show that (1) age-specific arthritis prevalence in the longitudinal Health and Retirement Study (HRS) from the United States has risen sharply since its inception in 1992, and (2) this rise is almost surely spurious. In periods for which the data sets are comparable, we find no such increase in the crosssectional National Health Interview Survey (NHIS), the primary source for prevalence data of chronic conditions in the US. More important, the upward trend in the HRS is not internally consistent: even though prevalence in the HRS rises sharply between 1992 and 1996 for 55 56 year-olds, the prevalence for that age group plummets to its 1992 level among the new cohort added in 1998 and then rises rapidly again between 1998 and 2002. We discuss possible reasons for these discrepancies and demonstrate that they are not due to sample attrition in the HRS.}, keywords = {Health Conditions and Status, Methodology}, author = {Sven E. Wilson and Benjamin L. Howell} } @article {7032, title = {Do Seniors Understand Their Risk of Moving to a Nursing Home?}, journal = {Health Services Research}, volume = {40}, year = {2005}, pages = {811}, publisher = {40}, abstract = {Objective: To determine whether seniors understand their risk of moving to a nursing home. Data Sources: We used longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) database. AHEAD is a nationally representative survey (n=8,203) of community dwellers aged 70 years and their spouses. Study Design: We followed respondents for 5 years from the date of the first interview fielded in 1993. Our primary dependent variable was whether respondents moved to a nursing home within 5 years of baseline; self-assessed probability of moving to a nursing home within 5 years, also assessed at baseline, was the primary explanatory variable. Principal Findings: We found that seniors who believed they were more likely to move to a nursing home within 5 years were indeed more likely to do so, and that most elders overestimated their likelihood of moving to a nursing home. Conclusions: Low rates of private long-term care insurance are not plausibly a result of seniors underestimating their personal risk of moving to a nursing home; such an assumption is inherent in many strategies to plan for the future long-term care needs of the baby boom generation.}, keywords = {Health Conditions and Status, Healthcare}, author = {Donald H. Taylor Jr. and Ostermann, Jan and Acuff, S. Will and Truls Ostbye} } @article {7034, title = {Do Socioeconomic Mortality Differences Decrease with Rising Age?}, journal = {Demographic Research}, volume = {13}, year = {2005}, pages = {35-62}, publisher = {13}, abstract = {The impact of SES on mortality is an established finding in mortality research. I examine, whether this impact decreases with age. Most research finds evidence for this decrease but it is unknown whether the decline is due to mortality selection. My data come from the US-Health and Retirement Study (HRS) and includes 9376 persons aged 59 , which are followed over 8 years. The variables allow a time varying measurement of SES, health and behavior. Event-history-analysis is applied to analyze mortality differentials. My results show that socioeconomic mortality differences are stable across ages whereas they decline clearly with decreasing health. The first finding that health rather than age is the equalizer combined with the second finding of unequally distributed health leads to the conclusion that in old age, the impact of SES is transferred to health and is stable across ages.}, keywords = {Demographics, Health Conditions and Status}, author = {Rasmus Hoffmann} } @article {5619, title = {Documentation of Chronic Disease Measures in the Health and Retirement Study}, year = {2005}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The focus of this report is on (1) self-rated overall health status and recent changes in overall health, (2) the presence of common chronic medical conditions and follow-up questions concerning treatments in all waves of the core HRS/AHEAD through 2002.}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Gwenith G Fisher and Jessica Faul and David R Weir and Robert B Wallace} } @article {5620, title = {Documentation of Cognitive Functioning Measures in the Health and Retirement Study}, year = {2005}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, keywords = {Health Conditions and Status, Methodology}, url = {http://hrsonline.isr.umich.edu/sitedocs/userg/dr-006.pdf}, author = {Mary Beth Ofstedal and Gwenith G Fisher and A. Regula Herzog} } @mastersthesis {6093, title = {Does Gendered Labor Force Structure Affect Adult Children{\textquoteright}s Provision of Transfer to Their Elderly Parents? An Examination of the Late-Middle-Aged Generation}, year = {2005}, month = {2005}, school = {University of Maryland, College Park}, abstract = {Adult children are key supporters of elderly parents, providing both monetary and time resources. In the existing literature, the most commonly used approach to assess this intergenerational transfer process is the "need versus ability" model. It posits that parents with higher need are more likely to receive support, whereas adult children equipped with better support-giving ability are more likely to give transfers. In addition, adult children{\textquoteright}s transfer motivation, including altruism, reciprocity, and rational calculations, all provide theoretical insight into the question of transfer differentials. Using the 1992 and 1996 Health and Retirement Study (HRS 92, 96), this dissertation goes beyond the need, ability, and motivation model to examine how adult children ages 51 to 61 satisfy their non-coresident parents{\textquoteright} need. This project incorporates gender norms and adult children{\textquoteright}s labor force participation constraints to assess the gendered division of transfer practices. The effects of spouses{\textquoteright} and siblings{\textquoteright} roles, resource competition between grandchildren and their grandparents, resource competition between two living parents, and adult children{\textquoteright}s life course transition, are also considered. Statistical analysis shows that both gender norms and the gendered labor force structure affect adult children{\textquoteright}s transfer behaviors. Adult sons tend to use monetary transfers to substitute for time contributions because their opportunity costs in the wage market are high. Conversely, because the social norms construe women as primary caregivers, adult daughters{\textquoteright} time contributions to parents do not decrease even when they are well-paid. Spouses of adult children may either be transfer supporters or resource competitors to their parents-in-law. While siblings are important in transfer practices, this study finds that sisters are more likely to substitute for adult children{\textquoteright}s caregiving roles, whereas brothers{\textquoteright} contributions supplement adult children{\textquoteright}s transfer efforts. Finally, adult children{\textquoteright}s transfer practices are sensitive to their employment transitions. Adult children who stayed in the labor force from 1992 to 1996 are the most likely to increase their amount of monetary transfers. On the other hand, those who retired from their paid jobs in the studied time interval are more likely to increase their time contributions.}, keywords = {Adult children, Demographics, Healthcare}, url = {http://hdl.handle.net/1903/2463}, author = {Shieh, Ching-yi} } @article {5617, title = {Does the Socioeconomic Mortality Gradient Interact with Age? Evidence from U.S. Survey Data and Danish Register Data}, year = {2005}, institution = {Rostock, Germany, Max Planck Institute for Demographic Research}, abstract = {The aim of our paper is to provide an answer to the questions if and why social differences in health and mortality decrease with age. Most research confirms this decrease but the reasons for it and the role of unobserved heterogeneity are unknown. The data used for our analysis come from the US Health and Retirement Study (n=9376) and from the Danish Demographic Database (Denmark s population above age 58). They offer detailed information about SES and health information. The technique of event-history-analysis is used, and frailty models address mortality selection. A new method is developed to consider systematic difference in the change of average frailty over age between social groups. SES differentials in mortality converge with age in Denmark but not in the US. In both countries, they converge strongly with decreasing health. When controlled for health, the differences are stable across age in both countries. This means that worsening health levels social mortality differences and not increasing age. Controlling for mortality selection removes the converging pattern over age.}, keywords = {Demographics, Health Conditions and Status}, author = {Rasmus Hoffmann} } @article {9789, title = {Dynamic Inefficiencies in Insurance Markets: Evidence from Long-Term Care Insurance}, journal = {The American Economic Review}, volume = {95}, year = {2005}, pages = {224-228}, abstract = {Most analyses of insurance market failures have been implemented in a one-period (static) setting, with considerably less attention devoted to problems arising in a multi-period (dynamic) context. In a dynamic framework, risk-averse individuals benefit not only from period-by-period "event" insurance, but also from insurance against becoming a bad risk and begin reclassified into a higher-risk group with a concomitant increase in premiums. We refer to this latter possibility as "reclassification risk." This article examines the private market for long-term care insurance in the US and present empirical evidence suggesting that it does not provide full insurance against reclassification risk.}, keywords = {Long-term Care, Medicare/Medicaid/Health Insurance, Risk Factors}, issn = {00028282}, url = {http://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/233029440?accountid=14667}, author = {Finkelstein, Amy and Kathleen McGarry and Sufi, Amir} } @article {6973, title = {Development and Validation of a Functional Morbidity Index to Predict Mortality in Community-Dwelling Elders}, journal = {Journal of General Internal Medicine}, volume = {19}, year = {2004}, pages = {1027-1033}, publisher = {19}, abstract = {OBJECTIVE: Functional measures have a great appeal for prognostic instruments because they are associated with mortality, they represent the end-impact of disease on the patient, and information about them can be obtained directly from the patient. However, there are no prognostic indices that have been developed for community-dwelling elders based primarily on functional measures. Our objective in this study was to develop and validate a prognostic index for 2-year mortality in community-dwelling elders, based on self-reported functional status, age, and gender. DESIGN: Population-based cohort study from 1993 to 1995. SETTING: Community-dwelling elders within the United States. PARTICIPANTS: Subjects, age 70 and over (N= 7,393), from the Asset and Health Dynamics Among the Oldest Old study. We developed the index in 4,516 participants (mean age 78, 84 white, 61 female), and validated it in 2,877 different participants (mean age 78, 73 white, 61 female). MAIN OUTCOME MEASURES: Prediction of 2-year mortality using risk factors such as activities of daily living, instrumental activities of daily living, additional measures of physical function, age, and gender. RESULTS: Overall mortality was 10 in the development cohort and 12 in the validation cohort. In the development cohort, 6 independent predictors of mortality were identified and weighted, using logistic regression models, to create a point scale: male gender, 2 points; age (76 to 80, 1 point; 80, 2 points); dependence in bathing, 1 point; dependence in shopping, 2 points; difficulty walking several blocks, 2 points; and difficulty pulling or pushing heavy objects, 1 point. We calculated risk scores for each patient by adding the points of each independent risk factor present. In the development cohort, 2-year mortality was 3 in the lowest risk group (0 to 2 points), 11 in the middle risk group (3 to 6 points), and 34 in the highest risk group ( 7 points). In the validation cohort, 2-year mortality was 5 in the lowest risk group, 12 in the middle risk group, and 36 in the highest risk group. The c-statistics for the point system were 0.76 and 0.74 in the development and validation cohorts, respectively. CONCLUSIONS: This prognostic index, which relies solely on self-reported functional status, age, and gender, provides a simple and accurate method of stratifying communitydwelling elders into groups at varying risk of mortality.}, keywords = {Health Conditions and Status, Methodology}, author = {Carey, Elise C. and Louise C Walter and Lindquist, Karla and Kenneth E Covinsky} } @article {6939, title = {Diabetes Diagnosis and Weight Loss in Middle-Aged Adults}, journal = {Research on Aging}, volume = {26}, year = {2004}, pages = {62-81}, publisher = {26}, abstract = {Using three waves of Health and Retirement Study data, this study investigated whether (a) self-reported physician-diagnosed diabetes prior to 1994 predicted weight loss between 1994 and 1996 in adults who were aged 51 to 61 and relatively healthy but overweight in 1992 (n = 2,642) and (b) socioeconomic status influenced that relationship. The authors found that these overweight middle-aged adults were at least 50 more likely to report that they lost at least 10 pounds of excess body weight if they had been diagnosed with diabetes than if they had not. Furthermore, the authors found that neither education nor net worth predicted weight loss in these adults. Identifying the social, psychological, and physiological mechanisms linking chronic conditions and health behaviors can inform policy makers and health care providers and enhance the development of effective interventions to prevent or reduce health risks in middle-aged and older adults.}, keywords = {Demographics, Health Conditions and Status, Healthcare}, doi = {10.1177/0164027503258741}, url = {http://roa.sagepub.com/content/26/1/62.abstract}, author = {Linda A. Wray and Caroline S Blaum and Mary Beth Ofstedal and A. Regula Herzog} } @article {6931, title = {Disability and Home Care Dynamics Among Unmarried Older Americans}, journal = {The Journals of Gerontology: Social Sciences}, volume = {59B}, year = {2004}, pages = {S25-S33}, publisher = {59B}, abstract = {Objectives. We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines. Methods. Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models. Results. Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care. Discussion. Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities.}, keywords = {Disabilities, Healthcare}, url = {http://psychsoc.gerontologyjournals.org/}, author = {Vicki A Freedman and Aykan, Hakan and John E. Marcotte and Douglas A. Wolf} } @article {6909, title = {On the Distribution and Dynamics of Health Costs}, journal = {Journal of Applied Econometrics}, volume = {19}, year = {2004}, note = {US Social Security Administration (SSA) // Center for Retirement Research at Boston College}, pages = {705-721}, publisher = {19}, abstract = {Using data from the Health and Retirement Survey and the Assets and Health Dynamics of the Oldest Old survey, we estimate the stochastic process that determines both the distribution and dynamics of health care costs. We find that the data-generating process for log health costs is well represented as the sum of a white noise process and a highly persistent AR(1) process. We also find that the innovations to this process can be modelled with a normal distribution that has been adjusted to capture the risk of catastrophic health care costs. Simulating this model, we find that in any given year 0.1 of households receive a health cost shock with a present value of at least 125,000. Copyright 2004 John Wiley and Sons, Ltd.}, keywords = {Health Conditions and Status, Healthcare}, url = {http://jae.wiley.com}, author = {Eric French and John Bailey Jones} } @article {5605, title = {The Division of Bequests}, year = {2004}, institution = {RAND}, keywords = {Adult children}, author = {Michael D Hurd and James P Smith} } @article {6911, title = {Do Changes in Pension Incentives Affect Retirement? A Longitudinal Study of Subjective Retirement Expectations}, journal = {Journal of Public Economics}, volume = {88}, year = {2004}, note = {National Science Foundation, grants 9905275 and 9907824}, pages = {1307-1333}, publisher = {88}, abstract = {This paper investigates the responsiveness of individuals retirement decisions to forward-looking measures of pension accumulations. In contrast to previous research, we use within-person variation in retirement incentives and are able to control for unobserved heterogeneity in tastes for retirement by studying a panel of subjective retirement expectations. We confirm that individuals do respond as expected to pension incentives, even when we control for individual fixed-effects. However, the magnitude of these responses differ when estimated from models based on within-person versus cross-sectional variation: the inclusion of fixed effects reduces the response by about half.}, keywords = {Expectations, Pensions}, url = {http://homepages.nyu.edu/ sc87/chanstevens_retirementexpectations.pdf}, author = {Sewin Chan and Ann H. Stevens} } @article {5578, title = {Do Spouses Coordinate Their Retirement Decisions?}, year = {2004}, institution = {Center for Retirement Research at Boston College}, abstract = {The movement of married women into the labor market is transforming retirement behavior. A generation ago, when few married women spent many years in the labor force, it was relatively simple for spouses to coordinate their retirement decisions. Couples typically focused on the generosity of the husbands retirement benefits and the impact of his retirement decision on future benefits. Today, however, retirement decisions are more difficult to coordinate, because many women have accumulated substantial retirement benefits in their own names. As a result, many couples now need to consider how the decision to stop work will affect income and retirement benefits for both spouses. The evidence suggests that couples like to retire together and, since husbands tend to be older than their wives, the increased labor force participation of women may lead to later retirement of men. This brief examines retirement behavior and measures the extent to which husbands and wives appear to coordinate their retirement decisions.}, keywords = {Adult children, Retirement Planning and Satisfaction}, url = {http://www.bc.edu/crr}, author = {Richard W. Johnson} } @article {6975, title = {Do the Near Elderly Value Mortality Risks Differently from Younger Persons?}, journal = {The Review of Economics and Statistics}, volume = {86}, year = {2004}, pages = {423-29}, publisher = {86}, abstract = {Wage hedonic models are estimated with the Health and Retirement Study to measure the risk / wage tradeoffs (value of statistical lives) for older workers. The analysis explicitly accounts for multiple employment states including retirement using a multinomial selection model. The results suggest that the oldest and most risk averse workers require significantly higher, not lower, compensation to accept increases in job related fatality risks.}, keywords = {Demographics, Expectations, Health Conditions and Status}, author = {Mary F. Evans and Kim, Hyun and Donald H. Taylor Jr.} } @article {5607, title = {Documentation of Physical Functioning Measures in the Health and Retirement Study and the Asset and Health Dynamics Among the Oldest Old Study}, year = {2004}, institution = {The University of Michigan}, abstract = {This document is part of a series of working papers on health-related measures in the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest-Old (AHEAD) study. The series currently contains papers on cognitive function, affective function, and physical function, the latter of which is the focus of this document. The purpose of this document is to aid prospective analysts in the appropriate use of the physical functioning data. To do so, this document provides an inventory of the physical functioning measures included in the survey interviews, describes the formats and origins of these measures, discusses their reliability, validity, and change over time and several options for working with the evolution of the questions, and provides SAS code for recoding the variables and creating simple summary measures.}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Stephanie J. Fonda and A. Regula Herzog} } @article {5587, title = {Does Childhood Schooling Affect Old Age Cognitive Function? Evidence from Natural Experiments}, year = {2004}, institution = {Harvard University}, keywords = {Adult children, Demographics, Health Conditions and Status}, author = {M. Maria Glymour and Lisa F Berkman and Robins, James M. and Ichiro Kawachi} } @article {6948, title = {Does urinary incontinence affect middle-aged and older women{\textquoteright}s time use and activity patterns?}, journal = {Obstet Gynecol}, volume = {104}, year = {2004}, month = {2004 Dec}, pages = {1327-34}, publisher = {104}, abstract = {

OBJECTIVE: To investigate the relationship between urinary incontinence and women{\textquoteright}s levels and hours of participation in 31 activities.

METHODS: A subset of panel members from the Health and Retirement Study completed the self-administered Consumption and Activities Mail Survey questionnaire in 2001. These data were linked with Health and Retirement Study 2000 data. Analyses were limited to 2,190 female Consumption and Activities Mail Survey self-respondents born in 1947 or earlier. Logistic regression was used to predict activity participation. Linear regression was used to predict the number of hours of participation.

RESULTS: The hypothesis that urinary incontinence affects women{\textquoteright}s time use and activity patterns was supported. Compared with the continent women, the incontinent women were less likely to have house cleaned, shopped, physically shown affection, or attended religious services in the recent past; and were more likely to have watched television or made music by singing or playing an instrument. Compared with continent activity participants, incontinent participants reported significantly fewer hours spent walking, communicating with friends and family by telephone or e-mail, working for pay, using a computer, and engaging in personal grooming and hygiene.

CONCLUSION: These findings substantiate prior work on the relationship between urinary incontinence and quality of life, and suggest a useful route for educating patients about the impact of urinary incontinence. Clinicians must be alert to opportunities for encouraging incontinent women to be active. It is also important to consider the implications for time use and activity patterns when advising patients about treatment and management options.

LEVEL OF EVIDENCE: II-2.

}, keywords = {Aged, Female, Humans, Interpersonal Relations, Leisure activities, Logistic Models, Middle Aged, Quality of Life, Urinary incontinence}, issn = {0029-7844}, doi = {10.1097/01.AOG.0000143829.21758.3c}, author = {Fultz, Nancy H. and Gwenith G Fisher and Kristi Rahrig Jenkins} } @article {6964, title = {Dynamic Modeling of the SSDI Application Timing Decision: The Importance of Policy Variables}, journal = {Journal of Applied Econometrics}, volume = {19}, year = {2004}, note = {RDA 1996-002}, pages = {671-685}, publisher = {19}, abstract = {This paper develops a dynamic programming model of the Social Security Disability Insurance (SSDI) application timing decision. We estimate the time to application from the point at which a health condition first begins to affect the kind or amount of work that a currently employed person can do. We use Health and Retirement Study (HRS) and restricted access Social Security earnings data for estimation. Our results show that the type of work-limiting health condition, presence of employer accommodation, and the relative value of income in the application state to income in the work state significantly affect the timing of SSDI application.}, keywords = {Social Security}, url = {https://ssrn.com/abstract=475041}, author = {R.V. Burkhauser and Butler, J.S. and Gumus, Gulcin} } @article {6891, title = {Determinants of self-perceived changes in health status among pre- and early-retirement populations.}, journal = {Int J Aging Hum Dev}, volume = {56}, year = {2003}, month = {2003}, pages = {197-222}, publisher = {56}, abstract = {

Using data from the 1992 and 1994 waves of the Health and Retirement Study (HRS), this study described reasons reported by pre- and early-retirement populations for perceived changes in global health status over a 2-year period. It then analyzed the association between self-perceptions of change and the actual changes in objective health conditions, controlling for demographics, emotional health status, and the changes in work status and health-affecting habits. The results were compared to the determinants of self-ratings of health at wave 2. Existing or increasing impairments in functional abilities were found to contribute to self-perceptions of decline. However, a diagnosis of new chronic disease and the experience of a major medical event per se did not universally contribute to self-perception of decline. The relationship between cross-sectional self-ratings of health and objective health conditions was more straightforward. Self-perception of improvement among people with serious health problems most likely owed to medical interventions and improvement in symptoms, the most frequently mentioned reasons for perceived improvement, and reflected the subjects{\textquoteright} selective optimization and resiliency.

}, keywords = {Activities of Daily Living, Age Factors, Female, Health Behavior, Health Status, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Retirement, Self Concept, United States}, issn = {0091-4150}, doi = {10.2190/T8JD-1P30-6MFT-8WHA}, author = {Namkee G Choi} } @article {6890, title = {Determinants of stability and changes in self-reported work disability among older working-age populations.}, journal = {J Aging Soc Policy}, volume = {15}, year = {2003}, month = {2003}, pages = {11-31}, publisher = {15}, abstract = {

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

}, keywords = {Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Self Disclosure, Surveys and Questionnaires}, issn = {0895-9420}, doi = {10.1300/J031v15n01_02}, author = {Namkee G Choi} } @article {5530, title = {Disability and Employment: Reevaluating the Evidence in Light of Reporting Errors}, number = {2002-06}, year = {2003}, note = {ProCite field 22 : 4 ProCite field 24 : 4}, institution = {Employee Benefits, Compensation and Pension Law}, abstract = {Long-standing debates about relationships between labor supply behavior and health status among persons nearing retirement age have centered largely on disagreements about the reliability of self-reported health indicators. In light of reporting errors in work capacity, this paper considers the problem of predicting how employment rates vary with disability status when true disability is unobserved. Rather than imposing the strong assumptions required to obtain point identification, we take a step back to evaluate what can be inferred under a variety of assumptions that are weaker but arguably more credible than those imposed in the existing literature. Although these assumptions do not identify the conditional employment rates except in special cases, nonparametric bounds for these parameters can be obtained. Using data from the Health and Retirement Study, we estimate a set of bounds that formalize the identifying power of a number of different assumptions that appear to have broad consensus in the literature. Our results suggest that models estimated under the assumption of fully accurate reporting lead to biased inferences. In particular, it appears that nonworkers tend to overreport disabilities.}, keywords = {Employment and Labor Force, Health Conditions and Status, Methodology}, doi = {http://dx.doi.org/10.2139/ssrn.337224}, author = {Kreider, Brent and John V Pepper} } @article {5568, title = {Do Pensions Impede Phased Retirement?}, number = {1353}, year = {2003}, institution = {IZA Institute of Labor Economics}, address = {Bonn, Germany}, abstract = {Many workers reveal a preference for a gradual reduction in work hours as they approach retirement ({\textquotedblleft}phased retirement{\textquotedblright}), rather than a sudden change from full-time work to full-time retirement. Pension regulations may impede phased retirement without a switch of employers by prohibiting access to pension assets. This study uses Health and Retirement Survey data to investigate the extent to which a gradual reduction in work hours is made difficult by pensions, particularly defined benefit plans. The study also explores other possible impediments to phased retirement.}, keywords = {Pensions, Retirement Planning and Satisfaction}, url = {https://www.iza.org/publications/dp/1353/do-pensions-impede-phased-retirement}, author = {Even, William and David A. Macpherson} } @article {8458, title = {Does the Current Climate Discourage Seasoned Pros?}, journal = {Wall Street Journal}, year = {2003}, chapter = {Career Journal}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, author = {Greene, Kelly} } @article {6837, title = {Death of a Parent and Risk-Taking: Midlife Assessment}, journal = {The Gerontologist}, volume = {42}, year = {2002}, publisher = {42}, keywords = {Risk Taking}, author = {Karen C. Swallen and Schwartzman, Luisa and Steven A Haas} } @article {6826, title = {Delays in Claiming Social Security Benefits}, journal = {Journal of Public Economics}, volume = {84}, year = {2002}, pages = {357-385}, publisher = {84}, abstract = {This paper focuses on Social Security benefit claiming behavior, a take-up decision that has been ignored in the previous literature. Using financial calculations and simulations based on an expected utility maximization model, we show that delaying benefit claim for a period of time after retirement is optimal in a wide variety of cases and that gains from delay may be significant. We find that approximately 10 of men retiring before their 62nd birthday delay claiming for at least one year after eligibility. We estimate hazard and probit models using data from the New Beneficiary Data System to test four cross-sectional predictions. While the data suggest that too few men delay, we find that the pattern of delays by early retirees is generally consistent with the hypotheses generated by our theoretical model.}, keywords = {Retirement Planning and Satisfaction, Social Security}, url = {http://econ-www.mit.edu/faculty/pdiamond/files/claim14.pdf}, author = {Courtney Coile and Diamond, Peter and Gruber, Jonathan and Jousten, Alain} } @article {6813, title = {Disability and the Labor Force Participation of Older Men in Canada}, journal = {Labour Economics}, volume = {9}, year = {2002}, pages = {405-432}, publisher = {9}, keywords = {Demographics, Disabilities, Employment and Labor Force}, author = {Campolieti, Michele} } @article {5522, title = {Do Retiree Health Benefits Cause Early Retirement?}, year = {2002}, note = {Robert Wood Johnson Foundation and to Princeton s Industrial Relations Section}, institution = {Princeton University}, abstract = {I examine whether the availability of early retiree health benefits increases the likelihood of early retirement. Although there is a positive association between the availability of retiree health benefits and early retirement, this association could be driven by other factors that are correlated with retiree health benefits and affect retirement decisions. I build a simple model to show that individuals in poor health and with poor outside insurance options value retiree health benefits more. I then use variation in health status and outside insurance options to examine, within a difference-in-differences framework, whether the estimated correlation between retiree health benefits and early retirement reflects demand for health insurance. My results indicate that the effect of retiree health benefits is not statistically significantly larger for those in poor health, but that it is larger for those who lack insurance from other sources, particularly from their spouses. I conclude that retiree health benefits do increase the hazard of early retirement and that demand for health insurance among the near-elderly is not closely tied to health status.}, keywords = {Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, url = {http://www.princeton.edu/ davel/rethealth.pdf}, author = {Linsenmeier, David M.} } @article {6811, title = {Does Informal Care from Adult Children Reduce Nursing Home Admissions for the Elderly?}, journal = {Inquiry}, volume = {39}, year = {2002}, publisher = {39}, keywords = {Adult children, Healthcare}, author = {LoSasso, Anthony T. and Richard W. Johnson} } @article {8452, title = {Does It Cost the Wealthy Too Much to Die?}, journal = {The New York Times}, year = {2002}, month = {June 30, 2002}, pages = {4}, publisher = {The New York Times Co.}, chapter = {Economic View}, address = {New York, NY}, keywords = {Adult children}, author = {Altman, Daniel} } @article {6801, title = {Does Marital History Matter? Marital Status and Wealth Outcomes Among Preretirement Adults}, journal = {Journal of Marriage and Family}, volume = {64}, year = {2002}, pages = {254-268}, publisher = {64}, keywords = {Adult children, Demographics, Event History/Life Cycle, Net Worth and Assets}, doi = {https://doi.org/10.1111/j.1741-3737.2002.00254.x}, author = {Janet M Wilmoth and Koso, G.} } @mastersthesis {6220, title = {Does Money Buy Better Health? Three essays examining the causes of socioeconomic differentials in health after midlife}, year = {2002}, month = {2002}, school = {University of Michigan}, abstract = {Does money buy better health? This dissertation seeks to more clearly discern whether social policy aimed at reducing health disparities is likely to be effective through programs that transfer income and wealth to needy adults in their latter working age years. First, I discuss explanations for why money might matter for health. Competing explanations emphasize patterned responses to social structural inequalities and individual health investments. The assumptions underlying these perspectives can be expressed in the language of experiments. Differences reduce to assumptions about the importance of unobserved heterogeneity bias, and the relative importance of fixed, time-varying, and health-related factors as sources of this bias. Second, I investigate the importance of money for health using a sample of 7,400 respondents and their age eligible spouses nearing or undergoing the transition into retirement. Four waves of data from the Health and Retirement Study (HRS) are used to estimate the influence of individual income, wealth, and education on three health outcomes: self-rated health, depressive symptoms, and functional limitations. Chapter Two seeks to more accurately compare the true effect of education with money on self-reported health. More so than education, income and wealth over the work career are influenced by health and other factors. Adjusting for family background and feedbacks from prior health to income reduces estimates of income influence by 75\% or more and wealth by about 50\%. The effect of education is also diminished, but only by 20 to 30\%. These findings suggest that the long-term influence of psychological skills and social environments derived from education outweigh the health benefit of greater economic resources in the peak earning years of middle age. Chapter Three focuses on minimizing unobserved heterogeneity bias due to fixed confounders. Results suggest that income and wealth boosts over several years will have only small influences on self-reported health. Chapter Four examines unexpected life events as sources of income variation, to set up natural experiments. Unexpected job loss, union membership, and occupation are instrument variables. Compared to unadjusted estimates, these alternative estimates suggest only a very small impact of income and wealth on self-reported health.}, keywords = {Demographics, Health Conditions and Status}, url = {https://deepblue.lib.umich.edu/handle/2027.42/123130}, author = {Berry, Brent M.} } @article {6839, title = {Driving life expectancy of persons aged 70 years and older in the United States.}, journal = {Am J Public Health}, volume = {92}, year = {2002}, month = {2002 Aug}, pages = {1284-9}, publisher = {92}, abstract = {

OBJECTIVES: We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older.

METHODS: Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey.

RESULTS: Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies.

CONCLUSIONS: Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.

}, keywords = {Accidents, Traffic, Activities of Daily Living, Aged, Aged, 80 and over, Automobile Driving, Decision making, Family Characteristics, Female, Frail Elderly, Humans, Interviews as Topic, Licensure, Life Expectancy, Logistic Models, Male, Risk Factors, Transportation, United States}, issn = {0090-0036}, doi = {10.2105/ajph.92.8.1284}, author = {Foley, Daniel J. and Heimovitz, Harley K. and Jack M. Guralnik and Brock, Dwight B.} } @mastersthesis {6324, title = {Dynamic Models of the Social Security Disability Insurance Application}, year = {2002}, note = {RDA}, month = {2002}, school = {Cornell University}, abstract = {This dissertation develops dynamic structural models--option value and dynamic programming models of the Social Security Disability Insurance (SSDI) application decision. In the first chapter, we estimate the time to application following the onset of a health condition that first begins to affect the kind or amount of work that a currently employed person can do. We use the Health and Retirement Study (HRS) augmented by linked restricted access Social Security earnings record data. We test both the in-sample and out-of-sample predictive accuracy of our models using multinomial likelihood ratio tests based on discrete periods. Based on their predictive validity, we find that our option value model is superior to both our dynamic programming model and our reduced form hazard model. We also investigate the robustness of the results by only including individuals for whom restricted access Social Security earnings record data are available in our sample. These results are virtually the same as the ones for the full sample. In the second chapter, we use the preferred option value model estimates from the first chapter to simulate application timing under alternative SSDI policies. Three types of disability policy reforms are simulated: changing the benefit amounts, changing program eligibility stringency by changing the acceptance rates, and extending employer accommodation to all individuals with work limiting health conditions. Our simulations suggest all three of these policy changes would have substantial effects on lifetime application rates and on expected spell lengths until application for SSDI, and hence on SSDI caseloads.}, keywords = {Healthcare, Social Security}, author = {Gumus, Gulcin} } @article {6772, title = {Demographics Shape Prevention Programs}, journal = {Employee Benefit Plan Review}, volume = {55}, year = {2001}, pages = {38-39}, publisher = {55}, keywords = {Demographics, Healthcare}, author = {Unattributed} } @article {6758, title = {Demography of Risk Aversion}, journal = {Journal of Risk and Insurance}, volume = {68}, year = {2001}, pages = {1-24}, publisher = {68}, abstract = {This paper uses HRS data to empirically estimate the model of risk aversion and examines attitudes to both pure and speculative risks across various segments of the population. Results show that those individuals that had already engaged in the risk-taking behavior of migrating across national borders (i.e.- non-natives) are significantly more inclined than natives to both pure and speculative risks. Similarly, those who are currently employed exhibit a significantly greater willingness to gamble their current income for a chance to double it. These findings, along with the fact that women seem to be significantly more risk adverse than men, are in agreement with earlier studies and were expected. Other results, that were not as expected, show that the self-employed are significantly more adverse to pure risks than those employed by others, yet the two groups are not significantly different in their attitudes toward speculative risks. Similarly, education seems to increase aversion to pure risks but also increases the willingness to accept speculative risks. In terms of the causal relationship between risk aversion and personal characteristics, it is clear that purely demographic variables affect an individual s degree of risk aversion and that differences in religious beliefs affect attitudes toward risk-taking. Other variables produced statistically significant relationships, but causality cannot be determined.}, keywords = {Demographics, Insurance, Net Worth and Assets, Risk Taking}, doi = {10.2307/2678130}, author = {Halek, Martin and Eisenhauer, Joseph G.} } @article {6745, title = {Depressive Symptomatology in Middle-aged and Older Married Couples: A dyadic analysis}, journal = {The Journals of Gerontology: Social Sciences}, volume = {56B}, year = {2001}, pages = {S352-64}, publisher = {56B}, abstract = {OBJECTIVES: Depressive symptomatology has been frequently conceptualized as an individual matter, but social contextual models argue that symptom levels are likely to covary in close relationships. The present study investigated correlation between spouses{\textquoteright} depressive symptomatology in middle-aged and older married couples, the influence of gender and race/ethnicity in predicting variability in symptom level, and the importance of individual-level covariates (education, health, and age) and couple-level covariates (household income and net worth). METHODS: Results were based on secondary analysis of Wave 1 interviews with White, Black, and Mexican American married couples (N = 5,423) from the Health and Retirement Study (HRS) and the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD). Dyadic data from husbands and wives were analyzed with multilevel modeling. RESULTS: Husbands{\textquoteright} and wives{\textquoteright} depressive symptoms were moderately correlated, gender and race/ethnicity (and their interaction) predicted depressive symptoms, and both individual-level and couple-level characteristics were significant covariates. Similarities as well as differences are noted between the HRS and AHEAD results. DISCUSSION: Results highlight the importance of dyadic data and multilevel models for understanding depressive symptomatology in married couples. The influence of race/ethnicity merits greater attention in future research. Differences in findings between HRS and AHEAD suggest life-course, cohort, or methodological influences.}, keywords = {Adult children, Demographics, Health Conditions and Status, Methodology}, doi = {10.1093/geronb/56.6.S352}, author = {Aloen L. Townsend and Baila Miller and Guo, S.} } @article {6775, title = {Do Smokers Respond to Health Shocks?}, journal = {The Review of Economics and Statistics}, volume = {83}, year = {2001}, pages = {675-687}, publisher = {83}, abstract = {This paper reports the first effort to use data to evaluate how new information, acquired through exogenous health shocks, affects people{\textquoteright}s longevity expectations. We find that smokers react differently to health shocks than do those who quit smoking or never smoked. These differences, together with insights from qualitative research conducted along with the statistical analysis, suggest specific changes in the health warnings used to reduce smoking. Our specific focus is on how current smokers responded to health information in comparison to former smokers and nonsmokers. The three groups use significantly different updating rules to revise their assessments about longevity. The most significant finding of our study documents that smokers differ from persons who do not smoke in how information influences their personal longevity expectations. When smokers experience smoking-related health shocks, they interpret this information as reducing their chances of living to age 75 or more. Our estimated models imply smokers update their longevity expectations more dramatically than either former smokers or those who never smoked. Smokers are thus assigning a larger risk equivalent to these shocks. They do not react comparably to general health shocks, implying that specific information about smoking-related health events is most likely to cause them to update beliefs. It remains to be evaluated whether messages can be designed that focus on the link between smoking and health outcomes in ways that will have comparable effects on smokers{\textquoteright} risk perceptions.}, keywords = {Health Conditions and Status}, issn = {0034-6535}, doi = {10.1162/003465301753237759}, author = {V. Kerry Smith and Donald H. Taylor Jr. and Frank A Sloan and Desvousges, William H. and F. Reed Johnson} } @article {6735, title = {Does Childhood Health Affect Chronic Morbidity in Later Life?}, journal = {Social Science and Medicine}, volume = {52}, year = {2001}, pages = {1269-1284}, publisher = {52}, abstract = {Examines whether childhood health has long-term and enduring consequences for chronic morbidity, and addresses two methodological issues of concern in the literature: (1) Is adult height a surrogate for childhood health experiences in modeling chronic disease in later life? and (2) Are the effects of adult socioeconomic status on chronic disease overestimated when childhood health is not accounted for? The analysis is based on a topical module to the third wave of the Health and Retirement Study, a representative survey of US adults, ages 55 -65, in 1996. Our results support the hypothesis that poor childhood health increases morbidity in later life. This association is found for cancer, lung disease, cardiovascular conditions, and arthritis/rheumatism. The associations were highly persistent in the face of statistical controls for both adult and childhood socioeconomic status. No support was found for using adult height as a proxy for the effects of childhood health experiences. Further, the effects of adult socioeconomic status were not overestimated when childhood health was excluded from the explanatory models. Results point to the importance of an integrated health care policy based on the premise of maximizing health over the entire life cycle. 6 Tables, 43 References. Adapted from the source document}, keywords = {Adult children, Demographics, Health Conditions and Status}, author = {Blackwell, Debra L. and Mark D Hayward and Eileen M. Crimmins} } @article {6754, title = {Does Retirement Education Teach Individuals to Save Pension Distributions?}, journal = {Social Security Bulletin}, volume = {64}, year = {2001}, pages = {48-65}, publisher = {64}, keywords = {Pensions, Retirement Planning and Satisfaction}, author = {Leslie A. Muller} } @article {5451, title = {Does the Balance of Power Within a Family Matter? The Case of the Retirement Equity Act}, year = {2001}, institution = {Innocenzo Gasparini Institute for Economic Research}, keywords = {Adult children, Pensions, Public Policy}, author = {Aura, Saku} } @article {6756, title = {Duration or Disadvantage? Exploring Nativity, Ethnicity and Health in Midlife}, journal = {The Journals of Gerontology: Social Sciences}, volume = {56B}, year = {2001}, pages = {S275-285}, publisher = {56B}, abstract = {Objectives This study examined nativity as a risk factor for poor physical and emotional health for an ethnically diverse population making the transition into retirement. The authors addressed whether the health disadvantage observed for immigrants lessens with increased time spent in the country (supporting theories of assimilation) or increases with duration of residence (supporting theories of cumulative disadvantage). Methods The sample was drawn from Waves 1 and 2 of the Health and Retirement Study (HRS), an in-depth economic, social, and health database of persons in midlife and beyond. The analyses were restricted to 9,912 native-born and 1,031 foreign-born individuals. Results The data revealed that after socioeconomic factors were controlled, foreign-born individuals were at higher risk of poor emotional health than their native-born counterparts. Although aging immigrants displayed worse health than the native-born population, this disadvantage was mediated by duration of residence (young age at migration) and socioeconomic incorporation. Discussion These findings extend our understanding of nativity and duration as risk factors for poor physical and emotional health. Immigrants may overcome the nativity disadvantages found for emotional distress with increased duration of residence, but the pattern becomes more complicated with the inclusion of race and Hispanic ethnicity.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status, Net Worth and Assets, Women and Minorities}, url = {http://psychsoc.gerontologyjournals.org/}, author = {Jacqueline L. Angel and Cynthia J. Buckley and Sakamoto, Arthur} } @article {6710, title = {Data Watch: Research Data in Health Economics}, journal = {Journal of Economic Perspectives}, volume = {14}, year = {2000}, pages = {203-216}, publisher = {14}, abstract = {This paper describes what data are available, what questions can be addressed by, and how one can gain access to data sets of interest to economists. The HRS and AHEAD are written up under the {\textquoteright}Longitudinal and Household Surveys of Health Status and Health Care Use{\textquoteright} section of the paper. The paper summarizes both studies, explains their longitudinal nature, and describes the data used. The HRS and AHEAD represent an incredibly rich source of information on the health and economic behavior of individuals nearing retirement.}, keywords = {Methodology}, doi = {10.1257/jep.14.4.203}, author = {Evans, William N. and Helen G Levy and Kosali I. Simon} } @article {8438, title = {{\textquoteright}Decade of Behavior{\textquoteright} project launched}, journal = {University Record}, year = {2000}, month = {October 9, 2000}, pages = {11}, publisher = {University of Michigan}, address = {Ann Arbor, MI}, keywords = {Retirement Planning and Satisfaction}, author = {American Psychological Society} } @inbook {5164, title = {Developments in Pensions}, booktitle = {Handbook of Insurance}, year = {2000}, note = {ProCite field 6 : In ProCite field 8 : ed.}, publisher = {Kluwer Academic Publishers}, organization = {Kluwer Academic Publishers}, address = {Boston/Dordrecht/London}, abstract = {A single reference source for professors, researchers, graduate students, regulators, consultants and practitioners, the book starts with the history and foundations of risk and insurance theory, followed by a review of prevention and precaution, asymmetric information, risk management, insurance pricing, new financial innovations, reinsurance, corporate governance, capital allocation, securitization, systemic risk, insurance regulation, the industrial organization of insurance markets and other insurance market applications. It ends with health insurance, longevity risk, long-term care insurance, life insurance financial products and social insurance.}, keywords = {Insurance, Pensions}, url = {https://www.springer.com/us/book/9781461401544}, author = {Olivia S. Mitchell}, editor = {Dionne, Georges} } @article {5423, title = {Differential Mortality and the Value of Individual Account Retirement Annuities}, year = {2000}, note = {RDA; National Institute of Aging and the National Bureau of Economic Research}, institution = {National Bureau of Economic Research, NBER Working Paper 7560}, abstract = {This paper examines the extent of redistribution that would occur under various annuity and bequest options as part of an individual accounts retirement program. I first estimate mortality differentials by gender, race, ethnicity and level of education using the National Longitudinal Mortality Study and document substantial differences. I then use these estimates to examine the expected transfers that would take place between socioeconomic groups under different assumptions about the structure of an annuity program. Using an expected present discounted value or money s worth calculation as the basis for comparison, I find that the size of transfers in an individual accounts program is highly sensitive to the benefit structure. For example, mandating a single-life, real annuity can result in expected transfers of as high as 20 of the account balance, often from economically disadvantaged groups toward groups that are better off. These transfers can be substantially reduced through the use of joint life annuities, survivor provisions and bequest options. For example, the largest expected negative transfer under a joint and full survivor annuity with a fully valued 20-year guarantee option is only 2 of the account balance. However, efforts to reduce the extent of redistribution generally do so at the cost of significantly lower annuity benefits paid to the individuals who contribute to the system.}, keywords = {Income, Net Worth and Assets}, url = {http://www.nber.org/papers/}, author = {Brown, Jeffrey R.} } @article {5415, title = {The Diversity of Risk Among Age-62 Retired Worker Beneficiaries}, number = {2000-8}, year = {2000}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {This article focuses on age-62 retired-worker beneficiaries, a group whose well-being may be affected by changes in Social Security retirement ages. The analysis: 1) develops different measures of risk of a poor retirement; 2) applies these measures to developing a range of estimates of the risk for age-62 beneficiaries at the threshold of retirement; and 3) assesses how the circumstances of and risks experienced by these beneficiaries vary by such factors as race, gender, health status and marital status. The findings point to great diversity of circumstances among these early retirees and suggest that narrow conceptions of risk may fall short of fully identifying the distributive consequences of retirement age changes, especially for African Americans, Hispanics, low-income, unmarried individuals and unhealthy early retirees.}, keywords = {Pensions}, url = {https://crr.bc.edu/working-papers/the-diversity-of-risk-among-age-62-retired-worker-beneficiaries/}, author = {Kingson, Eric R. and Arsenault, Yvonne} } @article {5411, title = {Documentation of Affective Functioning Measures in the Health and Retirement Study}, year = {2000}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {This paper documents the HRS measures of mental health status, also called affective functioning. It is intended for a wide range of users, particularly those who would like to include mental health in their research but are not familiar with the measures available in the HRS. It also addresses topics of interest to mental health specialists who are concerned with how the abbreviated scales in the HRS correspond to the full scales used in the existing literature. This paper provides users with an overview of the measures included in the study, including their origins and pedigree. It details the specific steps used to create standard summary variables for the scales measuring depressive symptoms and major depressive episodes, and includes SAS code for this variable creation in a Technical Appendix.}, keywords = {Health Conditions and Status}, author = {Steffick, Diane E.} } @article {5404, title = {Does Mental Health Affect Transitions out of the Labor Force in Older Workers?}, year = {2000}, institution = {American Sociological Association}, abstract = {This paper extends earlier studies on health and work by examining how mental health affects transitions out of paid work in the years prior to the traditional Social Security retirement ages. Specifically, I investigate how mental health is linked to transitions to early retirement or other unemployed state in 1996 for middle-age adults who were currently working in 1992 and, in particular, whether deficits in mental health affect those transitions. To answer those questions, I use data from the first three waves of the Health and Retirement Study, a panel study of a nationally representative sample of Americans age 51-61 in 1992. Results of logistic regression analyses indicated that mental health had a strong and significant influence on the move from paid work to unemployment in three ways, net of other documented health, job, and socioeconomic correlates of work status: (1) Above-average self-assessed mental health predicted the transition from current worker to retiree. (2) Above -average mental health played a protective role in keeping workers in the work force rather than being laid off, on sick leave, or otherwise unemployed. (3) Increased CES-D depressive symptoms between 1992 and 1994 predicted exits from paid employment and into other unemployment by 1996. The results also indicate that mental health was an even more important predictor of transitions out of paid work among middle-age workers than were physical health and functioning.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status, Healthcare, Retirement Planning and Satisfaction}, author = {Linda A. Wray} } @article {5424, title = {Drug Use Among the Elderly: An Assessment of California{\textquoteright}s Need for Prevention and Treatment Services}, year = {2000}, note = {RDA 1998-012}, institution = {State of California, Dept. of Alcohol and Drug Programs}, keywords = {Health Conditions and Status, Healthcare}, author = {Wong, Mamie M. and Anglin, M. Douglas} } @article {6631, title = {Demand for Home Modifications: A Household Production Function Approach}, journal = {Applied Economics}, volume = {31}, year = {1999}, note = {ProCite field 3 : Cornell U}, pages = {1273-81}, publisher = {31}, abstract = {Coping with activity limitations that occur in old age is an important issue in the context of increasing life expectancy and the, still, inevitable onset of chronic conditions in old age. Elderly households can be viewed as coping with activity limitations by producing functionality with the use of direct inputs that include home modifications. A model of the household production of functionality is developed within the general framework of household production function models of health. Hypotheses generated from this model are tested using a logit model for data from the Survey of Asset and Health Dynamics Among the Oldest Old (AHEAD). The main findings of the empirical analysis are that the demand for home modifications is fairly income-inelastic, home modifications and personal care are substitutes to some degree, the demand for home modifications increases with years of schooling, and that particular health conditions and the use of other assistive devices are important determinants of the demand for modifications.}, keywords = {Consumption and Savings, Health Conditions and Status, Housing, Net Worth and Assets}, doi = {10.1080/000368499323481}, author = {Kutty, Nandinee K.} } @article {5396, title = {Determinants of the Living Arrangements of the Elderly}, year = {1999}, institution = {Cambridge, MA, Harvard University}, abstract = {Abstract: Examined the determinants of the living arrangements of older adults. Data were obtained from the Assets and Health Dynamics Among the Oldest-Old (AHEAD) survey on 8,222 adults aged 70 and older in 1993 and 6,047 housing units. It was found that assisted living communities were favored by older households (especially those with the oldest person aged 85 or older) and when no adult children were living within 10 miles. However, preferences for assisted living communities were unaffected by the presence of difficulties with activities of daily living (ADLs) or instrumental ADLs (IADLs). Shared housing was favored by households with one or more members having difficulties with ADLs and IADLs and by households without any nonresident children. Supported housing was favored by households with one or more members having difficulties with ADLs and IADLs. Educational attainment, income, net worth, and sex had little to do with the selection of living arrangements. Blacks and Hispanics were less likely than whites to live in age-segregated housing and more likely to live in shared housing. An appendix provides information on the multinomial logit model used in the study.}, keywords = {Demographics, Health Conditions and Status, Housing}, author = {Shafer, Robert} } @article {6662, title = {Does Retirement Planning Affect the Level of Retirement Satisfaction?}, journal = {Financial Services Review}, volume = {8}, year = {1999}, pages = {117-27}, publisher = {8}, abstract = {This article analyzes the relationship between retirement planning and retirement satisfaction. Planning for retirement is positively related to the level of retirement satisfaction. As expected, individuals with higher incomes, larger net worths, and those who have partners are significantly more likely to be satisfied in retirement. However, even after controlling for these variables, results show that planning does indeed impact the level of retirement satisfaction. Furthermore, planning implies a higher level of satisfaction even for those who did not make the decision to retire voluntarily- - either because of health problems or an employer{\textquoteright}s decision.}, keywords = {Adult children, Demographics, Employment and Labor Force, Health Conditions and Status, Net Worth and Assets}, doi = {10.1016/S1057-0810(99)00036-0}, author = {Elder, Harold W. and Rudolph, Patricia M.} } @article {6652, title = {The Dynamic Effects of Health on the Labor Force Transitions of Older Workers}, journal = {Labour Economics}, volume = {6}, year = {1999}, pages = {179-202}, publisher = {6}, abstract = {This article analyzes the relationship between health and alternative labor force transitions, including labor force exit, job change, and application for disability insurance. Health is a very significant determinant of labor force patterns. Controlling for lagged values of health, poor contemporaneous health is strongly related to older men and women{\textquoteright}s exit from the labor force and their decisions to apply for disability insurance. Controlling for poor contemporaneous health, poor lagged health is associated with continued participation in the work force. The earlier a health shock occurs, the less likely it is to lead to labor force exit. People who experience health setbacks earlier in life tend to switch jobs instead of stopping to work. Results suggest that both poor health and declines in health are significant variables that help to explain retirement behavior.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status}, doi = {10.1016/S0927-5371(99)00015-9}, author = {John Bound and Michael Schoenbaum and Todd R. Stinebrickner and Timothy A Waidmann} } @article {6610, title = {Do medical conditions affect cognition in older adults?}, journal = {Health Psychol}, volume = {17}, year = {1998}, month = {1998 Nov}, pages = {504-12}, publisher = {17}, abstract = {

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

}, keywords = {Aged, Aged, 80 and over, Aging, Cerebrovascular Disorders, Cognition, Diabetes Complications, Diabetes Mellitus, Female, Health Status, Humans, Hypertension, Male, Mental Health}, issn = {0278-6133}, doi = {10.1037//0278-6133.17.6.504}, url = {https://pubmed.ncbi.nlm.nih.gov/9848800/}, author = {Elizabeth Zelinski and Eileen M. Crimmins and Sandra L Reynolds and Teresa Seeman} } @article {5358, title = {A Dynamic Structural Model of Health Insurance and Retirement}, year = {1998}, institution = {University of North Carolina-Chapel Hill}, keywords = {Medicare/Medicaid/Health Insurance, Pensions}, url = {https://cowles.yale.edu/sites/default/files/files/conf/2000/sdm_blau.pdf}, author = {David M. Blau and Gilleskie, Donna B.} } @article {6599, title = {Data Markets and the Production of Surveys}, journal = {Review of Economic Studies}, volume = {64}, year = {1997}, pages = {47-72}, publisher = {64}, abstract = {The production of data, and the functioning of the market for observations, are universal concerns to all fields of positive economics. Economists, however, have typically placed greater emphasis on systematically analyzing the consumption of data than on considering its production. In the production of data through surveys, an important input market is that of labor, in which a demander trades observations with the supplying sample members. This paper analyses optimal monopsony compensation in such data markets, the important relationship it bears to estimation using the data that are obtained, and the statistical effects of implicit public wage regulations that are present in US markets for observations.}, keywords = {Employment and Labor Force, Methodology}, doi = {10.2307/2971740}, author = {Philipson, Tomas} } @article {6566, title = {Demographic and economic correlates of health in old age.}, journal = {Demography}, volume = {34}, year = {1997}, note = {ProCite field 3 : RAND; UCLA and RAND}, month = {1997 Feb}, pages = {159-70}, publisher = {34}, abstract = {

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

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, Demography, Disabled Persons, ethnicity, Female, Health Status, Humans, Income, Male, Models, Econometric, Racial Groups, Socioeconomic factors, United States}, issn = {0070-3370}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9074837}, author = {James P Smith and Raynard Kington} } @article {6592, title = {Distribution and association of chronic disease and mobility difficulty across four body mass index categories of African-American women.}, journal = {Am J Epidemiol}, volume = {145}, year = {1997}, month = {1997 May 15}, pages = {865-75}, publisher = {145}, abstract = {

A majority of African-American women over the age of 50 are obese, have at least one chronic disease, and experience mobility difficulty. Using self-reported data from the 1992 Health and Retirement Study of 1,150 African-American women aged 30-70 years, this report first compares chronic disease prevalence and severity, pain, sensory deficits, and mobility difficulty across four categories of body mass index and, second, investigates whether body mass index affects the association of chronic disease with mobility difficulty. Body mass index was categorized as low, medium, high, and severe, being equal to 19-24 (20\%), 25-29 (38\%), 30-34 (24\%), and 35 or over (18\%), respectively. There were few differences when comparing the medium category with either the low or high category. Those in the severe body mass index category, however, reported significantly more frequent and severe hypertension, diabetes, cancer, heart disease, arthritis, pain, sensory deficits, and mobility difficulty than did those in the medium body mass index category. Obesity did not appear to affect the association between chronic disease and mobility difficulty. The relatively high rates of mobility difficulty observed among the severe body mass index group appear to be more likely a result of relatively high chronic disease prevalence and severity than to a disproportionate impact of these on mobility.

}, keywords = {Activities of Daily Living, Black People, Body Mass Index, Chronic disease, Comorbidity, Cross-Sectional Studies, Female, Health Behavior, Humans, Michigan, Middle Aged, Obesity, Prevalence, Regression Analysis, Severity of Illness Index, Socioeconomic factors}, issn = {0002-9262}, doi = {10.1093/oxfordjournals.aje.a009046}, author = {Daniel O. Clark and Mungai, S.M.} } @article {6568, title = {Distribution and Association of Chronic Disease and Mobility Difficulty Across Four Body Mass Index Categories of African-American Women}, journal = {American Journal of Epidemiology}, volume = {145}, year = {1997}, pages = {865-75}, publisher = {145}, abstract = {A majority of African-American women over the age of 50 are obese, have at least one chronic disease, and experience mobility difficulty. Using self-reported data from the 1992 Health and Retirement Study of 1,150 African-American women aged 30-70 years, this report first compares chronic disease prevalence and severity, pain, sensory deficits, and mobility difficulty across four categories of body mass index and, second, investigates whether body mass index affects the association of chronic disease with mobility difficulty. Body mass index was categorized as low, medium, high, and severe, being equal to 19-24 (20 ), 25-29 (38 ), 30-34 (24 ), and 35 or over (18 ), respectively. There were few differences when comparing the medium category with either the low or high category. Those in the severe body mass index category, however, reported significantly more frequent and severe hypertension, diabetes, cancer, heart disease, arthritis, pain, sensory deficits, and mobility difficulty than did those in the medium body mass index category. Obesity did not appear to affect the association between chronic disease and mobility difficulty. The relatively high rates of mobility difficulty observed among the severe body mass index group appear to be more likely a result of relatively high chronic disease prevalence and severity than to a disproportionate impact of these on mobility.}, keywords = {Demographics, Health Conditions and Status, Methodology, Other}, doi = {10.1093/oxfordjournals.aje.a009046}, author = {Daniel O. Clark and Mungai, S.M.} } @article {6580, title = {The division of family labor: care for elderly parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {102-9}, publisher = {52B}, abstract = {

We consider the division of caregiving efforts among the children of older, functionally limited parents. Our model of parental care assumes that care decisions are made in the context of an extended family, with each child taking into account not only the parent{\textquoteright}s needs and the child{\textquoteright}s own circumstances, but also the characteristics and actual care behavior of siblings. We propose a simultaneous-Tobit statistical framework that embodies these assumptions. The model is estimated using data from the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The findings indicate that a child{\textquoteright}s hours of parent care are reduced, but on much less than a one-for-one basis, as the parent-care hours of siblings increase. We also find that a child{\textquoteright}s supply of parent-care hours is reduced by having sisters, holding constant the care efforts of siblings.

}, keywords = {Aged, Caregivers, Family, Frail Elderly, Humans, Models, Theoretical, Time Factors}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.102}, author = {Douglas A. Wolf and Vicki A Freedman and Beth J Soldo} } @article {6594, title = {Do health selection effects last? A comparison of morbidity rates for elderly adult immigrants and US-born elderly persons.}, journal = {J Cross Cult Gerontol}, volume = {12}, year = {1997}, month = {1997 Dec}, pages = {317-39}, publisher = {12}, abstract = {

This paper uses the Assets and Health Dynamics of the Oldest Old (AHEAD) data set to examine the influence of nativity on the health status, measured by self-reported presence of chronic diseases, of the elderly US-resident population. In particular, age at time of migration is used to examine the potential lingering influence of self-selection for good health among immigrants who entered the USA as adults. Bivariate analyses and logistic regression models are presented. The results of these analyses show that the influence of positive selection for health varies depending on the disease studied. Self-selection for good health is maintained for cancer, heart disease, stroke, and lung disease. This self-selection effect is seen after controlling for socioeconomic factors and health behaviors. While these latter factors are more influential, this study indicates that good health in a population at young ages is maintained throughout the lifespan.

}, issn = {0169-3816}, doi = {10.1023/a:1006527615599}, author = {Karen C. Swallen} } @article {5341, title = {Do Parents Divide Resources Equally Among Children? Evidence from the AHEAD Survey}, year = {1997}, institution = {Syracuse University}, keywords = {Adult children, Net Worth and Assets}, author = {Dunn, Thomas A. and John W R Phillips} } @article {6572, title = {Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey.}, journal = {Am J Public Health}, volume = {87}, year = {1997}, month = {1997 May}, pages = {755-9}, publisher = {87}, abstract = {

OBJECTIVES: This study examined whether smokers recognize that smoking is likely to shorten their lives and, if so, whether they understand the magnitude of this effect.

METHODS: People{\textquoteright}s expectations about their chances of reaching age 75 were compared with epidemiological predictions from life tables for never, former, current light, and current heavy smokers. Data on expectations of reaching age 75 came from the Health and Retirement Survey, a national probability sample of adults aged 50 through 62 years. Predictions came from smoking-specific life tables constituted from the 1986 National Mortality Followback Survey and the 1985 and 1987 National Health Interview Surveys.

RESULTS: Among men and women, the survival expectations of never, former, and current light smokers were close to actual predictions. However, among current heavy smokers, expectations of reaching age 75 were nearly twice as high as actuarial predictions.

CONCLUSIONS: These findings suggest that at least heavy smokers significantly underestimate their risk of premature mortality.

}, keywords = {Cognition, Female, Health Surveys, Humans, Life Tables, Longevity, Male, Middle Aged, Retirement, Risk, Sex Factors, Smoking, Survival Analysis}, issn = {0090-0036}, doi = {10.2105/ajph.87.5.755}, author = {Michael Schoenbaum} } @article {6559, title = {Differential Rates of Cardiovascular Disease Among the Immigrant Elderly}, journal = {American Journal of Epidemiology}, volume = {143}, year = {1996}, pages = {S50}, publisher = {143}, abstract = {This paper examines the difference in morbidity among foreign-born and native-born elderly populations in the United States. Findings suggest that other differences between immigrant and native populations contribute to differential disease rates.}, keywords = {Demographics, Health Conditions and Status, Net Worth and Assets}, author = {Karen C. Swallen} } @article {6545, title = {Disentangling the effects of disability status and gender on the labor supply of Anglo, black, and Latino older workers.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {299-310}, publisher = {36}, abstract = {

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

}, keywords = {Black or African American, Disabled Persons, Employment, Female, Hispanic or Latino, Humans, Male, Middle Aged, Models, Theoretical, Multivariate Analysis, Sex Factors, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/36.3.299}, author = {Santiago, A.M. and Clara G. Muschkin} } @inbook {5129, title = {Demographics, the Housing Market, and the Welfare of the Elderly}, booktitle = {Studies in the economics of aging}, series = {National Bureau of Economic Research Project Report series}, year = {1994}, note = {ProCite field[3]: U CA, BerkeleyProCite field[8]: ed.}, pages = {225-85}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, address = {Chicago and London}, keywords = {Consumption and Savings, Demographics, Housing}, author = {Daniel McFadden}, editor = {David A Wise} }