@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 {DAS2024103011, title = {Dyadic contagion in cognitive function: A nationally-representative longitudinal study of older U.S. couples}, journal = {Social Science Research}, volume = {120}, year = {2024}, pages = {103011}, abstract = {Later-life cognitive function is strongly influenced by one{\textquoteright}s environment. At this life stage, a partner{\textquoteright}s behaviors and attributes{\textemdash}including their own cognitive status{\textemdash}are a key environmental determinant. A recent {\textquotedblleft}social allostasis{\textquotedblright} theory also yields specific predictions on patterns of mutual influence{\textemdash}or {\textquotedblleft}contagion{\textquotedblright}{\textemdash}in cognitive function. Yet, no population representative studies have examined these coupled dynamics. Using recently developed fixed-effects cross-lagged panel modeling (FE-CLPM) methods and ten-year data from the Health and Retirement Study{\textemdash}nationally-representative of U.S. adults over 50{\textemdash}the current study filled this gap. Results supported dyadic cognitive contagion over the long- but not short-run. Short-term associations suggested intriguing {\textquotedblleft}cognitive cycling{\textquotedblright} possibilities among both men and women that need further investigation. Overall, results supported a theoretical model of coupled {\textquotedblleft}cognitive careers,{\textquotedblright} and relational inducement of allostatic load. Especially among men, recurrent impulses also cumulatively induced substantial path-dependent cognitive improvements, supporting the added value of repeated over one-time interventions. Theoretical and substantive implications are discussed.}, keywords = {Allostatic load, Dyadic cognitive careers, FE-CLPM, Global cognitive function, Social allostasis}, issn = {0049-089X}, doi = {https://doi.org/10.1016/j.ssresearch.2024.103011}, author = {Aniruddha Das} } @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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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} } @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 {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 {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 {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 {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 {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 {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 {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 { 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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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} } @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 {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 {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 {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 {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 {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 {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 {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} } @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 {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} } @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} } @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 {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} } @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 {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} } @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} } @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 {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 {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 {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 {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} } @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 {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 {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 {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 {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 {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} } @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 {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} }