@article {13825, title = {Marital Quality and Depressive Symptoms among Older Hispanic Adults in the United States.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, year = {Forthcoming}, abstract = {

OBJECTIVES: Despite the cultural importance of marriage as a social support system and its well-established link to mental health, older Hispanic adult populations, which are the largest racial and ethnic minoritized groups, remain understudied. The current study examined how positive and negative dimensions of marital quality are associated with depressive symptoms.

METHODS: Data from Hispanic adults aged 51 years and older (n = 1,012) were obtained from the 2016 and 2018 Health and Retirement Study (HRS) waves. The CES-D scale (0-8 symptoms) was modeled as a function of positive and negative marital quality measures (1-4), as well as the relevant covariates.

RESULTS: Results from a negative binomial regression model showed that a one-unit change in positive and negative marital quality was associated with a 23.61\% reduction and a 23.74\% increase, respectively, in depressive symptoms. The interaction terms with marital quality and gender, as well as marital quality and religion, were not statistically significant.

DISCUSSION: In the U.S., a large percentage of older Hispanic adults are immigrants, and their extended family tends to reside in their countries of origin. As such, older Hispanic adults may have smaller social networks, and marital quality most likely represents a culturally important social support network in later life. Significant associations between depressive symptoms and marital quality among older Hispanic adults should receive more attention in family and public health policy discussions, particularly given the increasing diversity in U.S. society.

}, keywords = {Cultural factors, health-related quality of life, Marriage, Social Support}, issn = {1758-5368}, doi = {10.1093/geronb/gbae032}, author = {Nazario-Acevedo, Jaminette M and Yamashita, Takashi and Bulanda, Jennifer Roebuck and Brown, J Scott} } @article {10.1093/geroni/igae013, title = {Measuring Psychological Resilience in Aging: Findings from the Health and Retirement Study (HRS) and National Longitudinal Study of Adolescent to Adult Health (Add Health)}, journal = {Innovation in Aging}, year = {Forthcoming}, abstract = {This study aimed to evaluate the measurement properties of two emerging psychological resilience (PR) measures constructed for use in large national data sources and to test their reliability across social axes including race/ethnicity, gender, and socioeconomic status.Using 2006/2008 data, the Simplified Resilience Score (SRS) and the Add Health Resilience Scale (AHRS) were tested using overall and multi-group measurement models in a structural equation modeling (SEM) framework.Both PR measures perform well as reliable, one factor latent constructs capturing adaptive capacity at various life stages. Both measures showed measurement consistency across social axes, with specific differences in item measurement across some racial/ethnic groups.The results indicate these measures represent high quality, consistent measures of PR in nationally representative aging and health data. The availability of reliable, valid measures of PR enables consistent evaluation of resilience in health and aging processes.}, keywords = {Adaptation, coping, Measurement Invariance, structural equation modelling, Wellbeing}, issn = {2399-5300}, doi = {10.1093/geroni/igae013}, author = {Taylor, Miles G and Bruefach, Tyler and Carr, Dawn Celeste} } @article {13695, title = {Memory trajectories and disability among older couples: the mediating role of depressive symptoms.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, year = {Forthcoming}, abstract = {

OBJECTIVE: Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands{\textquoteright} and wives{\textquoteright} memory trajectories and their prospective disability status.

METHODS: Longitudinal data from the Health and Retirement Study 2004-2018 were used. Older (aged 50+) heterosexual couples who had no limitations in activity of daily living at the baseline (2004) were included (N = 1,310). Latent class growth analysis grouped wives and husbands into distinct memory trajectories in 2004-2014. A structural equation model examined the actor and partner effects of memory trajectories on depressive symptoms in 2016 and disability status in 2018. The mediating effect of depressive symptoms was tested.

RESULTS: Four distinct memory trajectories were found: persistently high, high and slow decline, moderate and slow decline, and low and rapid decline. Only the wife{\textquoteright}s low and rapid decline memory trajectory predicted her own more depressive symptoms (β = 0.588, 95\% CI = 0.209, 0.967) and her husband{\textquoteright}s more depressive symptoms (β = 0.326, 95\% CI = 0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (β = 0.046, 95\% CI = 0.036, 0.057 for wives; β = 0.060, 95\% CI = 0.046, 0.074 for husbands).

DISCUSSION: The wife{\textquoteright}s low and rapid decline trajectory was associated with her own and her husband{\textquoteright}s more depressive symptoms, which in turn increased the disability risk for both partners. Timely identification and treatment of memory decline among wives have the potential to mitigate couples{\textquoteright} depressive symptoms and, ultimately, disability risks.

}, keywords = {Dyad research, latent class growth analysis, Memory, Older couples, trajectory}, issn = {1758-5368}, doi = {10.1093/geronb/gbad163}, author = {Kong, Dexia and Lu, Peiyi and Jiang, Da and Chan, Helen Yue Lai} } @article {13757, title = {Money may matter: Financial hardship and its association with satisfaction of care among people living with dementia.}, journal = {Journal of the American Geriatrics Society}, year = {Forthcoming}, abstract = {Financial hardship is a multidimensional construct that includes, but is not limited to, out-of-pocket costs. Financial hardship has mostly been studied in patients with cancer and is independently associated with decreased treatment adherence,1 worse quality of life,2 worse psychological and physical symptoms,2, 3 and mortality4 {\textemdash} outcomes of great importance to people living with dementia (PLWD) as well. However, there are limited data specifically examining the prevalence or the impact of financial hardship among PLWD. Our objectives are to estimate the prevalence of financial hardship among PLWD and describe measures of satisfaction with life and with health care among PLWD, compared to a cancer cohort.}, keywords = {Dementia, Finances, Life Satisfaction}, issn = {1532-5415}, doi = {10.1111/jgs.18723}, author = {Miller, Katherine E M and White, Lindsay and Coe, Norma B and Khandelwal, Nita} } @article {Biroli2021.03.05.434163, title = {Moral Hazard Heterogeneity: Genes and Health Insurance Influence Smoking after a Health Shock}, journal = {bioRxiv}, year = {Forthcoming}, abstract = {Decision-making in the realm of health behaviors, such as smoking or drinking, is influenced both by biological factors, such as genetic predispositions, as well as environmental factors, such as financial liquidity and health insurance status. We show how the choice of smoking after a cardio-vascular health shock is jointly determined by the interaction between these biological and environmental constraints. Individuals who suffer a health shock when uninsured are 25.6 percentage points more likely to reduce smoking, but this is true only for those who have a low index of genetic predisposition to smoking. Individuals with a low index of genetic predisposition are more strategic and flexible in their behavioral response to an external shock. This differential elasticity of response depending on your genetic variants is evidence of individual-level heterogeneity in moral hazard. These results suggest that genetic heterogeneity is a factor that should be considered when evaluating the importance and fairness of health insurance policies.JEL CODES I12, I13, D63, D91Competing Interest StatementThe authors have declared no competing interest.}, keywords = {Genetics, Health Insurance, health shock, Smoking}, doi = {10.1101/2021.03.05.434163}, author = {Biroli, Pietro and Zwyssig, Laura} } @article {13584, title = {The Mediating Role of Sense of Control in the Associations Between Remote Contacts and Loneliness Among Older Adults.}, journal = {Research on Aging}, volume = {46}, year = {2024}, pages = {167-175}, abstract = {

This study explored whether a sense of control over social life mediated the associations between using remote contact (phone calls, letters/emails, social media) and loneliness for socially isolated older adults. We used path analysis with the 2014 and 2016 Health and Retirement Study datasets ( = 3767). Results showed that more frequent phone calls and letters/emails were associated with lower levels of loneliness through sense of control. However, sense of control did not mediate the association between social media and loneliness. Findings suggest that promoting sense of control over social life by remote contact, particularly phone calls and letters/emails, may be effective in alleviating loneliness for isolated older adults.

}, keywords = {isolated older adults, Loneliness, path analysis, remote contact, Sense of control}, issn = {1552-7573}, doi = {10.1177/01640275231206484}, author = {Yoon, Dokyung and Gallo, Haley and Gassoumis, Zachary D and Joo, Susanna} } @article {13867, title = {Medicare Decisions Often Made in Tandem by Couples}, year = {2024}, publisher = {AARP}, keywords = {Couples, Medicare}, url = {https://www.aarp.org/health/medicare-insurance/info-2024/couples-make-medicare-decisions-together.html}, author = {Urban, Peter} } @article {13738, title = {Mediterranean diet and a health behavior index in relation to cardiovascular biomarkers: Data from the Health and Retirement Study}, journal = {Nutrition, Metabolism \& Cardiovascular Diseases (NMCD)}, year = {2024}, abstract = {Background and aim Although lifestyle factors have been repeatedly examined for their role on cardiovascular diseases, their composite effect has not been frequently explored. We aimed to investigate the relation of dietary patterns (DPs) and a health behavior index (HBI) with cardiovascular biomarkers. Methods and results A cross-sectional analysis with data from 3461 US residents, participants in the Health and Retirement Study (HRS), was performed. Nutritional data were obtained with a food frequency questionnaire, while adherence to Mediterranean Diet (MD) was determined by the Mediterranean Diet Score. A posteriori DPs were estimated using principal component analysis and the HBI was constructed combining adherence to MD, smoking status, physical activity levels, alcohol consumption and body mass index. Multiple linear regression models were performed to examine the relation between DPs or HBI and levels of C-reactive protein (CRP), glycosylated hemoglobin (HbA1C), cystatin C (Cys C), total cholesterol (TC), high density lipoprotein (HDL) and TC:HDL in blood. Multiple linear regression showed that the {\textquotedblleft}healthy{\textquotedblright} DP and the MD had a significant negative association with CRP and Cys C (p < 0.05), while the {\textquotedblleft}Western-type{\textquotedblright} DP had a significant positive association with TC:HDL ratio, CRP and Cys C. Moreover, the HBI was positively associated with HDL (p < 0.05) and negatively associated with TC:HDL ratio, CRP and Cys C (p < 0.05). Conclusions Adherence to MD and to a healthy dietary pattern was negatively associated with biomarkers of inflammation, while the HBI was associated with a better cardiometabolic profile, assessed with blood biomarkers.}, keywords = {Biomarkers, Cardiovascular Inflammation, Dietary patterns, Mediterranean diet}, doi = {https://doi.org/10.1016/j.numecd.2024.01.004}, author = {Philippos Orfanos and Vasiliki Benetou and Elena Riza and Ionas Papassotiriou} } @article {13763, title = {Meet the {\textquoteright}forgotten middle{\textquoteright} of Americans over 75 facing a rocky retirement}, year = {2024}, publisher = {Business Insider}, keywords = {Retirement}, url = {https://www.businessinsider.com/retirement-savings-investment-crisis-middle-class-americans-racial-inequality-2024-2}, author = {Kaplan, Juliana} } @article {13864, title = {More problems equal more pain for middle-age and older adults, UWM study finds}, year = {2024}, publisher = {UWM Report, The University of Wisconsin-Milwaukee}, keywords = {Chronic pain, life stressors, race and ethnicity}, url = {https://uwm.edu/news/more-problems-equal-more-pain-for-middle-age-and-older-adults-uwm-study-finds/}, author = {Otto, Laura} } @article {12970, title = {Marital Quality and Alcohol Use among Couples in Mid- and Later-Life.}, journal = {Journal of Applied Gerontology}, volume = {42}, year = {2023}, pages = {1068-1077}, abstract = {

Spouses influence one another{\textquoteright}s drinking behavior, but little research has explored how relationship quality may impact older couples{\textquoteright} alcohol use. Using data from the 2014-2018 waves of the Health and Retirement Study (HRS) and actor-partner interdependence models, we examined how marital quality is related to total alcohol consumption and risk of heavy drinking for married couples over age 50. Neither husbands{\textquoteright} nor wives{\textquoteright} perceptions of negative marital quality were related to changes in heavy drinking or number of drinks consumed over the observation period. However, wives{\textquoteright} positive marital quality was associated with increased risk of heavy alcohol use for both wives and husbands, and with an increase in the number of drinks wives consume over time. Couples over age 50 do not appear to use alcohol as a way of coping with negative marital relationships, but rather may increase their drinking in the context of positive relationships.

}, keywords = {actor-partner interdependence model, Drinking, Marriage, relationship satisfaction}, issn = {1552-4523}, doi = {10.1177/07334648221143305}, author = {Bulanda, Jennifer Roebuck and Curl, Angela L and Roberts, Amy Restorick} } @article {13190, title = {Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations.}, journal = {Alzheimers Dement}, volume = {19}, year = {2023}, month = {2023 May}, pages = {2218-2225}, abstract = {

INTRODUCTION: The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings.

METHODS: We used data from the Harmonized Cognitive Assessment Protocol Surveys (HCAP) in five countries (total N~=~11,250) to quantify associations between items on functional limitations and cognitive impairment.

RESULTS: Many items performed better in the United States and England compared to South Africa, India, and Mexico. Items on the Community Screening Instrument for Dementia (CSID) had the least variability across countries (SD~=~0.73~vs. 0.92 [Blessed] and 0.98 [Jorm IQCODE]), but also the weakest associations with cognitive impairment (median odds ratio [OR]~=~2.23~vs. 3.01 [Blessed] and 2.75 [Jorm IQCODE]).

DISCUSSION: Differences in cultural norms for reporting functional limitations likely influences performance of items on functional limitations and may affect the interpretation of results from substantive studies.

HIGHLIGHTS: There was substantial cross-country variation in item performance. Items from the Community Screening Instrument for Dementia (CSID) had less cross-country variability but lower performance. There was more variability in performance of instrumental activities of daily living (IADL) compared to activities of daily living (ADL) items. Variability in cultural expectations of older adults should be taken into account. Results highlight the need for novel approaches to assessing functional limitations.

}, keywords = {Activities of Daily Living, Aged, Cognitive Dysfunction, Dementia, England, Humans, Surveys and Questionnaires, United States}, issn = {1552-5279}, doi = {10.1002/alz.12994}, author = {Nichols, Emma and Ng, Derek K and Hayat, Shabina and Kenneth M. Langa and Lee, Jinkook and Steptoe, Andrew and Deal, Jennifer A and Gross, Alden L} } @article {13692, title = {Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults.}, journal = {Neurology}, volume = {101}, year = {2023}, pages = {e2355-e2363}, abstract = {

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

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

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

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

}, keywords = {Aged, Aging, Biology, Biomarkers, DNA Methylation, Heart Diseases, Humans, Middle Aged, Saliva, Stroke, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000207909}, author = {Waziry, Reem and Gu, Yian and Boehme, Amelia K and Williams, Olajide A} } @article {12967, title = {Measures of physical performance as mediators between personality and cognition in two prospective studies.}, journal = {Archives of Gerontology and Geriatrics}, volume = {107}, year = {2023}, pages = {104902}, abstract = {

Few studies have examined the pathways linking personality to cognition. This study aimed to examine whether measures of physical performance (gait speed, peak expiratory flow (PEF), and grip strength) mediated the association between five-factor model personality traits and cognition (memory performance, subjective memory, and informant-rated cognition). Participants were aged 57 to 95 years from the Health and Retirement Study (HRS, N~=~4,109) and the English Longitudinal Study of ageing (ELSA, N~=~3,584). In HRS, personality and demographic factors were assessed in 2008/2010, physical performance in 2012/2014, and memory performance and subjective memory in 2016/2018. Informant-rated cognition was obtained in 2016 for an HRS subsample. In ELSA, personality and demographic factors were assessed in 2010/2011, physical performance in 2012/2013, and objective and subjective memory in 2014/2015. Informant-rated cognition was obtained in 2018 for an ELSA subsample. With a few exceptions, replicable patterns of mediation were found across HRS and ELSA. Slower gait speed partially mediated the association between higher neuroticism, lower conscientiousness and worse scores on all three cognitive measures (memory performance, subjective memory, and informant-rated cognition). Slower gait also partially mediated the association between openness and both objective and subjective memory. There was less replicable evidence for a mediating role of PEF and grip strength. The present study advances knowledge on the pathways linking personality to cognition in older adults and supports the hypothesis that personality associations with better physical function can help support healthy cognitive aging.

}, keywords = {Cognition, Personality, Physical Functional Performance}, issn = {1872-6976}, doi = {10.1016/j.archger.2022.104902}, author = {Stephan, Yannick and Sutin, Angelina R and Luchetti, Martina and Aschwanden, Damaris and Cabibel, Vincent and Terracciano, Antonio} } @article {13537, title = {Measuring spatial availability of children for older adults with disability.}, journal = {Social Science \& Medicine}, volume = {335}, year = {2023}, pages = {116201}, abstract = {

BACKGROUND: Having an adult child living with or nearby may prevent parents with disability from moving to nursing homes and reduce the use of paid care services. Despite the profound implications for care resources and utilization among older adults, there is no measure summarizing the spatial availability of all adult children for an older adult. Our study aims to develop a holistic measure of adult children{\textquoteright}s spatial availability to assess potential family care resources for older adults with disability.

METHODS: Data were obtained from the population-based, longitudinal study in the U.S., the Health and Retirement Study (HRS). We selected a nationally representative sample of older adults 55+ years with disability. Using multivariable two-part regression models, we developed a care-weighted child spatial availability for caregiving (CSAC) index, which summarizes the spatial dispersion of all adult children accounting for potential caregiving associated with distance. We also constructed a reference index of child spatial proximity (CSP) focusing only on spatial distance by employing Gaussian kernel weighting functions.

RESULTS: CSAC index highlights the great importance of having an adult child in the same household (vs. nearby or far) for receiving care among older adults with disability, compared to the CSP index, showing relatively a gradual decline over the spatial distance. Both indices vary substantially by older adults{\textquoteright} sociodemographic attributes.

CONCLUSIONS: The holistic indices of adult child spatial availability will contribute to assessing care resources for older adults, albeit future development is needed to extend the utility of the indices tailored for specific care needs.

}, keywords = {ADL/IADL disability, Family availability, Geographic dispersion of children, Intergenerational caregiving, Sociodemographic disparity}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.116201}, author = {Cho, Tsai-Chin and Park, Bona and Choi, Hwajung} } @article {12737, title = {The Mediating Role of Biomarkers in the Association between Subjective Aging and Episodic Memory.}, journal = {The Journals of Gerontology, Series B }, volume = {78}, year = {2023}, pages = {242-252}, abstract = {

OBJECTIVES: Subjective aging, indexed by subjective age and self-perceptions of aging (SPA), is consistently related to cognition in adulthood. The present study examined whether blood biomarkers mediate the longitudinal associations between subjective aging indices and memory.

METHODS: Data of 5,369 individuals aged 50 to 94 years (Mean= 66.89 years, SD= 9.22; 60\% women) were drawn from the Health and Retirement Study (HRS). Subjective age, SPA, and demographic factors were assessed in 2012/2014. Interleukin-6, C-reactive protein, albumin, cystatin C, N-terminal pro B-type natriuretic peptide (NT-proBNP), fasting glucose, Vitamin D, hemoglobin, red cells distribution width, and epigenetic aging were assessed as part of the HRS Venuous Blood Study in 2016. Memory was measured in 2018. The mediators (except for epigenetic aging, which was assessed in a subsample) were tested simultaneously in models that accounted for demographic covariates.

RESULTS: An older subjective age was related to worse memory partially through higher fasting glucose, higher cystatin C, higher NT-proBNP, and accelerated epigenetic aging. Negative SPA were related to worse memory through lower Vitamin D3, higher fasting glucose, higher cystatin C, higher NT-proBNP, and accelerated epigenetic aging. The biomarkers explained between 2\% and 10\% of subjective age and between 1\% and 8\% of SPA associations with memory. Additional analysis revealed that biomarkers continued to be significant mediators when physical inactivity and depressive symptoms were included as additional mediators.

CONCLUSION: The present study adds to existing research on the association between subjective aging and memory by providing new evidence on the biological mediators of this association.

}, keywords = {biological factors, longitudinal, mechanisms, Memory, self-perceptions of aging, Subjective age}, issn = {1758-5368}, doi = {10.1093/geronb/gbac155}, author = {Stephan, Yannick and Sutin, Angelina R and Luchetti, Martina and Aschwanden, Damaris and Terracciano, Antonio} } @article {13168, title = {The mediating role of Vitamin D in the association between personality and memory: Evidence from two samples.}, journal = {Biol Psychol}, volume = {178}, year = {2023}, month = {2023 Mar}, pages = {108525}, abstract = {

Five-Factor Model (FFM) personality traits are consistently related to cognition in old age. However, little is known about the biological mediators of this association. The present study examined whether levels of Vitamin D mediated the association between personality and memory. Participants were adults aged 50-96 years from the Health and Retirement Study (HRS, N~=~5229) and the English Longitudinal Study of Ageing (ELSA, N~=~4249). In HRS, personality and demographic factors were assessed in 2012/2014, Vitamin D was assessed in 2016, and memory was assessed in 2018. In ELSA, personality and demographic factors were obtained in 2010/2011, Vitamin D was measured in 2012/2013, and memory was assessed in 2014/2015. In both samples, higher extraversion and conscientiousness were related to higher levels of Vitamin D, whereas higher neuroticism was related to lower Vitamin D. In both samples, higher Vitamin D partly mediated the association between both higher extraversion and conscientiousness and better memory. The association between higher neuroticism and worse memory at follow-up was partially mediated by lower Vitamin D in the HRS and ELSA. Vitamin D did not mediate the association between higher openness and better memory. The present study extends the personality-cognition literature by providing new replicable evidence that Vitamin D is a biological mediator.

}, keywords = {Adult, Aging, Humans, Longitudinal Studies, Neuroticism, Personality, Vitamin D}, issn = {1873-6246}, doi = {10.1016/j.biopsycho.2023.108525}, author = {Stephan, Yannick and Sutin, Angelina R and Luchetti, Martina and Aschwanden, Damaris and Terracciano, Antonio} } @mastersthesis {13478, title = {Medicaid and the Life Course: An Intersectional Mixed-Methods Approach}, year = {2023}, pages = {135}, type = {phd}, abstract = {Health insurance coverage is associated with better access to health care and better health outcomes at every age. The United States does not provide universal health insurance, and most people pay for private insurance that is linked to their job. Individuals whose jobs do not provide insurance have three choices: to remain uninsured, to buy their own insurance, or, in some cases, apply for public health insurance. Select populations in the US may be eligible for public health insurance coverage through Medicare and Medicaid. Medicare provides essentially universal insurance coverage for adults over 65, and, although enrollment is required, there is no application to determine eligibility. Alternately, Medicaid is a means-tested program with a stringent application process and recertification requirements, and take-up rates vary greatly across the US. In some states, individuals who do not have insurance through their employer can apply for and enroll in Medicaid. Individuals with Medicare coverage can also apply for Medicaid. Individuals who are {\textquotedblleft}dually eligible{\textquotedblright} for Medicare and Medicaid, represent a uniquely vulnerable population due to their age, income, health, and life course exposures to marginalization, poverty, and other risk factors.Medicaid provides an essential health safety net for people in the United States living in poverty, particularly for individuals with high health care needs and costs. Many adults over 65 will need Medicaid to cover health and long-term care costs, yet the process by which older adults gain access to Medicaid is complex and burdensome. Chapter 1 includes the results of a qualitative study of Medicaid enrollment among residents of a skilled nursing facility (SNF). In interviews with caregivers and staff at the Department of Social Services (DSS) in a large, urban county in North Carolina, I find that family members are often applying their aging relatives, and that these applicants have difficulty navigating the Medicaid application process. In addition, I find that prior exposure to institutional care settings facilitates knowledge about Medicaid eligibility and enrollment criteria. Finally, all respondents commented on the costs associated with SNF care. In particular, respondents with higher incomes noted the long process of becoming eligible, while lower income respondents noted the inevitability of running out of funds. This qualitative study illustrates the distinct ways that older adults, marginalized due to their health and socioeconomic status, engage with social welfare programs in the US.Building on the results from Chapter 1, in Chapter 2 I employ an intersectional, life course approach to assess predictors of Medicaid enrollment in later life. In Chapter 1 I hypothesize that, for institutionalized individuals, having living kin facilitates Medicaid enrollment. In addition, I hypothesize that individuals who have experienced health events requiring a skilled nursing facility (SNF) or other institutional care stay, as well as individuals who have low incomes are more likely to enroll in Medicaid as older adults. Using data from 10 waves of the Health and Retirement Survey I test each hypothesis, accounting for other dimensions of social and health disparities. Alternate to my expectations, individuals without living kin are more likely to enroll in Medicaid than those with living family members. Results from discrete-time logit models confirm the second hypothesis, that individuals who have had a short-term SNF stay are more likely to enroll in Medicaid over a two-year period. In addition, as expected from both interviews and Medicaid policy, income is the single greatest predictor of enrollment in late life. Enrollment odds, though, are distinctly racialized and gendered: Black and Hispanic individuals are more likely to enroll than whites, women are at a greater risk than men, and women of color are at the highest risk. In addition, having a higher income is less protective for marginalized racial and ethnic groups than for white populations.In the third chapter, I examine late life health as an outcome of structural, state-level variations in Medicaid policy. Although every US state is required to provide some form of Medicaid coverage to {\textquotedblleft}Aged, Blind, and Disabled{\textquotedblright} adults, each state establishes distinct requirements and benefits. In this study I use 10 waves of restricted data from the Health and Retirement Survey (HRS) to examine late life consequences of state-level Medicaid generosity. Using multistate life tables, this study demonstrates that Medicaid generosity is associated with more years dually covered by Medicare and Medicaid. In addition, I demonstrate that racial and gender marginalization, low income, and specific late life health risks contribute to inequitable health and mortality outcomes in late life.}, keywords = {0573:Public health, 0626:Sociology, 0630:Public policy, Gender marginalization, Health Insurance, Medicaid policy, Medicare, Public Health, Public Policy, socioeconomic status, Sociology}, isbn = {9798379569433}, url = {https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/medicaid-life-course-intersectional-mixed-methods/docview/2820001588/se-2}, author = {Petry,Sarah} } @article {13323, title = {Medication misuse and overuse in community-dwelling persons with dementia.}, journal = {J Am Geriatr Soc}, year = {2023}, abstract = {

BACKGROUND: Persons with dementia (PWD) have high rates of polypharmacy. While previous studies have examined specific types of problematic medication use in PWD, we sought to characterize a broad spectrum of medication misuse and overuse among community-dwelling PWD.

METHODS: We included community-dwelling adults aged >=66 in the Health and Retirement Study from 2008 to 2018 linked to Medicare and classified as having dementia using a validated algorithm. Medication usage was ascertained over the 1-year prior to an HRS interview date. Potentially problematic medications were identified by: (1) medication overuse including over-aggressive treatment of diabetes/hypertension (e.g., insulin/sulfonylurea with hemoglobin A1c < 7.5\%) and medications inappropriate near end of life based on STOPPFrail and (2) medication misuse including medications that negatively affect cognition and medications from 2019 Beers and STOPP Version 2 criteria. To contextualize, we compared medication use to people without dementia through a propensity-matched cohort by age, sex, comorbidities, and interview year. We applied survey weights to make our results nationally representative.

RESULTS: Among 1441 PWD, median age was 84 (interquartile range = 78-89), 67\% female, and 14\% Black. Overall, 73\% of PWD were prescribed >=1 potentially problematic medication with a mean of 2.09 per individual in the prior year. This was notable across several domains, including 41\% prescribed >=1 medication that negatively affects cognition. Frequently problematic medications included proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antihypertensives, and antidiabetic agents. Problematic medication use was higher among PWD compared to those without dementia with 73\% versus 67\% prescribed >=1 problematic medication (p = 0.002) and mean of 2.09 versus 1.62 (p < 0.001), respectively.

CONCLUSION: Community-dwelling PWD frequently receive problematic medications across multiple domains and at higher frequencies compared to those without dementia. Deprescribing efforts for PWD should focus not only on potentially harmful central nervous system-active medications but also on other classes such as PPIs and NSAIDs.

}, issn = {1532-5415}, doi = {10.1111/jgs.18463}, author = {Deardorff, W James and Jing, Bocheng and Growdon, Matthew E and Yaffe, Kristine and Boscardin, W John and Boockvar, Kenneth S and Steinman, Michael A} } @article { WOS:001023986400001, title = {Meditation and Cognitive Outcomes: A Longitudinal Analysis Using Data From the Health and Retirement Study 2000-2016}, journal = {MINDFULNESS}, volume = {14}, year = {2023}, pages = {1705-1717}, abstract = {ObjectiveWe aimed to assess the association between meditation practice and cognitive function over time among middle-aged and older adults.MethodWe included Health and Retirement Study (HRS) participants assessed for meditation practice in the year 2000 as part of the HRS alternative medicine module (n = 1,160) and were followed up for outcomes over 2000-2016 period. We examined the association between meditation \& GE; twice a week vs none/less frequent practice and changes in the outcomes of recall, global cognitive function, and quantitative reasoning using generalized linear regression models. Stratified analyses among persons with/without self-reported baseline depressive symptoms were conducted to assess the link between meditation and cognitive outcomes.ResultsAmong our full study sample, meditation \& GE; twice a week was not significantly associated with total recall [\& beta; = -0.20; 95\% CI: -0.97, 0.57; p = 0.61], global cognitive function [\& beta; = 0.05; 95\% CI: -1.01, 1.12; p = 0.92], and quantitative reasoning [\& beta; = -11.48; 95\% CI: -31.27, 8.32; p = 0.26]. However, among those who did not have self-reported depressive symptoms at baseline, meditation \& GE; twice a week was associated with improvement in cognitive outcomes such as total recall [\& beta; = 0.11; 95\% CI: 0.03, 0.18; p = 0.01] and global cognitive function [\& beta; = 0.22; 95\% CI: 0.05, 0.40; p = 0.01] over time.ConclusionsFrequent meditation practice might have a protective effect on cognitive outcomes over time, but this protection could be limited to those without self-reported baseline depressive symptoms. Future studies could incorporate more precise meditation practice assessment, investigate the effect of meditation on cognitive outcomes over time, and include more rigorous study designs with randomized group assignment.Pre-registrationThis study is not preregistered.}, keywords = {Aging, Cognition, Complementary. Alternative Medicine, meditation}, issn = {1868-8527}, doi = {10.1007/s12671-023-02165-w}, author = {Lopes, Snehal and Shi, Lu and Pan, Xi and Gu, Yian and Dengler-Crish, Christine and Li, Yan and Tiwari, Biplav and Zhang, Donglan} } @article {13533, title = {Memory and language cognitive data harmonization across the United States and Mexico.}, journal = {Alzheimer{\textquoteright}s \& Dementia (Amsterdam, Netherlands)}, volume = {15}, year = {2023}, pages = {e12478}, abstract = {

INTRODUCTION: We used cultural neuropsychology-informed procedures to derive and validate harmonized scores representing memory and language across population-based studies in the United States and Mexico.

METHODS: Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS-HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We statistically co-calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education.

RESULTS: We included 3170 participants from the HRS-HCAP (age~=~76.6 [standard deviation (SD): 7.5], 60\% female) and 2042 participants from the Mex-Cog (age~=~68.1 [SD: 9.0], 59\% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education.

DISCUSSION: A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross-national studies.

HIGHLIGHTS: We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross-national studies of Alzheimer{\textquoteright}s disease and related dementias.

}, keywords = {Alzheimer{\textquoteright}s disease, cognitive aging, cross-cultural, cultural neuropsychology, harmonization}, issn = {2352-8729}, doi = {10.1002/dad2.12478}, author = {Arce Renter{\'\i}a, Miguel and Brice{\~n}o, Emily M and Chen, Diefei and Saenz, Joseph and Lindsay C Kobayashi and Gonzalez, Christopher and Vonk, Jet M J and Richard N Jones and Jennifer J Manly and Wong, Rebeca and David R Weir and Kenneth M. Langa and Gross, Alden L} } @article {12861, title = {Mental and Physical Health Pathways Linking Insomnia Symptoms to Cognitive Performance 14 Years Later.}, journal = {Sleep}, volume = {46}, year = {2023}, pages = {zsac262}, abstract = {

STUDY OBJECTIVES: Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender.

METHODS: Participants included 2,595 adults ages 51-88 at baseline (Mage=64.00{\textpm}6.66, 64.5\% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, nighttime awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographics and global cognition.

RESULTS: Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06<=β<=-0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3\%-19.5\% of these associations and vascular disease explained 6.3\%-14.6\% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender.

CONCLUSIONS: Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.

}, keywords = {cognitive aging, Dementia, depression, gender, insomnia, neuropsychology, vascular diseases}, issn = {1550-9109}, doi = {10.1093/sleep/zsac262}, author = {Zaheed, Afsara B and Chervin, Ronald D and Spira, Adam P and Zahodne, Laura B} } @article {doi:10.1177/23780231231186072, title = {Mental Health Effects of Income over the Adult Life Course}, journal = {Socius}, volume = {9}, year = {2023}, pages = {23780231231186072}, abstract = {While a gradient between income and depression is well documented, associational estimates are subject to bias due to measurement errors, reverse causation, and other sources of confounding. Causal studies are few and report small and divergent estimates, even in their direction. But prior research has important limitations for causal inference, such as relying on comparisons between individuals sensitive to each other{\textquoteright}s relative income or capturing only a subset of pathways through which income affects well-being. This study leverages longitudinal and genomic data to assess how much some known biases affect the income-depression gradient and to what extent the gradient might be reflective of a causal effect. Findings from three U.S. samples{\textemdash}representing early midlife, late midlife, and older adulthood{\textemdash}are suggestive of a beneficial effect of income on mental health, especially in late midlife and beyond. The results have implications for interpreting the nature of socioeconomic disparities in mental health.}, keywords = {Adult, Income, Mental Health}, doi = {10.1177/23780231231186072}, author = {Tamkinat Rauf} } @article {13614, title = {Methodology for Analysis of the U.S. Health and Retirement Study}, journal = {Dying Broke}, year = {2023}, publisher = {The New York Times}, address = {New York, NY}, keywords = {cognitive function, Langa-Weir classification, Methodology}, url = {https://www.nytimes.com/2023/11/14/health/retirement-survey-analysis.html?action=click\&module=RelatedLinks\&pgtype=Article}, author = {The New York Times and KFF Health News} } @article {13063, title = {Methods and (Lack of) Theory in Digital Inclusion, Digital Divide, and Digital Equity Research on Older Adults}, year = {2023}, pages = {1869}, institution = {Victoria University of Wellington}, address = {Wellington, New Zealand}, abstract = {Older adults, as a group, have been the focus of considerable attention from digital inclusion researchers. The paper analyses literature on the digital inclusion, digital divide, and digital equity of older adults from the last five years (2017-2022) to explore the extent to which recent digital inclusion research considers developments in the field and explores how research has progressed from exploration to theory building and the empirical testing of models. The paper contributes to our understanding of digital inclusion research on older adults through an analysis of methodologies and theories employed, and the topics investigated. Trends, deficits and gaps for future research are identified, with suggestions for how our knowledge, understanding and conceptualization of older adults{\textquoteright} digital inclusion may be advanced further.}, keywords = {and Inclusion in Digital Government: Narrowing the Divides, Digital Divide, digital equity, digital inclusion, Diversity, Equity, Literature Review, maturity}, author = {Alfred Chikomba and Anne Goulding and Lara Sanderson and Allan Sylvester and Jennifer Campbell-Meier} } @article {aguila_lee_wong_2021, title = {Migration, work, and retirement: the case of Mexican-origin populations}, journal = {Journal of Pension Economics and Finance}, year = {2023}, abstract = {Mexico and the United States both face rapid population aging as well as older populations with high poverty rates. Among the most vulnerable populations of retirement age in either nation are Mexican immigrants to the United States. This work uses data from the U.S. Health and Retirement Study and the Mexican Health and Aging Study to assess retirement decisions among persons born in Mexico and working in either nation as well as such decisions by non-Hispanic Whites in the United States. Social security system incentives matter for the retirement of Mexican immigrants in the U.S. but not for return-migrants in Mexico. }, keywords = {Hispanics, Immigrants, Retirement, Social Security}, doi = {10.1017/S1474747221000342}, author = {Emma Aguila and Lee, Zeewan and Rebeca Wong} } @article {13064, title = {Milk intake, lactase persistence genotype, plasma proteins and risks of cardiovascular events in the Swedish general population.}, journal = {Eur J Epidemiol}, volume = {38}, year = {2023}, pages = {211-224}, abstract = {

To investigate the associations of milk intake (non-fermented and fermented milk), lactase persistence (LCT-13910~C/T) genotype (a proxy for long-term non-fermented milk intake), and gene-milk interaction with risks of cardiovascular disease (CVD) and CVD mortality. Also, to identify the CVD-related plasma proteins and lipoprotein subfractions associated with milk intake and LCT-13910~C/T genotype. The prospective cohort study included 20,499 participants who were followed up for a mean of 21 years. Dietary intake was assessed using a modified diet history method. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95\% confidence intervals (CIs). After adjusting for sociodemographic and lifestyle factors, higher non-fermented milk intake was significantly associated with higher risks of coronary heart disease (CHD) and CVD mortality, whereas higher fermented milk intake was significantly associated with lower risks of CVD and CVD mortality. The genotype associated with higher milk (mainly non-fermented) intake was positively associated with CHD (CT/TT vs. CC HR = 1.27; 95\% CI: 1.03, 1.55) and CVD (HR = 1.22; 95\% CI: 1.05, 1.42). The association between rs4988235 genotype and CVD mortality was stronger in participants with higher milk intake than among participants with lower intake (P for interaction < 0.05). Furthermore, leptin, HDL, and large HDL were associated with non-fermented milk intake, while no plasma proteins or lipoprotein subfractions associated with fermented milk intake and LCT-13910~C/T genotype were identified. In conclusion, non-fermented milk intake was associated with higher risks of CHD and CVD mortality, as well as leptin and HDL, whereas fermented milk intake was associated with lower risks of CVD and CVD mortality.

}, keywords = {Animals, Cardiovascular Diseases, diet, Genotype, Humans, Lactase, Leptin, Milk, Prospective Studies, Risk Factors, Sweden}, issn = {1573-7284}, doi = {10.1007/s10654-022-00937-7}, author = {Zhang, Shunming and Li, Huiping and Engstr{\"o}m, Gunnar and Niu, Kaijun and Qi, Lu and Born{\'e}, Yan and Sonestedt, Emily} } @article {13331, title = {The mode effect of web-based surveying on the 2018 HRS measure of cognitive functioning.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2023}, abstract = {

OBJECTIVES: Measuring cognition in an aging population is a public health priority. A move towards survey measurement via the web (as opposed to phone or in-person) is cost effective but challenging as it may induce bias in cognitive measures. We examine this possibility using an experiment embedded in the 2018 wave of data collection for the US Health and Retirement Study (HRS).

METHODS: We utilize techniques from multiple group item response theory to assess the effect of survey mode on performance on the HRS cognitive measure. We also study the problem of attrition by attempting to predict dropout and via approaches meant to minimize bias in subsequent inferences due to attrition.

RESULTS: We find evidence of an increase in scores for HRS respondents who are randomly assigned to the web-based mode of data collection in 2018. Web-based respondents score higher in 2018 than do phone-based respondents, and they show much larger gains relative to 2016 performance and subsequently larger declines in 2020. The bias in favor of web-based responding is observed across all items, but most pronounced for the serial 7 task and numeracy items. Due to the relative ease of the web-based mode, we suggest a cutscore of 12 being used to indicate CIND (cognitively impaired but not demented) status when using the web-based version rather than 11.

DISCUSSION: The difference in mode may be non-ignorable for many uses of the HRS cognitive measure. In particular, it may require reconsideration of some cutscore-based approaches to identify impairment.

}, issn = {1758-5368}, doi = {10.1093/geronb/gbad068}, author = {Domingue, Benjamin W and McCammon, Ryan and Brady T. West and Kenneth M. Langa and David R Weir and Jessica Faul} } @article {13609, title = {More Problems, More Pain: The Role of Chronic Life Stressors and Racial/Ethnic Identity on Chronic Pain Among Middle-Aged and Older Adults in the United States.}, journal = {Chronic Stress (Thousand Oaks, Calif.)}, volume = {7}, year = {2023}, pages = {24705470231208281}, abstract = {

There is a high prevalence of chronic pain among middle-aged and older adults in the United States. Chronic life stressors have been shown to have detrimental consequences for myriad health conditions, including chronic pain. However, there is limited evidence on the types of chronic life stressors that affect middle-aged and older adults and how these stressors influence the chronic pain burden in this population. Moreover, the interaction between chronic life stressors and racial/ethnic identity remains poorly understood as it relates to chronic pain. The current analysis used the 2018 Health and Retirement Study to investigate relationships between chronic life stressors and odds to experience any chronic pain and high-impact chronic pain. Chronic life stressors were characterized, overall and by racial/ethnic identity, and the main and interaction effects were calculated to evaluate relationships between chronic life stressors, racial/ethnic identity, and odds of experiencing any chronic pain and high-impact chronic pain. Results indicate that in 2018, the most common chronic life stressor among middle-aged and older adults was dealing with their own health problems (68\%), followed by dealing with the physical or emotional issues affecting a spouse or child (46\%). Adjusted analyses showed that a higher total of chronic life stressors increased the odds of middle-aged and older adults experiencing any chronic pain and high-impact chronic pain. There were no significant interactions between the overall chronic life stress burden and racial/ethnic identity as a predictor of odds to experience any chronic pain or high-impact chronic pain, but significant interaction effects were found related to specific chronic life stressors. Findings underscore the significant impact of chronic life stressors on the chronic pain burden among middle-aged and older adults in the United States, which cut across racial/ethnic identity.

}, keywords = {Chronic pain, Chronic stressors, Health and Retirement Study, high-impact chronic pain, middle-aged and older adults}, issn = {2470-5470}, doi = {10.1177/24705470231208281}, author = {Spector, Antoinette L and Quinn, Katherine G and Wang, Inga and Gliedt, Jordan A and Fillingim, Roger B and Cruz-Almeida, Yenisel} } @article {13146, title = {More than just a bad day? Traumatic life events and self-control in old age.}, journal = {PLoS One}, volume = {18}, year = {2023}, month = {2023}, pages = {e0266312}, abstract = {

The behavioral economics literature suggests that exposure to traumatic events shifts preference features including risk aversion and time preference. In this study, we examined the association between traumatic life events and self-control in old age. Data were obtained from the Health and Retirement Study, which offers retrospective data on trauma exposure and early life characteristics. The results showed that experiences of serious physical attacks or assaults is associated with a 3.1\% reduction in self-control, adjusted for demographic and childhood socioeconomic characteristics. The attacks or assaults were experienced approximately 30 years prior to the survey, indicating that traumatic life events exert a lasting influence on self-control. Further analyses found no difference in the association between the experience of serious physical attacks or assaults and self-control according to the timing of occurrence. Our findings are consistent with the evidence that experiences of natural disasters or armed conflicts increase impatience among survivors.

}, keywords = {Armed Conflicts, Child, Humans, Retrospective Studies, Self-control, Stress Disorders, Post-Traumatic, Surveys and Questionnaires}, issn = {1932-6203}, doi = {10.1371/journal.pone.0266312}, author = {Choung, Youngjoo and Pak, Tae-Young} } @article {13232, title = {Mortality Risks, Subjective Well-Being and Polygenic Scores: Evidence from the Health and Retirement Study}, year = {2023}, abstract = {The relationship between an individual{\textquoteright}s subjective well-being and their future mortality prospects has been well documented. Using data from the Health and Retirement Study combined with genetic information, we present empirical evidence of how this relationship operates through various channels. Our findings reveal that both the genetic and environmental factors contributing to subjective well-being have a significant impact not only on the objective mortality of participants in our study, but also on the bias in their survival estimation{\textemdash}measured as the disparity between individuals{\textquoteright} subjective and objective survival probabilities. Our gender-specific analyses further reveal diverging observations for females and males in terms of explaining the bias in survival estimation.}, keywords = {mortality risks, polygenic scores, Well-being}, url = {https://static1.squarespace.com/static/57cef2a1197aea734bbcf35c/t/63ee9ed4d4495627dae0725c/1676582613273/Mortality_genetics_SWB_Feb2023.pdf}, author = {Lisa Posey and Sharon Tennyson and Nan Zhu} } @article {13468, title = {Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study.}, journal = {Gerontology}, volume = {69}, year = {2023}, pages = {826-838}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Arthritis, C-reactive protein, Diabetes Mellitus, Disabled Persons, Female, Glycated Hemoglobin, Heart Diseases, Humans, Hypertension, Inflammation, Longitudinal Studies, Male, multimorbidity, Prospective Studies, Stroke}, issn = {1423-0003}, doi = {10.1159/000528648}, author = {Botoseneanu, Anda and Markwardt, Sheila and Qui{\~n}ones, Ana R} } @article {12918, title = {Multimorbidity burden and developmental trajectory in relation to later-life dementia: A prospective study.}, journal = {Alzheimer{\textquoteright}s \& Dementia}, year = {2023}, abstract = {

INTRODUCTION: This study assessed the associations of multimorbidity burden and its developmental trajectory with later-life dementia.

METHODS: Among 5923 Health and Retirement Study participants, major chronic conditions including hypertension, diabetes mellitus, cancer, lung diseases, heart disease, stroke, psychological disorders, and arthritis were self- or~proxy-reported in 1994-2008. Dementia diagnosis was self- or proxy-reported in 2008-2018. We used Cox regression to assess the associations of multimorbidity with incident dementia.

RESULTS: During follow-up (median = 8 years), 701 participants developed dementia. Each additional chronic condition in 2008 was related to 15\% (confidence interval: 9\% to 22\%) higher hazard of dementia. Multimorbidity trajectories in 1994-2008 were classified as "rapid growth", "steady growth", "slow growth", and "no new condition" by the group-based trajectory modelling methods. Compared to "no new condition", the "rapid growth" trajectory was related to 32\% (3\% to 69\%) higher dementia risk.

CONCLUSIONS: Both multimorbidity burden and its developmental trajectory were prospectively associated with risk of dementia.

}, keywords = {Dementia, healthy aging, multimorbidity}, issn = {1552-5279}, doi = {10.1002/alz.12840}, author = {Chen, Hui and Zhou, Yaguan and Huang, Liyan and Xu, Xiaolin and Yuan, Changzheng} } @article {13649, title = {Multiple periods of loneliness may add up to higher mortality risk}, year = {2023}, publisher = {Michigan News, University of Michigan}, keywords = {Life Expectancy, Loneliness, mortality risk}, url = {https://news.umich.edu/multiple-periods-of-loneliness-may-add-up-to-higher-mortality-risk/}, author = {Kim North Shine} } @article {12369, title = {Macro-Demographics and Ageing in Emerging Asia: the Case of Indonesia.}, journal = {Journal of Population Ageing}, volume = {15}, year = {2022}, pages = {7-38}, abstract = {

In common with a number of other emerging economies in South East Asia, Indonesia is confronting rapid demographic transition at a low level of per capita income. The fourth largest country in the world by population size, Indonesia will face new challenges for fiscal sustainability and policy design, as in coming decades its labour force begins to shrink, and the older population becomes relatively more numerous. In this paper, we demonstrate how strong data sources, from international agencies, national sources, and surveys of the Health and Retirement Study (HRS) family, are available and can be combined to generate a statistical profile of an emerging economy. Such profiles have value in themselves but can also be used as the basis for specifying macroeconomic models of demographic transition, of the overlapping generations (OLG) type, and for various other purposes. The profile presented here will serve to inform both policymakers and the broader community of the long-run trends which will inexorably impact Indonesian society in coming decades. It indicates that major social protection policy development will be needed over the next period to avert widespread hardship, especially among older cohorts.

}, keywords = {Asia, Household survey data, Indonesia, Population ageing}, issn = {1874-7884}, doi = {10.1007/s12062-022-09358-6}, author = {Kudrna, George and Le, Trang and Piggott, John} } @inbook {Schmidt2022, title = {Male Plus Low Income = Double Whammy}, booktitle = {The end of medicine as we know it - and why your health has a future}, year = {2022}, pages = {61{\textendash}69}, publisher = {Springer International Publishing}, organization = {Springer International Publishing}, abstract = {Check-up success at the GP, check-up success at the dentist, less diabetes, healthier diet, less alcohol consumption, more exercise, better sleep, less stress, and life expectancy all correlate somehow with better education and higher socio-economic status and virtually not at all with the healthcare systems in place in each country. Some of the most different health systems are those in the USA (mostly private) and the UK (state-run), for example. In the USA, people tend to have private health insurance up to 65, often through their employer; in England, healthcare is free and funded by taxes. How education affects health in old age in both countries was investigated in two studies: in the UK {\textquoteleft}{\textquoteleft}English Longitudinal Study of Ageing (ELSA){\textquoteright}{\textquoteright} and in the USA {\textquoteleft}{\textquoteleft}Health and Retirement Study{\textquoteright}{\textquoteright}. The result is as follows: Differences in both health systems have little effect on the expected years of life in good health. The situation is different with education and socio-economic status.}, keywords = {Education, ELSA, health care system, Low income, Male, socio-economic status}, isbn = {978-3-030-95293-8}, doi = {10.1007/978-3-030-95293-8_5}, author = {Schmidt, Harald H. H. W.} } @article {12674, title = {Management of Financial Assets by Older Adults With and Without Dementia or Other Cognitive Impairments.}, journal = {JAMA Network Open}, volume = {5}, year = {2022}, pages = {e2231436}, abstract = {Dementia and other cognitive impairments are prevalent among US older adults.1 Brain changes linked to cognitive impairment can lead to overconfidence, memory problems, and deficits in decision-making.2,3 These changes can have financial consequences, including missed bill payments, risky investment choices, and financial exploitation.3,4 To characterize the population at risk of cognitive impairment{\textendash}associated asset mismanagement, we assessed the extent to which older US adults with and without cognitive impairment manage their own money, including risky assets (eg, stocks and loans).}, keywords = {Cognitive Dysfunction, Dementia, Financial Statements}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2022.31436}, author = {Li, Jing and Wang, Shuqi and Nicholas, Lauren Hersch} } @article {12786, title = {Managing the onset of a new disease in older age: Housing wealth, mortgage borrowing, and medication adherence.}, journal = {Social Science \& Medicine}, volume = {314}, year = {2022}, pages = {115437}, abstract = {

The relationship between wealth and health is an important yet complex topic for health research. While prior studies document the importance of wealth for healthy aging, the understanding of the mechanisms through which wealth supports health consumption is limited. We investigate the wealth-to-health link by explicitly modeling the effect of liquidating home equity through borrowing on health expenditures, measured here as cost-related non-adherence to prescription medications (CRN), following the onset of one of six costly diseases on or after age 65. Using individual-level data from the 2002-2018 waves of the U.S. Health and Retirement Study (3,772 respondents; 13,708 observations), we exploit exogenous spatial and intertemporal variation in ZIP-code level house values to instrument for borrowing. Results indicate each additional $10,000 in new mortgage borrowing is associated with a 1.6 percentage point reduction in CRN. In subsample regressions, this relationship is strongest for older adults for whom home equity is their largest source of wealth. In a falsification test, we find no relationship between house value changes and CRN for older renters, and no effect of mortgage borrowing on prescription drug non-adherence for health or memory reasons. Our results contribute to the literature by documenting how housing wealth can be tapped by older adults through borrowing to smooth health-related consumption following disease diagnosis. However, not all older homeowners are willing or able to borrow from home equity. Our findings suggest that it is not simply the stock of housing wealth that leads to better health outcomes, but instead the liquidation of housing wealth. Housing wealth is thus not a uniform social determinate of health for older homeowners as it is moderated by the ability to borrow.

}, keywords = {health shock, Housing wealth, Medications, mortgage borrowing, Retirement}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2022.115437}, author = {Moulton, Stephanie and Rhodes, Alec and Haurin, Donald and Loibl, C{\"a}zilia} } @article {12413, title = {Marital Loss and Cognitive Function: Does Timing Matter?}, journal = {The Journals of Gerontology, Series B}, volume = {77}, year = {2022}, pages = {1916-1927}, abstract = {

OBJECTIVES: This study examines the association between age at marital loss (i.e., divorce or widowhood) and cognitive function in later life and whether the association differs by gender.

METHODS: We used mixed-effects models, drawing on longitudinal data from the Health and Retirement Study (1998-2016). The analytical samples included older adults aged 51 and older who had ever been widowed (N=5,639 with 25,537 person-waves) or divorced (N=10,685 with 50,689 person-waves).

RESULTS: We find that those who were widowed at younger ages had lower cognitive function than their counterparts who were widowed at older ages, for both men and women, after controlling for covariates. Household income and health-related factors partially accounted for the positive association between age at widowhood and cognitive function. Those who divorced at younger ages also had lower cognitive function than their counterparts who divorced at older ages, but this association was only present among men, not women. Health-related factors partially accounted for the associations between age at divorce and cognitive function among men.

DISCUSSION: Findings highlight the importance of considering the role of timing of marital loss in cognitive health among older adults.

}, keywords = {Cognition, Divorce, gender, Timing of life course events, Widowhood}, issn = {1758-5368}, doi = {10.1093/geronb/gbac069}, author = {Zhang, Zhenmei and Liu, Hui and Zhang, Yan} } @article {12036, title = {Marital Transitions, Change in Depressive Symptomology, and Quality of Social Relationships in Midlife and Older U.S. Adults: An Analysis of the Health and Retirement Study.}, journal = {The International Journal of Aging and Human Development}, volume = {95}, year = {2022}, pages = {349-371}, abstract = {

Preventing negative health outcomes following marital transitions can promote personal recovery and well-being. We used the Health and Retirement Study (HRS) (2012, 2014) to test whether social relationship quality moderated the association between marital transition and change in depressive symptomology among U.S. adults aged 50 and older (n = 3,705). Marital status transitions between 2012 and 2014 included remained married/partnered, divorced/separated, and widowed. Depressive symptomology was measured using the Center for Epidemiological Studies Depression Scale 8 Short Form (CES-D 8). Social support, social contact, and social strain were indicators of social relationship quality. Change in depressive symptomology was modeled using autoregressive multiple regression. Social relationship quality appeared to influence depressive symptomatology for those experiencing divorce/separation. Compared to individuals who remained married/partnered, depressive symptomatology in those experiencing separation/divorce decreased among those reporting low social support, increased among those reporting high social support, and increased among those who reported low social strain. Limitations and clinical implications are discussed.

}, keywords = {depression, Divorce, marital transitions, Mental Health, Social Support, Widowhood}, issn = {1541-3535}, doi = {10.1177/00914150211066551}, author = {Julia E Tucker and Nicholas J Bishop and Wang, Kaipeng and Phillips, Farya} } @article {12538, title = {Married Mixed-gender Couples{\textquoteright} Midlife Employment and Later Life Well-being and Housework}, journal = {Sex Roles}, volume = {87}, year = {2022}, pages = {154{\textendash}166}, abstract = {This study explored the role of midlife market-work arrangements of married mixed-gender couples on gendered experiences in emotional well-being and housework during the encore years. Working during midlife may shape long-term outcomes after couples leave the workforce and begin retirement. Using three theories of gender as a framework to understand work sharing in couples, the study theoretically connects work arrangements in midlife with long-term predictions of gender differences in couple emotional well-being and housework. Using longitudinal data from the Health and Retirement Study (2000{\textendash}2015; N = 3,231), the study found that gender differences in housework were similar in male-earner and dual-earner couples during the encore years. However, women in male-earner marriages reported low levels of emotional well-being in the encore years, while men in dual-earner couples in mid-life reported high levels of well-being. The findings suggest more gendered experiences in midlife employment correlated with worse mental health in the encore years for women. Understanding midlife employment as a protective factor against depressive symptoms is useful for families, practitioners, and policymakers to be aware of as they seek to understand and mitigate drivers of poor mental health during the encore years. The study demonstrates a need for further development of dynamic theoretical models to explain gender differences over the life course.}, keywords = {Couples, Division of labor, Housework, Sex roles, Well Being}, doi = {10.1007/s11199-022-01306-0}, author = {Wikle, Jocelyn S and Yorgason, Jeremy B.} } @article {12555, title = {Married Women Lost Most of Their Retirement Income Edge: Study}, year = {2022}, publisher = {ThinkAdvisor}, keywords = {Marriage, Retirement income, Social Security, women}, url = {https://www.thinkadvisor.com/2022/07/12/married-women-lost-most-of-their-retirement-income-edge-study/}, author = {Bell, Allison} } @article {12410, title = {A Matched Cohort Analysis for Examining the Association Between Slow Gait Speed and Shortened Longevity in Older Americans}, journal = {Journal of Applied Gerontology}, volume = {41}, year = {2022}, pages = {1905-1913}, abstract = {

This investigation examined the association between slow gait speed, as defined with newly established cut-points, and all-cause mortality in older Americans with a matched cohort analysis. The analytic sample included 10,259 Americans aged >=65 years from the 2006-2014 waves of the Health and Retirement Study. Walking speed was measured in participant residences. Slow gait speed cut-points of <0.60 and <0.75 m/s were used separately for classifying participants as having slow walking speed. Nearest-neighbor propensity score matching was used to match the slow to the not-slow cohorts separately using both cut-points using relevant covariates. Persons with gait speed <0.60 m/s had a 1.42 higher hazard for mortality (95\% CI: 1.28-1.57). Older Americans with gait speed <0.75 m/s had a 1.36 higher hazard for mortality (95\% CI: 1.23-1.50). Slow gait speed may represent failing health and addressing how slow gait speed could be improved may help with referrals to appropriate interventions.

}, keywords = {Aging, Epidemiology, Geriatric Assessment, Physical Functional Performance, walk test}, issn = {1552-4523}, doi = {10.1177/07334648221092399}, author = {McGrath, Brenda M and Johnson, Pamela Jo and McGrath, Ryan and Cawthon, Peggy M and Klawitter, Lukus and Choi, Bong-Jin} } @article {NBERw30007, title = {Measuring Valuation of Liquidity with Penalized Withdrawals}, number = {30007}, year = {2022}, institution = {National Bureau of Economic Research}, abstract = {We propose using penalized withdrawals from retirement savings accounts, identified from U.S. tax records, as a revealed-preference tool to characterize households{\textquoteright} valuation of liquidity. A simple dynamic model formalizes the notion that the prevalence of withdrawals can be used to characterize American households{\textquoteright} valuation of liquidity over time and space. We find pervasive evidence of high valuation of liquidity, hence that shocks are imperfectly insured. Declines in households{\textquoteright} income lead to sudden, large, and persistent jumps in the probability of penalized withdrawals. Both local economic conditions and persistent household characteristics play an important role, with the average valuation of liquidity being higher in financially underdeveloped areas as well as in black communities which are plausibly marginalized from the credit market. Finally, applying our tool to the Great Recession, we find that more affected areas saw larger increases in penalized withdrawals, plausibly driven by tightening of local credit conditions. Our analysis offers a new tool to study the valuation of liquidity and our results point to sizable welfare gains from social insurance policies targeted at both households and locations over time.}, keywords = {Great Recession, Liquidity, penalized withdrawals}, doi = {10.3386/w30007}, author = {Coyne, David and Fadlon, Itzik and Porzio, Tommaso} } @article {11790, title = {Medicare claims data underestimate hallucinations in older adults with dementia}, journal = {The American Journal of Geriatric Psychiatry}, volume = {30}, year = {2022}, pages = {352-359}, abstract = {Objective Administrative claims data are used to study the incidence and outcomes of dementia-related hallucinations, but the validity of International Classification of Diseases (ICD) codes for identifying dementia-related hallucinations is unknown. Methods We analyzed Medicare-linked survey data from two nationally representative studies of U.S. older adults (the National Health and Aging Trends Study and the Health and Retirement Study) which contain validated cognitive assessments and a screening question for hallucinations. We identified older adults who had dementia or were permanent nursing home residents, and we combined this with questionnaire responses to define dementia-related hallucinations. Using Medicare claims data, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD codes for dementia-related hallucinations overall and within prespecified strata of age, neurologic comorbidity, and health care utilization. Results We included 2,337 older adults with dementia in our cohort. Among 3,789 person-years of data, 1,249 (33.0\%) had hallucations, and of these 286 had a qualifying ICD code for dementia-related hallucinations or psychosis (sensitivity 22.9\%). Of 2,540 person-years of dementia without hallucinations, 284 had a diagnosis code for hallucinations (specificity 88.8\%). PPV was 50.2\%, and NPV was 70.1\%. Sensitivity was greatest (57.0\%) among those seeing a psychiatrist. Otherwise, there were no significant differences in sensitivity, specificity, PPV, or NPV by age, neurologic diagnosis, or neurologist care. Conclusion Dementia-related hallucinations are poorly captured in administrative claims data, and estimates of their prevalence and outcomes using these data are likely to be biased.}, keywords = {Dementia, Hallucinations, Medicare, sensitivity, specificity, validity}, isbn = {1064-7481}, doi = {10.1016/j.jagp.2021.07.018}, author = {Ali G Hamedani and Weintraub, Daniel and Allison W Willis} } @article {ANKUDA2022866, title = {Medicare Coverage at the End of Life: Separate and Unequal?}, journal = {Journal of Pain and Symptom Management}, volume = {63}, year = {2022}, pages = {866}, abstract = {Outcomes 1. Contrast the pros and cons of different Medicare insurance types, from a patient perspective 2. Understand and describe out-of-pocket costs across Medicare Original Research Background Medicare coverage varies across beneficiaries, with some opting into Medicare Advantage (MA) versus traditional Medicare (TM); some are enrolled in supplementary insurance, and some are dually enrolled in Medicaid. It is unknown how variation affects those at the end of life and their families, Research Objectives We aim to characterize types of Medicare coverage at the end of life and assess how coverage type affects out-of-pocket spending in the last year of life. Methods We used the Health and Retirement Study, a nationally representative cohort study, to identify decedents between 1998 and 2016 with linked Medicare claims. Medicare insurance types were defined as TM alone, TM with supplementary insurance, MA, and dual eligible. We examined the sociodemographic and health characteristics of decedents across insurance groups and the reported out-of-pocket expenditures for hospitalizations in the last year of life. Results We identified 7,910 decedents, 8.5\% who were enrolled in TM alone, 43.9\% in TM with supplementary insurance, 27.2\% in MA, and 20.5\% duals. Although rates of MA grew over time, rates of TM with supplementary insurance fell. Compared to those with supplementary insurance or in MA, those in TM alone were younger, more likely to be male, in the lowest quartile of wealth, without a high school education, non-Hispanic Black, or Hispanic/Latino. Preliminary investigation of out-of-pocket costs showed that among those hospitalized in the last year of life, 31.4\% of those with TM alone spent more than $2,000 out of pocket, compared to 14.9\% in MA and 11.5\% with supplementary insurance. Conclusion Across those enrolled in Medicare at the end of life but without Medicaid, those in TM alone are more likely to be from racial and ethnic minority groups and with lower education and wealth and yet face higher out-of-pocket spending. Implications for Research, Policy, or Practice Differences within Medicare create differential cost burdens at the end of life that may increase disparities for patients and their families.}, keywords = {end of life, Medicare, out-of-pocket costs}, issn = {0885-3924}, doi = {https://doi.org/10.1016/j.jpainsymman.2022.02.055}, author = {Claire Ankuda} } @article {12407, title = {Medicare spending associated with a dementia diagnosis among older adults.}, journal = {Journal of the American Geriatrics Society}, volume = {70}, year = {2022}, pages = {2592-2601}, abstract = {

BACKGROUND: Over 6 million Americans have Alzheimer{\textquoteright}s Disease or Related Dementia (ADRD) but whether spikes in spending surrounding a new diagnosis reflect pre-diagnosis morbidity, diagnostic testing, or treatments for comorbidities is unknown.

METHODS: We used the 1998-2018 Health and Retirement Study and linked Medicare claims from older (>=65) adults to assess incremental quarterly spending changes just before versus just after a clinical diagnosis (diagnosis cohort, n~=~2779) and, for comparative purposes, for a cohort screened as impaired based on the validated Telephone Interview for Cognitive Status (TICS) (impairment cohort, n~=~2318). Models were adjusted for sociodemographic and health characteristics. Spending patterns were examined separately by sex, race, education, dual eligibility, and geography.

RESULTS: Among the diagnosis cohort, mean (SD) overall spending was $4773 ($9774) per quarter - 43\% of which was spending on hospital care ($2048). In adjusted analyses, spending increased by $8400 (p < 0.001), or 156\%, from $5394 in the quarter prior to $13,794 in the quarter including the diagnosis. Among the cohort in which impairment was incidentally detected using the TICS, adjusted spending did not change from just before to after detection of impairment, from $2986 before and $2962 after detection (p~=~0.90). Incremental spending changes did not differ by sex, race, education, dual eligibility, or geography.

CONCLUSION: Large, transient spending increases accompany an ADRD diagnosis that may not be attributed to impairment or changes in functional status due to dementia. Further study may help reveal how treatment for comorbidities is associated with the clinical diagnosis of dementia, with potential implications for Medicare spending.

}, keywords = {Dementia, Diagnosis, impairment, Medicare, utilization}, issn = {1532-5415}, doi = {10.1111/jgs.17835}, author = {Hoffman, Geoffrey J and Donovan T Maust and Harris, Melissa and Ha, Jinkyung and Davis, Matthew A} } @article {12989, title = {MODE EFFECTS ON COGNITIVE FUNCTIONING ASSESSMENTS IN THE HEALTH AND RETIREMENT STUDY}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, pages = {163}, abstract = {As the population of the US ages, there is interest in assessing health conditions associated with age and longevity, such as age-related decline in cognitive functioning. As a result, there is an increased focus on measuring cognitive functioning in surveys of older populations. One challenge relates to conducting comparable measurement across survey modes (e.g., phone vs. web). Compounding this is that mode of survey administration is often not assigned randomly making inter-group comparison more difficult. This paper addresses these issues using a novel experiment embedded within the Health and Retirement Study (HRS). The HRS, a US-based cohort of people over 50, has measured cognition since its inception using both in-person and telephone modes. In 2018, a sample of approximately 3700 respondents was identified as web-eligible based on a prior report of internet access along with other selection criteria. Of these, 60\% were randomly selected for the web sample with the remainder serving as controls, assigned to telephone mode for comparison purposes. We deploy techniques from item response theory (IRT) and differential item functioning (DIF) to estimate the difference in cognitive functioning between web and phone respondents in 2018 based on longitudinal cognition data collected prior to 2018. Second, we estimate the overall effect of taking the survey via the web as compared to the phone. Third, we examine item-level variation in the magnitude of the mode effect and suggest possible methods for adjustment to support longitudinal consistency. These results are important in guiding future research that utilizes web-based cognitive measures.}, keywords = {Cognition, cognitive functioning assessments}, doi = {10.1093/geroni/igac059.652}, author = {Jessica Faul and Domingue, Ben and Stenhaug, Ben and Brady T. West and Kenneth M. Langa and David R Weir} } @article {12033, title = {Modeling Interaction and Dispersion Effects in the Analysis of Gene-by-Environment Interaction.}, journal = {Behavior Genetics}, volume = {52}, year = {2022}, pages = {56-64}, abstract = {

Genotype-by-environment interaction (GxE) studies probe heterogeneity in response to risk factors or interventions. Popular methods for estimation of GxE examine multiplicative interactions between individual genetic and environmental measures. However, risk factors and interventions may modulate the total variance of an epidemiological outcome that itself represents the aggregation of many other etiological components. We expand the traditional GxE model to directly model genetic and environmental moderation of the dispersion of the outcome. We derive a test statistic, [Formula: see text], for inferring whether an interaction identified between individual genetic and environmental measures represents a more general pattern of moderation of the total variance in the phenotype by either the genetic or the environmental measure. We validate our method via extensive simulation, and apply it to investigate genotype-by-birth year interactions for Body Mass Index (BMI) with polygenic scores in the Health and Retirement Study (N = 11,586) and individual genetic variants in the UK Biobank (N = 380,605). We find that changes in the penetrance of a genome-wide polygenic score for BMI across birth year are partly representative of a more general pattern of expanding BMI variation across generations. Three individual variants found to be more strongly associated with BMI among later born individuals, were also associated with the magnitude of variability in BMI itself within any given birth year, suggesting that they may confer general sensitivity of BMI to a range of unmeasured factors beyond those captured by birth year. We introduce an expanded GxE regression model that explicitly models genetic and environmental moderation of the dispersion of the outcome under study. This approach can determine whether GxE interactions identified are specific to the measured predictors or represent a more general pattern of moderation of the total variance in the outcome by the genetic and environmental measures.

}, keywords = {Gene {\texttimes} environment interaction, Gene-by-environment interaction, GxE, G{\texttimes}E, Heteroscedasticity, vQTL}, issn = {1573-3297}, doi = {10.1007/s10519-021-10090-8}, author = {Benjamin W Domingue and Kanopka, Klint and Mallard, Travis T and Trejo, Sam and Elliot M Tucker-Drob} } @article {MARSHALL2022101102, title = {Modeling the impact of financial hardship and age on self-rated health and depressive symptoms pre/post the great recession}, journal = {SSM - Population Health}, volume = {18}, year = {2022}, pages = {101102}, abstract = {Stressful life events such as a recession, could be devastating on a macro and micro level. Although there have been a number of articles written examining the health effects of the recession, little is known about age differences in the relationship between financial stressors and health pre and post the 2008 recession. Using the Health and Retirement study, we investigated the relationship between two forms of financial hardships, mental and physical health among middle aged (N = 4403) and older adults) (N = 2709). Our findings indicate that with regard to financial hardships experienced pre/post recessionary periods there are differences by age. Specifically, older adults tend to report having less financial hardship than their younger counterparts. Additionally, reduced medication use due to costs was a significant predictor of poor self-rated health among middle aged participants compared to older adults. These results highlight the selective impact of recessions on certain age groups. They also suggests that economic recessions may also produce short-term procyclical health effects. Future research should focus on the relationship between other sources of financial hardship among middle-aged and older adults pre/post-recession at shorter time intervals.}, keywords = {Depressive symptoms, financial difficulties, Great Recession, Self-rated health}, issn = {2352-8273}, doi = {https://doi.org/10.1016/j.ssmph.2022.101102}, author = {Gillian L. Marshall and Bailey Ingraham and Jasmine Major and Eva Kahana and Kim Stansbury} } @article {12431, title = {Modelling Correlated Bivariate Binary Data: A Comparative View}, journal = {Bulletin of the Malaysian Mathematical Sciences Society}, year = {2022}, abstract = {This study focused on comparing selected commonly used marginal models with marginal-conditional models for analyzing correlated longitudinal binary data. A simulation study shows that for explaining the relationship among the covariates and the repeated outcomes, each of the proposed models show competitive results in terms of bias and coverage probability as compared to the marginal models. If the repeated outcomes are associated or if the distribution of outcome variables are not identical at different follow-ups, the marginal-conditional models give better results in terms of bias and coverage probability of the estimates. For keeping the number of parameters to be estimated as small as possible, the regressive model is suggested for data with more than three follow-ups. The methods are illustrated with an example using Health and Retirement Study data.}, keywords = {Bivariate binary outcomes, Conditional model, Marginal conditional model, marginal model}, doi = {10.1007/s40840-022-01290-4}, author = {Gulshan, Jahida and Khan, Azmeri and M Ataharul Islam} } @article {12900, title = {More Evidence Insomnia Contributes to Cognitive Decline}, year = {2022}, publisher = {Medscape}, keywords = {Cognitive decline, insomnia}, url = {https://www.medscape.com/viewarticle/984487}, author = {Brooks, Megan} } @article {12495, title = {Mortality and morbidity in ageing men: Biology, Lifestyle and Environment.}, journal = {Reviews in Endocrine and Metabolic Disorders}, volume = {23}, year = {2022}, pages = {1285-1304}, abstract = {

Males live shorter lives than women in all countries. The universality of shorter male life expectancy is a 21st Century phenomena. It occurs with the decline in infectious diseases and the rise in cardiovascular diseases accounting for mortality. Male/female differences in morbidity are not as succinctly characterized. Men have a higher prevalence of lethal diseases, which is linked to their lower life expectancy. Women have more non-lethal conditions such as depression and arthritis; which may also be linked in part to longer survival. Men have better physical functioning and less disability which is partly explained by gender differences in diseases and also by their greater strength, size, and stamina. Gender differences in risk factors for disease have changed over time with the prevalence and treatment of risk as well as differential behavior by gender. Examination of what are seen as basic molecular and cellular measures related to aging indicates men age faster than women; however, even these basic biological measures result from a combination of biology, behavior, and social factors.

}, keywords = {Cholesterol, Diabetes, Epigenetic aging, gender, Heart disease, Hypertension, Life Expectancy, sex, Stroke}, issn = {1573-2606}, doi = {10.1007/s11154-022-09737-6}, author = {Zhao, Erfei and Eileen M. Crimmins} } @article {doi:10.1080/08882746.2021.2006548, title = {Mortgage delinquency, foreclosure, and cognition in later life}, journal = {Housing and Society}, volume = {49}, year = {2022}, pages = {113-127}, abstract = {The rapid growth in housing insecurity among older adults is a major public health concern. While there is evidence that stress contributes to poor health, the relationship between housing-related financial stressors and cognitive functioning is relatively unknown. We investigated the association between the personal experiences of mortgage delinquency and foreclosure and cognition and its sub-components of episodic memory and mental status among Americans age 65 years and older. Using the data from two concatenated waves (2010, 2012) of the Health and Retirement Study, we analyzed data for respondents (N = 6,612) across both waves using generalized linear regressions. Our findings suggest that there is a negative association between mortgage delinquency/foreclosure and cognitive scores. Further, we found a negative association between mortgage delinquency and mental status among women, specifically. These results highlight the importance of financial well-being vis-{\`a}-vis housing stability and its significance to mental well-being and cognition of adults in later life. Future research is needed to identify macro-level stressors such as mortgage delinquency and/or foreclosure. Such information would improve strategies for prevention and intervention particularly for older adults living on fixed incomes who have little opportunity to earn pre-retirement levels of income.}, keywords = {Cognition, Foreclosure, mortgage delinquency, Stress}, doi = {https://doi.org/10.1080/08882746.2021.2006548}, author = {Gillian L Marshall and Sarah L. Canham and Eva Kahana and Eric B Larson} } @article {12926, title = {Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults.}, journal = {Journal of Multimorbidity and Comorbidity}, volume = {12}, year = {2022}, pages = {26335565221143012}, abstract = {

BACKGROUND: Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology.

METHODS: We analyzed 16~years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (>=65~years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains.

RESULTS: We identified four distinct multidimensional trajectory groups: (1) (32.7\% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) (32.9\%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) (19.9\%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) (14.1\%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two classes.

CONCLUSIONS: There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.

}, keywords = {Cognition, depression, joint trajectories, multimorbidity}, issn = {2633-5565}, doi = {10.1177/26335565221143012}, author = {Qui{\~n}ones, Ana R and Nagel, Corey L and Botoseneanu, Anda and Newsom, Jason T and Dorr, David A and Kaye, Jeffrey and Thielke, Stephen M and Allore, Heather G} } @article {11626, title = {Multifaceted Demands of Work and Their Associations with Cognitive Functioning: Findings From the Health and Retirement Study.}, journal = {The Journals of Gerontology: Series B }, volume = {77}, year = {2022}, pages = {351-361}, abstract = {

OBJECTIVES: The present study examines the associations among mental, social, and physical demands of work with cognitive functioning among older adults in the United States.

METHODS: Data from 3,176 respondents in the Health and Retirement Study were analyzed using growth curve modeling (2004-2014). The study investigated differences by gender, race, ethnicity, and education.

RESULTS: Higher mental and social demands of work were associated with higher levels of initial cognitive functioning, but not significantly associated with slower cognitive decline over time. Physical demands of work were negatively associated with initial cognitive functioning and also marginally associated with a slower rate of decline in cognitive functioning going into older adulthood. In stratified analyses, results varied by sociodemographic characteristics.

DISCUSSION: The results partially support the environmental complexity hypothesis and the productive aging framework in that higher mental and social demands and lower physical demands relate to better cognitive functioning at baseline, with the differences appearing stable throughout older adulthood. The stratified results shed light on addressing disparities in cognitive aging and work environments.

}, keywords = {Cognition, Employment, Older workers}, issn = {1758-5368}, doi = {10.1093/geronb/gbab087}, author = {Lee, Yeonjung Jane and Gonzales, Ernest and Andel, Ross} } @article {12247, title = {Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {e89-e97}, abstract = {

BACKGROUND: Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups.

METHOD: We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (>=2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases.

RESULTS: Overweight and obesity were more prevalent in non-Hispanic Black (82.3\%) and Hispanic (78.9\%) than non-Hispanic White (70.9 \%) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants.

CONCLUSIONS: Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.

}, keywords = {Body Mass Index, Disease accumulation, multimorbidity, Race/ethnicity}, issn = {1758-535X}, doi = {10.1093/gerona/glab116}, author = {Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Allore, Heather G and Jason T Newsom and David A Dorr and Ana R Qui{\~n}ones} } @article {12539, title = {Multimorbidity and Employment Outcomes Among Middle-Aged US Cancer Survivors.}, journal = {Journal of Occupational and Environmental Medicine}, volume = {64}, year = {2022}, pages = {476-481}, abstract = {

OBJECTIVE: The objective of this study was to evaluate the relationship between multimorbidity and subsequent 2-year employment outcomes among middle-aged United States (US) cancer survivors. In addition, we examined whether the relationship differed by survivor characteristics.

METHODS: Data of 633 cancer survivors (ages 51 to 64) from the 2014 Health and Retirement Study were used to identify multimorbidity profiles and evaluate associations between multimorbidity and prolonged unemployment during follow-up.

RESULTS: Approximately 64\% of cancer survivors met the criteria for multimorbidity. Latent class analysis revealed three distinct multimorbidity profiles distinguished by the presence or absence of psychiatric disorders. We observed a significant association between high psychiatric multimorbidity and prolonged unemployment after 2-year follow-up (relative risk = 2.78, 95\% Confidence Interval = 1.28 to 6.00), with the effect more pronounced among low-income survivors.

CONCLUSIONS: Psychiatric multimorbidity was associated with prolonged unemployment among middle-aged cancer survivors, particularly among low-income survivors.

}, keywords = {Cancer Survivors, Employment, multimorbidity, Neoplasms, Survivors, Unemployment}, issn = {1536-5948}, doi = {10.1097/JOM.0000000000002473}, author = {Ekenga, Christine C and Kim, BoRin and Kwon, Eunsun and Park, Sojung} } @article {12919, title = {Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study.}, journal = {BMC Geriatrics}, volume = {22}, year = {2022}, pages = {910}, abstract = {

BACKGROUND: Multimorbidity is highly prevalent and associated with several adverse health outcomes, including functional limitations. While maintaining physical functioning is relevant for all adults, identifying those with multimorbidity at risk for faster rates of physical functioning decline may help to target interventions to delay the onset and progression of disability. We quantified the association of multimorbidity with rates of long-term disability and objective physical functioning decline.

METHODS: In the Health and Retirement Study, we computed the Multimorbidity-Weighted Index (MWI) by assigning previously validated weights (based on physical functioning) to each chronic condition. We used an adjusted negative binomial regression to assess the association of MWI with disability (measured by basic and instrumental activities of daily living [ADLs, IADLs]) over 16~years, and linear mixed effects models to assess the association of MWI with gait speed and grip strength over 8~years.

RESULTS: Among 16,616 participants (mean age 67.3, SD 9.7~years; 57.8\% women), each additional MWI point was associated with a 10\% increase in incidence rate of disability (IRR: 1.10; 95\%CI: 1.09, 1.10). In 2,748 participants with data on gait speed and grip strength, each additional MWI point was associated with a decline in gait speed of 0.004~m/s (95\%CI: -0.006, -0.001). The association with grip strength was not statistically significant (-0.01~kg, 95\%CI: -0.73, 0.04). The rate of decline increased with time for all outcomes, with a significant interaction between time and MWI for disability progression only.

CONCLUSION: Multimorbidity, as weighted on physical functioning, was associated with long-term disability, including faster rates of disability progression, and decline in gait speed. Given the importance of maintaining physical functioning and preserving functional independence, MWI is a readily available tool that can help identify adults to target early on for interventions.

}, keywords = {Activities of Daily Living, Hand Strength, multimorbidity, Retirement, walking speed}, issn = {1471-2318}, doi = {10.1186/s12877-022-03548-9}, author = {Aubert, Carole E and Kabeto, Mohammed and Kumar, Navasuja and Wei, Melissa Y} } @article {11729, title = {Multimorbidity and Social Participation Is Moderated by Purpose in Life and Life Satisfaction.}, journal = {Journal of Applied Gerontology}, volume = {41}, year = {2022}, pages = {560-570}, abstract = {

OBJECTIVES: We examined the association between multimorbidity and social participation and whether purpose in life and life satisfaction moderate this relationship.

METHODS: Participants were 12,825 Health and Retirement Study adults. We used multiple linear regression to examine the association between a cumulative-updated multimorbidity-weighted index (MWI) and social participation.

RESULTS: Among adults with average purpose in life or life satisfaction, MWI was associated with lower social participation. For those with above average purpose in life, each 1-point increase in MWI was associated with a 0.11-point (95\% confidence interval [CI]: [0.07, 0.14]) better social participation score. Participants with above average life satisfaction experienced a 0.04-point (95\% CI: [0.02, 0.07]) better social participation score with each 1-point increase in MWI.

DISCUSSION: Multimorbidity was associated with worse social participation, but this was reversed by above average purpose in life and life satisfaction. Interventions that improve well-being should be assessed to enhance social participation among older adults with any degree of multimorbidity.

}, keywords = {Epidemiology, health-related quality of life, Leisure, Successful aging}, issn = {1552-4523}, doi = {10.1177/07334648211027691}, author = {Jamie E Luster and Ratz, David and Melissa Y Wei} } @article {12985, title = {Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)}, journal = {Innovation in Aging}, volume = {5}, year = {2022}, pages = {614}, abstract = {Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2\%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2\%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6\%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1\% in youngest age category [67-69] vs. 50.3\% for incident and 66.7\% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6\% CIND/dementia vs. 15.4\% for incident and 16.8\% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4\%) than in the incident (11.8\%) and no multimorbidity groups (13.4\%). Non-Hispanic White beneficiaries were more represented in the incident (83.5\%) than the prevalent (77.2\%) and the no multimorbidity (77.7\%). Hispanic beneficiaries were more represented in the no (8.9\%) than the prevalent (7.4\%) and incident multimorbidity groups (4.7\%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.}, keywords = {Medicare Beneficiaries, multimorbidity progression}, doi = {10.1093/geroni/igab046.2347}, author = {Qui{\~n}ones, Ana R and Markwardt, Sheila and Allore, Heather and Newsom, Jason and Nagel, Corey and Dorr, David and Botoseneanu, Anda} } @article {12596, title = {Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults.}, journal = {Journal of Health and Social Behavior}, year = {2022}, abstract = {

Although the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992-2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.

}, keywords = {Bereavement, cardiometabolic health, race, racial disadvantage, Stress}, issn = {2150-6000}, doi = {10.1177/00221465221114485}, author = {Donnelly, Rachel and Cha, Hyungmin and Umberson, Debra} } @article {11906, title = {Multiple Reasons for Perceived Everyday Discrimination and All-Cause Mortality Risk Among Older Black Adults.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {310-314}, abstract = {

BACKGROUND: The present study assessed whether reporting multiple reasons for perceived everyday discrimination was associated with an increased risk for all-cause mortality risk among older Black adults.

METHODS: This study utilized data from a subsample of older Black adults from the Health and Retirement Study (HRS), a nationally representative panel study of older adults in the United States. Our measure of multiple reasons for perceived everyday discrimination was based on self-reports from the 2006/2008 HRS waves. Respondents{\textquoteright} vital status was obtained from the National Death Index and reports from key household informants (spanning 2006-2019). Cox proportional hazard models, which accounted for covariates linked to mortality, were used to estimate the risk of all-cause mortality.

RESULTS: During the observation period, 563 deaths occurred. Twenty percent of Black adults attributed perceived everyday discrimination to three or more sources. In demographic adjusted models, attributing perceived everyday discrimination to three or more sources was a statistically significant predictor of all-cause mortality risk (hazard ratio= 1.45; 95\%, confidence interval=1.12 - 1.87). The association remained significant (hazard ratio=1.49, 95\%, confidence interval=1.15 - 1.93) after further adjustments for health, behavioral, and economic characteristics.

CONCLUSION: Examining how multiple reasons for perceived everyday discrimination relate to all-cause mortality risk has considerable utility in clarifying the unique contributions of perceived discrimination to mortality risk among older Black adults. Our findings suggest that multiple reasons for perceived everyday discrimination are a particularly salient risk factor for mortality among older Black adults.

}, keywords = {Aging, Black Americans, Discrimination, Mortality}, issn = {1758-535X}, doi = {10.1093/gerona/glab281}, author = {Ryon J. Cobb and Connor M Sheehan and Louie, Patricia and Christy L Erving} } @article {12579, title = {Multivariate estimation of factor structures of complex traits using SNP-based genomic relationships.}, journal = {BMC Bioinformatics}, volume = {23}, year = {2022}, pages = {305}, abstract = {

BACKGROUND: Heritability and genetic correlation can be estimated from genome-wide single-nucleotide polymorphism (SNP) data using various methods. We recently developed multivariate genomic-relatedness-based restricted maximum likelihood (MGREML) for statistically and computationally efficient estimation of SNP-based heritability ([Formula: see text]) and genetic correlation ([Formula: see text]) across many traits in large datasets. Here, we extend MGREML by allowing it to fit and perform tests on user-specified factor models, while preserving the low computational complexity.

RESULTS: Using simulations, we show that MGREML yields consistent estimates and valid inferences for such factor models at low computational cost (e.g., for data on 50 traits and 20,000 individuals, a saturated model involving 50 [Formula: see text]{\textquoteright}s, 1225 [Formula: see text]{\textquoteright}s, and 50 fixed effects is estimated and compared to a restricted model in less than one hour on a single notebook with two 2.7 GHz cores and 16 GB of RAM). Using repeated measures of height and body mass index from the US Health and Retirement Study, we illustrate the ability of MGREML to estimate a factor model and test whether it fits the data better than a nested model. The MGREML tool, the simulation code, and an extensive tutorial are freely available at https://github.com/devlaming/mgreml/ .

CONCLUSION: MGREML can now be used to estimate multivariate factor structures and perform inferences on such factor models at low computational cost. This new feature enables simple structural equation modeling using MGREML, allowing researchers to specify, estimate, and compare genetic factor models of their choosing using SNP data.

}, keywords = {Genome, Genome-Wide Association Study, Genomics, Multifactorial Inheritance, Phenotype, Polymorphism, Single Nucleotide}, issn = {1471-2105}, doi = {10.1186/s12859-022-04835-3}, author = {de Vlaming, Ronald and Slob, Eric A W and Groenen, Patrick J F and Rietveld, Cornelius A} } @article {11514, title = {Music Engagement and Episodic Memory among Middle-Aged and Older Adults: A National Cross-Sectional Analysis.}, journal = {The Journals of Gerontology: Series B}, volume = {77}, year = {2022}, pages = {558-566}, abstract = {

OBJECTIVES: To determine whether music engagement influences middle-aged and older adults{\textquoteright} performance on episodic memory tasks.

METHODS: Secondary data analysis of a sample (N = 4,592) of cognitively healthy adults from the 2016 Health and Retirement Study were used for this study. Multivariable regression models were used to analyze the cross-sectional differences in performance on tasks of episodic memory between participants who listened to music (n= 3,659) or sang or played an instrument (n= 989).

RESULTS: On average, participants recalled 10.3 words out of a possible 20. Regression analyses showed that both music listening and singing or playing an instrument were independently associated with significantly better episodic memory.

DISCUSSION: The findings provide the first population-based evidence that music engagement is associated with better episodic memory among middle-aged and older adults. Future studies should examine whether the association is causal or has a dose response.

}, keywords = {age norms, healthcare policy, lifestyle, Memory, Music, regression methods}, issn = {1758-5368}, doi = {10.1093/geronb/gbab044}, author = {Rouse, Hillary J and Jin, Ying and Hueluer, Gizem and Huo, Meng and Bugos, Jennifer A and Veal, Britney and Torres, Mia and Peterson, Lindsay and Dobbs, Debra and Meng, Hongdao} } @article {12284, title = {My Wife Is My Insurance Policy: Household Bargaining and Couples{\textquoteright} Purchase of Long-Term Care Insurance.}, journal = {Research on Aging}, volume = {44}, year = {2022}, pages = {692-708}, abstract = {

This paper examines household decisions over long-term care insurance (LTCI) purchases through a bargaining lens. Long-term care insurance purchase is a discrete decision around which spouses{\textquoteright} interests may diverge substantially. The cost of buying LTCI is typically borne by both spouses, but the benefits of LTCI go disproportionately to women, who are more likely to need long-term care for themselves, and to benefit from the asset protection and other support LTCI offers in the event their husband needs care. Using panel data on married couples ages 50-75 from the US Health and Retirement Study (HRS), we test and find support for the hypothesis that spouses{\textquoteright} relative bargaining power is related to LTCI purchase decisions. In particular, when husbands have final say in household decisions, LTCI coverage is less likely. The findings suggest that spouse{\textquoteright}s relative bargaining power matters for health care choices and, therefore, for the welfare of older men and women.

}, keywords = {Household bargaining, Long-term care insurance, random-effects multinomial logistic regression}, issn = {1552-7573}, doi = {10.1177/01640275211046322}, author = {Tennyson, Sharon and Yang, Hae Kyung and Woolley, Frances} } @article {11360, title = {Maintaining Sense of Purpose Following Health Adversity in Older Adulthood: A Propensity Score Matching Examination.}, journal = {The Journals of Gerontology: Series B }, volume = {76}, year = {2021}, pages = {1574-1579}, abstract = {

OBJECTIVES: Research has demonstrated sense of purpose predicts better health in older adulthood. However, work is limited with respect to understanding how experiencing a health event or illness diagnosis impacts older adults{\textquoteright} sense of purpose.

METHOD: The current study employed a propensity score matching approach to compare older adults who did or did not experience an adverse health event on changes in sense of purpose across three waves of the Health and Retirement Study. Sense of purpose was assessed at each wave, and changes were compared between people who did versus did not experience one of seven diagnoses and health events.

RESULTS: When propensity score matching was employed, no differences in trajectories of change for sense of purpose were found with respect to all seven events. Individual differences in trajectories though were evidenced across groups.

DISCUSSION: The current findings suggest that even when health events impact older adults{\textquoteright} physical functioning or place limitations on their activity, it may hold little ramifications for their sense of purpose. Future research should consider this potential for resilience, focusing on how adults compensate for losses.

}, keywords = {health events, older adulthood, propensity score matching, Sense of purpose}, issn = {1758-5368}, doi = {10.1093/geronb/gbab002}, author = {Patrick L Hill and Beck, Emorie D and Joshua J Jackson} } @article {10996, title = {Making the Decision to Move to a Nursing Home: Longitudinal Evidence From the Health and Retirement Study}, journal = {Journal of Applied Gerontology}, volume = {40}, year = {2021}, pages = {1197-1205}, abstract = {This study applied the theory of planned behavior to examine predictors of U.S. older adults? (65+ years) intention and behavior of moving to a nursing home. Two waves of Health and Retirement Study data were used (N = 9,969). Moving intention was measured by respondents? self-reported probability to move in the next 5 years in Wave 1. Moving behavior was measured by whether they actually moved in Wave 2. Structural equation modeling was used to examine the relationships of demographic and health predictors with moving intention and behavior. For both genders, advanced age, poorer health, having fewer children, and long-term care insurance were associated with higher levels of moving intention and behavior. Men?s intention was a significant predictor of subsequent moving behavior. However, women?s intention was not associated with moving behavior, probably due to inadequate resources to support their preference. The findings provide meaningful personhood-centered insights into nursing home entry decisions.}, keywords = {decision-making, moving, nursing home, theory of planned behavior}, isbn = {0733-4648}, doi = {https://doi.org/10.1177/0733464820949042}, author = {Lu, Peiyi and Kong, Dexia and Shelley, Mack} } @article {11541, title = {Marital loss and risk of dementia: Do race and gender matter?}, journal = {Social Science \& Medicine}, volume = {275}, year = {2021}, pages = {113808}, abstract = {

Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p~<~0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.

}, keywords = {Dementia, Divorce, gender, Income, Marital Status, race, Widowhood}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2021.113808}, author = {Zhang, Zhenmei and Hui Liu and Seung-won Emily Choi} } @article {11365, title = {Marital Quality and Salivary Telomere Length Among Older Men and Women in the United States.}, journal = {Journal of Aging and Health}, volume = {33}, year = {2021}, pages = {300-309}, abstract = {

The link between marital quality and cellular aging remains underexplored. This study examined how both positive and negative marital quality were associated with salivary telomere length among partnered adults in the United States over the age of 50{\textdegree}years. Data were from the 2008 Health and Retirement Study ( = 3203). Ordinary least squares regression was used to estimate the link between marital quality and telomere length. While neither positive nor negative marital quality was significantly associated with telomere length among older women, positive and negative marital quality had an interacting effect on telomere length among men. Specifically, when negative marital quality was low, higher positive marital quality was associated with shorter telomere length, whereas when negative marital quality was high, higher positive marital quality was associated with longer telomere length. The findings speak to the complex nature of intimate partnerships and the implications of these partnerships for cellular aging processes.

}, keywords = {Aging, intimate relationships, Marital quality, Telomere}, issn = {1552-6887}, doi = {10.1177/0898264320980250}, author = {Yu, Yan-Liang and Hui Liu} } @article {11269, title = {Marital quality, gender, and later-life depressive symptom trajectories.}, journal = {Journal of Women \& Aging}, volume = {33}, year = {2021}, pages = {122-136}, abstract = {

We analyze six waves of data (2006-2016) from the Health and Retirement Study (n~=~4,342) to examine how marital quality is associated with depressive symptom trajectories among a group of continuously married older adults. Results show gender parity in how own perceptions of positive and negative dimensions of marital quality are related to depressive symptom trajectories. In addition, spousal perceptions of negative marital quality are positively associated with growth in depressive symptomatology regardless of gender. Spousal perceptions of positive marital quality, however, are associated with lower depressive symptoms only for women.

}, keywords = {Depressive symptoms, gender, Marital quality}, issn = {1540-7322}, doi = {10.1080/08952841.2020.1818538}, author = {Jennifer R. Bulanda and Takashi Yamashita and J Scott Brown} } @article {11529, title = {Marital Transitions, Housing, and Long-Term Care in Old Age}, year = {2021}, abstract = {Retired couples dissave housing wealth at a much slower rate than singles, conditional on income. This paper studies mechanisms through which marital transitions affect housing decisions of retirees. We develop and estimate a life-cycle savings model where marital transitions affect long-term care arrangements, bequest motives, and eligibility for means-tested welfare programs. We find that the key driver behind the stark difference in dissaving of housing wealth between retired couples and singles varies substantially by income. For low-income households, how means-tested public insurance treats housing has the most impact on their housing decisions. For middle- and highincome households, family caregiving and bequest motives are the dominant driver, respectively. Our counterfactual policy experiments show that the current structure of the Medicaid estate recovery program which exempts housing wealth only for couples is more desirable than alternative rules, such as extending the homestead exemption to singles or providing the exemption to singles only. By inducing lower-income couples to decumulate housing wealth at a slower rate, the current Medicaid program reduces impoverishment risk in retirement.}, keywords = {Couples, Housing, Retirement}, url = {http://www.ko-ami.com/uploads/1/0/5/9/105963965/chang_ko_march2021.pdf}, author = {Chang, Minsu and Ko, Ami} } @mastersthesis {11688, title = {Measurement Invariance in the CESD-8 and Assessment of Mood Correlates Between American and Mexican Community Studies on the Multisystemic Geriatric Depression Cycle}, volume = {Ph.D.}, year = {2021}, school = {University of Central Florida}, address = {Orlando, FL}, abstract = {The Health and Retirement Study is a longitudinal study that is conducted every other year in the United States and has served as a precursor to similar studies across the world, such as the Mexican Health and Aging Study. The purpose of the current project was evaluating the relationship between depressive symptoms, inflammation and physical activity levels using data from the HRS and MHAS studies. The current project was divided in two main studies. The first study aimed at establishing measurement invariance in a brief questionnaire about depressive symptoms, the CES-D 8. The second study looked at various theories of depression including the inflammation theory and the economic theory of depression and other constructs in a larger, novel model called the Multisystemic Geriatric Depression Cycle. For the first study, MPlus was used to conduct measurement invariance analyses in 15,319 participants ages sixty- five and older from both datasets. For the second study, various regression, mediation and moderation analyses were conducted using variables like C-reactive protein, physical activity, loneliness, frequency of social contact and perceived social support. Because measurement invariance was not supported by results in Study 1, analyses and results in Study 2 were only interpreted for the HRS sample. Results from second study showed support for the inflammation theory of depression, partial support for the economic theory of depression with cross-sectional data, and the cross-sectional and longitudinal mediating effect of perceived negative social support in the relationship between loneliness and depression. This project highlights further need for improvement of measures administered cross-culturally to guarantee meaningful comparison of construct of depression among culturally diverse groups. This study adds to the growing body of literature guiding harmonization efforts from the Program on Global Aging, Health and Policy.}, keywords = {CESD-8, depression, Inflammation, Loneliness, Measurement Invariance, MHAS, perceived social support, Physical activity}, url = {https://stars.library.ucf.edu/cgi/viewcontent.cgi?article=1510\&context=etd2020}, author = {Manuel Herrera Legon} } @inbook {doi:https://doi.org/10.1002/9781119376965.ch11, title = {Measuring Cognition in a Multi-Mode Context}, booktitle = {Advances in Longitudinal Survey Methodology}, year = {2021}, pages = {250-271}, publisher = {John Wiley \& Sons, Ltd}, organization = {John Wiley \& Sons, Ltd}, chapter = {11}, abstract = {Although multi-mode studies may present complications for a variety of survey measures, tests of cognitive ability are particularly problematic. Measures of cognitive ability have been incorporated in many surveys, and they are especially common in longitudinal surveys of health and ageing. Despite these challenges, there are few mode comparisons that focus on cognitive measures, and the implications of mixed-mode design decisions for the measurement of cognition in longitudinal surveys remain largely unclear. In general, cognitive assessments in surveys share several qualities that complicate implementation across modes. If comparability of tests is a priority, it is important to identify tests that are suitable for administration across different modes. Regardless of how comparable the tests are in terms of administration protocol, however, there are still likely to be some measurement differences by mode.}, keywords = {administration protocol, Cognitive Ability, cognitive assessments, longitudinal surveys, mixed-mode design}, isbn = {9781119376965}, doi = {https://doi.org/10.1002/9781119376965.ch11}, author = {Ofstedal, Mary Beth and McClain, Colleen A. and Couper, Mick P. and Lynn, Peter} } @inbook {11410, title = {Measuring life course events and life histories}, booktitle = {Handbook of Aging and the Social Sciences (Ninth Edition)Handbooks of Aging}, year = {2021}, pages = {33-47}, publisher = {Academic Press}, organization = {Academic Press}, chapter = {3}, abstract = {Whereas some life events are considered potential sources of stress, others are viewed as markers of interconnected life course transitions and processes. In this chapter, we first review the theoretical roots of measures of life events and discuss longstanding methodological critiques regarding the categorization of life events and factors associated with the reliability and validity of reports. We then review calendar interview methods that employ an Event (or Life) History Calendar approach to collect timeline data. These methods, based on cognitive theories of autobiographical memory, are designed to facilitate retrospective recall of thematic temporal sequences of personal memories. We describe the challenges of collecting retrospective life histories in studies of older adults, strategies used to evaluate the veracity of retrospective life history recall, and summarize recent analytic methods that examine the heterogeneity and dynamics of domain-specific and cross-domain timing and sequencing of transitions and events in the lives of individuals.}, keywords = {calendar interview methods, Life event inventories, methodological issues, report accuracy, retrospective life histories, Sequence analysis}, isbn = {978-0-12-815970-5}, doi = {https://doi.org/10.1016/B978-0-12-815970-5.00003-6}, author = {Jacqui Smith and Hu, Mengyao and Lee, Haena}, editor = {Kenneth F Ferraro and Deborah Carr} } @article {Hou12, title = {Measuring Racial/Ethnic Retirement Wealth Inequality}, journal = {The Journal of Retirement}, volume = {8}, year = {2021}, pages = {12{\textendash}28}, abstract = {As the US population becomes more diverse, it will be increasingly important for policymakers addressing Social Security{\textquoteright}s solvency to understand how reliant various racial and ethnic groups will be on the program versus other sources of retirement wealth. Yet, to date, studies on retirement wealth have tended not to focus on race and ethnicity, have largely ignored the role of Social Security, or have excluded the most recent cohort approaching retirement{\textemdash}the Late Boomers. This project uses data from the Health and Retirement Study (HRS) to document the retirement resources of White, Black, and Hispanic households at various points in the wealth distribution for five HRS cohorts of 51- to 56-year-olds between 1992 and 2016.TOPICS: Retirement, wealth management, social securityKey Findings▪ In 2016, the typical Black household had 46 percent of the retirement wealth of the typical White household; the typical Hispanic household had 49 percent. This inequality would be much higher but for the presence of Social Security.▪ The 1992 to 2010 HRS cohorts showed little change in retirement wealth inequality, although a decline in 51- to 56-year-old White households{\textquoteright} retirement wealth between 2010 and 2016 narrowed the racial and ethnic gaps in retirement wealth slightly.▪ The progressivity of Social Security, combined with lower average incomes for minority households, means that replacement rates are more equal than wealth{\textemdash}in 2016, the replacement rate of Black households was 82 percent of White households and Hispanic households was 95 percent.}, keywords = {Retirement, Social Security, Wealth management}, issn = {2326-6899}, doi = {10.3905/jor.2020.1.079}, author = {Wenliang Hou and Geoffrey T. Sanzenbacher} } @article {11891, title = {Measuring the COVID-19 Mortality Burden in the United States : A Microsimulation Study.}, journal = {Annals of Internal Medicine}, volume = {174}, year = {2021}, pages = {1700-1709}, abstract = {

BACKGROUND: Fully assessing the mortality burden of the COVID-19 pandemic requires measuring years of life lost (YLLs) and accounting for quality-of-life differences.

OBJECTIVE: To measure YLLs and quality-adjusted life-years (QALYs) lost from the COVID-19 pandemic, by age, sex, race/ethnicity, and comorbidity.

DESIGN: State-transition microsimulation model.

DATA SOURCES: Health and Retirement Study, Panel Study of Income Dynamics, data on excess deaths from the Centers for Disease Control and Prevention, and nursing home death counts from the Centers for Medicare \& Medicaid Services.

TARGET POPULATION: U.S. population aged 25 years and older.

TIME HORIZON: Lifetime.

PERSPECTIVE: Individual.

INTERVENTION: COVID-19 pandemic through 13 March 2021.

OUTCOME MEASURES: YLLs and QALYs lost per 10~000 persons in the population. The estimates account for the age, sex, and race/ethnicity of decedents, along with obesity, smoking behavior, lung disease, heart disease, diabetes, cancer, stroke, hypertension, dementia, and nursing home residence.

RESULTS OF BASE-CASE ANALYSIS: The COVID-19 pandemic resulted in 6.62 million QALYs lost (9.08 million YLLs) through 13 March 2021, with 3.6 million (54\%) lost by those aged 25 to 64 years. The greatest toll was on Black and Hispanic communities, especially among men aged 65 years or older, who lost 1138 and 1371 QALYs, respectively, per 10~000 persons. Absent the pandemic, 38\% of decedents would have had average or above-average life expectancies for their subgroup defined by age, sex, and race/ethnicity.

RESULTS OF SENSITIVITY ANALYSIS: Accounting for uncertainty in risk factors for death from COVID-19 yielded similar results.

LIMITATION: Estimates may vary depending on assumptions about mortality and quality-of-life projections.

CONCLUSION: Beyond excess deaths alone, the COVID-19 pandemic imposed a greater life expectancy burden on persons aged 25 to 64 years, including those with average or above-average life expectancies, and a disproportionate burden on Black and Hispanic communities.

PRIMARY FUNDING SOURCE: National Institute on Aging.

}, keywords = {COVID-19, mortality burden}, issn = {1539-3704}, doi = {10.7326/M21-2239}, author = {Julian Reif and Heun-Johnson, Hanke and Tysinger, Bryan and Darius Lakdawalla} } @article {11394, title = {MEDICAID AND MORTALITY: NEW EVIDENCE FROM LINKED SURVEY AND ADMINISTRATIVE DATA}, journal = {Quarterly Journal of Economics}, volume = {136}, year = {2021}, pages = {1783{\textendash}1829}, abstract = {We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic status, citizenship status, and public program participation. We find that prior to the ACA expansions, mortality rates across expansion and nonexpansion states trended similarly, but beginning in the first year of the policy, there were significant reductions in mortality in states that opted to expand relative to nonexpanders. Individuals in expansion states experienced a 0.132 percentage point decline in annual mortality, a 9.4\% reduction over the sample mean, as a result of the Medicaid expansions. The effect is driven by a reduction in disease-related deaths and grows over time. A variety of alternative specifications, methods of inference, placebo tests, and sample definitions confirm our main result.}, keywords = {administrative data, Medicaid, Mortality}, doi = {10.1093/qje/qjab004}, author = {Miller, Sarah and Johnson, Norman and Wherry, Laura R.} } @article {11547, title = {Medicaid Coverage {\textquoteright}Cliff{\textquoteright} Increases Expenses And Decreases Care For Near-Poor Medicare Beneficiaries.}, journal = {Health Affairs }, volume = {40}, year = {2021}, pages = {552-561}, abstract = {

Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance from Medicaid, an employer, or a Medigap plan. Near-poor Medicare beneficiaries (with incomes more than 100~percent but less than 200~percent of the federal poverty level) are ineligible for Medicaid but frequently lack alternative supplemental coverage, resulting in a supplemental coverage "cliff" of 25.8~percentage points just above the eligibility threshold for Medicaid (100~percent of poverty). We estimated that beneficiaries affected by this supplemental coverage cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55~percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. Lower prescription drug use was partly driven by low take-up of Part D subsidies, which Medicare beneficiaries automatically receive if they have Medicaid. Expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies would lessen cost-related barriers to health care among near-poor Medicare beneficiaries.

}, keywords = {Medicaid, Medicare}, issn = {1544-5208}, doi = {10.1377/hlthaff.2020.02272}, author = {Roberts, Eric T and Glynn, Alexandra and Cornelio, Noelle and Donohue, Julie M and Gellad, Walid F and McWilliams, J Michael and Lindsay M Sabik} } @article {11908, title = {Medicaid Expansion and the Mental Health of Spousal Caregivers}, number = {IZA DP No. 14754}, year = {2021}, institution = {Institute of Labor Economics}, address = {Bonn, Germany}, abstract = {Health insurance expansions can exert wellbeing effects on individuals who provide informal care to their loved ones, reducing their experience of depression. This study exploits evidence from the Affordable Care Act{\textquoteright}s (ACA) Medicaid expansion to examine the effects on the mental wellbeing of informal caregivers. Drawing on an event study and a Difference-in-Differences (DID) design we investigate the policy impact of ACA Medicaid expansion using longitudinal evidence (from the Health and Retirement Study, HRS) for 2010 to 2018 for low-income individuals aged 64 or below. We find that ACA{\textquoteright}s Medicaid expansion reduced depressive symptoms among caregivers, and specifically we estimate that exposure to ACA Medicaid expansion gives rise to a 0.38 points (equivalent to 4-5\%) reduction in the CESD score (a negative scale in which the lowest scale indicates the best mental wellbeing). We also find that ACA Medicaid causes a spillover effect at the household level, improving the well-being of the spouse care recipient. Our results are robust to various specifications, and we identify several potential driving mechanisms for the findings: reductions in out-of-pocket expenses and labor supply and, as expected, increased Medicaid uptake. The evidence from falsification tests confirms that the estimated effects are purely due to ACA{\textquoteright}s Medicaid expansion and no other phenomena.}, keywords = {ACA, Informal care, insurance expansion, Medicaid, mental wellbeing, spousal mental health}, issn = {2365-9793}, url = {https://ftp.iza.org/dp14754.pdf}, author = {Costa-Font, Joan and Raut, Nilesh} } @article {11380, title = {Memory and Personality Development in Adulthood: Evidence From Four Longitudinal Studies.}, journal = {The Journals of Gerontology, Series B }, volume = {76}, year = {2021}, pages = {88-97}, abstract = {

OBJECTIVES: Personality traits have been related to concurrent memory performance. Most studies, however, have focused on personality as a predictor of memory; comparatively less is known about whether memory is related to personality development across adulthood. Using 4 samples, the present study tests whether memory level and change are related to personality change in adulthood.

METHOD: Participants were drawn from 2 waves of the Wisconsin Longitudinal Study Graduates (WLSG; N = 3,232, mean age = 64.28, SD = 0.65) and Wisconsin Longitudinal Study Siblings (WLSS; N = 1,570, mean age = 63.52, SD = 6.69) samples, the Midlife in the United States (MIDUS; N = 1,901, mean age = 55.43, SD = 10.98), and the Health and Retirement Study (HRS; N = 6,038, mean age = 65.47, SD = 8.28). Immediate and delayed recall and the 5 major personality traits were assessed at baseline and follow-up.

RESULTS: There was heterogeneity in the associations across samples. A meta-analysis of latent change in the four samples indicated that lower baseline memory performance was related to an increase in neuroticism (B = -0.002; 95\% CI = -0.004, -0.0008) and a decrease in agreeableness (B = 0.004; 95\% CI = 0.002, 0.007) and conscientiousness (B = 0.005; 95\% CI = 0.0008, 0.010). In addition, declines in memory were related to steeper declines in extraversion (B = 0.06; 95\% CI = 0.003, 0.11), openness (B = 0.04; 95\% CI = 0.007, 0.069), and conscientiousness (B = 0.05; 95\% CI = 0.019, 0.09).

DISCUSSION: The present study indicates that poor memory and declines in memory over time are related to maladaptive personality change. These associations, however, were small and inconsistent across samples.

}, keywords = {Adulthood, longitudinal, Memory, Personality Development}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa086}, author = {Yannick Stephan and Angelina R Sutin and Martina Luchetti and Antonio Terracciano} } @article {11963, title = {Memory Decline After Coronary Revascularization: Procedure Type Does Not Change Risk}, journal = {Clinical Essentials}, year = {2021}, publisher = {Medpage Today}, abstract = {Despite the absence of conclusive evidence that revascularization accelerates rate of cognitive decline in older adults, concern exists. After a retrospective study showed greater cognitive decline following CABG than observed in a matched cohort of Medicare beneficiaries, strategies to reduce this risk were pursued.1 Several studies compared outcomes in CABG patients exposed or not exposed to cardiopulmonary bypass pumps, which is among suspected causes for neurologic impairment.2-5 No difference up to five years after revascularization was seen.}, keywords = {coronary revascularization, memory decline}, url = {https://www.medpagetoday.com/resource-centers/acs-related-conditions/memory-decline-after-coronary-revascularization-procedure-type-does-not-change-risk/3530}, author = {Bosworth, Ted} } @article {11732, title = {Mendelian Randomization of Dyslipidemia on Cognitive Impairment Among Older Americans}, journal = {Frontiers in Neurology}, volume = {12}, year = {2021}, abstract = {Background: Altered lipid metabolism may be a risk factor for dementia, and blood cholesterol level has a strong genetic component. We tested the hypothesis that dyslipidemia (either low levels of high-density lipoprotein cholesterol (HDL-C) or high total cholesterol) is associated with cognitive status and domains, and assessed causality using genetic predisposition to dyslipidemia as an instrumental variable. Methods: Using data from European and African genetic ancestry participants in the Health and Retirement Study, we selected observations at the first non-missing biomarker assessment (waves 2006-2012). Cognition domains were assessed using episodic memory, mental status, and vocabulary tests. Overall cognitive status was categorized in three levels (normal, cognitive impairment non-dementia, dementia). Based on 2018 clinical guidelines, we compared low HDL-C or high total cholesterol to normal levels. Polygenic scores for dyslipidemia were used as instrumental variables in a Mendelian randomization framework. Multivariable logistic regressions and Wald-type ratio estimators were used to examine associations. Results: Among European ancestry participants (n = 8,781), at risk HDL-C levels were associated with higher odds of cognitive impairment (OR = 1.20, 95\% CI: 1.03, 1.40) and worse episodic memory, specifically. Using cumulative genetic risk for HDL-C levels as a valid instrumental variable, a significant causal estimate was observed between at risk low HDL-C levels and higher odds of dementia (OR = 2.15, 95\% CI: 1.16, 3.99). No significant associations were observed between total cholesterol levels and cognitive status. No significant associations were observed in the African ancestry sample (n = 2,101). Conclusion: Our study demonstrates low blood HDL-C is a potential causal risk factor for impaired cognition during aging in non-Hispanic whites of European ancestry. Dyslipidemia can be modified by changing diets, health behaviors, and therapeutic strategies, which can improve cognitive aging. Studies on low density lipoprotein cholesterol, the timing of cholesterol effects on cognition, and larger studies in non-European ancestries are needed.}, keywords = {blood cholesterol, cognitive domain, Dementia, Mendelian randomization, polygenic score}, doi = {10.3389/fneur.2021.660212}, author = {Fu, Mingzhou and Kelly M Bakulski and Higgins, Cesar and Erin B Ware} } @article {11226, title = {Midlife Marital Dissolution and the Onset of Cognitive Impairment.}, journal = {Gerontologist}, volume = {61}, year = {2021}, pages = {1085-1094}, abstract = {

BACKGROUND AND OBJECTIVES: Marital dissolution has become more common in midlife with the doubling of the divorce rate among middle-aged adults. Guided by the stress model that stipulates losing economic, social, and psychological resources lowers well-being, we posited that midlife adults who experienced divorce or widowhood were at greater risk of cognitive impairment than the continuously married. Subsequent repartnering was expected to negate the increased risk.

RESEARCH DESIGN AND METHODS: We used data from the 1998-2016 Health and Retirement Study to estimate discrete-time event history models using logistic regression to predict cognitive impairment onset for men and women.

RESULTS: Roughly 27\% of men who experienced spousal death in midlife went on to experience mild cognitive impairment by age 65. For women, experiencing divorce or widowhood was associated with higher odds of cognitive impairment onset although these differentials were accounted for by economic, social, and psychological resources. Men and women who repartnered after marital dissolution did not appreciably differ from their continuously married counterparts in terms of their likelihoods of cognitive impairment onset.

DISCUSSION AND IMPLICATIONS: A stressful life event, midlife marital dissolution can be detrimental to cognitive well-being, placing individuals at increased risk of developing dementia in later life. The growing diversity of partnership experiences during the second half of life points to the continued importance of examining how union dissolution and formation shape health and well-being.

}, keywords = {Divorce, health, Marriage, Social Support, Widowhood}, issn = {1758-5341}, doi = {10.1093/geront/gnaa193}, author = {Susan L. Brown and Lin, I-Fen and Vielee, Alyssa and Kagan A Mellencamp} } @article {11717, title = {Midlife Wealth Mobility and Long-term Cardiovascular Health.}, journal = {JAMA Cardiology}, volume = {6}, year = {2021}, pages = {1152-1160}, abstract = {

Importance: The association of socioeconomic status and cardiovascular outcomes has been well described, but little is known about whether longitudinal changes in wealth are associated with cardiovascular health status.

Objective: To evaluate the association between midlife wealth mobility and risk of cardiovascular events.

Design, Setting, and Participants: This longitudinal, retrospective cohort study included US adults 50 years or older who participated in the Health and Retirement Study. Participants in the primary analysis had no history of cardiovascular disease and had observations in at least two of three 5-year age intervals (50-54, 55-59, and 60-64 years) and follow-up after 65 years of age. Data were collected from January 1, 1992, to December 31, 2016, and analyzed from November 10, 2020, to April 26, 2021.

Exposures: Quintiles of wealth (reflecting total nonhousing assets) were defined within each of 4 birth cohorts (1931-1935, 1936-1940, 1941-1945, and 1946-1950). Wealth mobility was defined as an increase or a decrease of 1 or more wealth quintiles and was compared with wealth stability (same quintile over time) using covariate-adjusted Cox proportional hazards regression models.

Main Outcomes and Measures: Composite outcome of nonfatal cardiovascular event (myocardial infarction, heart failure, cardiac arrhythmia, or stroke) or cardiovascular death.

Results: A total of 5579 participants were included in the primary analysis (mean [SD] age, 54.2 [2.6] years; 3078 women [55.2\%]). During a mean (SD) follow-up of 16.9 (5.8) years, 1336 participants (24.0\%) experienced a primary end point of nonfatal cardiovascular event or cardiovascular death (14.4 [95\% CI, 13.6-15.2] per 1000 patient-years). Higher initial wealth (per quintile) was associated with lower cardiovascular risk (adjusted hazard ratio [aHR] per quintile, 0.89 [95\% CI, 0.84-0.95]; P = .001). When compared with stable wealth, participants who experienced upward wealth mobility (by at least 1 quintile) had independently lower hazards of a subsequent nonfatal cardiovascular event or cardiovascular death (aHR, 0.84 [95\% CI, 0.73-0.97]; P = .02), and participants who experienced downward wealth mobility had higher risks (aHR, 1.15 [95\% CI, 1.00-1.32]; P = .046).

Conclusions and Relevance: These findings suggest that upward wealth mobility relative to peers in late middle age is associated with lower risks of cardiovascular events or death after 65 years of age.

}, keywords = {cardiology, Cardiovascular Risk Factors, Methods, Research, Statistics}, issn = {2380-6591}, doi = {10.1001/jamacardio.2021.2056}, author = {Machado, Sara and Sumarsono, Andrew and Vaduganathan, Muthiah} } @article {Blanchettjor.2021.1.093, title = {Minding the Gap in Subjective Mortality Estimates}, journal = {The Journal of Retirement}, volume = {9}, year = {2021}, abstract = {This article explores the accuracy of subjective life expectancy estimates using data primarily from the from the Health and Retirement Study (HRS). Although individuals appear to some sense about their likelihood of survival (i.e., their subjective mortality), there are notable gaps in these estimates, consistent with past research. Evidence suggests that although subjective estimates may be relatively accurate, on average, and that households appear to do a relatively good job considering various objective factors (for example, health status), there are often significant errors in individual forecasts, and households do not appear to correctly consider all the relevant objective factors (such as income and smoking). Therefore, financial planners need to educate themselves on how to better model and personalize mortality assumptions into financial plans versus relying on purely subjective estimates to ensure that planning assumptions are as accurate as possible.TOPICS: Retirement, wealth management, legal/regulatory/public policyKey Findings▪ Errors in mortality forecasts can have a significant impact on a variety of household decisions, such as required savings, optimal retirement spending, etc.▪ This analysis suggests that while individuals appear to have some sense of their mortality, there can be notable errors in these estimates and that a number of attributes are not appropriately considered when forecasting mortality.▪ Given the clear gaps that exist in subjective mortality estimates, objective information should largely (or entirely) be the basis for any type of retirement period estimate in a financial plan.}, keywords = {legal/regulatory/public policy, Retirement, Wealth management}, issn = {2326-6899}, doi = {10.3905/jor.2021.1.093}, author = {David Blanchett} } @article {11431, title = {Modeling Multiple Time-Varying Related Groups: A Dynamic Hierarchical Bayesian Approach with an Application to the Health and Retirement Study}, journal = {Journal of the American Statistical Association}, volume = {116}, year = {2021}, pages = {558-568}, abstract = {Abstract As the population of the older individuals continues to grow, it is important to study the relationship among the variables measuring financial health and physical health of the older individuals to better understand the demand for healthcare, and health insurance. We propose a semiparametric approach to jointly model these variables. We use data from the Health and Retirement Study (HRS) which includes a set of correlated longitudinal variables measuring financial and physical health. In particular, we propose a Dynamic Hierarchical Matrix Stick-Breaking Process (DH-MSBP) prior for some of the model parameters to account for the time dependent aspects of our data. This prior introduces dependence among the parameters across different groups which varies over time. A Lasso type shrinkage prior is specified for the covariates with time-invariant effects for selecting the set of covariates with significant effects on the outcomes. Through joint modeling, we are able to study the physical health of the older individuals conditional on their financial health, and vice-versa. Based on our analysis, we find that the health insurance (medicare) provided by the government (of the United States) to the older individuals is very effective, and it covers most of the medical expenditures. However, none of the health insurances conveniently cover the additional medical expenses due to chronic diseases like cancer and heart problem. Simulation studies are performed to assess the operating characteristics of our proposed modeling approach.}, keywords = {Dynamic Model, Hierarchical Bayes, Joint modeling, Lasso, Matrix Stick-Breaking Process}, doi = {10.1080/01621459.2021.1886105}, author = {Kiranmoy Das and Pulak Ghosh and Michael J. Daniels} } @article {11698, title = {Moderate to severe chronic pain in later life: risk and resilience factors for recovery}, journal = {The Journal of Pain}, volume = {22}, year = {2021}, pages = {1657-1671}, abstract = {Despite extensive research on the development and risk factors of chronic pain, the process of recovery from chronic pain in later life has been rarely studied. We estimated the recovery rate of moderate to severe chronic pain (chronic pain of moderate or severe severity or interfering with usual activities) among older adults and investigated predictors of recovery. Leveraging the longitudinal Health and Retirement Study 2006{\textendash}2016 data (6 waves), we estimated the biennial national attrition-adjusted recovery rate of moderate to severe chronic pain among 6,132 US adults aged 65{\textendash}75 at baseline. Generalized estimating equation Poisson models examined pain-related, sociodemographic, psychosocial and health-related factors in relation to recovery within any 2-year interval using longitudinal lagged design. Between 2006{\textendash}2016, the prevalence of moderate to severe chronic pain increased from 28\% to 33\% with the incidence increasing from 14\% to 18\% and the recovery rate approximately 30\%. Previous chronic pain duration, age, chronic diseases and a personality trait (agreeableness) were associated with a lower probability of recovery. Greater financial wealth and physical activity, better sleep quality and self-reported health were associated with a greater probability of recovery. Interventions that improve physical activity and sleep quality may be important avenues for reducing chronic pain burden among older adults.}, keywords = {biopsychosocial, high-impact chronic pain, Moderate to severe chronic pain, Recovery}, doi = {10.1016/j.jpain.2021.05.007}, author = {Li, Rui and Dworkin, Robert H. and Chapman, Benjamin P and Becerra, Adan Z and Yang, Luoying and Christopher J Mooney and Christopher L Seplaki} } @mastersthesis {11402, title = {MODERATION EFFECTS OF SPOUSAL INTERACTIONS ON THE RELATIONSHIP BETWEEN PAIN INTENSITY AND DEPRESSIVE SYMPTOMS IN OLDER ADULTS WITH PAIN}, volume = {Doctor of Philosophy}, year = {2021}, school = {Case Western Reserve University}, address = {Cleveland, OH}, abstract = {This dissertation investigated the relationship between pain intensity and depressive symptoms for older married adults, and examined whether positive and negative spousal interactions buffered and/or exacerbated the impact of pain intensity on depressive symptoms. The stress process theory (Pearlin, 1989) and social interaction theories (Cohen \& Wills, 1985; Rook, 1984) provide the theoretical grounds for hypotheses in this dissertation. The sample consisted of 863 married adults with pain, age 60 and older, obtained from the Health and Retirement Study 2014 data. Hierarchical negative binomial regression models were applied. Results partially supported the relationship between pain intensity (i.e., mild, moderate, or severe pain) and depressive symptoms. The severe pain intensity group showed significantly higher depressive symptoms than the moderate pain group. There was no significant difference in depressive symptoms between the mild and moderate pain groups. Results also partially supported the exacerbating effects of negative spousal interactions (NSI). NSI increased the effect of pain intensity only when respondents reported mild or moderate pain. NSI did not exacerbate the relationship between severe pain intensity and depressive symptoms. This dissertation found inconsistent results about the buffering effect of positive spousal interactions (PSI). PSI buffered the relationship between pain intensity and number of depressive symptoms across all levels of pain intensity when moderating effects of NSI were not controlled. However, PSI was not a significant moderator when the moderating effects of NSI were controlled. Social workers need to educate other healthcare professionals about the necessity of adequate pain treatment, emphasizing that older adults with severe pain are at risk of having higher depressive symptoms. Pain management interventions need to be tailored for older adults with co-occurring severe pain and depressive symptoms. Interventions also need to integrate psychoeducational contents about negative spousal interactions with content about pain management for older adults with mild or moderate pain. The inconsistent results about the buffering effects of PSI suggest caution in a hasty conclusion that only NSI, not PSI, is a significant moderator. Future studies are needed to clarify the relationship between PSI and NSI and gain further insight into differences between pain intensity groups.}, keywords = {Depressive symptoms, Older Adults, pain, spousal interactions}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=case1599085431244253}, author = {Lee, Jeong Woo} } @article {11697, title = {More seniors may have undiagnosed dementia than previously thought}, year = {2021}, publisher = {Michigan News, University of Michigan}, address = {Ann Arbor, MI}, abstract = {Only 1 in 10 older adults in a large national survey who were found to have cognitive impairment consistent with dementia reported a formal medical diagnosis of the condition. Using data from the Health and Retirement Study to develop a nationally representative sample of roughly 6 million Americans age 65 or older, researchers at the University of Michigan, North Dakota State University and Ohio University found that 91\% of people with cognitive impairment consistent with dementia told questioners they had a formal medical diagnosis of Alzheimer{\textquoteright}s disease or dementia.}, keywords = {Dementia, undiagnosed}, url = {https://news.umich.edu/more-seniors-may-have-undiagnosed-dementia-than-previously-thought/}, author = {Bailey, Laura} } @article {10.1093/geronb/gbz156, title = {Mortality and Obesity among US Older Adults: The Role of Polygenic Risk}, journal = {The Journals of Gerontology, Series B}, volume = {76}, year = {2021}, pages = {343-347}, abstract = {To examine the relationship between obesity and mortality as a function of polygenic risk for obesity among older US adults.Using data from the 1994-2014 Health and Retirement Study in conjunction with genome-wide data, we evaluated the risk of mortality as a function of obesity classification, an individual{\textquoteright}s polygenic risk score (PGS) for obesity, and their interaction, stratified by sex. We conducted our analyses using cox proportional hazard models.Among those with an average PGS for obesity (8,143 [68.8 \%]), obese I (HR = 0.7}, keywords = {Mortality, Obesity, polygenic risk, Polygenic risk score}, issn = {1079-5014}, doi = {10.1093/geronb/gbz156}, author = {Vinneau, Justin M and Huibregtse, Brooke M and Laidley, Thomas M and Joshua A Goode and Jason D Boardman} } @article {12126, title = {Multi-Ancestry Genome-wide Association Study Accounting for Gene-Psychosocial Factor Interactions Identifies Novel Loci for Blood Pressure Traits.}, journal = {Human Genetics and Genomics Advances}, volume = {2}, year = {2021}, pages = {100013}, abstract = {

Psychological and social factors are known to influence blood pressure (BP) and risk of hypertension and associated cardiovascular diseases. To identify novel BP loci, we carried out genome-wide association meta-analyses of systolic, diastolic, pulse, and mean arterial BP taking into account the interaction effects of genetic variants with three psychosocial factors: depressive symptoms, anxiety symptoms, and social support. Analyses were performed using a two-stage design in a sample of up to 128,894 adults from 5 ancestry groups. In the combined meta-analyses of Stages 1 and 2, we identified 59 loci (p value <5e-8), including nine novel BP loci. The novel associations were observed mostly with pulse pressure, with fewer observed with mean arterial pressure. Five novel loci were identified in African ancestry, and all but one showed patterns of interaction with at least one psychosocial factor. Functional annotation of the novel loci supports a major role for genes implicated in the immune response (), synaptic function and neurotransmission (), as well as genes previously implicated in neuropsychiatric or stress-related disorders (). These findings underscore the importance of considering psychological and social factors in gene discovery for BP, especially in non-European populations.

}, keywords = {blood pressure traits}, issn = {2666-2477}, doi = {10.1016/j.xhgg.2020.100013}, author = {Sun, Daokun and Melissa Richard and Musani, Solomon K and Yun Ju Sung and Thomas W Winkler and Schwander, Karen and Jin-Fang Chai and Guo, Xiuqing and Kilpel{\"a}inen, Tuomas O and Vojinovic, Dina and Aschard, Hugues and Traci M Bartz and Bielak, Lawrence F and Brown, Michael R and Chitrala, Kumaraswamy and Hartwig, Fernando P and Horimoto, Andrea R V R and Liu, Yongmei and Alisa Manning and Noordam, Raymond and Smith, Albert V and Sarah E Harris and K{\"u}hnel, Brigitte and Lyytik{\"a}inen, Leo-Pekka and Ilja M Nolte and Rauramaa, Rainer and van der Most, Peter J and Wang, Rujia and Erin B Ware and Weiss, Stefan and Wen, Wanqing and Yanek, Lisa R and Dan E Arking and Donna K Arnett and Barac, Ana and Boerwinkle, Eric and Broeckel, Ulrich and Chakravarti, Aravinda and Chen, Yii-Der Ida and Cupples, L Adrienne and Davigulus, Martha L and de Las Fuentes, Lisa and de Mutsert, Ren{\'e}e and de Vries, Paul S and Delaney, Joseph A C and Ana V Diez Roux and D{\"o}rr, Marcus and Jessica Faul and Fretts, Amanda M and Gallo, Linda C and Hans-J{\"o}rgen Grabe and Gu, C Charles and Tamara B Harris and Hartman, Catharina C A and Heikkinen, Sami and Ikram, M Arfan and Isasi, Carmen and Johnson, W Craig and Jost Bruno Jonas and Kaplan, Robert C and Komulainen, Pirjo and Krieger, Jose E and Levy, Daniel and Liu, Jianjun and Kurt Lohman and Luik, Annemarie I and Martin, Lisa W and Meitinger, Thomas and Milaneschi, Yuri and Jeff O{\textquoteright}Connell and Walter R Palmas and Peters, Annette and Peyser, Patricia A and Pulkki-Raback, Laura and Raffel, Leslie J and Reiner, Alex P and Kenneth Rice and Robinson, Jennifer G and Rosendaal, Frits R and Schmidt, Carsten Oliver and Schreiner, Pamela J and Schwettmann, Lars and Shikany, James M and Shu, Xiao-Ou and Stephen Sidney and Sims, Mario and Smith, Jennifer A and Sotoodehnia, Nona and Strauch, Konstantin and Tai, E Shyong and Taylor, Kent and Andr{\'e} G Uitterlinden and Cornelia M van Duijn and Waldenberger, Melanie and Wee, Hwee-Lin and Wei, Wen-Bin and Wilson, Gregory and Xuan, Deng and Yao, Jie and Zeng, Donglin and Zhao, Wei and Zhu, Xiaofeng and Alan B Zonderman and Becker, Diane M and Ian J Deary and Gieger, Christian and Lakka, Timo A and Lehtim{\"a}ki, Terho and Kari E North and Oldehinkel, Albertine J and Brenda W J H Penninx and Snieder, Harold and Wang, Ya-Xing and David R Weir and Zheng, Wei and Michele K Evans and Gauderman, W James and Gudnason, Vilmundur and Horta, Bernardo L and Liu, Ching-Ti and Dennis O Mook-Kanamori and Alanna C Morrison and Pereira, Alexandre C and Psaty, Bruce M and Amin, Najaf and Fox, Ervin R and Charles Kooperberg and Sim, Xueling and Laura Bierut and Rotter, Jerome I and Sharon L R Kardia and Franceschini, Nora and Rao, Dabeeru C and Myriam Fornage} } @article {11593, title = {A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study.}, journal = {Scientific Reports}, volume = {11}, year = {2021}, pages = {8783}, abstract = {

Polypharmacy is commonly defined based on the number of medications taken concurrently using standard cut-offs, but several studies have highlighted the need for a multidimensional assessment. We developed a multidimensional measure of polypharmacy and compared with standard cut-offs. Data were extracted for 2141 respondents of the 2007 Prescription Drug Survey, a sub-study of the Health Retirement Study. Latent classes were identified based on multiple indicators of polypharmacy, including quantity, temporality and risk profile. A four-class model was selected based on fit statistics and clinical interpretability: {\textquoteright}High risk, long-term{\textquoteright} (Class 1), {\textquoteright}Low risk, long-term{\textquoteright} (Class 2), {\textquoteright}High risk, short-term{\textquoteright} (Class 3), and {\textquoteright}High risk for drug interactions, medium-term, regular{\textquoteright} (Class 4). Classes differed regarding sex, cohabitation, disability and multimorbidity. Participants in the {\textquoteright}low risk{\textquoteright} class tended to be male, cohabitating, and reported fewer health conditions, compared to {\textquoteright}high risk{\textquoteright} classes. Polypharmacy classes were compared to standard cut-offs (5+ or 9+ medications) in terms of overlap and mortality risk. The three {\textquoteright}high risk{\textquoteright} classes overlapped with the groups concurrently taking 5+ and 9+ medications per month. However, the multidimensional measure further differentiated individuals in terms of risk profile and temporality of medication taking, thus offering a richer assessment of polypharmacy.

}, keywords = {Diseases, Health Care, Medical research, Risk Factors}, issn = {2045-2322}, doi = {10.1038/s41598-021-86331-x}, author = {Carr, Ewan and Federman, Alex and Dzahini, Olubanke and Dobson, Richard J and Bendayan, Rebecca} } @article {11072, title = {Multigenerational Households during Childhood and Trajectories of Cognitive Functioning Among U.S. Older Adults}, journal = {The Journals of Gerontology: Series B}, volume = {76}, year = {2021}, pages = {1161-1172}, abstract = {Family structure in childhood influences early brain development and cognitive performance in adulthood. Much less is known about its long-term impact on later-life cognitive functioning. We extend the two-generation family structure approach to investigate the potential contribution of living with grandparents in multigenerational households to differences in cognitive functioning at older ages.Data were drawn from nine waves of the Health and Retirement Study (1998-2014) merged with newly-collected childhood family history data. Five types of family structure were assessed: two-parent households, two-parent households with grandparents, single-parent households, single-parent households with grandparents, and grandparent-headed households. Growth curve models were used to estimate trajectories of cognitive functioning over time.Childhood family structure was significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Relative to those from two-parent households, individuals who grew up in multigenerational households showed higher levels of cognitive functioning, including those living with a single parent and grandparents. Those who lived with a single parent alone were the most disadvantaged. The effects of these multigenerational households persisted net of childhood and adulthood socioeconomic status and health outcomes.Grandparent coresidence may cultivate a socially enriched home environment, providing resources and protection for early cognitive development that could persist throughout life. Multigenerational living arrangements are likely to increase as the contemporary population ages. More research needs to be done to understand the impact of these living arrangements on future generations{\textquoteright} brain health and cognitive aging.}, isbn = {1079-5014}, doi = {https://doi.org/10.1093/geronb/gbaa165}, author = {Lee, Haena and Lindsay H Ryan and Mary Beth Ofstedal and Jacqui Smith} } @article {10.1093/geroni/igab046.2347, title = {Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)}, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {614}, abstract = {Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2\%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2\%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6\%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1\% in youngest age category [67-69] vs. 50.3\% for incident and 66.7\% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6\% CIND/dementia vs. 15.4\% for incident and 16.8\% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4\%) than in the incident (11.8\%) and no multimorbidity groups (13.4\%). Non-Hispanic White beneficiaries were more represented in the incident (83.5\%) than the prevalent (77.2\%) and the no multimorbidity (77.7\%). Hispanic beneficiaries were more represented in the no (8.9\%) than the prevalent (7.4\%) and incident multimorbidity groups (4.7\%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.}, issn = {2399-5300}, doi = {10.1093/geroni/igab046.2347}, author = {Qui{\~n}ones, Ana and Markwardt, Sheila and Allore, Heather and Newsom, Jason and Nagel, Corey and Dorr, David and Botoseneanu, Anda} } @article {12062, title = {MULTIMORBIDITY TRAJECTORY CLASSES AS PREDICTED BY RACE, ETHNICITY, AND SOCIAL RELATIONSHIP QUALITY}, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {873}, abstract = {Growth mixture modeling was used to classify multimorbidity (>=2 chronic conditions) trajectories over a 10-year period (2006-2016) in the Health and Retirement Study (N = 7,151, mean age = 68.6 years). Race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White) and social relationship quality (positive social support and negative social exchanges, such as criticisms) were then used to predict trajectory class membership, controlling for age, sex, education, and wealth. We identified three trajectory classes: initial low levels and rapid accumulation of multimorbidity (increasing: 12.6\%), initial high levels and gradual accumulation of multimorbidity (high: 19.5\%), and initial low levels and gradual accumulation of multimorbidity (low: 67.9\%). Blacks were more than twice as likely to be in the increasing (OR = 2.04, CI[1.29,3.21]) and high (OR = 2.28 CI[1.58,3.206]) multimorbidity groups compared with Whites, but there were no significant differences between Hispanics and Whites for either trajectory class (OR = .84 CI[.47,1.51]and OR = .74 CI[.41,1.34], respectively). Increments in perceived support were associated with significantly lower risk of membership in the increasing (OR = .59, CI[.46,.78]) and high classes (OR = .54 CI[.42,.69]), and increments in negative exchanges were associated with significantly higher risk of membership in the increasing (OR = 1.64 CI[1.19,2.25]) and high classes (OR = 2.22 CI[1.64,3.00]). These results provide important new information for understanding health disparities and the role of social relationships associated with multimorbidity in middle and later life that may aid in identifying those most at risk and suggesting possible interventions for mitigating that risk.}, keywords = {multimorbidity, Race/ethnicity, social relationship}, url = {https://watermark.silverchair.com/igab046.3157.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAw4wggMKBgkqhkiG9w0BBwagggL7MIIC9wIBADCCAvAGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMvYWi7nxZ2T3DhQ7tAgEQgIICwQjhrrWTdWJufk1mgdVsBv4wjBsKIMO8ZZuAA3KbKU}, author = {Newson, Jason and O{\textquoteright}Neill, AnneMarie and Denning, Emily C and Anda Botoseneanu and Allore, Heather G and Corey L Nagel and David A Dorr and Ana R Qui{\~n}ones} } @article {11728, title = {Muscle weakness is a prognostic indicator of disability and chronic disease multimorbidity.}, journal = {Experimental Gerontology}, volume = {152}, year = {2021}, pages = {111462}, abstract = {

BACKGROUND: The objective of this study was to use nationally-representative data on Americans greater than 50~years of age to determine the association between grip strength and inflammation as independent predictors of incident disability, chronic multimorbidity and dementia.

METHODS: Middle age and older adults (n~=~12,618) from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Longitudinal modeling was performed to examine the association between baseline grip strength (normalized to body mass: NGS) and high sensitivity C-reactive protein (hs-CRP) (>=3.0~mg/L) with incident physical disabilities (i.e., >=2 limitations to activities of daily living), chronic multimorbidity (>=2 of chronic conditions), and dementia.

RESULTS: The odds of incident disability were 1.25 (95\% CI: 1.20-1.30) and 1.31 (95\% CI: 1.26-1.36) for men and women respectively, for each 0.05-unit lower NGS. The odds of incident chronic multimorbidity were 1.14 (95\% CI: 1.08-1.20) and 1.14 (95\% CI: 1.07-1.21) for men and women respectively for each 0.05-unit lower NGS. The odds of incident dementia were 1.10 for men (95\% CI: 1.02-1.20) for each 0.05-unit lower NGS, but there was no significant association for women. Elevated hs-CRP was only associated with chronic multimorbidity among men (OR~=~1.29; 95\% CI: 1.00-1.73) and women (OR~=~1.60; 95\% CI: 1.26-2.02).

CONCLUSIONS: Our findings indicate a robust inverse association between NGS and disability and chronic, multimorbidity in older men and women, and dementia in men. Elevated hs-CRP was only associated with chronic multimorbidity in men and women. Healthcare providers should implement measures of grip strength in routine health assessments and discuss the potential dangers of weakness as well as interventions to improve strength with their patients.

}, keywords = {Aging, Chronic disease, Dementia, Disability, Grip strength, weakness}, issn = {1873-6815}, doi = {10.1016/j.exger.2021.111462}, author = {Mark D Peterson and Casten, Kimberly and Collins, Stacey and Hassan, Halimah and Garc{\'\i}a-Hermoso, Antonio and Jessica Faul} } @article {12058, title = {Music Engagement and Episodic Memory among Middle-Aged and Older Adults: A National Longitudinal Analysis }, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {707}, abstract = {Recent research suggests that engagement with particular activities, such as music, can influence age-related changes in episodic memory. However, it is unclear whether, and to what, extent music engagement is associated with the trajectory of episodic memory. The objective of this study is to examine how passive (i.e., listening to music) and/or active (i.e., singing or playing an instrument) music engagement influences episodic memory over a period of 12 years. Secondary data analysis of a sample (N=5095) of cognitively healthy adults from the Health and Retirement Study were used for this study. Linear mixed effects models were used to examine the independent effect of different levels of music engagement (i.e., low, medium, and high) on changes in performance on episodic memory tasks, while controlling for confounding factors. Compared to those with low engagement (i.e., neither listening nor singing/ playing an instrument), respondents who reported being engaged at the medium (i.e., either listening or singing/ playing an instrument) or high (i.e., both listening and singing/ playing an instrument) level performed 0.24 (p=0.003) and 0.52 (p<0.001) points better, respectively. We found evidence that music engagement attenuated the decline in episodic memory. The findings suggest that music engagement may be a protective factor against aged-related decline in episodic memory. Therefore, music engagement may offer a promising non-pharmacological intervention for dementia risk mitigation among community-living middle-aged and older adults. Future research should examine whether interventions to increase music engagement can affect the trajectories of aged-related decline in cognition in this large and growing population.}, keywords = {Episodic Memory, Music}, doi = {https://doi.org/10.1093/geroni/igab046.2625}, author = {Rouse, Hillary J and Hueluer, Gizem and Torres, Mia and Du, Yan and Conner, Kyaien O and Meng, Hongdao} } @article {10159, title = {Major discrimination experiences, education, and genes.}, journal = {Journal of Aging and Health}, volume = {32}, year = {2020}, pages = {753-763}, abstract = {

OBJECTIVES: Rather than acting as a buffer, educational attainment has a known positive linkage with major experiences of lifetime discrimination. Recently established genetic roots of education, then, may also influence such reports. The current study examined these patterns.

METHODS: Data were from the 2010 wave of the Health and Retirement Study. Polygenic scores indexed one{\textquoteright}s genetic propensity for more education. Mediation analysis was through counterfactual methods.

RESULTS: Among Whites as well as Blacks, genetic antecedents of education also elevated discrimination reports. Part of this influence was channeled through education. At least among Whites, direct effects were also found.

DISCUSSION: Major discrimination experiences seem partly rooted in genes. Mechanisms are tentatively suggested. Direct genetic influences, in particular, indicate potential confounding of previously estimated linkages between discrimination and health or life course factors. Given the range of these prior results, and their implications for healthy aging, investigation of these possibilities is needed.

}, keywords = {Discrimination, Education, Genetics, Racial/ethnic differences}, issn = {1552-6887}, doi = {10.1177/0898264319851661}, author = {Aniruddha Das} } @article {11033, title = {Making it Work: Transitions From Physically Demanding Employment in Advanced Age}, year = {2020}, institution = {Cornell University}, address = {Ithaca, NY}, abstract = {As workers age, they may find it increasingly difficult to sustain employment, particularly if their work is physically demanding. While some workers transition to less onerous roles in the later stage of their careers, others have few employment alternatives. This analysis explores the interaction between older adults{\textquoteright} education and transitions from physically demanding jobs. Using longitudinal data from the Health and Retirement Study, I track changes in employment status and work conditions for the original cohort of interviewees until retirement. Descriptive social sequence analysis reveals that physical demands are most prevalent in the careers of older men and women without a college education. Transitions to less demanding roles feature most clearly in the career sequences of the most educated workers. Using regression analysis, however, I find that workers in physically demanding jobs are no less likely to be employed than their similarly educated peers in less demanding roles. Further, for workers with similar job demands, employment probabilities are comparable across education levels. Overall, my findings suggest that educational attainment can explain differences in the demands older workers face, but does not affect the probability of continued employment in the pre-retirement years.}, keywords = {Education, employment status, work conditions}, url = {https://ardraw.policyresearchinc.org/wp-content/uploads/2020/08/Hyland_Cohort-3_Final-Paper.pdf}, author = {Hyland, Megan} } @article {11062, title = {MARGINAL MODELS FOR LONGITUDINAL COUNT DATA WITH DROPOUTS}, journal = {Journal of Statistical Research}, volume = {54}, year = {2020}, chapter = {27-42}, abstract = {In this article, we investigate marginal models for analyzing incomplete longitudinal count data with dropouts. Specifically, we explore commonly used generalized estimating equations and weighted generalized estimating equations for fitting log-linear models to count data in the presence of monotone missing responses. A series of simulations were carried out to examine the finite-sample properties of the estimators in the presence of both correctly specified and misspecified dropout mechanisms. An application is provided using actual longitudinal survey data from the Health and Retirement Study (HRS) (HRS, 2019)}, keywords = {Count data, Generalized estimating equation, longitudinal study, Missing response, Weighted generalized estimating equation}, issn = {0256 - 422 X}, doi = {https://doi.org/10.47302/jsr.2020540102}, author = {Zubair, Seema and Sinha, Sanjoy K.} } @article {10046, title = {A marginal structural model approach to analyse work-related injuries: An example using data from the Health and Retirement Study.}, journal = {Injury Prevention}, year = {2020}, month = {2019 Apr 24}, abstract = {

BACKGROUND: Biases may exist in the limited longitudinal data focusing on work-related injuries among the ageing workforce. Standard statistical techniques may not provide valid estimates when the data are time-varying and when prior exposures and outcomes may influence future outcomes. This research effort uses marginal structural models (MSMs), a class of causal models rarely applied for injury epidemiology research to analyse work-related injuries.

METHODS: 7212 working US adults aged >=50 years, obtained from the Health and Retirement Study sample in the year 2004 formed the study cohort that was followed until 2014. The analyses compared estimates measuring the associations between physical work requirements and work-related injuries using MSMs and a traditional regression model. The weights used in the MSMs, besides accounting for time-varying exposures, also accounted for the recurrent nature of injuries.

RESULTS: The results were consistent with regard to directionality between the two models. However, the effect estimate was greater when the same data were analysed using MSMs, built without the restriction for complete case analyses.

CONCLUSIONS: MSMs can be particularly useful for observational data, especially with the inclusion of recurrent outcomes as these can be incorporated in the weights themselves.

}, keywords = {Survey Methodology, Working conditions}, issn = {1475-5785}, doi = {10.1136/injuryprev-2018-043124}, author = {Navneet Kaur Baidwan and Susan Goodwin Gerberich and Kim, Hyun and Andrew D Ryan and Timothy Church and Benjamin D Capistrant} } @article {11189, title = {MARITAL QUALITY, LONELINESS, AND DEPRESSIVE SYMPTOMS LATER IN LIFE: THE MODERATING ROLE OF OWN AND SPOUSAL FUNCTIONAL LIMITATIONS}, journal = {Research in Human Development}, year = {2020}, abstract = {Loneliness is a mechanism through which marital quality relates to older adults? mental health. Links between marital quality, loneliness, and depressive symptoms, however, are often examined independent of older adults? functional health. The current study therefore examines whether associations between marital quality, loneliness, and depressive symptoms are contextually dependent on individuals? own (or their spouse?s) functional limitations, as well as on gender. Data came from couples (N = 1084) who participated in the Health and Retirement Study (HRS), a nationally representative dataset of older adults (age 50+). We utilized data from the 2014 leave-behind psychosocial questionnaire to measure spousal support/strain and loneliness, and interview data from 2014 to measure baseline depressive symptoms and demographic covariates (e.g., race and education). Depressive symptoms in 2016 served as the focal outcome variable. Findings from a series of path models estimated in MPLUS indicated that loneliness is a mechanism through which spousal support predicts older adults? depressive symptoms. Such linkages, however, were dependent on individuals? own functional limitations and gender. For functionally limited males in particular, spousal support was shown to reduce depressive symptoms insofar as it was associated with lower levels of loneliness; otherwise, it was associated with higher levels of depressive symptoms. Such findings reinforce the importance of taking a contextualized approach when examining associations between support and emotional well-being later in life.}, keywords = {depression, Loneliness, Marriage}, isbn = {1542-7609}, doi = {https://doi.org/10.1080/15427609.2020.1837598}, author = {Marini, Christina M. and Ashley E. Ermer and Fiori, Katherine L. and Amy Rauer and Proulx, Christine M.} } @article {10140, title = {Marital status and dementia: Evidence from the Health and Retirement Study.}, journal = {Journals of Gerontology. Series B, Psychological Sciences and Social Sciences}, year = {2020}, abstract = {

OBJECTIVES: We provide one of the first population-based studies of variation in dementia by marital status in the U.S.

METHOD: We analyzed data from the Health and Retirement Study (2000-2014). The sample included 15,379 respondents (6,650 men and 8,729 women) age 52 and over in 2000 who showed no evidence of dementia at the baseline survey. Dementia was assessed using either the modified version of the Telephone Interview for Cognitive Status (TICS) or the proxy{\textquoteright}s assessment. Discrete-time hazard regression models were estimated to predict odds of dementia.

RESULTS: All unmarried groups, including the cohabiting, divorced/separated, widowed, and never married, had significantly higher odds of developing dementia over the study period than their married counterparts; economic resources and, to a lesser degree, health-related factors accounted for only part of the marital status variation in dementia. For divorced/separated and widowed respondents, the differences in the odds of dementia relative to married respondents were greater among men than among women.

DISCUSSION: These findings will be helpful for health policy makers and practitioners who seek to better identify vulnerable subpopulations and to design effective intervention strategies to reduce dementia risk.

}, keywords = {Cognitive Ability, Dementia, Marriage}, issn = {1758-5368}, doi = {10.1093/geronb/gbz087}, author = {Hui Liu and Zhang, Zhenmei and Kenneth M. Langa} } @article {11301, title = {Married or Partnered Adults{\textquoteright} Self-Perceptions of Aging in Later Life: The Context of Gender}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {620-621}, abstract = {Marriage or other types of partnerships are consequential for health in later life, but its association to self-perceptions of aging remains a relatively unexplored area of research. This study used three waves of panel data from the Health and Retirement Study (N = 4,315) to examine how changes in the health status and relationship quality over time contribute to self-perceptions of aging for married/partnered men and women. Multilevel models showed that women demonstrated more positive self-perceptions of aging than men, but there was no gender difference in how self-perceptions of aging became more negative over time. The findings on the main and moderating effects of health and relationship quality give evidence that changes across time, as well as average differences in individual characteristics, may affect self-perceptions of married/partnered men and women differently. The context in which gender shapes key aspects of life contributes to self-perceptions of aging in later life.}, keywords = {Couples, gender, self-perceptions of aging}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa057.2112}, author = {Kim, Yijung and Kim, Kyungmin and Shevaun Neupert and Boerner, Kathrin} } @article {11145, title = {Measurement Equivalence of Subjective Well-Being Scales under the Presence of Acquiescent Response Style for the Racially and Ethnically Diverse Older Population in the United States}, journal = {Survey Research Methods}, volume = {14}, year = {2020}, pages = {417-437}, abstract = { With valid assessment of subjective well-being (SWB) at the forefront of social science research, comparability of measurement scales designed to capture SWB across racial/ethnic groups has been questioned. This study examines measurement properties of well-established SWB scales and their comparability between older Hispanics and Whites in the U.S.. Methods. We analyzed the Health and Retirement Study data in order to examine measurement invariance of the satisfaction with life (SWL), positive affect (PAF) and purpose in life (PIL) scales across non-Hispanic Whites, Hispanics interviewed in English and Hispanics interviewed in Spanish through multigroup confirmatory factor analysis and examined their validity by linking their latent scores with covariates of SWB. Examinations of measurement properties further considered acquiescence response style. Results. Strict, scalar and metric invariance was observed for SWL, PAF and PIL, respectively. However, when latent scores estimated from these invariance models were regressed on the validation measures, the relationship was weaker for Hispanics than Whites, suggesting a lower level of validity for Hispanics than Whites. A lower level of invariance was observed for respondents who acquiesced than their counterpart, while the validity was not necessarily hampered by acquiescent response style. Discussion. Our analysis suggests that the traditional measurement invariance test may not be effective under the presence of acquiescent response style for SWB instruments that use the Likert-type response scales. Research into cross-cultural measurement of SWB that considers systematic difference in conceptualization of SWB as well as response styles may improve our ability to understand SWB of the increasingly diverse population.}, keywords = {Cross-cultural Differences, Measurement Equivalence, Measurement Invariance, Minority and Diverse Populations, Subjective well-being}, issn = {1864-3361}, doi = {10.18148/srm/2020.v14i4.7413}, author = {Lee, Sunghee and Elizabeth Vasquez and Lindsay H Ryan and Jacqui Smith} } @article {11077, title = {A Measurement Model of Depressive Symptoms among Older, African American Women}, journal = {American International Journal of Social Science }, volume = {9}, year = {2020}, abstract = {For more than four decades, researchers have found depression to be a common mental illness among the elderly. Depression is a generalized mood disorder characterized by feelings of sadness and hopelessness, a sense of worthlessness, difficulty concentrating, loss of interest, and decrease in energy level. This definition is reflected in the Geriatric Depression Scale (GDS). The rates of depression among elderly residents of institutions are 67\% higher than among elderly adults residing at home. As in the United States, elderly women are twice as likely to be diagnosed with depressive symptoms as elderly men.. Time and again, research has revealed that depression is a significant problem for individuals later in life and may affect their psychological well-being. Using data from the Health and Retirement Study (HRS) 2010 wave, a secondary analysis was conducted to examine depression among community-dwelling, African American women, age 50 and over, as it relates to age, social support, religion, caregiving, and physical health. Intersectionality and social construction were used as theoretical frameworks for the study. Findings indicated significant relationships between depression and age, social support, and physical health. However, depression is treatable with pharmacotherapy, psychotherapy or combination of both.The overall purpose of this study was to explore the factors that may predict depression among older African American females, as well as identify gaps in the literature and add to the knowledge base about depression among this population of color, and develop a framework for future studies investigating mental health issues among diverse populations beyond African Americans.}, keywords = {African Americans, depressive symptoms and research, Older Adults, women}, issn = {2325-4149 }, doi = {doi:10.30845/aijss.v9n2p1}, author = {Baldwin-Clark, Tamika and de Carvalho, Jackson} } @article {11271, title = {Measuring Altruism}, year = {2020}, institution = {University of Colorado, Boulder}, address = {Boulder, CO}, abstract = {Altruism relates to the main goal of socialization, to a core attribute of personality, and to theories concerned with human nature (Krebs, 1970). However, little economic literature has directly measured altruism. Does altruism exist in people{\textquoteright}s economic behavior? Does it vary systematically with relationships and demographics? Utilizing the Health and Retirement Study{\textquoteright}s rich information on altruistic behavior, I structurally estimate a measure of altruism and find that altruism exists and that after controlling for demographics and behavior, the level of altruism increases with the intimacy of relationships. Senior white people who are healthier and have more children are more altruistic than others. People measured as being more selfless tend to retire later, to save more before retirement and for precautionary purposes, to be more likely to leave a bequest greater than $10,000, to transfer more than $500 to children while alive, and to spend more than 100 hours helping a grandchild.}, keywords = {Altruism}, url = {https://jiannanzhou.com/research/altruism/Altruism_Zhou_Paper.pdf}, author = {Zhou, Jiannan} } @article {10803, title = {Measuring Frailty in Administrative Claims Data: Comparative Performance of Four Claims-Based Frailty Measures in the U.S. Medicare Data}, journal = {The Journals of Gerontology: Series A}, volume = {75}, year = {2020}, pages = {1120-1125}, abstract = {There has been increasing effort to measure frailty in the U.S. Medicare data. The performance of claims-based frailty measures has not been compared.This cross-sectional study included 3,097 community-dwelling fee-for-service Medicare beneficiaries (mean age 75.6 years) who participated in the 2008 Health and Retirement Study examination. Four claims-based frailty measures developed by Davidoff, Faurot, Segal, and Kim were compared against frailty phenotype, a deficit-accumulation frailty index (FI), and activities of daily living (ADL) dependence using Spearman correlation coefficients and C-statistics.Claims-based frailty measures were positively associated with frailty phenotype (prevalence in <=10th vs \>90th percentile: 8.0\% vs 41.3\% for Davidoff; 5.9\% vs 53.1\% for Faurot; 3.3\% vs 48.0\% for Segal; 2.9\% vs 51.0\% for Kim) and FI (mean in <=10th vs \>90th percentile: 0.17 vs 0.33 for Davidoff; 0.13 vs 0.37 for Faurot; 0.12 vs 0.31 for Segal; 0.10 vs 0.37 for Kim). The age and sex-adjusted C-statistics for frailty phenotype for Davidoff, Faurot, Segal, and Kim indices were 0.73, 0.74, 0.73, and 0.78, respectively, and partial correlation coefficients with FI were 0.18, 0.32, 0.26, and 0.55, respectively. The results for ADL dependence were similar (prevalence in <=10th vs \>90th percentile: 3.7\% vs 50.5\% for Davidoff; 2.3\% vs 55.0\% for Faurot; 3.0\% vs 38.3\% for Segal; 2.3\% vs 50.8\% for Kim). The age and sex-adjusted C-statistics for the indices were 0.79, 0.80, 0.74, and 0.81, respectively.The choice of a claims-based frailty measure can influence the identification of older adults with frailty and disability in Medicare data.}, keywords = {Frailty, Geriatric Assessment, Health Services, Medicare claims data}, issn = {1079-5006}, doi = {10.1093/gerona/glz224}, url = {https://pubmed.ncbi.nlm.nih.gov/31566201/}, author = {Kim, Dae Hyun and Patorno, Elisabetta and Pawar, Ajinkya and Lee, Hemin and Schneeweiss, Sebastian and Robert J Glynn} } @article {11037, title = {Measuring More Than Exposure: Does Stress Appraisal Matter for Black-White Differences in Anxiety and Depressive Symptoms among Older Adults?}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {igaa040}, abstract = {Prior research and theory suggest that exposure to objectively stressful events contributes to mental health disparities. Yet, Blacks report higher cumulative stress exposure than whites but lower levels of common psychiatric disorders. In order to understand why Blacks bear disproportionate stress exposure but similar or better mental health relative to whites, we need to consider race differences in not only stress exposure, but also stress appraisal{\textemdash}how upsetting stress exposures are perceived to beWe examine whether race differences in the number of reported chronic stressors across five domains (health, financial, residential, relationship, caregiving) and their appraised stressfulness explain Black-white differences in anxiety and depressive symptoms. Data come from 6,019 adults ages 52+ from the 2006 Health and Retirement StudyOlder Blacks in this sample experience greater exposure to chronic stressors but appraise stressors as less upsetting relative to whites. In fully adjusted models stress exposure is related to higher levels of anxiety and depressive symptoms and perceiving stress as upsetting is associated with higher symptomology for whites and Blacks. We also find that Blacks report greater anxiety symptoms but fewer depressive symptoms with more stress exposure relative to whites. Stress appraisal partially explains race differences in the association between stress exposure and anxiety symptoms and fully explains race differences in the association between exposure and depressive symptomsThe relationship between race, chronic stress exposure, and mental health is mediated by stress appraisal. Stress appraisal provides insight on important pathways contributing to Black-white mental health disparities in older adulthood}, keywords = {Aging, Chronic stress, Health Disparities, Mental Health}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa040}, author = {Lauren L Brown and Leah R. Abrams and Uchechi A Mitchell and Jennifer A Ailshire} } @article {10554, title = {Measuring Racial/Ethnic Retirement Wealth Inequality}, number = {WP$\#$2020-2}, year = {2020}, institution = {Center for Retirement Research at Boston College}, abstract = {As the U.S. population becomes more diverse, it will be increasingly important for policymakers addressing Social Security{\textquoteright}s solvency to understand how reliant various racial and ethnic groups will be on the program versus other sources of retirement wealth. Yet, to date, studies on retirement wealth have tended not to focus on race and ethnicity, have largely ignored the role of Social Security, or have excluded the most recent cohort approaching retirement {\textendash} the Late Boomers. This project uses data from the Health and Retirement Study (HRS) to document the retirement resources of white, black, and Hispanic households at various points in the wealth distribution for five HRS cohorts of 51-56 year olds between 1992 and 2016. }, keywords = {race-ethnicity, Wealth Inequality}, url = {https://crr.bc.edu/working-papers/measuring-racial-ethnic-retirement-wealth-inequality/}, author = {Wenliang Hou and Geoffrey T. Sanzenbacher} } @article {11089, title = {Medicaid Utilization among Middle-age and Older Adults: A Health and Retirement Study Longitudinal Analysis (1998 to 2014).}, journal = {Journal of Aging \& Social Policy}, year = {2020}, month = {2020 Sep 30}, pages = {1-17}, abstract = {

With over fifteen million older adults in the United States relying on the means-tested Medicaid program for healthcare coverage, there has been concern over rising Medicaid costs among this rapidly growing age group. Few studies have longitudinally examined trends among older beneficiaries over time to identify factors related to Medicaid utilization and to better understand how potential coverage changes might impact this group. This study used the 1998 to 2014 waves of the Health and Retirement Study (N~=~8,162) to analyze a representative sample of those aged 50 and older to ascertain demographic, health, and economic factors associated with Medicaid utilization over a sixteen-year period. The analyses showed stable probabilities of accessing the program over time and observed that the most vulnerable older adults make up the pool of Medicaid beneficiaries. There is no evidence of significant asset divestment in order to qualify for benefits. Multivariate analyses further revealed those who were older, female, minority race/ethnicity, less educated, in poorer health, below the federal poverty line, and with lower net wealth had a higher risk of utilizing Medicaid during the observed time period than their counterparts. Findings highlight the importance of monitoring changes in the documented risk factors over time in terms of their impact on Medicaid utilization and underscore the need to consider how these factors may be interrelated.

}, keywords = {medicaid beneficiaries, medicaid spend-down, Medicaid utilization}, issn = {1545-0821}, doi = {10.1080/08959420.2020.1824538}, author = {Jane Tavares and Marc A Cohen and Silberman, Susan and Popham, Lauren} } @article {NBERw26879, title = {Medical Spending, Bequests, and Asset Dynamics Around the Time of Death}, number = {26879}, year = {2020}, institution = {National Bureau of Economic Research}, type = {Report}, address = {Cambridge, MA}, abstract = {Using data from the Health and Retirement Survey, we document the changes in assets that occur before a person{\textquoteright}s death. Applying an event study approach, we find that during the 6 years preceding their deaths, the assets of single decedents decline, relative to those of similar single survivors, by an additional $20,000 on average. Over the same time span, the assets of couples who lose a spouse fall, relative to those of similar surviving couples, by an additional $90,000 on average. Households experiencing a death also incur higher out-of-pocket medical spending and other end-of-life expenses. This elevated spending is sufficient to explain (in accounting terms) the asset declines observed for singles but falls short of explaining the declines observed for couples. Bequests from the dying spouse to non-spousal heirs such as children are more than sufficient to explain the remainder.}, keywords = {Asset dynamics, End of life expenses, Medical spending}, doi = {10.3386/w26879}, url = {http://www.nber.org/papers/w26879}, author = {John Bailey Jones and Mariacristina De Nardi and Eric French and McGee, Rory and Rodgers, Rachel} } @article {10602, title = {Memory complaints and depressive symptoms over time: a construct-level replication analysis}, journal = {BMC Geriatrics}, volume = {20}, year = {2020}, pages = {57}, type = {Journal}, abstract = {Memory complaints and depressive symptoms are frequently associated in older adults and both serve as potential indicators of future cognitive decline. However, the temporal ordering of the development of these two symptoms remains unclear. The goal of the current study was to examine concurrent and temporal relationships between memory complaints and depressive symptoms in older adults.}, keywords = {Cognitive decline, Depressive symptoms, memory complaints, Older Adults, Replication analysis}, isbn = {1471-2318}, doi = {https://doi.org/10.1186/s12877-020-1451-1}, author = {Mogle, Jacqueline and Nikki L Hill and Bhargava, Sakshi and Tyler Reed Bell and Bhang, Iris} } @article {PPR:PPR338356, title = {Mendelian randomization of smoking behavior on cognitive status among older Americans}, journal = {Alzheimer{\textquoteright}s \& Dementia: The Journal of the Alzheimer{\textquoteright}s Association}, volume = {16}, year = {2020}, pages = {e041221}, abstract = {Background Smoking is associated with dementia status, and smoking behavior has a genetic component. In this study, we jointly test the associations between cumulative genetic risk for smoking, smoking behavior, and cognitive status. Method We conducted a cross-sectional study using the 2010 wave of the Health and Retirement Study. First, we used logistic regression to test the relationship between cumulative genetic risk for smoking and current smoking behavior. Second, we tested the association between smoking behavior and cognitive status. Third, we checked the assumption that cumulative genetic risk for smoking was not associated with cognitive status. All analyses were adjusted for age, sex, years of education, rural/urban residence and five ancestry-specific genetic principal components. Analyses were stratified by ancestry. Finally, a Mendelian randomization framework was used to test inferred causal relationships between smoking behavior and cognitive status via genetic instruments. Result Among European ancestry participants (n = 8,735), one standard deviation increase in smoking polygenic score was associated with 1.28 times odds of current smoking behavior (95\% confidence interval: 1.18, 1.38) relative to never smoking. Current smoking was associated with 1.62 times odds of cognitive impairment (95\% confidence interval: 1.29, 2.01) relative to never smokers and those with normal cognition. No association was observed between smoking polygenic score and cognitive status, an important assumption of the Mendelian randomization framework. Using the smoking genetic instrument, a significant inferred causal relationship was observed between current smoking and cognitive impairment (P=0.02, 1.53 odds ratio, 95\% confidence interval: 1.07, 2.18). Conclusion These findings demonstrate current smoking is likely causally related to cognitive impairment. Promotion of smoking cessation is important for public health and brain health specifically. Studies on dose and duration of smoking on cognition are critically needed, as well as in research non-European ancestries.}, keywords = {Dementia, Mendelian randomization, Smoking}, doi = {10.1002/alz.041221}, author = {Kelly M Bakulski and Fu, Mingzhou and Jessica Faul and Jin, Yuan and Erin B Ware} } @article {12124, title = {Meta-analysis of up to 622,409 individuals identifies 40 novel smoking behaviour associated genetic loci.}, journal = {Molecular Psychiatry}, volume = {25}, year = {2020}, pages = {2392-2409}, abstract = {

Smoking is a major heritable and modifiable risk factor for many diseases, including cancer, common respiratory disorders and cardiovascular diseases. Fourteen genetic loci have previously been associated with smoking behaviour-related traits. We tested up to 235,116 single nucleotide variants (SNVs) on the exome-array for association with smoking initiation, cigarettes per day, pack-years, and smoking cessation in a fixed effects meta-analysis of up to 61 studies (up to~346,813 participants). In a subset of 112,811 participants, a further one million SNVs were also genotyped and tested for association with the four smoking behaviour traits. SNV-trait associations with P < 5 {\texttimes} 10 in either analysis were taken forward for replication in up to 275,596 independent participants from UK Biobank. Lastly, a meta-analysis of the discovery and replication studies was performed. Sixteen SNVs were associated with at least one of the smoking behaviour traits (P < 5 {\texttimes} 10) in the discovery samples. Ten novel SNVs, including rs12616219 near TMEM182, were followed-up and five of them (rs462779 in REV3L, rs12780116 in CNNM2, rs1190736 in GPR101, rs11539157 in PJA1, and rs12616219 near TMEM182) replicated at a Bonferroni significance threshold (P < 4.5 {\texttimes} 10) with consistent direction of effect. A further 35 SNVs were associated with smoking behaviour traits in the discovery plus replication meta-analysis (up to 622,409 participants) including a rare SNV, rs150493199, in CCDC141 and two low-frequency SNVs in CEP350 and HDGFRP2. Functional follow-up implied that decreased expression of REV3L may lower the probability of smoking initiation. The novel loci will facilitate understanding the genetic aetiology of smoking behaviour and may lead to the identification of potential drug targets for smoking prevention and/or cessation.

}, keywords = {Biological Specimen Banks, Databases, Factual, Europe, Exome, Female, Genetic Loci, Humans, Male, Polymorphism, Single Nucleotide, Smoking, United Kingdom}, issn = {1476-5578}, doi = {10.1038/s41380-018-0313-0}, author = {Erzurumluoglu, A Mesut and Liu, Mengzhen and Jackson, Victoria E and Barnes, Daniel R and Datta, Gargi and Melbourne, Carl A and Young, Robin and Batini, Chiara and Surendran, Praveen and Jiang, Tao and Adnan, Sheikh Daud and Afaq, Saima and Agrawal, Arpana and Altmaier, Elisabeth and Antoniou, Antonis C and Asselbergs, Folkert W and Baumbach, Clemens and Laura Bierut and Bertelsen, Sarah and Boehnke, Michael and Bots, Michiel L and Brazel, David M and Chambers, John C and Chang-Claude, Jenny and Chen, Chu and Corley, Janie and Chou, Yi-Ling and David, Sean P and de Boer, Rudolf A and Christiaan de Leeuw and Joe G Dennis and Dominiczak, Anna F and Dunning, Alison M and Easton, Douglas F and Charles B Eaton and Elliott, Paul and Evangelou, Evangelos and Jessica Faul and Tatiana Foroud and Goate, Alison and Gong, Jian and Hans-J{\"o}rgen Grabe and Jeffrey Haessler and Christopher A Haiman and Hallmans, G{\"o}ran and Anke R Hammerschlag and Sarah E Harris and Andrew T Hattersley and Andrew C Heath and Hsu, Chris and Iacono, William G and Kanoni, Stavroula and Kapoor, Manav and Kaprio, Jaakko and Sharon L R Kardia and Karpe, Fredrik and Kontto, Jukka and Kooner, Jaspal S and Charles Kooperberg and Kuulasmaa, Kari and Laakso, Markku and Lai, Dongbing and Langenberg, Claudia and Le, Nhung and Lettre, Guillaume and Loukola, Anu and Luan, Jian{\textquoteright}an and Pamela A F Madden and Mangino, Massimo and Riccardo E Marioni and Marouli, Eirini and Marten, Jonathan and Nicholas G Martin and McGue, Matt and Michailidou, Kyriaki and Mihailov, Evelin and Moayyeri, Alireza and Moitry, Marie and M{\"u}ller-Nurasyid, Martina and Naheed, Aliya and Nauck, Matthias and Neville, Matthew J and Sune Fallgaard Nielsen and Kari E North and Markus Perola and Pharoah, Paul D P and Pistis, Giorgio and Tinca J Polderman and Posthuma, Danielle and Neil Poulter and Qaiser, Beenish and Rasheed, Asif and Reiner, Alex and Renstrom, Frida and Rice, John and Rohde, Rebecca and Rolandsson, Olov and Nilesh J Samani and Samuel, Maria and Schlessinger, David and H Steven Scholte and Scott, Robert A and Peter Sever and Shao, Yaming and Shrine, Nick and Smith, Jennifer A and John M Starr and Kathleen E Stirrups and Stram, Danielle and Heather M Stringham and Tachmazidou, Ioanna and Tardif, Jean-Claude and Thompson, Deborah J and Hilary A Tindle and Tragante, Vinicius and Trompet, Stella and Turcot, Val{\'e}rie and Tyrrell, Jessica and Vaartjes, Ilonca and Van Der Leij, Andries R and van der Meer, Peter and Varga, Tibor V and Verweij, Niek and V{\"o}lzke, Henry and Wareham, Nicholas J and Warren, Helen R and David R Weir and Weiss, Stefan and Wetherill, Leah and Yaghootkar, Hanieh and Yavas, Ersin and Jiang, Yu and Chen, Fang and Zhan, Xiaowei and Zhang, Weihua and Zhao, Wei and Zhao, Wei and Zhou, Kaixin and Amouyel, Philippe and Blankenberg, Stefan and Caulfield, Mark J and Chowdhury, Rajiv and Francesco Cucca and Ian J Deary and Deloukas, Panos and Di Angelantonio, Emanuele and Marco M Ferrario and Ferri{\`e}res, Jean and Franks, Paul W and Timothy M Frayling and Frossard, Philippe and Hall, Ian P and Caroline Hayward and Jansson, Jan-H{\r a}kan and Jukema, J Wouter and Kee, Frank and M{\"a}nnist{\"o}, Satu and Andres Metspalu and Munroe, Patricia B and B{\o}rge G Nordestgaard and Palmer, Colin N A and Veikko Salomaa and Sattar, Naveed and Timothy Spector and David P Strachan and van der Harst, Pim and Zeggini, Eleftheria and Saleheen, Danish and Adam S Butterworth and Wain, Louise V and Gon{\c c}alo R Abecasis and Danesh, John and Tobin, Martin D and Scott Vrieze and Liu, Dajiang J and Howson, Joanna M M} } @article {10670, title = {Methods and Early Recruitment of a Community-Based Study of Cognitive Impairment Among Mexican Americans and Non-Hispanic Whites: The BASIC-Cognitive Study}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {73}, year = {2020}, month = {2020}, pages = {185-196}, type = {Journal}, abstract = {Background: As the Mexican American (MA) population grows and ages, there is an urgent need to estimate the prevalence of cognitive impairment or dementia (CID), cognitive trajectories, and identify community resource needs. The Brain Attack Surveillance in Corpus Christi (BASIC)-Cognitive project is a population-based study to address these issues among older MAs and non-Hispanic whites (NHW) and their informal care providers. Objective: Present the methodology and initial recruitment findings for the BASIC-Cognitive project. Method: Random, door-to-door case ascertainment is used in Nueces County, Texas, to recruit community-dwelling and nursing home residents >=65 and informal care providers. Households are identified from a two-stage area probability sample, using Census data to aim for equal balance of MAs and NHWs. Individuals with cognitive screens indicative of possible CID complete neuropsychological assessment (Harmonized Cognitive Assessment Protocol from the Health and Retirement Study). Informal care providers complete comprehensive interview and needs assessment. Study pairs repeat procedures at 2-year follow-up. Asset and concept mapping are performed to identify community resources and study care providers{\textquoteright} perceptions of needs for individuals with CID. Results: 1,030 age-eligible households were identified, or 27\% of households for whom age could be determined. 1,320 individuals were age-eligible, corresponding to 1.3 adults per eligible household. Initial recruitment yielded robust participation in the MA eligible population (60\% of 689 individuals that completed cognitive screening). Conclusion: The BASIC-Cognitive study will provide critical information regarding the prevalence of CID in MAs, the impact of caregiving, and allocation of community resources to meet the needs of this population.}, keywords = {Caregivers, Dementia, Epidemiology, Health Resources, mexican american, mild cognitive impairment}, isbn = {1875-8908}, doi = {10.3233/JAD-190761}, url = {https://content.iospress.com/articles/journal-of-alzheimers-disease/jad190761}, author = {Emily Brice{\~n}o and Mehdipanah, Roshanak and Gonzales, Xavier and Steven G Heeringa and Deborah A Levine and Kenneth M. Langa and Garcia, Nelda and Longoria, Ruth and Lewis B Morgenstern} } @inbook {Laditka2020, title = {Microsimulation of Health Expectancies, Life Course Health, and Health Policy Outcomes}, booktitle = {International Handbooks of Population: International Handbook of Health Expectancies}, volume = {9}, year = {2020}, pages = {129{\textendash}138}, publisher = {Springer International Publishing}, organization = {Springer International Publishing}, address = {Basel}, abstract = {Active life expectancy measures life expectancy and the proportions of remaining life with and without disease or disability. Microsimulation, a useful tool for life course research, estimates active life expectancy by simulating individual lifetime health biographies, where the individual{\textquoteright}s status in one or more outcomes is known for each measured unit of life. In this chapter we describe how researchers use microsimulation to study active life expectancy, focusing on research of the past 20 years. We summarize the microsimulation process. We describe how researchers model current and future population health, calculate new active life expectancy measures, and forecast effects of policy change. We illustrate the application of microsimulation to active life expectancy research with a study of interval need, a measure of need for health care and other services focused on resource use. We describe strengths of microsimulation, considerations regarding its use, and directions for future research.}, keywords = {Active life expectancy, Forecasting, Health expectancy, health policy, Population Health}, isbn = {978-3-030-37668-0}, doi = {10.1007/978-3-030-37668-0_9}, author = {Laditka, Sarah B. and Laditka, James N. and Jagger, Carol}, editor = {Jagger, Carol and Eileen M. Crimmins and Saito, Yasuhiko and De Carvalho Yokota, Renata Tiene and Van Oyen, Herman and Robine, Jean-Marie} } @article {11069, title = {Middle-aged Americans report more pain than the elderly}, journal = {Research News}, year = {2020}, publisher = {EurekAlert/AAAS}, address = {Washington, D.C.}, abstract = {As people age, they tend to report more acute or chronic pain -- a common sign of getting older. Yet, in the United States, middle-aged adults are now reporting more pain than the elderly, according to a paper published in the Proceedings of the National Academy of Sciences (PNAS).}, keywords = {Aging, Body Weight, Death \& Dying, Gerontology, Longevity, pain, Public Health}, url = {https://www.eurekalert.org/pub_releases/2020-09/puww-mar091720.php}, author = {Huber, B. Rose} } @article {10968, title = {Mild cognitive impairment and receipt of procedures for acute ischemic stroke in older adults}, journal = {Journal of Stroke and Cerebrovascular Diseases}, volume = {29}, year = {2020}, abstract = {Background and purpose Older patients with pre-existing mild cognitive impairment (MCI) receive less evidence-based care after acute myocardial infarction, however, whether they receive less care after acute ischemic stroke (AIS) is unknown. We compared receipt of guideline-concordant procedures after AIS between older adults with pre-existing MCI and normal cognition. Methods Prospective study of 591 adults >=65 hospitalized for AIS between 2000 and 2014, and followed through 2015 using data from the nationally representative Health and Retirement Study, Medicare and American Hospital Association. We assessed pre-existing MCI (modified Telephone Interview for Cognitive Status score of 7{\textendash}11) and normal cognition (score of 12{\textendash}27). Primary outcome was a composite quality measure representing the number of 4 procedures (carotid imaging, cardiac monitoring, echocardiogram, and rehabilitation assessment) received within 30 days after AIS (ordinal scale with values of 0, 1, 2, 3{\textendash}4). Results Among survivors of AIS, 26.9\% had pre-existing MCI (62.9\% were women, with a mean [SD] age of 82.4 [7.7] years), and 73.1\% had normal cognition (51.4\% were women, with a mean age of 78.4 [7.2] years). Patients with pre-existing MCI, compared to cognitively normal patients, had 39\% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio, OR, 0.61 [95\% CI, 0.43{\textendash}0.87]; P=0.006). However, this association became non-significant after adjusting for patient and hospital factors (adjusted cumulative OR, 0.83 [95\% CI, 0.56{\textendash}1.24]; P=0.37). Lower cumulative odds of receiving the composite quality measure were associated with older patient age (adjusted cumulative OR per 1-year older age, 0.97 [95\% CI, 0.95{\textendash}0.99]; P=0.01) and Southern hospitals (adjusted cumulative OR for South vs North, 0.54 [95\% CI, 0.31{\textendash}0.94]; P=0.03). Conclusions Differences in receipt of guideline-concordant procedures after AIS exist between patients with pre-existing MCI and normal cognition. These differences were largely explained by patient and regional factors associated with receiving less AIS care.}, keywords = {Aging, cognitive impairment, Health policy/outcomes research, Ischemic stroke}, isbn = {1052-3057}, doi = {https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105083}, author = {Deborah A Levine and Andrzej T Galecki and Mohammed U Kabeto and Nallamothu, Brahmajee K. and Zahuranec, Darin B. and Lewis B Morgenstern and Lynda D Lisabeth and Bruno J Giordani and Kenneth M. Langa} } @article {10181, title = {Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults}, journal = {Journal of General Internal Medicine}, volume = {35}, year = {2020}, pages = {28{\textendash}35}, type = {Journal}, abstract = {Background Older adults with mild cognitive impairment (MCI) should receive evidence-based treatments when indicated. Providers and patients may overestimate the risk of dementia in patients with MCI leading to potential under-treatment. However, the association between pre-existing MCI and receipt of evidence-based treatments is uncertain. Objective To compare receipt of treatments for acute myocardial infarction (AMI) between older adults with pre-existing MCI and cognitively normal patients. Design Prospective study using data from the nationally representative Health and Retirement Study, Medicare, and American Hospital Association. Participants Six hundred nine adults aged 65 or older hospitalized for AMI between 2000 and 2011 and followed through 2012 with pre-existing MCI (defined as modified Telephone Interview for Cognitive Status score of 7{\textendash}11) and normal cognition (score of 12{\textendash}27). Main Measures Receipt of cardiac catheterization and coronary revascularization within 30 days and cardiac rehabilitation within 1 year of AMI hospitalization. Key Results Among the survivors of AMI, 19.2\% had pre-existing MCI (55.6\% were women and 44.4\% were male, with a mean [SD] age of 82.3 [7.5] years), and 80.8\% had normal cognition (45.7\% were women and 54.3\% were male, with a mean age of 77.1 [7.1] years). Survivors of AMI with pre-existing MCI were significantly less likely than those with normal cognition to receive cardiac catheterization (50\% vs 77\%; P < 0.001), coronary revascularization (29\% vs 63\%; P < 0.001), and cardiac rehabilitation (9\% vs 22\%; P = 0.001) after AMI. After adjusting for patient and hospital factors, pre-existing MCI remained associated with lower use of cardiac catheterization (adjusted hazard ratio (aHR), 0.65; 95\% CI, 0.48{\textendash}0.89; P = 0.007) and coronary revascularization (aHR, 0.55; 95\% CI, 0.37{\textendash}0.81; P = .003), but not cardiac rehabilitation (aHR, 1.01; 95\% CI, 0.49{\textendash}2.07; P = 0.98). Conclusions Pre-existing MCI is associated with lower use of cardiac catheterization and coronary revascularization but not cardiac rehabilitation after AMI.}, keywords = {Cognitive Ability, Heart disease, Medicare/Medicaid/Health Insurance}, issn = {0884-8734}, doi = {10.1007/s11606-019-05155-8}, url = {https://link.springer.com/article/10.1007\%2Fs11606-019-05155-8$\#$citeas}, author = {Deborah A Levine and Kenneth M. Langa and Andrzej T Galecki and Mohammed U Kabeto and Lewis B Morgenstern and Zahuranec, Darin B. and Bruno J Giordani and Lynda D Lisabeth and Nallamothu, Brahmajee K.} } @conference {AtaharulIslam20201999, title = {A model for assessing the association in the repeated measures of depression among the elderly}, booktitle = {Proceedings - 20th International Congress on Modelling and Simulation, MODSIM 2013}, year = {2020}, note = {cited By 0}, address = {Adelaide, Australia}, abstract = {The dependence in the outcome variables is a major issue of concern in modeling the correlated data stemmed from the repeated observations. The marginal models such as GEE and the conditional models based on Markov chain have been employed for longitudinal data in the past. However, it has been evident that without addressing the underlying association parameters, the analysis of repeated outcome variables remains far from being resolved. In this paper, a method has been demonstrated to model such data using the underlying dependence in the outcome variables as well as dependence between outcome and explanatory variables. An extension of the regressive model is shown in this paper and a comparison is demonstrated between the existing model (reduced model) and the proposed model (extended model). The models are illustrated for depression among the elderly population in the USA using the Health and Retirement Study data from 1992 to 1998. {\textcopyright} International Congress on Modelling and Simulation, MODSIM 2013.All right reserved.}, keywords = {Bivariate binary outcomes, Conditional model, joint model, marginal model, regressive model, Transition probability}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85080923221\&partnerID=40\&md5=3ec1edb7d724b41427a9f89bc8043c6c}, author = {M. Ataharul Islam and Rafiqul I Chowdhury and Bae, S. and Singh, K.P.} } @article {10878, title = { Moderate drinking may improve cognitive health for older adults, study says}, journal = {CNN Health}, year = {2020}, publisher = {CNN}, address = {Atlanta}, abstract = {If you enjoy a daily cocktail or some wine with dinner, you{\textquoteright}ll want to raise your glass to this: A new study found low to moderate drinking may improve cognitive function for White middle-aged or older adults.}, keywords = {Cognitive health, moderate drinking}, url = {https://www.cnn.com/2020/06/29/health/alcohol-cognitive-improvement-wellness/index.html}, author = {LaMotte, Sandee} } @article {11392, title = {Molecular Genetics, Risk Aversion, Return Perceptions, and Stock Market Participation}, number = {27638}, year = {2020}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {We show that molecular variation in DNA related to cognition, personality, health, and body shape, predicts an individual{\textquoteright}s equity market participation and risk aversion. Moreover, the molecular genetic endowments predict individuals{\textquoteright} return perceptions, most of which we find to be strikingly biased. The genetic endowments also strongly associate with many of the investor characteristics (e.g., trust, sociability, wealth) shown to explain heterogeneity in equity market participation. Our analysis helps elucidate why financial choices are heritable and how genetic endowments can help explain the links between financial choices, risk aversion, beliefs, and other variables known to explain stock market participation.}, keywords = {Genetics, return perceptions, Risk Aversion, stock market participation}, doi = {10.3386/w27638}, author = {Sias, Richard and Starks, Laura and Turtle, Harry J.} } @article {10940, title = {More than Selection Effects: Volunteering is Associated with Benefits in Cognitive Functioning}, journal = {The Journals of Gerontology: Series B}, year = {2020}, abstract = {Volunteering is a lifestyle behavior that bolsters cognitive resilience. However, previous studies have not assessed the degree to which cognitive functioning is predictive of becoming a volunteer (i.e., selection into volunteering), and how this might contribute to superior cognitive performance observed among volunteers. The purpose of this brief report is to address the role of cognition-related selection into becoming a volunteer in the association between formal volunteering and two cognitive measures: (1) overall cognitive function, and (2) self-rated memory.The Health and Retirement Study was used to assess whether, net of cognitive selection into volunteering, formal volunteering is associated with cognitive function.Selection explained between 4.9\% and 29\% of the effect of volunteering on cognitive function (depending on the cognitive outcome and the level of volunteering). However, net of cognitive selection into volunteering, among all cognitive measures there are beneficial effects of formal volunteering on cognitive function.}, keywords = {Alzheimer{\textquoteright}s disease, Cognition, Health Promotion, Volunteer activity}, isbn = {1079-5014}, doi = {https://doi.org/10.1093/geronb/gbaa101}, author = {Ben Lennox Kail and Dawn C Carr} } @article {doi:10.1111/jgs.16380, title = {Motoric Cognitive Risk Syndrome in Polypharmacy}, journal = {Journal of the American Geriatrics Society}, year = {2020}, month = {02/2020}, type = {Report}, abstract = {Risk factors for motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by slow gait and cognitive complaints, have been identified, but few are reversible. Polypharmacy is a potentially reversible risk factor for cognitive decline, but the relationship between MCR and polypharmacy has not been examined. Our aim was to compare the epidemiology of MCR and polypharmacy. DESIGN Cross-sectional. SETTING Community-based Health and Retirement Study cohort. PARTICIPANTS A total of 1119 adults 65 years and older (mean age = 74.7 {\textpm} 7.0 y; 59\% female). MEASUREMENTS Polypharmacy is defined as the use of five or more regularly scheduled medications. MCR is defined as cognitive complaints and slow gait in an individual without dementia. RESULTS The prevalence of MCR among 417 participants with polypharmacy was 10\%; it was 6\% among 702 participants without polypharmacy. The odds of meeting MCR criteria in those with polypharmacy was 1.8 (confidence interval = 1.0-3.0; P = .035) compared with those without polypharmacy, even after adjusting for high-risk medication use. CONCLUSION Our results show the coexistence of MCR and polypharmacy in older adults, suggesting a potentially modifiable risk factor for dementia.}, keywords = {Motoric Cognitive Risk Syndrome, Polypharmacy, Prevalence}, doi = {10.1111/jgs.16380}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16380}, author = {George, Claudene J. and Joe Verghese} } @article {10155, title = {Multimorbidity and cognitive decline over 14 years in older Americans.}, journal = {Journals of Gerontology. Series A, Biological Sciences \& Medical Sciences}, year = {2020}, abstract = {

BACKGROUND: Multimorbidity is associated with greater disability and accelerated declines in physical functioning over time in older adults. However, less is known about its effect on cognitive decline.

METHODS: Participants without dementia from the Health and Retirement Study were interviewed about physician-diagnosed conditions, from which their multimorbidity-weighted index (MWI) that weights diseases to physical functioning was computed. We used linear mixed-effects models to examine the predictor MWI with the modified Telephone Interview for Cognitive Status (TICSm, global cognition), 10-word immediate recall and delayed recall, and serial 7s outcomes biennially after adjusting for baseline cognition and covariates.

RESULTS: 14,265 participants, 60\% female, contributed 73,700 observations. Participants had a meanSD age 679.3 years and MWI 4.43.9 at baseline. Each point increase in MWI was associated with declines in global cognition (0.04, 95\%CI: 0.03-0.04 TICSm), immediate recall (0.01, 95\%CI: 0.01-0.02 words), delayed recall (0.01, 95\%CI: 0.01-0.02 words), and working memory (0.01, 95\%CI: 0.01-0.02 serial 7s) (all P<0.001). Multimorbidity was associated with faster declines in global cognition (0.003 points/year faster, 95\%CI: 0.002-0.004), immediate recall (0.001 words/year faster, 95\%CI: 0.001-0.002), and working memory (0.006 incorrect serial 7s/year faster, 95\%CI: 0.004-0.009) (all P<0.001), but not delayed recall compared with premorbid slopes.

CONCLUSIONS: Multimorbidity using a validated index weighted to physical functioning was associated with acute decline in cognition and accelerated and persistent cognitive decline over 14 years. This study supports an ongoing geriatric syndrome of coexisting physical and cognitive impairment in adults with multimorbidity. Clinicians should monitor and address both domains in older multimorbid adults.

}, keywords = {Cognitive Ability, Comorbidity, Longitudinal data}, issn = {1758-535X}, doi = {10.1093/gerona/glz147}, author = {Melissa Y Wei and Deborah A Levine and Laura B Zahodne and Mohammed U Kabeto and Kenneth M. Langa} } @article {vanZon2020705, title = {Multimorbidity and the Transition Out of Full-Time Paid Employment: A Longitudinal Analysis of the Health and Retirement Study}, journal = {The Journals of Gerontology: Series B}, volume = {75}, year = {2020}, pages = {705-715}, abstract = {OBJECTIVES: This study aims to examine whether older workers aged 50-64 years with multimorbidity are at increased risk to transition from full-time paid employment to part-time employment, partial retirement, unemployment, disability, economic inactivity, full retirement or die than workers without a chronic health condition and workers with one chronic health condition, and whether socioeconomic position (SEP) modifies these transitions. METHOD: Using data from the Health and Retirement Study (1992-2014; n = 10,719), sub-distribution hazard ratios with 95\% confidence intervals were calculated with a time-varying Fine and Gray competing-risks survival regression model to examine exit from full-time paid employment. We investigated the modifying effect of SEP by examining its interaction with multimorbidity. RESULTS: Workers with multimorbidity had a higher risk of transitioning to partial retirement (1.45; 1.22, 1.72), disability (1.84; 1.21, 2.78) and full retirement (1.63; 1.47, 1.81), and they had a higher mortality risk (2.58; 1.71, 3.88) than workers without chronic disorders. Compared to workers with one chronic health condition, workers with multimorbidity had an increased risk for partial (1.19; 1.02, 1.40) and full retirement (1.29; 1.17, 1.42), and mortality (1.49; 1.09, 2.04). Only SEP measured as educational level modified the relationship between multimorbidity and mortality. DISCUSSION: Workers with multimorbidity seem more prone to leave full-time paid employment than workers without or with one a chronic health condition. Personalized work accommodations may be necessary to help workers with multimorbidity prolong their working life. {\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America.}, keywords = {chronic health, condition labor market participation, socioeconomic position, Transition}, doi = {10.1093/geronb/gbz061}, author = {Sander K. R. van Zon and Reijneveld, S.A. and Galaurchi, A. and Carlos F. Mendes de Leon and Josue Almansa and B{\"u}ltmann, U.} } @article {doi:10.1111/jgs.16310, title = {Multimorbidity in Medicare Beneficiaries: Performance of an ICD-Coded Multimorbidity-Weighted Index}, journal = {Journal of the American Geriatrics Society}, volume = {n/a}, year = {2020}, abstract = {OBJECTIVES Most older adults have multimorbidity that impairs physical functioning, but it is difficult to quantify using claims data. We previously developed and validated a multimorbidity-weighted index (MWI) that embeds physical functioning through disease weightings. We mapped these conditions to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and compared them with existing indices. DESIGN Population-based prospective cohort. SETTING Respondents to the 2006-2016 waves of the Health and Retirement Study (HRS) with linked Medicare claims data and continuous enrollment in 2006. PARTICIPANTS Community-dwelling Medicare-eligible HRS participants (N = 9923; mean age = 75.5 {\textpm} 8.5 y). MEASUREMENTS Individuals were followed for future physical functioning (2006-2014) and mortality (2007-2016). MWI conditions were mapped to ICD-9-CM codes to produce an ICD-coded MWI (MWI-ICD). We compared MWI-ICD, simple disease count, Charlson, Elixhauser, and the health-related quality of life comorbidity index (HRQOL-CI) through distributions, hazard ratios for mortality, and relationships with future physical functioning. RESULTS MWI-ICD exhibited the broadest distribution and most unique values (5891). Left censoring was most pronounced for Charlson (34.3\% score = 0) and Elixhauser (13.1\% score = 0) vs MWI (5.0\% score = 0). Hazard ratios and concordance (C)-statistics for mortality across extreme quartiles were similar for MWI-ICD, Elixhauser, and Charlson but lower for disease count and the HRQOL-CI. For physical functioning, MWI-ICD yielded the greatest contrast across extreme quartiles and overall coefficient of determination (R2). CONCLUSION MWI-ICD was significantly associated with mortality and future physical functioning and comparable with established metrics for mortality prediction although not weighted to mortality. MWI-ICD successfully captures diseases accumulation and functioning in claims data.}, keywords = {administrative claims data, Comorbidity, Medicare, multimorbidity, physical functioning}, doi = {10.1111/jgs.16310}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16310}, author = {Melissa Y Wei and Ratz, David and Kenneth J Mukamal} } @article {10898, title = {Multiple chronic conditions and risk of cognitive impairment and dementia among older Americans: findings from the Aging, Demographics, and Memory Study (ADAMS)}, journal = {Aging, Neuropsychology, and CognitionAging, Neuropsychology, and Cognition}, year = {2020}, month = {2020/07/07}, abstract = {ABSTRACT This study examined the relationship between multiple chronic conditions (MCC) and risk of cognitive impairment with no dementia (CIND) and dementia among older Americans. A sample of 637 individuals aged 70 or older was drawn from the Aging, Demographics, and Memory Study, a supplementary dataset of the larger national Health and Retirement Study. Multinomial logistic regression analysis was conducted to investigate the association between MCC and cognition categorized as (a) no cognitive impairment, (b) CIND, or (c) dementia. Having MCC, particularly three or more chronic conditions, was significantly related to being diagnosed with CIND in our study, but not dementia. Our findings suggest that the presence of MCC may be a risk factor for cognitive impairment in later life. However, further investigation using a longitudinal design is needed to better understand the mechanism of how MCC may be related to CIND and dementia among older adults in the United States.}, keywords = {Aging, and memory study, cognitive impairment with no dementia, Dementia, Demographics, multimorbidity, Multiple Chronic Conditions}, isbn = {1382-5585}, doi = {10.1080/13825585.2020.1790492}, author = {Yura Lee and Cho, Youngjoo and Oh, Hyunkyoung} } @article {11297, title = {Multiple Dimensions of Perceived Discrimination, Race-Ethnicity, and Mortality Risk Among Older Adults}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {581 }, abstract = {The present study utilized data from the Health and Retirement Study (N=12,988) to investigate the joint consequences of multiple dimensions of perceived discrimination on mortality risk. Perceived discrimination is based on responses from the 2006/2008 HRS waves and included everyday discrimination, the number of attributed reasons for everyday discrimination, and major lifetime discrimination. Vital status was obtained from the National Death Index and reports from key household informants (spanning 2006{\textendash}2016). Cox proportional hazard models were used to estimate the risk of mortality. During the observation period, 3,494 deaths occurred. Only the number of attributed reasons for discrimination predicted mortality risk when all discrimination measures were estimated in the same model (Hazard Ratio [HR]=1.09; 95\%, Confidence Interval [CI]=1.05 - 1.14), holding all else constant. Overall, the number of attributed reasons for everyday discrimination is a particularly salient risk factor for mortality in later life.}, keywords = {mortality risk, Perceived Discrimination, race-ethnicity}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1936}, author = {Ryon J. Cobb} } @article {10080, title = {Many Americans will need long-term care. Most won{\textquoteright}t be able to afford it.}, journal = {The New York Times}, year = {2019}, address = {New York City}, keywords = {Aging in place, Financial Health, Medicare/Medicaid/Health Insurance, News}, url = {https://www.nytimes.com/2019/05/10/health/assisted-living-costs-elderly.html}, author = {Paula Span} } @article {9921, title = {Marital Transitions and Depressive Symptoms among Older Adults: Examining Educational Differences.}, journal = {Gerontology}, year = {2019}, abstract = {

BACKGROUND: Later decades of the life course have undergone rapid transformations due to demographic changes in ageing societies, such as more frequent occurrences of later-life marital transitions. Adaption to these transitions, even when welcomed, brings novel chances and challenges in negotiating new social roles in old age, which could reinforce preexisting disparities in the acquisition and mastery of resources, social ties, and coping strategies.

OBJECTIVES: Because the ability to weather later-life marital transitions may depend on the long arm of education acquired earlier in the life course, the present study aims to identify and track trends in the prevalence of marriage, divorce/separation, and widowhood among sociodemographic subgroups; link the occurrence of those transitions with mental health; and test the influence of educational attainment on these associations.

METHODS: We employ an intraindividual, within-person approach to quantify the occurrence of marital transitions and their impact using data from the Health and Retirement Study (n = 22,013; 1992-2010). Measures of transition occurrence, depressive symptoms, and educational attainment were available across up to 10 biennial assessments.

RESULTS: Individuals with less than a high school diploma displayed the highest likelihood of losing their significant other through divorce/separation or death. Marital loss was associated with increasing, and marital gain with decreasing, depressive symptoms. Compared to those with less than a high school diploma, individuals with a high school or general equivalency diploma exhibited larger increases in depressive symptoms associated with widowhood, even though their average levels of depressive symptoms were lower in the absence of this transition.

CONCLUSIONS: Our findings revealed a predictable educational gradient for the occurrence of marital transitions and later-life mental health. Yet higher, formalized education did not protect the participants from increased depression in the presence of a loss-related transition, which could suggest that the strains of spousal loss may to some degree function as a leveler of the preexisting social inequalities of stratified life courses. We conclude that the benefits conferred by education are not necessarily ubiquitous, and its impact on the adaptation to spousal loss may be more complex and nuanced depending on the range of prior experiences and available coping strategies.

}, keywords = {Depressive symptoms, Education, Marriage}, issn = {1423-0003}, doi = {10.1159/000493681}, author = {Recksiedler, Claudia and Stawski, Robert S} } @article {9566, title = {Market Volatility and Financial Satisfaction: The Role of Financial Self-Efficacy}, journal = {Journal of Behavioral Finance}, volume = {20}, year = {2019}, pages = {42-52 }, abstract = {This study investigates the role of financial self-efficacy (FSE) in moderating the relationship between market volatility and financial satisfaction within a sample of 3,405 adults 50 years old and over from the Health and Retirement Study. Results revealed that market volatility had no statistically significant effect with financial satisfaction for those with moderate or high FSE, but market volatility did have a negative effect for those with low FSE. Results suggest that FSE is an important predictor of financial satisfaction amidst market volatility and should be considered when establishing an appropriate asset allocation for client portfolios.}, keywords = {Economics, Financial Health, Market analyses, Risk Factors}, issn = {1542-7560}, doi = {10.1080/15427560.2018.1434655}, url = {https://www.tandfonline.com/doi/full/10.1080/15427560.2018.1434655https://www.tandfonline.com/doi/pdf/10.1080/15427560.2018.1434655}, author = {Asebedo, Sarah D. and Payne, Patrick} } @article {9992, title = {Marriage and physical capability at mid to later life in England and the USA.}, journal = {PLoS One}, volume = {14}, year = {2019}, pages = {e0209388}, abstract = {Background Married people have lower rates of mortality and report better physical and mental health at older ages, compared to their unmarried counterparts. However, there is limited evidence on the association between marriage and physical capability, the ability to carry out the tasks of daily living, which is predictive of future mortality and social care use. We investigate the association between marital status and physical capability at mid to later life in England and the United States. Methods We examine the association between marriage and physical capability at mid to later life in England and the USA using two performance-based measures of physical capability: grip strength and walking speed. Multiple linear regression was carried out on Wave 4 (2008) of the English Longitudinal Study of Ageing (ELSA) and Waves 8 and 9 (2006 and 2008) of the US Health and Retirement Study (HRS). Results In age adjusted models married men and women had better physical capability than their unmarried counterparts. Much of the marriage advantage was explained by the greater wealth of married people. However, remarried men were found to have stronger grip strength and widowed and never married men had a slower walking speed than men in their first marriage, which was not explained by wealth, demographic and socioeconomic characteristics, health behaviours, chronic disease or depressive symptoms. There were no differences in the association between England and the USA. Conclusions Marriage may be an important factor in maintaining physical capability in both England and the USA, particularly because of the greater wealth which married people have accrued by the time they reach older ages. The grip strength advantage for remarried men may be due to unobserved selective factors into remarriage.}, keywords = {Disabilities, Gait speed, Grip strength, Marriage}, issn = {1932-6203}, doi = {10.1371/journal.pone.0209388}, author = {Wood, Natasha and McMunn, Anne and Webb, Elizabeth and Stafford, Mai} } @article {9953, title = {Married people walk faster and have stronger grip, new study says}, journal = {CNN}, volume = {2019}, number = {01/25/2019}, year = {2019}, publisher = {CNN}, address = {Atlanta}, keywords = {Health Conditions and Status, Marriage, News, Physical Health}, url = {https://us.cnn.com/2019/01/24/health/married-people-fitter-healthier-study-scli-intl/index.html}, author = {Emily Dixon} } @article {10668, title = {Measurement of Fall Injury With Health Care System Data and Assessment of Inclusiveness and Validity of Measurement Models}, journal = {JAMA Network Open}, volume = {2}, year = {2019}, pages = {e199679-e199679}, abstract = {National injury surveillance systems use administrative data to collect information about severe fall-related trauma and mortality. Measuring milder injuries in ambulatory clinics would improve comprehensive outcomes measurement across the care spectrum.To assess a flexible set of administrative data{\textendash}only algorithms for health systems to capture a greater breadth of injuries than traditional fall injury surveillance algorithms and to quantify the algorithm inclusiveness and validity associated with expanding to milder injuries.In this longitudinal diagnostic study of 13 939 older adults (>=65 years) in the nationally representative Health and Retirement Study, a survey was conducted every 2 years and was linked to hospital, emergency department, postacute skilled nursing home, and outpatient Medicare claims (2000-2012). During each 2-year observation period, participants were considered to have sustained a fall-related injury (FRI) based on a composite reference standard of having either an external cause of injury (E-code) or confirmation by the Health and Retirement Study patient interview. A framework involving 3 algorithms with International Classification of Diseases, Ninth Revision codes that extend FRI identification with administrative data beyond the use of fall-related E-codes was developed: an acute care algorithm (head and face or limb, neck, and trunk injury reported at the hospital or emergency department), a balanced algorithm (all acute care algorithm injuries plus severe nonemergency outpatient injuries), and an inclusive algorithm (almost all injuries). Data were collected from January 1, 1998, through December 31, 2012, and statistical analysis was performed from August 1, 2016, to March 1, 2019.Validity, measured as the proportion of potential FRI diagnoses confirmed by the reference standard, and inclusiveness, measured as the proportion of reference-standard FRIs captured by the potential FRI diagnoses.Of 13 939 participants, 1672 (42.4\%) were male, with a mean (SD) age of 77.56 (7.63) years. Among 50 310 observation periods, 9270 potential FRI diagnoses (18.4\%) were identified; these were tested against 8621 reference-standard FRIs (17.1\%). Compared with the commonly used method of E-coded{\textendash}only FRIs (2-year incidence, 8.8\% [95\% CI, 8.6\%-9.1\%]; inclusion of 51.5\% [95\% CI, 50.4\%-52.5\%] of the reference-standard FRIs), FRI inclusion was increased with use of the study framework of algorithms. With the acute care algorithm (2-year incidence, 12.6\% [95\% CI, 12.4\%-12.9\%]), validity was prioritized (88.6\% [95\% CI, 87.4\%-89.8\%]) over inclusiveness (62.1\% [95\% CI, 61.1\%-63.1\%]). The balanced algorithm showed a 2-year incidence of 14.6\% (95\% CI, 14.3\%-14.9\%), inclusion of 65.3\% (95\% CI, 64.3\%-66.3\%), and validity of 83.2\% (95\% CI, 81.9\%-84.6\%). With the inclusive algorithm, the number of potential FRIs increased compared with the E-code{\textendash}only method (2-year incidence, 17.4\% [95\% CI, 17.1\%-17.8\%]; inclusion, 68.4\% [95\% CI, 67.4\%-69.3\%]; validity, 75.2\% [95\% CI, 73.7\%-76.6\%]).The findings suggest that use of algorithms with International Classification of Diseases, Ninth Revision codes may increase inclusion of FRIs by health care systems compared with E-codes and that these algorithms may be used by health systems to evaluate interventions and quality improvement efforts.}, keywords = {Fall injury, Health Care, Inclusiveness}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2019.9679}, author = {Lillian C. Min and Mary Tinetti and Kenneth M. Langa and Ha, Jinkyung and Neil B. Alexander and Geoffrey J Hoffman} } @article {9802, title = {Measuring Social Participation in the Health and Retirement Study.}, journal = {Gerontologist}, year = {2019}, abstract = {

Background and Objectives: Large data sets have the potential to reveal useful information regarding social participation; however, most data sets measure social participation via individual items without a global assessment of social participation.

Research Design and Methods: We used data from the Health and Retirement Study (HRS) to assess whether 8 items from questionnaire pertaining to social participation (religious attendance, caring for an adult, activities with grandchildren, volunteering, charity work, education, social clubs, nonreligious organizations) formed a reliable, cohesive scale and to explore the predictive validity of this scale. We included respondents 65 years and older in the HRS who returned the psychosocial questionnaire in 2010 and 2012 with responses to the social participation items (n = 4,317 and n = 3,978). Three scales were explored: SoPart-30 using the original scoring; SoPart-10 using modified scoring; and SoPart-5 using dichotomous scoring.

Results: Five items were retained as a single factor for each scale, and graded response models and Mokken scale analysis confirmed the scale items with the SoPart-10 scale having the highest reliability (alpha = 0.74).

Discussion and Implications: Results suggest that a scale derived from the social participation items in the HRS may be useful in characterizing general social participation levels and identifying modifiable factors that can promote it in older populations.

}, keywords = {Social Factors, Social Support, Survey Methodology}, issn = {1758-5341}, doi = {10.1093/geront/gny094}, author = {Bret Howrey and Carri L. Hand} } @mastersthesis {10339, title = {Measuring the Impact of Aging and Migration on the Economic Activity of the United States}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-07-10}, pages = {99}, school = {The University of Texas at San Antonio}, type = {phd}, abstract = {The United States is experiencing changes in its demographic structure. On the one hand, the United States is at the end of the demographic transition and continues to experience declining fertility rates and increasing life expectancy. This transition is leading to an aging society. On the other hand, the United States continues to be a country that attracts migrants from across the world, and the share of the foreign-born population is reaching historical highs and continues to grow. In this dissertation, I explore the relationship between these changes and their effect on economic output. I first measure the contribution of international migration on the length and magnitude of the demographic dividend. International migration impacts the age-structure of the host population because migrants are more likely to move at certain ages. Thus, it is possible to measure their contribution to the United States economy by studying the changes in the support ratio. Next, I explore how an aging society can impact the economic output of the United States by measuring the changes in consumption as a share of the gross domestic product as a society changes its age-structure. Finally, I look into how the spending behavior of retirees varies by place of origin to learn how an increasingly foreign population might behave. The objective of this dissertation, and its main contribution, is to separate the demographic processes and measure its influence on specific aspects of the economy.}, keywords = {0938:Demography, Aging, consumption, Demographic dividend, Demographic processes, Demography, Social Sciences}, isbn = {9781392181102}, author = {Gallardo de,las P.} } @article {9967, title = {Mediators of the association between religious service attendance and mortality.}, journal = {American Journal of Epidemiology}, volume = {188}, year = {2019}, pages = {96-101}, abstract = {Mounting evidence consistently shows associations between religious service attendance and reduced mortality risk, yet research identifying mediators remains limited. Using prospective data from the Health and Retirement Study (2006-2014; n = 5,200 US adults), we evaluated a range of potential mediators. After robust control for confounders (demographic, health, health-behavior, and social factors), among positive psychological factors, we observed mediation through increased life satisfaction (5.27\%; P <= 0.001) and possibly positive affect (1.52\%; P = 0.06) but not optimism, mastery, or purpose. Among dimensions of psychological distress, we observed mediation through reductions in hopelessness (1.92\%; P = 0.01), trait anger (1.98\%; P = 0.03), state anger (2.23\%; P = 0.03), and possibly loneliness (1.21\%; P = 0.06), but not cynical hostility or negative affect, and some evidence that increased anxiety (-3.61\%; P = 0.008) and possibly depressive symptoms (-1.14\%; P = 0.05) increased mortality odds. Among social factors, we observed mediation through contact with friends (10.73\%; P = 0.005) but not living with a spouse or contact with children or other family. Among health behaviors, we observed mediation through exercise (5.38\%; P <= 0.001) and negative mediation through alcohol frequency (-2.55\%; P = 0.03) and possibly body mass index (-2.34\%; P = 0.08) but not smoking. These results highlight a range of mediators that might underlie the association between religious service attendance and reduced risk of mortality.}, keywords = {Mortality, Optimism, Religion}, issn = {1476-6256}, doi = {10.1093/aje/kwy211}, author = {Eric S Kim and Tyler J VanderWeele} } @article {10063, title = {Medicare expenditures attributable to dementia.}, journal = {Health Services Research}, year = {2019}, abstract = {

OBJECTIVE: To estimate dementia{\textquoteright}s incremental cost to the traditional Medicare program.

DATA SOURCES: Health and Retirement Study (HRS) survey-linked Medicare part A and B claims from 1991 to 2012.

STUDY DESIGN: We compared Medicare expenditures for 60~months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.

DATA COLLECTION/EXTRACTION METHODS: We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components.

PRINCIPAL FINDINGS: Dementia{\textquoteright}s five-year incremental cost to the traditional Medicare program is approximately $15~700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex-specific differential mortality associated with dementia.

CONCLUSIONS: Dementia{\textquoteright}s cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post-acute care services could produce substantial savings.

}, keywords = {Cognition \& Reasoning, Dementia, Medicare linkage, Medicare/Medicaid/Health Insurance}, issn = {1475-6773}, doi = {10.1111/1475-6773.13134}, author = {Lindsay L Waite and Fishman, Paul and Basu, Anirban and Paul K Crane and Eric B Larson and Norma B Coe} } @article {10072, title = {Mental illness, not obesity status, is associated with food insecurity among the elderly in the Health and Retirement Study.}, journal = {Journal of Nutrition in Gerontology and Geriatrics}, volume = {38}, year = {2019}, pages = {149-172}, abstract = {

OBJECTIVES: Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations.

METHODS: We conducted a cross-sectional study of 2868 participants{\textquoteright} aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history.

RESULTS: Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity.

DISCUSSION: Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.

}, keywords = {BMI, Depressive symptoms, Food insecurity, Mental Health}, issn = {2155-1200}, doi = {10.1080/21551197.2019.1565901}, author = {Diana P Brostow and Gunzburger, Elise and Lauren M. Abbate and Lisa A Brenner and Kali S Thomas} } @article {10225, title = {A meta-analysis of genome-wide association studies identifies multiple longevity genes.}, journal = {Nature Communications}, volume = {10}, year = {2019}, month = {08/2019}, pages = {3669}, abstract = {

Human longevity is heritable, but genome-wide association (GWA) studies have had limited success. Here, we perform two meta-analyses of GWA studies of a rigorous longevity phenotype definition including 11,262/3484 cases surviving at or beyond the age corresponding to the 90th/99th survival percentile, respectively, and 25,483 controls whose age at death or at last contact was at or below the age corresponding to the 60th survival percentile. Consistent with previous reports, rs429358 (apolipoprotein E (ApoE) ε4) is associated with lower odds of surviving to the 90th and 99th percentile age, while rs7412 (ApoE ε2) shows the opposite. Moreover, rs7676745, located near GPR78, associates with lower odds of surviving to the 90th percentile age. Gene-level association analysis reveals a role for tissue-specific expression of multiple genes in longevity. Finally, genetic correlation of the longevity GWA results with that of several disease-related phenotypes points to a shared genetic architecture between health and longevity.

}, keywords = {genes, Genome-Wide Association Study, GWA, longevity genes, meta-analysis}, issn = {2041-1723}, doi = {10.1038/s41467-019-11558-2}, url = {https://www.ncbi.nlm.nih.gov/pubmed/31413261}, author = {Deelen, Joris and Daniel S Evans and Dan E Arking and Tesi, Niccol{\`o} and Nygaard, Marianne and Liu, Xiaomin and Wojczynski, Mary K and Biggs, Mary L and van der Spek, Ashley and Atzmon, Gil and Erin B Ware and Sarnowski, Chlo{\'e} and Albert Vernon Smith and Sepp{\"a}l{\"a}, Ilkka and Cordell, Heather J and Dose, Janina and Amin, Najaf and Alice M. Arnold and Kristin L. Ayers and Barzilai, Nir and Becker, Elizabeth J and Beekman, Marian and Blanch{\'e}, H{\'e}l{\`e}ne and Christensen, Kaare and Christiansen, Lene and Collerton, Joanna C and Cubaynes, Sarah and Steven R Cummings and Davies, Karen and Debrabant, Birgit and Deleuze, Jean-Fran{\c c}ois and Duncan, Rachel and Jessica Faul and Franceschi, Claudio and Galan, Pilar and Gudnason, Vilmundur and Tamara B Harris and Huisman, Martijn and Hurme, Mikko A and Jagger, Carol and Jansen, Iris and Jylh{\"a}, Marja and K{\"a}h{\"o}nen, Mika and Karasik, David and Sharon L R Kardia and Kingston, Andrew and Kirkwood, Thomas B L and Lenore J Launer and Lehtim{\"a}ki, Terho and Lieb, Wolfgang and Lyytik{\"a}inen, Leo-Pekka and Martin-Ruiz, Carmen and Min, Junxia and Nebel, Almut and Anne B Newman and Nie, Chao and Nohr, Ellen A and Orwoll, Eric S and Thomas T Perls and Province, Michael A and Psaty, Bruce M and Olli T Raitakari and Reinders, Marcel J T and Robine, Jean-Marie and Rotter, Jerome I and Sebastiani, Paola and Jennifer A Smith and S{\o}rensen, Thorkild I A and Kent D Taylor and Andr{\'e} G Uitterlinden and van der Flier, Wiesje and Sven J van der Lee and Cornelia M van Duijn and van Heemst, Diana and James W Vaupel and David R Weir and Ye, Kenny and Zeng, Yi and Zheng, Wanlin and Holstege, Henne and Douglas P Kiel and Kathryn L Lunetta and Eline P Slagboom and Joanne M Murabito} } @article {10096, title = {Middle-income seniors risk falling through cracks in housing market}, journal = {The Washington Post}, year = {2019}, month = {05/28/2019}, address = {Washington, DC}, keywords = {Financial Health, Housing, News}, url = {https://www.washingtonpost.com/dc-md-va/2019/05/28/middle-income-seniors-risk-falling-through-cracks-housing-market/?noredirect=on\&utm_term=.91fda3cf4f5b}, author = {Tara Bahrampour} } @article {10.1093/geroni/igz038.1928, title = {MOBILITY TRAJECTORIES, HEALTHCARE SATISFACTION, AND PERCEIVED DISABILITY DISCRIMINATION AMONG OLDER ADULTS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, month = {11}, pages = {S523-S524}, abstract = {Although functional mobility limitations are associated with increased healthcare needs in later life, little research explores how older adults with varying functional mobility trajectories experience healthcare quality. To this end, we explore the effects of functional mobility trajectories on differences in healthcare treatment satisfaction, perceived disability discrimination in healthcare settings, and perceived everyday disability discrimination. We analyzed 9 waves of the Health and Retirement Study (n=29,284, 1998-2014, ages 50-84). First, we estimate age-specific group-based trajectories of functional mobility across age using finite mixture models. Second, we use multinomial logistic regression to identify sociodemographic factors that place individuals at elevated risk of membership in each group. Third, we explore how membership in one disability trajectory group over another affects healthcare satisfaction, perceptions of everyday discrimination in the context of healthcare treatment settings, and perceived discrimination in everyday life. Regression models include clustered standard errors to account for heteroscedasticity across repeated observations of individuals over time. We identify six group-based trajectories of functional mobility limitation among aging Americans. Black, female, and less-educated Americans are at higher risk of membership in disadvantaged trajectories, characterized by more rapidly increasing counts of functional mobility limitations, than their counterparts. Disadvantaged functional limitation trajectories are associated with lower levels of healthcare satisfaction, higher levels of perceived physical disability discrimination in healthcare treatment settings, and higher levels of perceived physical discrimination in other contexts of everyday life. The present study advances our knowledge of how older adults experience healthcare settings and discrimination across functional mobility status trajectories.}, keywords = {Disabilities, disability discrimination, Discrimination, Healthcare, healthcare satisfaction, Mobility Limitation}, issn = {2399-5300}, doi = {10.1093/geroni/igz038.1928}, url = {https://doi.org/10.1093/geroni/igz038.1928}, author = {Mueller, Collin and Jessica S West} } @article {10491, title = {Modeling Income in the Near Term 8 and 2014}, year = {2019}, institution = {Urban Institute}, abstract = {Modeling Income in the Near Term (MINT) is a dynamic microsimulation model developed by the Social Security Administration to facilitate analysis of proposals to change Social Security benefits and payroll taxes. This primer describes MINT{\textquoteright}s development history. It then details the model{\textquoteright}s starting sample and the specification of its demographic and economic aging modules, including the calculators that compute various benefits and taxes. It also provides information about previous analyses that have relied on MINT.}, keywords = {Finance, Income}, url = {https://www.urban.org/sites/default/files/publication/100965/modeling_income_in_the_near_term_8_and_2014_primer.pdf}, author = {Melissa Favreault and Karen E. Smith} } @mastersthesis {10150/633228, title = {Modeling the Impact of Chronic Disease on Work Life}, volume = {Ph.D. in D.N.P.}, year = {2019}, note = {This study utilizes historic chronic disease and employment data from the University of Michigan Health and Retirement Study (HRS) to specify a multivariate regression model for forecasting the impact of specific chronic diseases on work life. The purpose of the study is to create a new model for forecasting chronic disease-adjusted work life years, which is a measure of disease burden due to chronic disease. The ability to work may be considered a proxy for quality of life, as it is a means by which a person preserves their financial independence and maintains their financial capacity for self-care. This forecasting model is germane to advanced nursing practice, as it provides practitioners a tool to measure patients{\textquoteright} ability to work given various scenarios of chronic disease {\textendash} many of which, are preventable. This tool may be useful for motivating patients to adopt healthy lifxestyle behaviors such as smoking cessation, weight loss, exercise, and adopting healthy eating habits so they may change chronic disease trajectories and preserve their ability to work and financially provide for themselves and their families. This advocacy and promotion of patient health through self-care is a cornerstone of advanced nursing practice (Thrasher, 2002). Furthermore, this tool may also be useful for calculating or forecasting disease burden in terms of an individual{\textquoteright}s attenuated work years or lost productivity. On a larger scale, this tool may be used to calculate lost labor force participation of a population or group of individuals. These statistics may be used as quality improvement measures, economic forecasting data, or for justifying healthcare policy changes or for the allocation of healthcare resources.}, month = {2019}, school = {University of Arizona}, address = {Tucson, AZ}, abstract = {This study utilizes historic chronic disease and employment data from the University of Michigan Health and Retirement Study (HRS) to specify a multivariate regression model for forecasting the impact of specific chronic diseases on work life. The purpose of the study is to create a new model for forecasting chronic disease-adjusted work life years, which is a measure of disease burden due to chronic disease. The ability to work may be considered a proxy for quality of life, as it is a means by which a person preserves their financial independence and maintains their financial capacity for self-care. This forecasting model is germane to advanced nursing practice, as it provides practitioners a tool to measure patients{\textquoteright} ability to work given various scenarios of chronic disease {\textendash} many of which, are preventable. This tool may be useful for motivating patients to adopt healthy lifxestyle behaviors such as smoking cessation, weight loss, exercise, and adopting healthy eating habits so they may change chronic disease trajectories and preserve their ability to work and financially provide for themselves and their families. This advocacy and promotion of patient health through self-care is a cornerstone of advanced nursing practice (Thrasher, 2002). Furthermore, this tool may also be useful for calculating or forecasting disease burden in terms of an individual{\textquoteright}s attenuated work years or lost productivity. On a larger scale, this tool may be used to calculate lost labor force participation of a population or group of individuals. These statistics may be used as quality improvement measures, economic forecasting data, or for justifying healthcare policy changes or for the allocation of healthcare resources.}, keywords = {Chronic disease, Disease, modeling, working}, url = {http://hdl.handle.net/10150/633228}, author = {Allman, Violeta Suzara} } @article {10121, title = {The Moderating Role of Depressive Symptoms Between Financial Assets and Bequests Expectation}, journal = {Journal of Family and Economic Issues}, volume = {40}, year = {2019}, pages = {498{\textendash}510}, abstract = {This study investigated the association between financial assets and bequests expectation, specifically whether having depression moderated the association. Our sample included 10,340 middle-aged and older Americans from the 2014 Health and Retirement Study. Results from ordinary least squares regression models showed a positive association between financial assets and bequests expectation, whereas a negative association between depression and bequests expectation. Furthermore, a moderating role of depression was revealed. Specifically, the relationship between financial assets and bequests expectation was stronger for individuals with depression than for individuals without depression. Future research and practice should incorporate perspectives of both financial assets and depressive symptoms to more effectively help individuals and families deal their current financial situation as well as identify their estate planning needs. We also discuss public policy implications of the findings.}, keywords = {Decision making, Depressive symptoms, Financial Health}, issn = {1058-0476}, doi = {10.1007/s10834-019-09621-7}, author = {Shinae L Choi and Wilmarth, Melissa J.} } @article {9990, title = {Moral hazard and long-term care insurance}, journal = {The Geneva Papers on Risk and Insurance - Issues and Practice}, volume = {44}, year = {2019}, pages = {231{\textendash}251}, abstract = {In private long-term care insurance markets, moral hazard is central to pricing and long-run robustness of the market, yet there is remarkably little evidence on the extent to which moral hazard is present in long-term care insurance. We use Health and Retirement Study data from 1996 to 2014 to assess moral hazard in nursing home and home care use in private long-term care insurance, employing a combination of propensity score matching and instrumental variables approaches. We find evidence of significant moral hazard in home care use and a potentially meaningful but noisy effect on nursing home use. Policymakers designing incentives to promote private long-term care insurance should consider the consequences of moral hazard.}, keywords = {Aging in place, Long-term care insurance, Nursing homes}, issn = {1018-5895}, doi = {10.1057/s41288-018-00119-1}, author = {R. Tamara Konetzka and Daifeng He and Dong, Jing and John A. Nyman} } @mastersthesis {10233, title = {Mortgage Loans and Financial Security Among Middle-aged and Older Americans}, volume = {Doctor of Philosophy (PhD)}, year = {2019}, month = {10/2019}, school = {University of Kentucky}, type = {Doctoral Dissertation}, address = {Lexington, United States}, abstract = {Mortgage loan debt is prevalent among middle-aged and older Americans. With higher average outstanding balances, many people are unlikely to pay off their mortgage debt by retirement. Meanwhile, as people age, health shocks are more likely to occur. Medical expenses may compete with mortgage payments and relate to financial insecurity in later years. In order to alleviate financial strain during times of financial hardship, senior homeowners may find reverse mortgage the solution they are looking for. Targeting American adults age 50 and older, this dissertation investigates mortgage loan debt and financial security using panel data from the Health and Retirement Study. Chapter 1 provides an overview of this dissertation and three studies. Chapter 2 investigates whether retirement preparedness plays a role in mortgage status at retirement, shown here as whether a person has mortgage debt and how much the remaining balance is (Waves 2004-2014). Chapter 3 examines health impact on likelihood of paying off mortgage loans under different health conditions, with estimates on expected time to mortgage payoff (Waves 2004-2014). Chapter 4 focuses on reverse mortgages and their impact on senior borrowers{\textquoteright} financial satisfaction and liquidity constraint (Waves 2010-2016). Chapter 5 summarizes major findings in three studies and highlights the contribution of this dissertation toward middle-aged and older Americans{\textquoteright} financial security. Limitations of three studies are discussed in Chapter 6. Three studies provide evidence on 1) the importance of preparedness on reduced mortgage burden; 2) adverse impact of health shock on likelihood of mortgage payoff; and 3) using reverse mortgages to reduce financial strain and increase financial satisfaction. Implications are addressed in each study.}, keywords = {Aging, Financial security, Mortgage Loans, Mortgages}, doi = {https://doi.org/10.13023/etd.2019.069}, url = {https://uknowledge.uky.edu/hes_etds/68/}, author = {Zhang, Qun} } @article {12128, title = {Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity.}, journal = {Nature Communications}, volume = {10}, year = {2019}, pages = {376}, abstract = {

Many genetic loci affect circulating lipid levels, but it remains unknown whether lifestyle factors, such as physical activity, modify these genetic effects. To identify lipid loci interacting with physical activity, we performed genome-wide analyses of circulating HDL cholesterol, LDL cholesterol, and triglyceride levels in up to 120,979 individuals of European, African, Asian, Hispanic, and Brazilian ancestry, with follow-up of suggestive associations in an additional 131,012 individuals. We find four loci, in/near CLASP1, LHX1, SNTA1, and CNTNAP2, that are associated with circulating lipid levels through interaction with physical activity; higher levels of physical activity enhance the HDL cholesterol-increasing effects of the CLASP1, LHX1, and SNTA1 loci and attenuate the LDL cholesterol-increasing effect of the CNTNAP2 locus. The CLASP1, LHX1, and SNTA1 regions harbor genes linked to muscle function and lipid metabolism. Our results elucidate the role of physical activity interactions in the genetic contribution to blood lipid levels.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Asians, Blacks, Brazil, Calcium-Binding Proteins, Cholesterol, Cholesterol, HDL, Cholesterol, LDL, Exercise, Female, Genetic Loci, Genome-Wide Association Study, Genotype, Hispanic or Latino, Humans, LIM-Homeodomain Proteins, Lipid Metabolism, Lipids, Male, Membrane Proteins, Microtubule-Associated Proteins, Middle Aged, Muscle Proteins, Nerve Tissue Proteins, Transcription Factors, Triglycerides, Whites, Young Adult}, issn = {2041-1723}, doi = {10.1038/s41467-018-08008-w}, author = {Kilpel{\"a}inen, Tuomas O and Bentley, Amy R and Noordam, Raymond and Yun Ju Sung and Schwander, Karen and Thomas W Winkler and Jakupovi{\'c}, Hermina and Daniel I Chasman and Alisa Manning and Ntalla, Ioanna and Aschard, Hugues and Brown, Michael R and de Las Fuentes, Lisa and Franceschini, Nora and Guo, Xiuqing and Vojinovic, Dina and Aslibekyan, Stella and Feitosa, Mary F and Kho, Minjung and Musani, Solomon K and Melissa Richard and Wang, Heming and Wang, Zhe and Traci M Bartz and Bielak, Lawrence F and Campbell, Archie and Dorajoo, Rajkumar and Fisher, Virginia and Hartwig, Fernando P and Horimoto, Andrea R V R and Li, Changwei and Kurt Lohman and Marten, Jonathan and Sim, Xueling and Smith, Albert V and Tajuddin, Salman M and Alver, Maris and Amini, Marzyeh and Boissel, Mathilde and Jin-Fang Chai and Chen, Xu and Divers, Jasmin and Evangelou, Evangelos and Gao, Chuan and Graff, Mariaelisa and Sarah E Harris and He, Meian and Hsu, Fang-Chi and Jackson, Anne U and Jing Hua Zhao and Kraja, Aldi T and K{\"u}hnel, Brigitte and Laguzzi, Federica and Lyytik{\"a}inen, Leo-Pekka and Ilja M Nolte and Rauramaa, Rainer and Riaz, Muhammad and Robino, Antonietta and Rueedi, Rico and Heather M Stringham and Takeuchi, Fumihiko and van der Most, Peter J and Varga, Tibor V and Verweij, Niek and Erin B Ware and Wen, Wanqing and Li, Xiaoyin and Yanek, Lisa R and Amin, Najaf and Donna K Arnett and Boerwinkle, Eric and Brumat, Marco and Brian E Cade and Canouil, Micka{\"e}l and Chen, Yii-Der Ida and Concas, Maria Pina and Connell, John and de Mutsert, Ren{\'e}e and de Silva, H Janaka and de Vries, Paul S and Demirkan, Ayse and Ding, Jingzhong and Charles B Eaton and Jessica Faul and Friedlander, Yechiel and Gabriel, Kelley P and Ghanbari, Mohsen and Giulianini, Franco and Gu, Chi Charles and Gu, Dongfeng and Tamara B Harris and He, Jiang and Heikkinen, Sami and Heng, Chew-Kiat and Hunt, Steven C and Ikram, M Arfan and Jost Bruno Jonas and Koh, Woon-Puay and Komulainen, Pirjo and Krieger, Jose E and Stephen B Kritchevsky and Kutalik, Zolt{\'a}n and Kuusisto, Johanna and Langefeld, Carl D and Langenberg, Claudia and Lenore J Launer and Leander, Karin and Lemaitre, Rozenn N and Lewis, Cora E and Liang, Jingjing and Liu, Jianjun and M{\"a}gi, Reedik and Manichaikul, Ani and Meitinger, Thomas and Andres Metspalu and Milaneschi, Yuri and Mohlke, Karen L and Thomas H Mosley and Murray, Alison D and Michael A Nalls and Nang, Ei-Ei Khaing and Nelson, Christopher P and Nona, Sotoodehnia and Norris, Jill M and Nwuba, Chiamaka Vivian and Jeff O{\textquoteright}Connell and Palmer, Nicholette D and Papanicolau, George J and Pazoki, Raha and Nancy L Pedersen and Peters, Annette and Peyser, Patricia A and Polasek, Ozren and David J Porteous and Poveda, Alaitz and Olli T Raitakari and Rich, Stephen S and Neil Risch and Robinson, Jennifer G and Rose, Lynda M and Rudan, Igor and Schreiner, Pamela J and Scott, Robert A and Stephen Sidney and Sims, Mario and Smith, Jennifer A and Snieder, Harold and Sofer, Tamar and John M Starr and Sternfeld, Barbara and Strauch, Konstantin and Tang, Hua and Kent D Taylor and Tsai, Michael Y and Tuomilehto, Jaakko and Andr{\'e} G Uitterlinden and van der Ende, M Yldau and van Heemst, Diana and Voortman, Trudy and Waldenberger, Melanie and Wennberg, Patrik and Wilson, Gregory and Xiang, Yong-Bing and Yao, Jie and Yu, Caizheng and Yuan, Jian-Min and Zhao, Wei and Alan B Zonderman and Becker, Diane M and Boehnke, Michael and Bowden, Donald W and de Faire, Ulf and Ian J Deary and Elliott, Paul and T{\~o}nu Esko and Freedman, Barry I and Froguel, Philippe and Paolo P. Gasparini and Gieger, Christian and Kato, Norihiro and Laakso, Markku and Lakka, Timo A and Lehtim{\"a}ki, Terho and Patrik K E Magnusson and Oldehinkel, Albertine J and Brenda W J H Penninx and Nilesh J Samani and Shu, Xiao-Ou and van der Harst, Pim and Jana V. van Vliet-Ostaptchouk and Vollenweider, Peter and Wagenknecht, Lynne E and Wang, Ya X and Wareham, Nicholas J and David R Weir and Wu, Tangchun and Zheng, Wei and Zhu, Xiaofeng and Michele K Evans and Franks, Paul W and Gudnason, Vilmundur and Caroline Hayward and Horta, Bernardo L and Tanika N Kelly and Liu, Yongmei and Kari E North and Pereira, Alexandre C and Ridker, Paul M and Tai, E Shyong and van Dam, Rob M and Fox, Ervin R and Sharon L R Kardia and Liu, Ching-Ti and Dennis O Mook-Kanamori and Province, Michael A and Redline, Susan and Cornelia M van Duijn and Rotter, Jerome I and Charles Kooperberg and Gauderman, W James and Psaty, Bruce M and Kenneth Rice and Munroe, Patricia B and Myriam Fornage and Cupples, L Adrienne and Charles N Rotimi and Alanna C Morrison and Rao, Dabeeru C and Ruth J F Loos} } @article {9517, title = {Machine learning approaches to the social determinants of health in the Health and Retirement study.}, journal = {SSM Popul Health}, volume = {4}, year = {2018}, pages = {95-99}, abstract = {

Background: Social and economic factors are important predictors of health and of recognized importance for health systems. However, machine learning, used elsewhere in the biomedical literature, has not been extensively applied to study relationships between society and health. We investigate how machine learning may add to our understanding of social determinants of health using data from the Health and Retirement Study.

Methods: A linear regression of age and gender, and a parsimonious theory-based regression additionally incorporating income, wealth, and education, were used to predict systolic blood pressure, body mass index, waist circumference, and telomere length. Prediction, fit, and interpretability were compared across four machine learning methods: linear regression, penalized regressions, random forests, and neural networks.

Results: All models had poor out-of-sample prediction. Most machine learning models performed similarly to the simpler models. However, neural networks greatly outperformed the three other methods. Neural networks also had good fit to the data (between 0.4-0.6, versus <0.3 for all others). Across machine learning models, nine variables were frequently selected or highly weighted as predictors: dental visits, current smoking, self-rated health, serial-seven subtractions, probability of receiving an inheritance, probability of leaving an inheritance of at least $10,000, number of children ever born, African-American race, and gender.

Discussion: Some of the machine learning methods do not improve prediction or fit beyond simpler models, however, neural networks performed well. The predictors identified across models suggest underlying social factors that are important predictors of biological indicators of chronic disease, and that the non-linear and interactive relationships between variables fundamental to the neural network approach may be important to consider.

}, keywords = {Biomarkers, Computer science, Machine learning, Neural network, Social Factors, Social Support}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2017.11.008}, author = {Seligman, Benjamin and Tuljapurkar, Shripad and David Rehkopf} } @article {9765, title = {Major Depression and Subthreshold Depression among Older Adults Receiving Home Care.}, journal = {American Journal of Geriatric Psychiatry}, volume = {26}, year = {2018}, month = {05/2018}, pages = {939-949}, abstract = {

OBJECTIVE: This study aims to estimate the prevalence and correlates of major and subthreshold depression and the extent of treatment utilization in older adults receiving home care.

METHODS: The study sample included 811 community-dwelling adults aged 60 and over who received paid home care during the 2008-2014 waves of the Health and Retirement Study. Depression was assessed using short forms of the Composite International Diagnostic Interview and the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to examine correlates of depression type and treatment utilization.

RESULTS: One in two older home care recipients suffered from probable depression; 13.4\% of the sample suffered from major depression and an additional 38.7\% met study criteria for subthreshold depression. The majority (72.7\%) of participants with major depression and almost half (44.5\%) of participants with subthreshold depression reported taking medication for anxiety or depression. One-third (33.2\%) of older home care recipients with major depression and 14.2\% of those with subthreshold depression reported receiving formal psychiatric or psychological treatment. Males as compared with females and persons with pain problems as compared with no pain complaints had a higher risk of subthreshold and major depression. The receipt of medication or psychiatric treatment declined with age. African Americans were less likely to receive medication for anxiety or depression compared with non-Hispanic whites.

CONCLUSION: Depression affects a substantial proportion of older adults receiving home care and may be inappropriately treated. Future research is needed to develop optimal strategies for integrating depression assessment and treatment into home care.

}, keywords = {Caregiving, Community-dwelling, Depressive symptoms}, issn = {1545-7214}, doi = {10.1016/j.jagp.2018.05.001}, author = {Xiang, Xiaoling and Amanda N Leggett and Himle, Joseph A and Helen C Kales} } @mastersthesis {10329, title = {Making Ends Meet in a Social Context: Grandparent Childcare during the 2008 Recession, Debt of the Poor and Financial Innovation, and Relative Poverty{\textquoteright}s Effect on Election Outcomes}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-01-19}, pages = {209}, school = {Colorado State University}, type = {phd}, abstract = {The chapters illustrate dynamics of the choices of individuals and households when facing income and time constraints in the recent United States. In the first chapter, grandparent childcare provision is studied from the supply side with a focus on the effect of the 2008 recession. Findings suggest differing effects for lower income respondents, and female respondents. In the second essay, I test a structural consumption model building on Brown (2007) and extending into recent periods using newly available data. Results suggest that Minskian effects are present in consumption in the U.S. Lastly, I test a new relative poverty measure against the more traditional form and study its relation to electoral outcomes from 2000-2016. Results suggest that state-level relative poverty decreases the likelihood of Republican victories. All of these aspects investigate the relationship between the social and the economic in the modern U.S.}, keywords = {0501:Economics, Childcare, Economics, Elections, Grandparent childcare, Minsky, Relative poverty, Social Sciences}, isbn = {9780438788695}, url = {https://mountainscholar.org/handle/10217/193120}, author = {Michael Ewing Roberts} } @article {9561, title = {Many Americans Try Retirement, Then Change Their Minds}, journal = {The New York Times}, year = {2018}, address = {New York City}, keywords = {Bridge employment, News, Purpose in life, Retirement Planning and Satisfaction}, url = {https://www.nytimes.com/2018/03/30/health/unretirement-work-seniors.html}, author = {Paula Span} } @mastersthesis {10323, title = {Marital Biography and Well-Being in Later Life: The Role of Remarriage, Disruption Pathways, and Duration on Health, Parent-Child Contact, and Ambivalence Toward Children}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-09-06}, pages = {170}, school = {Bowling Green State University}, type = {phd}, abstract = {In 2015, nearly 30\% of individuals aged 50 and older had two or more marriages compared to 19\% in 1980, indicating that a growing share of older adults either divorced or were widowed during early or midlife and later remarried. Although widowhood remains a common exit from marriage in later life, divorce to people over 50 is also on the rise. Despite increasingly complex marital biographies of older adults, few researchers have examined differences between disruption pathways (i.e., one divorce, one widowhood, or multiple disruptions) and whether remarriage is associated with fewer costs of marital disruption. It is also unclear whether duration remarried or unmarried relates to better or worse health after different disruption pathways. Using the 1992{\textendash}2014 Health and Retirement Study, I investigate the associations of different disruption pathways, subsequent remarriage relative to being unmarried, and duration remarried or unmarried with older adults{\textquoteright} mental and physical health, contact with children, and ambivalence toward children. I also account for gender differences as the health and parent-child ties of men and women often differ in later life. This dissertation underscores the need to pay attention to older people with multiple disruptions, as they are often disadvantaged in health and parent-child relationships relative to older adults with one divorce or widowhood. The findings regarding the role of remarriage for each well-being outcome are mixed. Remarriage is beneficial for the mental health of men relative to being unmarried after any type of disruption, and for the physical health of divorced women. Although remarriage relates to more frequent parent-child contact for divorced men, remarriage relates to less contact among women after one widowhood or multiple disruptions. Remarriage also links to greater ambivalence among men after multiple disruptions. Duration also matters, but not uniformly across outcomes. Remarried men after multiple disruptions have worse mental health with more years remarried men after one divorce, indicating that duration remarried after multiple disruptions links to poorer mental health than duration remarried after one divorce. Although men with multiple disruptions have less contact with children than widowed men, additional years remarried yield more contact for men with multiple disruptions than for men with one widowhood. Moreover, women who remarry after widowhood have less contact with children than their unmarried counterparts, but each year remarried after widowhood is associated with more contact, suggesting these remarried women rebuild ties with children over time. In sum, my dissertation highlights the utility of employing different disruption pathways, subsequent remarriage, and duration remarried or unmarried to capture increasing complexity of marital biographies among older adults and to clarify its association with multiple dimensions of well-being.}, keywords = {0351:Gerontology, 0493:Aging, 0626:Sociology, 0628:Individual \& family studies, 0938:Demography, Aging, Demography, Families, Gerontology, Health and environmental sciences, Individual \& family studies, Marital disruption, Marital duration, Older Adults, Remarriage, Social Sciences, Sociology}, isbn = {9780438275652}, url = {https://etd.ohiolink.edu/pg_10?::NO:10:P10_ETD_SUBID:167588}, author = {Anna M Hammersmith} } @article {9749, title = {Means Testing Federal Health Entitlement Benefits}, journal = {Tax Policy and the Economy}, volume = {32}, year = {2018}, month = {Jan-05-2018}, pages = {173 - 210}, abstract = {Recent federal legislation has linked the price paid for health insurance benefits to current income. Under the Patient Protection and Affordable Care Act of 2010, individuals and families with income as high as 400\% of the federal poverty level are eligible for premium tax credits that limit their health insurance premiums to under 10\% of their income. Under the Medicare Modernization Act of 2003, higher-income beneficiaries face income-related premiums over three times the standard premium for Part B coverage. For workers at or near retirement age, means testing based on current income provides an incentive for early retirement, dissaving, and income manipulation, raising concerns about the efficiency of such means testing. Further, current income is subject to short-term fluctuations, making it a noisy predictor of ability to pay. Using the Health and Retirement Study and linked Social Security earnings histories, this paper introduces a measure of lifetime income that compares favorably to current income as a basis for means testing. It offers less short-term variation in premiums while improving incentives for preretirement work and saving.}, keywords = {Affordable Care Act, Health Insurance, Income, Medicare, Poverty, Social Security linkage}, issn = {0892-8649}, doi = {10.3386/w23990}, author = {Andrew A. Samwick} } @article {9606, title = {Measuring Cognition in a Multi-mode Context}, year = {2018}, month = {05-2018}, pages = {1-48}, institution = {Survey Research Center, Institute for Social Research, University of Michigan}, address = {Ann Arbor, MI}, keywords = {Cognitive Ability, Mode effects, Survey Methodology}, author = {McClain, Colleen A. and Mary Beth Ofstedal and Mick P. Couper} } @article {9855, title = {Measuring Sarcopenia Severity in Older Adults and the Value of Effective Interventions}, journal = {The journal of nutrition, health \& aging}, year = {2018}, month = {Jun-09-2019}, abstract = {Objectives: Little is known about the severity and long-term health and economic consequences of sarcopenia. We developed a sarcopenia index to measure severity in older Americans and estimated the long-term societal benefits generated by effective interventions to mitigate severity. Design: Using a micro-simulation model, we quantified the potential societal value generated in the US in 2010{\textendash}2040 by reductions in sarcopenia severity in older adults. All analyses were performed in Stata and SAS. Setting \& Participants: Secondary data from the National Health and Nutrition Examination Survey (NHANES) (N = 1634) and Health and Retirement Study (HRS) (N = 952) were used to develop a sarcopenia severity index in older adults. Measurements: Multitrait multi-method and factor analyses were used to validate and calibrate the sarcopenia severity index, which was modeled as a function of gait speed, walking without an assistive device, and moderate physical activity. Results: In representative elderly populations, reducing sarcopenia severity by improving gait speed by 0.1 m/s in those with gait speed under 0.8 m/s generated a cumulative benefit of $65B by 2040 (2015 dollars). Improving walking ability in those with walking difficulty generated cumulative social benefit of $787B by 2040. Conclusions: Reducing sarcopenia severity would generate significant health and economic benefits to society{\textemdash} almost $800B in the most optimistic scenarios. {\textcopyright} 2018, The Author(s). }, keywords = {Economics, health, Physical activity, Sacropenia}, issn = {1279-7707}, doi = {10.1007/s12603-018-1104-7}, url = {http://link.springer.com/10.1007/s12603-018-1104-7http://link.springer.com/content/pdf/10.1007/s12603-018-1104-7.pdf}, author = {MacEwan, Joanna P. and Thomas M Gill and Johnson, K. and Doctor, J. and Jeffrey Sullivan and Shim, J. and Dana P Goldman} } @article {9840, title = {Medicaid Crowd-Out of Long-Term Care Insurance with Endogenous Medicaid Enrollment}, journal = {Journal of Human Capital}, volume = {12}, year = {2018}, month = {10/2018}, pages = {431-474}, abstract = {I examine the impact of policies lowering long-term care insurance (LTCI) premiums and Medicaid availability on the LTCI demand of unmarried elderly women living in four states--California, Florida, Texas, and Michigan--by developing and estimating a stochastic dynamic model of decisions on LTCI purchase, Medicaid enrollment, nursing home use, and asset holdings. The model parameters are estimated using the Health and Retirement Study from 1998 to 2004 by simulated maximum likelihood estimation. Counterfactual policy experiments based on the estimated parameters show that both price elasticity and Medicaid crowd-out of LTCI demand are small for the population studied.}, keywords = {Economics, Long-term care insurance, Medicare/Medicaid/Health Insurance, Policy}, issn = {1932-8575}, url = {http://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/2114680715?accountid=14667}, author = {Kim, Geena} } @article {9866, title = {Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries}, journal = {Journal of the American Geriatrics Society}, volume = {66}, year = {2018}, pages = {2298-2304}, abstract = {OBJECTIVES: To estimate the incremental direct medical care costs associated with first fracture observable in high-risk older adults. DESIGN: Retrospective analysis of claims and survey data over a 3-year period from the Health and Retirement Study (HRS), a nationally representative biennial study of individuals aged 50 and older. SETTING: United States. PARTICIPANTS: Participants were HRS respondents who consented to have their Medicare claims data linked to the HRS data, were aged 65 or older, had at least 1 risk factor for fracture observable in the data, and experienced a fracture between 1996 and 2008 (n = 689) and their propensity score{\textendash}matched controls (n = 689). MEASUREMENTS: Total Medicare, inpatient, outpatient, emergency department, physician office visit, and prescription drug care expenditures were primary outcomes. Two-staged generalized linear models were estimated using a difference-in-differences model. RESULTS: Fracture cases{\textquoteright} total Medicare expenditures increased by $13,929 (95\% confidence interval (CI)=$11,920{\textendash}15,938, p <.001) more than those of matched controls from the year before the index or fracture date to 1 year after the index date. Inpatient expenditures of $12,751 (95\% CI=$10,790{\textendash}14,7111, p <.001) more for fracture cases than comparison cases primarily drove this increase. Two and 3 years after fracture, there were no significant differences in growth in expenditures between the two groups. Results did not vary according to whether the fracture was at the hip or other site. CONCLUSION: Fractures impose a significant economic burden, especially in the first year after the fracture, in Medicare beneficiaries with at least 1 risk factor for fracture. Our sample was limited to community-dwelling individuals, and we are unable to control for fracture history before the study period. Costs may be greater for those in skilled nursing and similar facilities and for those who have had a previous fracture.}, keywords = {Medicare linkage, Medicare/Medicaid/Health Insurance, Risk Factors}, doi = {10.1111/jgs.15585}, url = {http://doi.wiley.com/10.1111/jgs.15585http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15585/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111\%2Fjgs.15585}, author = {Kandice Kapinos and Fischer, Shira H. and Mulcahy, Andrew and Hayden, Orla and Barron, Richard} } @article {8825, title = {Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States.}, journal = {Int J Health Serv}, volume = {48}, year = {2018}, month = {2018 01}, pages = {42-56}, abstract = {

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004-2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005-2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults{\textquoteright} overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

}, keywords = {Aged, Health Services for the Aged, Humans, Medicare Part D, United States}, issn = {1541-4469}, doi = {10.1177/0020731416676226}, url = {http://joh.sagepub.com/lookup/doi/10.1177/0020731416676226}, author = {Chen, Cheng-Chia and Hsien-Chang Lin and Seo, Dong-Chul} } @article {https://doi.org/10.1002/hec.3579, title = {Mental health and retirement savings: Confounding issues with compounding interest}, journal = {Health Economics}, volume = {27}, year = {2018}, pages = {404-425}, abstract = {Summary The questionable ability of the U.S. pension system to provide for the growing elderly population combined with the rising number of people affected by depression and other mental health issues magnifies the need to understand how these household characteristics affect retirement. Mental health problems have a large and significant negative effect on retirement savings. Specifically, psychological distress is associated with decreasing the probability of holding retirement accounts by as much as 24 percentage points and decreasing retirement savings as a share of financial assets by as much as 67 percentage points. The magnitude of these effects underscores the importance of employer management policy and government regulation of these accounts to help ensure households have adequate retirement savings.}, keywords = {depression, household finance, Mental Health, retirement savings, Social Security}, doi = {https://doi.org/10.1002/hec.3579}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3579}, author = {Bogan, Vicki L. and Fertig, Angela R.} } @article {9268, title = {The Mental Health Benefits of Acquiring a Home in Older Age: A Fixed-Effects Analysis of Older Americans}, journal = {American Journal of Epidemiology}, volume = {187}, year = {2018}, pages = {465{\textendash}473}, abstract = {Homeownership is consistently associated with better mental health, but whether becoming a homeowner in later in life has positive psychological benefits has not been examined. We assessed whether acquiring a home after 50 is associated with depression in a representative sample of older Americans. We used individual fixed-effects models based on data from 20,524 respondents aged >=50 from the Health and Retirement Study and interviewed biannually between 1993 and 2010. Depressive symptoms were measured using the 8-item Centre for Epidemiologic Studies Depression scale. Controlling for confounders, becoming a homeowner in later life predicted a decline in depressive symptoms in the same year (β = -0.0768, 95\% CI [confidence interval]: -0.152, -0.007). The association remained significant after two years (β = -0.0556, 95\% CI: -0.134 to -0.001) but weakened afterwards. Buying a home for reasons associated with positive characteristics of the new house or neighborhood drove this association (β = -0.426, 95\% CI: -0.786, -0.066), while acquiring a home for reasons associated with characteristics of the previous home or neighbourhood, the desire to be closer to relatives, downsizing or upsizing did not predict mental health improvements. Findings suggest that there are small but significant benefits for mental health associated with acquiring a home in older age.}, keywords = {Consumption and Savings, Housing, Mental Health, Retirement Planning and Satisfaction}, issn = {0002-9262}, doi = {10.1093/aje/kwx278}, url = {http://academic.oup.com/aje/article/doi/10.1093/aje/kwx278/4080981/The-Mental-Health-Benefits-of-Acquiring-a-Home-inhttp://academic.oup.com/aje/article-pdf/doi/10.1093/aje/kwx278/19501585/kwx278.pdf}, author = {Courtin, Emilie and Jennifer B Dowd and Mauricio Avendano} } @article {9806, title = {Meta-analysis of genome-wide association studies for height and body mass index in \~{}700000 individuals of European ancestry.}, journal = {Human Molecular Genetics}, volume = {27}, year = {2018}, pages = {3641-3649}, abstract = {Recent genome-wide association studies (GWAS) of height and body mass index (BMI) in \~{}250000 European participants have led to the discovery of \~{}700 and \~{}100 nearly independent single nucleotide polymorphisms (SNPs) associated with these traits, respectively. Here we combine summary statistics from those two studies with GWAS of height and BMI performed in \~{}450000 UK Biobank participants of European ancestry. Overall, our combined GWAS meta-analysis reaches N~\~{}700000 individuals and substantially increases the number of GWAS signals associated with these traits. We identified 3290 and 941 near-independent SNPs associated with height and BMI, respectively (at a revised genome-wide significance threshold of P~<~1~{\texttimes}~10-8), including 1185 height-associated SNPs and 751 BMI-associated SNPs located within loci not previously identified by these two GWAS. The near-independent genome-wide significant SNPs explain \~{}24.6\% of the variance of height and \~{}6.0\% of the variance of BMI in an independent sample from the Health and Retirement Study (HRS). Correlations between polygenic scores based upon these SNPs with actual height and BMI in HRS participants were \~{}0.44 and \~{}0.22, respectively. From analyses of integrating GWAS and expression quantitative trait loci (eQTL) data by summary-data-based Mendelian randomization, we identified an enrichment of eQTLs among lead height and BMI signals, prioritizing 610 and 138 genes, respectively. Our study demonstrates that, as previously predicted, increasing GWAS sample sizes continues to deliver, by the discovery of new loci, increasing prediction accuracy and providing additional data to achieve deeper insight into complex trait biology. All summary statistics are made available for follow-up studies.}, keywords = {BMI, Genetics, GWAS, Height}, issn = {1460-2083}, doi = {10.1093/hmg/ddy271}, author = {Yengo, Loic and Sidorenko, Julia and Kathryn E Kemper and Zheng, Zhili and Andrew R Wood and Michael N Weedon and Timothy M Frayling and Joel N Hirschhron and Yang, Jian and Peter M Visscher} } @article {9988, title = {Meta-analysis of genome-wide association studies for height and body mass index in \~{}700000 individuals of European ancestry}, journal = {Human Molecular Genetics}, volume = {27}, year = {2018}, pages = {3641-3649}, abstract = {Recent genome-wide association studies (GWAS) of height and body mass index (BMI) in similar to 250000 European participants have led to the discovery of similar to 700 and similar to 100 nearly independent single nucleotide polymorphisms (SNPs) associated with these traits, respectively. Here we combine summary statistics from those two studies with GWAS of height and BMI performed in similar to 450000 UK Biobank participants of European ancestry. Overall, our combined GWAS meta-analysis reaches N similar to 700000 individuals and substantially increases the number of GWAS signals associated with these traits. We identified 3290 and 941 near-independent SNPs associated with height and BMI, respectively (at a revised genome-wide significance threshold of P < 1 x 10(-8)), including 1185 height-associated SNPs and 751 BMI-associated SNPs located within loci not previously identified by these two GWAS. The near-independent genome-wide significant SNPs explain similar to 24.6\% of the variance of height and similar to 6.0\% of the variance of BMI in an independent sample from the Health and Retirement Study (HRS). Correlations between polygenic scores based upon these SNPs with actual height and BMI in HRS participants were similar to 0.44 and similar to 0.22, respectively. From analyses of integrating GWAS and expression quantitative trait loci (eQTL) data by summary-data-based Mendelian randomization, we identified an enrichment of eQTLs among lead height and BMI signals, prioritizing 610 and 138 genes, respectively. Our study demonstrates that, as previously predicted, increasing GWAS sample sizes continues to deliver, by the discovery of new loci, increasing prediction accuracy and providing additional data to achieve deeper insight into complex trait biology. All summary statistics are made available for follow-up studies.}, keywords = {BMI, Genetics, GWAS, Height}, issn = {0964-6906}, doi = {10.1093/hmg/ddy271}, author = {Yengo, Loic and Sidorenko, Julia and Kathryn E Kemper and Zheng, Zhili and Andrew R Wood and Michael N Weedon and Timothy M Frayling and Joel N Hirschhron and Yang, Jian and Peter M Visscher} } @mastersthesis {10261, title = {Methods for Improving Efficiency of Planned Missing Data Designs}, volume = {PhD}, year = {2018}, month = {06/2018}, pages = {110}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {Any survey specifically constructed so that at least some variables are unobserved on a subset of participants is a planned missing data design, where missing data represent an intentional feature of the study. Use of planned missing data designs can potentially reduce costs, improve data quality, and reduce unplanned missing data, and advancements in missing data methodology and multiple imputation software make planned missing data designs more attractive than before. Two commonly used planned missing data designs are two-phase sampling and split questionnaire design. Two-phase sampling is used to improve the efficiency of an estimate for a single outcome that is costly to measure, while the split questionnaire design is primarily used to reduce survey length. First, we propose new methods for selecting our second phase sample in two-phase surveys to reduce the variance of our estimate. When our outcome variable is continuous, we can use the data collected in Phase I for selecting our Phase II sample in order to increase the precision of the estimates. For other instances, we propose an adaptive sampling method to select Phase II samples in order to improve estimation of the quantity of interest. Next, we examine the performance of several design allocations for implementing a split questionnaire survey in a longitudinal study. While many papers examined the administration of split questionnaire designs in cross-sectional studies, research in applying these methods to longitudinal studies has been limited. For our project, we focus on the commonly used 3-form design and propose several methods to administer the 3-form split questionnaire in a longitudinal study. Using simulations and data from the Health and Retirement Study, we compare the performance of each proposed design under several correlation structures. Finally, we propose a method for improving variable allocation in split questionnaire designs. We establish a criterion that allows us to determine which variable allocations minimize the loss of information due to missing data. We use the Kullback-Leibler divergence between the posterior distribution of the parameters with missing data and the posterior distribution without missing data to locate optimal designs. After establishing a criterion for comparing designs, we propose a search algorithm to find optimal variable allocations, as it would be difficult to enumerate all possible designs as the number of variables grows.}, keywords = {Data designs, planned missing data, split questionnaire design, two-phase sampling}, url = {https://deepblue.lib.umich.edu/handle/2027.42/144155?show=full}, author = {Imbriano, Paul} } @article {9500, title = {MHC-Dependent Mate Selection within 872 Spousal Pairs of European Ancestry from the Health and Retirement Study}, journal = {Genes}, volume = {9}, year = {2018}, pages = {53}, abstract = {Disassortative mating refers to the phenomenon in which individuals with dissimilar genotypes and/or phenotypes mate with one another more frequently than would be expected by chance. Although the existence of disassortative mating is well established in plant and animal species, the only documented example of negative assortment in humans involves dissimilarity at the major histocompatibility complex (MHC) locus. Previous studies investigating mating patterns at the MHC have been hampered by limited sample size and contradictory findings. Inspired by the sparse and conflicting evidence, we investigated the role that the MHC region played in human mate selection using genome-wide association data from 872 European American spouses from the Health and Retirement Study (HRS). First, we treated the MHC region as a whole, and investigated genomic similarity between spouses using three levels of genomic variation: single-nucleotide polymorphisms (SNPs), classical human leukocyte antigen (HLA) alleles (both four-digit and two-digit classifications), and amino acid polymorphisms. The extent of MHC dissimilarity between spouses was assessed using a permutation approach. Second, we investigated fine scale mating patterns by testing for deviations from random mating at individual SNPs, HLA genes, and amino acids in HLA molecules. Third, we assessed how extreme the spousal relatedness at the MHC region was compared to the rest of the genome, to distinguish the MHC-specific effects from genome-wide effects. We show that neither the MHC region, nor any single SNPs, classic HLA alleles, or amino acid polymorphisms within the MHC region, were significantly dissimilar between spouses relative to non-spouse pairs. However, dissimilarity in the MHC region was extreme relative to the rest of genome for both spousal and non-spouse pairs. Despite the long-standing controversy, our analyses did not support a significant role of MHC dissimilarity in human mate choice.}, keywords = {Ancestry, Disassortative mating, Genetics}, doi = {10.3390/genes9010053}, url = {http://www.mdpi.com/2073-4425/9/1/53http://www.mdpi.com/2073-4425/9/1/53/pdf}, author = {Qiao, Zhen and Joseph Powell} } @article {9552, title = {Military Service, Childhood Socio-Economic Status, and Late-Life Lung Function: Korean War Era Military Service Associated with Smaller Disparities.}, journal = {Military Medicine}, year = {2018}, abstract = {Background: Military service is associated with smoking initiation, but U.S. veterans are also eligible for special social, financial, and healthcare benefits, which are associated with smoking cessation. A key public health question is how these offsetting pathways affect health disparities; we assessed the net effects of military service on later life pulmonary function among Korean War era veterans by childhood socio-economic status (cSES). Methods: Data came from U.S.-born male Korean War era veteran (service: 1950-1954) and non-veteran participants in the observational U.S. Health and Retirement Study who were alive in 2010 (average age = 78). Veterans (N = 203) and non-veterans (N = 195) were exactly matched using coarsened exact matching on birth year, race, coarsened height, birthplace, childhood health, and parental and childhood smoking. Results were evaluated by cSES (defined as maternal education <8 yr/unknown or >=8 yr), in predicting lung function, as assessed by peak expiratory flow (PEF), measured in 2008 or 2010.

Findings: While there was little overall association between veterans and PEF [β = 12.8 L/min; 95\% confidence interval (CI): (-12.1, 37.7); p = 0.314; average non-veteran PEF = 379 L/min], low-cSES veterans had higher PEF than similar non-veterans [β = 81.9 L/min; 95\% CI: (25.2, 138.5); p = 0.005], resulting in smaller socio-economic disparities among veterans compared to non-veterans [difference in disparities: β = -85.0 L/min; 95\% CI: (-147.9, -22.2); p = 0.008].

Discussion: Korean War era military service appears to disproportionately benefit low-cSES veteran lung functioning, resulting in smaller socio-economic disparities among veterans compared with non-veterans.

}, keywords = {Childhood, Lung Volume Measurements, Socioeconomic factors, Veterans}, issn = {1930-613X}, doi = {10.1093/milmed/usx196}, author = {Anusha M Vable and Mathew V Kiang and Basu, Sanjay and Kara E Rudolph and Ichiro Kawachi and S. V. Subramanian and M. Maria Glymour} } @article {9631, title = {Mind \& Matter: The Deadly Risk of Losing your Financial Nest Egg -- WSJ}, journal = {Dow Jones Institutional News}, year = {2018}, month = {May 12, 2018}, chapter = {Business and Economics}, address = {New York City, NY}, abstract = { }, keywords = {Finances, Financial burden, Financial Health, Mortality, Stress}, url = {http://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/2037885625?accountid=14667}, author = {Susan Pinker} } @article {9907, title = {The minimum wage and incentives for full-time work under the Social Security retirement earnings test}, number = {CRR WP 2018-13}, year = {2018}, month = {10/2018}, pages = {1-39}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {This paper examined how the earnings test affects the hours and employment of men who claim early benefits. It uses 1982-2016 data from the Current Population Survey and 1992-2014 data from the Health and Retirement Study. Critical components of the analysis include the idea that for any fixed earnings-test threshold amount, an increase in the hourly wage at which a beneficiary can work reduces the number of hours needed annually to hit the threshold. This feature of the test and substantial state-by-calendar year variation from increases in the minimum wage, which lower the threshold level of hours at which the earnings test binds, are used to identify the impact of the test on labor supply on the intensive and extensive margins for men who claim early. }, keywords = {Gender Differences, Policy, Retirement Planning and Satisfaction, Social Security}, url = {http://crr.bc.edu/wp-content/uploads/2018/10/wp_2018-13.pdf}, author = {Gary V. Engelhardt} } @article {doi:10.1111/1475-6773.12640, title = {Modeling Health Care Spending Growth of Older Adults}, journal = {Health Services Research}, volume = {53}, year = {2018}, pages = {138-155}, abstract = {Objective To forecast out-of-pocket health care spending among older adults. Long-term forecasts allow policy makers to explore potential impacts of policy scenarios, but existing microsimulations do not incorporate details of supplemental insurance coverage and income effects on health care spending. Data Sources Dynamic microsimulation calibrated to survey and administrative data. Study Design We augment Urban Institute{\textquoteright}s Dynamic Simulation of Income Model (DYNASIM) with modules that incorporate demand responses and economic equilibria, with dynamics driven by exogenous technological change. A lengthy technical appendix provides details of the microsimulation model and economic assumptions for readers interested in applying these techniques. Principal Findings The model projects total out-of-pocket spending (point of care plus premiums) as a share of income for adults aged 65 and older. People with lower incomes and poor health fare worse, despite protections of Medicaid. Spending rises 40 percent from 2012 to 2035 (from 10 to 14 percent of income) for the median beneficiary, but it increases from 5 to 25 percent of income for low-income beneficiaries and from 23 to 29 percent for the near poor who are in fair/poor health. Conclusions Despite Medicare coverage, near-poor seniors will face out-of-pocket spending that would render them, in practical terms, underinsured.}, keywords = {Health Care Costs, Health Insurance, Medicare Beneficiaries, simulations}, doi = {10.1111/1475-6773.12640}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12640}, author = {Hatfield, Laura A. and Melissa Favreault and McGuire, Thomas G. and M.E. Chernew} } @mastersthesis {10293, title = {Modeling Job-demand Conditional Dynamics in Physical and Cognitive Functioning on Changes in Older Workers{\textquoteright} Wellbeing over Time}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-07-22}, pages = {104}, school = {Saint Louis University}, type = {phd}, abstract = {Workforce aging presents organizations and researchers with the possibility that older workers will eventually retire, taking with them their accumulated skills and industry knowledge. Thus, it is important to understand the factors that promote the working individual{\textquoteright}s wellbeing across the lifespan to maintain their employability. Part of these efforts is the study of successful aging at work, which can be generally understood as achieving and maintaining positive outcomes across one{\textquoteright}s work lifespan. Successful aging theories emphasize the importance of understanding the person and contextual factors that influence wellbeing across the lifespan. Indeed, person factors such as health and fluid intelligence both indicate decrements in older individuals that likely result in decreases in wellbeing over time. The Job-Demands Resources (JD-R) model provides insight into how contextual, work-related factors like levels of job demands are also likely to have a negative, main effect on wellbeing over time. Moreover, older workers likely differ in the extent to which changes in health and cognition impact wellbeing, and job demands likely serve as a moderator of these relationships. The current study draws from the JD-R model and lifespan theories to understand the extent to which job demands exacerbate the effects that changes in health and fluid intelligence have on changes in wellbeing in a sample of older workers from the Health and Retirement Study.}, keywords = {0624:Occupational psychology, Aging, Fluid intelligence, health, Health and Retirement Study, Job demands, Occupational psychology, Psychology, Wellbeing}, isbn = {9780438127869}, url = {https://search.proquest.com/docview/2070621126?pq-origsite=gscholar}, author = {Toomey,Eileen C.} } @article {9254, title = {Moderate alcohol use and apolipoprotein E-4 (ApoE-4): Independent effects on cognitive outcomes in later life.}, journal = {Journal of Clinical and Experimental Neuropsychology}, volume = {40}, year = {2018}, pages = {326-337}, abstract = {

OBJECTIVES: Substantive past research suggests that moderate alcohol use confers beneficial health outcomes. The study of moderate alcohol use and cognition has produced variable findings. The primary goal was to examine the relationship between alcohol use and cognitive aging over time (Experiment 1), in a demographically representative, longitudinal survey of older adults. Experiment 2 examined the hypothesis that apolipoprotein E-4 (ApoE-4) would moderate the relationship between moderate drinking and performance on cognitive domains.

METHOD: The sample was drawn from the Aging, Demographics, and Memory Study (ADAMS) supplement of the Health and Retirement Study (HRS) and included 856 participants over age 65 in 2001. Follow-up data were from 2002, 2006, and 2008. Alcohol use was measured via self-report. Control variables included gender, age, race, number of years of education, medical burden (total number of medical diseases), and marital status.

RESULTS: Results of Experiment 1 indicated that moderate alcohol use was significantly associated with better baseline functioning across cognitive measures (p~<=~.05), but had no significant effect on rate of change over time across cognitive domains. Results of Experiment 2 indicated that while ApoE-4 carriage did not moderate the relationship between alcohol use and cognitive performance, generally, both ApoE-4 and moderate alcohol use were significant predictors of cognitive performance.

CONCLUSIONS: Overall, findings from this study support past findings that moderate alcohol use is associated with better cognitive functioning among community-dwelling older adults, and these relative benefits appear to persist throughout later life. However, the role of individual differences on manifestation of benefit remain very poorly understood. Future research should further examine the respective roles of demographic differences associated with cognitive aging, genetic moderators, and the influence of social interaction.

}, keywords = {Alcohol Consumption, APoE4, Cognitive Ability}, issn = {1744-411X}, doi = {10.1080/13803395.2017.1343803}, author = {Herring, Danielle and Daniel Paulson} } @article {9440, title = {The Moderating Role of Employment Status and Gender on Relationships Between Psychological Age and Health: A Two-Wave Cross-Lagged Panel Analysis of Data From the Health and Retirement Study}, journal = {Work, Aging and Retirement}, volume = {4}, year = {2018}, pages = {79-95}, abstract = {In this study we explored the direction of over-time relationships between psychological age (PA) and 4 facets of health for older adults, with social comparison theory (SCT) and stereotype embodiment theory (SET) providing the rationale for competing causal orderings of these relationships. Expanding on recent longitudinal work (Petery, 2015; Spuling, Miche, Wurm, \& Wahl, 2013) we investigated whether over-time employment status (employed, transition to retired, retired), gender, and the interaction of employment status and gender moderate the nature of these relationships for older (over 50 years old) adults. We examined data on PA and indicators of general, functional, physical, and mental health from the Health and Retirement Study collected at 2 time points, 4 years apart. Hypothesis testing on the causal ordering of the 2 constructs and the proposed moderations were conducted, with each health facet examined independently using cross-lagged panel path analysis and multigroup analysis of employment by gender subgroups. Effect sizes for relationships between PA and health were small in magnitude for all health facets and all employment status and gender subgroups. The apparent primary causal direction of relationships differed by health facet, with support provided for both Health > PA and PA > Health temporal orderings. Furthermore, with the exception of physical health, which exhibited consistent support for a Health -> PA relationship, the primary causal direction of the relationship between PA and health depended on both employment status and gender, jointly. These provide further evidence of the complexity of the health-PA relationship.}, keywords = {Employment and Labor Force, Gender Differences, Health Conditions and Status, Marriage, Subjective age}, issn = {2054-4642}, doi = {10.1093/workar/wax019}, url = {http://academic.oup.com/workar/article/4/1/79/4056158http://academic.oup.com/workar/article-pdf/4/1/79/23296319/wax019.pdf}, author = {Janet L. Barnes-Farrell and Petery, Gretchen A.}, editor = {Lindsay H Ryan} } @article {9844, title = {Mortality Risk, Insurance, and the Value of Life}, number = {2105077792}, year = {2018}, month = {09/2018}, institution = {National Bureau of Economic Research, Inc.}, address = {Cambridge, United States}, abstract = {We develop and apply a generalized framework for valuing health and longevity improvements that departs from conventional assumptions of full annuitization and deterministic mortality. In contrast to conventional theory, we find a given mortality improvement may be worth more, not less, to patients facing shorter lives. Using real-world data, we calculate that severe illness can increase the value of statistical life by over $1 million. This result reconciles an anomaly in the research on preferences for life-extension. Moreover, our framework can value the prevention of mortality and of illness. We calculate that treating illness is up to an order of magnitude more valuable to consumers than prevention, even when both extend life equally. This asymmetry helps explain low observed investment in preventive care. Finally, we show that retirement annuities boost aggregate demand for life-extension. For instance, Social Security adds $11.5 trillion (10.5 percent) to the value of post-1940 longevity gains. }, keywords = {Insurance, Mortality, Preventative Care, Risk Factors, Social Security}, issn = {08982937}, url = {https://search.proquest.com/docview/2105077792/9E9B46C457234F7APQ?accountid=14667}, author = {Daniel Bauer and Julian Reif} } @mastersthesis {10252, title = {Mortgage debt and retirement transition decisions.}, volume = {Doctor of Philosophy}, year = {2018}, month = {05/2019}, pages = {190}, school = {University of Missouri}, address = {Columbia, MO}, abstract = { In this study, a series of logit models for discrete time were employed to investigate the association between home mortgage debt and the retirement transition decisions of older homeowners. Retirement transitions under investigation were a) the transition from the workforce to full retirement and b) the transition from full-time work to the mutually exclusive competing risks of bridge employment and full retirement. With hypotheses informed by both the STREAM framework and results from previous studies, older homeowners with home mortgage debt were expected to exit the workforce later than those without home mortgage debt. Further, a negative relationship was expected between the loan-to-value ratio and the probability of exiting the workforce in a sample of only homeowners with home mortgage debt. Data were utilized from the 2006, 2008, 2010, 2012, and 2014 waves of the Health and Retirement Study. Results from this study revealed that, holding all else equal, older homeowners with home mortgage debt are more likely to delay their exit from the workforce. Further, the results indicate that older homeowners who are male, are college graduates, and are at the lower and upper ends of the net worth spectrum are more likely to delay their withdrawal from the workforce when they carry home mortgage debt. However, homeowners with this type of debt are not necessarily more likely to engage in bridge work between periods of full-time work and full retirement. Further, results revealed that the loan-to-value ratio was not a significant contributor to the retirement transition decisions of older homeowners with home mortgage debt. Because the presence of home mortgage debt was a factor in the retirement transition decisions of older homeowners, but the degree of leverage was not, the results from this study indicate that the psychological impact of mortgage debt might be more important in retirement transition decision-making among older homeowners than the financial impact of mortgage debt. Results from this study provide the foundation for understanding the association between home mortgage debt and the retirement transition decisions among older homeowners and should be of interest to American policymakers, financial planners and educators, business organizations, and other researchers.}, keywords = {Bridge Employment; Retirement Transitions; Mortgage Debt}, url = {https://krex.k-state.edu/dspace/handle/2097/39519?show=full}, author = {Anderson, Somer G.} } @article {9810, title = {Mother{\textquoteright}s education and late-life disparities in memory and dementia risk among US military veterans and non-veterans.}, journal = {Journal of Epidemiology and Community Health}, volume = {72}, year = {2018}, pages = {1162-1167}, abstract = {

BACKGROUND: Adverse childhood socioeconomic status (cSES) predicts higher late-life risk of memory loss and dementia. Veterans of U.S. wars are eligible for educational and economic benefits that may offset cSES disadvantage. We test whether cSES disparities in late-life memory and dementia are smaller among veterans than non-veterans.

METHODS: Data came from US-born men in the 1995-2014 biennial surveys of the Health and Retirement Study (n=7916 born 1928-1956, contributing n=38 381 cognitive assessments). Childhood SES was represented by maternal education. Memory and dementia risk were assessed with brief neuropsychological assessments and proxy reports. Military service (veteran/non-veteran) was evaluated as a modifier of the effect of maternal education on memory and dementia risk. We employed linear or logistic regression models to test whether military service modified the effect of maternal education on memory or dementia risk, adjusted for age, race, birthplace and childhood health.

RESULTS: Low maternal education was associated with worse memory than high maternal education (β = -0.07 SD, 95\% CI -0.08 to -0.05), while veterans had better memory than non-veterans (β = 0.03 SD, 95\% CI 0.02 to 0.04). In interaction analyses, maternal education disparities in memory were smaller among veterans than non-veterans (difference in disparities = 0.04 SD, 95\% CI 0.01 to 0.08, p = 0.006). Patterns were similar for dementia risk.

CONCLUSIONS: Disparities in memory by maternal education were smaller among veterans than non-veterans, suggesting military service and benefits partially offset the deleterious effects of low maternal education on late-life cognitive outcomes.

}, keywords = {Cognitive Ability, Dementia, Education, Memory, Veterans}, issn = {1470-2738}, doi = {10.1136/jech-2018-210771}, author = {Anusha M Vable and Chloe W Eng and Elizabeth R Mayeda and Basu, Sanjay and Jessica R Marden and Hamad, Rita and M. Maria Glymour} } @article {9158, title = {Multimorbidity and physical and cognitive function: performance of a new multimorbidity-weighted index.}, journal = {Journals of Gerontology Series A: Biological Sciences \& Medical Sciences}, volume = {73}, year = {2018}, pages = {225}, abstract = {

Background: Multimorbidity is an important health outcome but is difficult to quantify. We recently developed a multimorbidity-weighted index (MWI) and herein assess its performance in an independent nationally-representative cohort.

Methods: Health and Retirement Study (HRS) participants completed an interview on physician-diagnosed chronic conditions and physical functioning. We determined the relationship of chronic conditions on physical functioning and validated these weights with the original, independently-derived MWI. We then determined the association between MWI with physical functioning, grip strength, gait speed, basic and instrumental activities of daily living (ADL/IADL) limitations, and the modified Telephone Interview for Cognitive Status (TICS-m) in adjusted models.

Results: Among 20,509 adults, associations between chronic conditions and physical functioning varied several-fold. MWI values based on weightings in the HRS and original cohorts correlated strongly (Pearson{\textquoteright}s r=0.92) and had high classification agreement (Kappa statistic=0.80, p<0.0001). Participants in the highest vs. lowest MWI quartiles had weaker grip strength (-2.91 kg, 95\%CI: -3.51, -2.30), slower gait speed (-0.29 m/s, 95\%CI: -0.35, -0.23), more ADL (0.79, 95\%CI: 0.71, 0.87) and IADL (0.49, 95\%CI: 0.44, 0.55) limitations, and lower TICS-m (-0.59, 95\%CI: -0.77, -0.41) (all P<0.001). We observed monotonic graded relationships for all outcomes with increasing MWI quartiles.

Conclusion: A multimorbidity index weighted to physical functioning performed nearly identically in a nationally-representative cohort as it did in its development cohorts, confirming broad generalizability. MWI was strongly associated with subjective and objective physical and cognitive performance. Thus, MWI serves as a valid patient-centered measure of multimorbidity, an important construct in research and clinical practice.

}, keywords = {Cognition \& Reasoning, Comorbidity}, issn = {1758-535X}, doi = {10.1093/gerona/glx114}, author = {Melissa Y Wei and Mohammed U Kabeto and Kenneth M. Langa and Kenneth J Mukamal} } @mastersthesis {10434, title = {A multistage model for prediction of sequence of events.}, volume = {PhD}, year = {2018}, pages = {131}, school = {University of Dhaka}, address = {Dhaka, Bangladesh}, abstract = {This dissertation investigates the existing methods for risk prediction of a sequence of events from longitudinal studies for the continuous time data, in addition to, proposing a simple alternative method. These outcomes (events) can change status at different followups that may produce a large number of paths or trajectories. Also, regressive models for multinomial and ordinal outcomes for discrete time data to obtain a joint model for a sequence of events for risk prediction is proposed. A key challenge is the simplification and generalization of the existing method for continuous time data for risk prediction for a large sequence of events at different stages. Most of the models are proposed to solve the problem arising from the progression of specific diseases process. The proposed alternative multistage procedure simplifies the transition models for risk prediction of a sequence of events for continuous time data. This framework provides the estimates for each stage in the process conditionally and the conditional estimates are linked based on marginal and conditional models to obtain the joint probabilities needed for predicting the status of disease based on the potential risk factors. The proposed method of prediction is a new development using a series of events in conditional setting arising from the beginning to the endpoint. Also, a general form of integral is developed for predicting the joint probability of a sequence of events from longitudinal studies for (i) different types of trajectories and (ii) any segment of a trajectory along with the generalization to any number of stages which is a new development. In follow-up or panel studies, multinomial outcomes may occur within an interval where transition times are not exactly known, or the time of the event is itself discrete. Available models for risk prediction for multinomial outcomes with specified risk factors are only for a single response and are not extended for prediction of a sequence of events for discrete time data for different stages. The regressive models for multinomial outcomes are proposed and then a modeling framework is developed to predict the joint probabilities for a sequence of events. The proposed models link the marginal and sequence of conditional models to provide the joint model needed for predicting the probability of a trajectory based on specified covariate patterns. The marginal model uses the outcome variable at the baseline and the models at the subsequent follow-ups provide the estimates of the parameters of the conditional models. The major improvement of the proposed framework is that one needs to fit a significantly smaller number of models compared to the conditional models such as Markov models. The independence of the repeated outcomes will allow using simpler models, and the goodness-of-fit of the joint model is required for model performance. The proposed goodness-of-fit test for joint model is obtained by linking marginal and conditional models. The test for independence uses marginal models for each repeated outcomes. The simulation study and application using real data prove the usefulness and illustrate the performance of these tests. For ordinal outcomes from longitudinal studies regressive proportional odds model, and in the case of violation of proportional odds assumption regressive partial proportional odds model are proposed. Then a framework is developed to predict joint probabilities for a sequence of ordinal outcomes. The major improvement of the proposed model is that only one model is required for each repeated outcome compared to the sequence of conditional models such as Markov models. Results from these two models are compared to that from the proposed regressive multinomial logistic model. Also, test for goodnessof-fit and test for independence are shown. The proposed models provide the estimates for each stage in the process conditionally, and the joint model can be obtained for any order to predict the risk of a sequence of events. Proposed regressive partial proportional odds model and regressive multinomial models showed better performance compared to the regressive proportional odds model when proportional odds assumption is violated. Simulation studies showed satisfactory performance of the proposed regressive models for ordinal outcomes. All the proposed model and the risk prediction framework for both continuous and discrete time data are a new development. The major improvement of the proposed model is that it reduces the over-parameterization. One can easily add interaction terms among previous outcomes, and predictors in the proposed framework which may provide a better understanding of the underlying process and the relationships between outcomes and risk factors. Using the developed framework, modeling and risk prediction for a sequence of events can be performed in many fields of studies such as epidemiology, public health, survival analysis, genetics, reliability, environmental studies, etc. This model would be very useful for analyzing big data. One can use the existing software for model fitting, and risk prediction of a sequence of events.}, keywords = {model}, url = {http://repository.library.du.ac.bd/xmlui/handle/123456789/1290}, author = {Rafiqul I Chowdhury} } @article {9238, title = {Muscle weakness and physical disability in older Americans: Longitudinal findings from the U.S. Health and Retirement Study}, journal = {The Journal of Nutrition, Health \& Aging}, volume = {22}, year = {2018}, month = {04/2018}, abstract = {Importance: Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. Objective: To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. Design: We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. Setting: General community, nationally representative sample of older Americans. Participants: Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91\% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. Results: In this nationally representative sample (n= 8,725), 44\% of individuals were classified as weak at baseline. At follow-up, 55\% remained independent with no change in their ADL status, 11\% had an onset of disability and 4\% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54\% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95\% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95\% CI= 2.15, 2.16, p<.0001). Conclusions: This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes.}, keywords = {Activities of Daily Living, Disabilities, Muscle Weakness}, issn = {1279-7707}, doi = {10.1007/s12603-017-0951-y}, url = {http://link.springer.com/10.1007/s12603-017-0951-yhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/article/10.1007/s12603-017-0951-y/fulltext.html}, author = {Kate A Duchowny and Philippa J Clarke and Mark D Peterson} } @mastersthesis {10269, title = {Muscle Weakness in Older Americans: Examining the Measurement, Health Outcomes and Life Course Determinants.}, volume = {PhD}, year = {2018}, month = {10/2018}, pages = {170}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {Muscle weakness, as measured by hand grip strength, has been shown to be an important indicator of future disability, chronic disease status and early mortality. While muscle weakness is considered an important prognostic indicator, how best to measure weakness, the long term health outcomes associated with muscle weakness across different sub-populations and the life course determinants remain poorly understood. Indeed, there is little agreement on how best to measure muscle weakness across different groups and how to screen for muscle weakness in order to prevent disability and premature mortality. We begin by first deriving cutpoints for muscle weakness in a nationally representative sample of older adults from the Health and Retirement Study. After using Classification and Regression Tree (CART) models to identify cutpoints, we found that fifty-five percent of men (max grip strength < 39kg) and 47\% of women (< 22kg) were classified as weak. Higher cutpoints were identified for Black males (< 40kg) and females (< 31kg), and the prevalence of weakness (57\% and 88\%, respectively), was higher compared to Whites. As an extension to these results, we examine the validity of these cutpoints in a longitudinal setting to determine whether muscle weakness is associated with disability dynamics and premature mortality. We found that clinical muscle weakness, as identified by sex/race specific population-derived cutpoints from Aim 1, is strongly associated with the onset, progression and persistence of physical disability status. The odds of experiencing an onset of ADL disability were 54\% higher among weak individuals compared those who were not weak at baseline. We also found that weak individuals had a steeper decline in their survival trajectory, compared to non-weak individuals. Specifically, weak individuals were over 50\% more likely to die earlier than non-weak individuals. Lastly, the third aim of this dissertation seeks to quantify and understand whether experiencing stressful and traumatic events across the life course influences trajectories of grip strength in later life. We found that life course trauma and stress experienced during emerging/early adulthood was associated with both mean grip strength at age 50 and trajectories of grip strength over time. Among Black men, stress and trauma experienced during emerging/early adulthood was not only related to higher mean grip strength at age 50, but also associated with steeper declines as individuals aged over time compare to White men. Among Black women, traumatic events during emerging/early adulthood were associated with lower mean grip strength at age 50. Taken together, the results of this dissertation chart new territory in its overall goal to improve the measurement of muscle health across the diverse, older adult population and in identifying those most at risk for future disability and premature mortality. This dissertation also demonstrates the importance of investigating how life course social exposures drive differential vulnerability to muscle weakness among older adults. The results of this dissertation can be used to inform clinical practice in screening adults for muscle weakness while also seeking to shift the distribution of muscle weakness at the population level in order to intervene among those who are most vulnerable.}, keywords = {health outcomes, Muscle Weakness, Older Adults, social epidemiology}, url = {https://deepblue.lib.umich.edu/handle/2027.42/145837}, author = {Kate A Duchowny} } @article {9575, title = {The myth of outliving your retirement savings}, journal = {Reuters}, volume = {2018}, year = {2018}, publisher = {Reuters}, address = {Canary Wharf}, keywords = {Financial Health, Retirement Planning and Satisfaction}, url = {https://www.reuters.com/article/us-column-marksjarvis-savingsmyth/the-myth-of-outliving-your-retirement-savings-idUSKBN1I3293}, author = {Gail MarksJarvis} } @article {9892, title = {The Myth of Steady Retirement Spending, and Why Reality May Cost Less}, journal = {The New York Times}, year = {2018}, month = {11/29/2018}, chapter = {Retiring}, address = {New York City}, keywords = {Finances, News, Retirement Planning and Satisfaction}, url = {https://www.nytimes.com/2018/11/29/business/retirement/retirement-spending-calculators.html}, author = {Peter Finch} } @article {9351, title = {A machine-learning heuristic to improve gene score prediction of polygenic traits.}, journal = {Scientific Reports}, volume = {7}, year = {2017}, pages = {12665}, abstract = {Machine-learning techniques have helped solve a broad range of prediction problems, yet are not widely used to build polygenic risk scores for the prediction of complex traits. We propose a novel heuristic based on machine-learning techniques (GraBLD) to boost the predictive performance of polygenic risk scores. Gradient boosted regression trees were first used to optimize the weights of SNPs included in the score, followed by a novel regional adjustment for linkage disequilibrium. A calibration set with sample size of ~200 individuals was sufficient for optimal performance. GraBLD yielded prediction R (2) of 0.239 and 0.082 using GIANT summary association statistics for height and BMI in the UK Biobank study (N = 130 K; 1.98 M SNPs), explaining 46.9\% and 32.7\% of the overall polygenic variance, respectively. For diabetes status, the area under the receiver operating characteristic curve was 0.602 in the UK Biobank study using summary-level association statistics from the DIAGRAM consortium. GraBLD outperformed other polygenic score heuristics for the prediction of height (p < 2.2 {\texttimes} 10(-16)) and BMI (p < 1.57 {\texttimes} 10(-4)), and was equivalent to LDpred for diabetes. Results were independently validated in the Health and Retirement Study (N = 8,292; 688,398 SNPs). Our report demonstrates the use of machine-learning techniques, coupled with summary-level data from large genome-wide meta-analyses to improve the prediction of polygenic traits.}, keywords = {Genetics, Machine learning, Meta-analyses, Validation}, issn = {2045-2322}, doi = {10.1038/s41598-017-13056-1}, author = {Pare, Guillaume and Mao, Shihong and Wei Q. Deng} } @article {8903, title = {Marital Biography, Social Security Receipt, and Poverty.}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {2017 Jan}, pages = {86-110}, abstract = {

Increasingly, older adults are unmarried, which could mean a larger share is at risk of economic disadvantage. Using data from the 2010 Health and Retirement Study, we chart the diverse range of marital biographies, capturing marital sequences and timing, of adults who are age eligible for Social Security and examine three indicators of economic well-being: Social Security receipt, Social Security benefit levels, and poverty status. Partnereds are disproportionately likely to receive Social Security and they enjoy relatively high Social Security benefits and very low poverty levels. Among singles, economic well-being varies by marital biography and gender. Gray divorced and never-married women face considerable economic insecurity. Their Social Security benefits are relatively low, and their poverty rates are quite high (over 25\%), indicating Social Security alone is not sufficient to prevent these women from falling into poverty. By comparison, gray widoweds are the most advantaged singles.

}, keywords = {Gender Differences, Marriage, Older Adults, Poverty, Social Security}, issn = {1552-7573}, doi = {10.1177/0164027516656139}, author = {Lin, I-Fen and Susan L. Brown and Anna M Hammersmith} } @article {9617, title = {Marriage-related Policies in an Estimated Life-cycle Model of Households{\textquoteright} Labor Supply and Savings for Two Cohorts}, number = {WP 2017-371}, year = {2017}, pages = {1-79}, institution = {Michigan Retirement Research Center}, address = {Ann Arbor, MI}, abstract = {In the United States, both taxes and old age Social Security benefits explicitly depend on one{\textquoteright}s marital status. We study the effects of eliminating these marriage-related provisions on the labor supply and savings of two different cohorts. To do so, we estimate a rich life-cycle model of couples and singles using the method of simulated moments (MSM) on the 1945 and 1955 birth-year cohorts. Our model matches well the life-cycle profiles of labor market participation, hours, and savings for married and single people and generates plausible elasticities of labor supply. We find that these marriage-related provisions reduce the participation of married women over their life cycle, the participation of married men after age 55, and the savings of couples. These effects are large for both the 1945 and 1955 cohorts, even though to start with the latter had much higher labor market participation of married women.}, keywords = {Labor force participation, Marriage, Models, Social Security}, url = {http://mrrc.isr.umich.edu/wp371/}, author = {Borella, Margherita and Mariacristina De Nardi and Yang, Fang} } @article {9013, title = {Medicare Expenditures Associated With Hospital and Emergency Department Use Among Beneficiaries With Dementia.}, journal = {Inquiry}, volume = {54}, year = {2017}, month = {2017 Jan}, pages = {46958017696757}, abstract = {Understanding expenditure patterns for hospital and emergency department (ED) use among individuals with dementia is crucial to controlling Medicare spending. We analyzed Health and Retirement Study data and Medicare claims, stratified by beneficiaries{\textquoteright} residence and proximity to death, to estimate Medicare expenditures for all-cause and potentially avoidable hospitalizations and ED visits. Analysis was limited to the Medicare fee-for-service population age 65 and older. Compared with people without dementia, community residents with dementia had higher average expenditures for hospital and ED services; nursing home residents with dementia had lower average expenditures for all-cause hospitalizations. Decedents with dementia had lower expenditures than those without dementia in the last year of life. Medicare expenditures for individuals with and without dementia vary by residential setting and proximity to death. Results highlight the importance of addressing the needs specific to the population with dementia. There are many initiatives to reduce hospital admissions, but few focus on people with dementia.}, keywords = {Dementia, Emergency services, Medicare linkage, Older Adults}, issn = {1945-7243}, doi = {10.1177/0046958017696757}, author = {Daras, Laura Coots and Feng, Zhanlian and Joshua M Wiener and Kaganova, Yevgeniya} } @article {9232, title = {The Mediterranean Diet Might Be the Secret to Living Longer {\textemdash} and Better}, journal = {Yahoo Health}, volume = {2017}, number = {08/04/2017}, year = {2017}, publisher = {Yahoo!}, address = {Sunnyvale, CA}, keywords = {Eating habits, Longevity, News}, url = {https://www.yahoo.com/beauty/mediterranean-diet-might-secret-living-longer-better-190825518.html}, author = {Korin Miller} } @article {9454, title = {Is Memory Decline Associated With Inflammatory Response?}, journal = {Journal of Aging and Health}, year = {2017}, pages = {898264317742809}, abstract = {

OBJECTIVE: To examine whether changes in memory over a 10-year period could predict a change in C-reactive protein (CRP) levels.

METHOD: A mixed model analysis was first conducted to obtain the estimates for change in memory over the 10-year period using data from the Health and Retirement Study. Then a multivariate regression to determine whether a change in episodic memory could predict subsequent CRP levels was conducted. Furthermore, a general linear model was conducted to determine differences in CRP levels among different rates of change in episodic memory.

RESULTS: Greater declines in episodic memory were associated with higher levels of subsequent CRP (Estimate = -0.32, SE = 0.12, β = -.03, p = .008). The general linear model revealed that those with greater memory declines were more likely to have higher levels of CRP, F = 26.50, p < .001.

DISCUSSION: These results highlight the notion that memory decline and inflammation may be intertwined, and we discuss various avenues that warrant further investigation.

}, keywords = {Biomarkers, Cognitive Ability, Inflammation, Memory}, issn = {1552-6887}, doi = {10.1177/0898264317742809}, author = {Amber M Tetlow and Andel, Ross and Frank J Infurna} } @article {8563, title = {Mental health and breast cancer screening utilization among older Hispanic women.}, journal = {J Women Aging}, volume = {29}, year = {2017}, month = {2017 Mar-Apr}, pages = {163-172}, abstract = {

Considerable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women{\textquoteright}s participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

}, keywords = {Affect, Aged, Anxiety, Breast Neoplasms, Early Detection of Cancer, Female, Hispanic Americans, Humans, Logistic Models, Middle Aged, Motivation, Patient Acceptance of Health Care, United States, Vulnerable Populations}, issn = {1540-7322}, doi = {10.1080/08952841.2015.1113726}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27485158}, author = {Tamara J. Cadet and Berrett-Abebe, Julie and Stewart, Kathleen} } @article {8900, title = {Mental retirement and health selection: Analyses from the U.S. Health and Retirement Study.}, journal = {Social Science \& Medicine}, volume = {178}, year = {2017}, month = {2017 Jan 22}, pages = {78-86}, abstract = {

BACKGROUND: Research has recently suggested that retirement may decrease cognitive engagement, resulting in cognitive aging. Few studies have systematically documented whether or how selectivity into retirement shapes the relationship between retirement and cognitive aging.

METHODS: We draw on data from the Health and Retirement Study (1998-2012) to examine the relationship between cognition and retirement for 18,575 labor force participants. Longitudinal regression discontinuity modeling was used to examine performance and decline in episodic memory. Models differentiated three forms of selection bias: indirect and direct selection as well as reverse causation. To further interrogate the disuse hypothesis, we adjust for confounding from health and socioeconomic sources.

RESULTS: Results revealed that individuals who retired over the course of the panel were substantially different in terms of health, wealth and cognition when compared to those who remained employed. However, accounting for observed selection biases, significant associations were found linking longer retirement with more rapid cognitive decline.

DISCUSSION: This study examined respondents who were in the labor force at baseline and transitioned into retirement. Analyses suggested that those who retired over the course of the panel had worse overall functioning, but also experienced more rapid declines after retirement that increased the rate of aging by two-fold, resulting in yearly losses of 3.7\% (95\% CI~=~[3.5, 4.0]) of one standard deviation in functioning attributable to retirement. Results are supportive of the view that retirement is associated with more rapid cognitive aging.

}, keywords = {Cognitive Ability, Memory, Older Adults, Retirement Planning and Satisfaction}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2017.01.019}, author = {Sean A. P. Clouston and Denier, Nicole} } @article {9087, title = {Military service, combat exposure, and health in the later lives of US men }, journal = {Longitudinal and Life Course Studies}, volume = {8}, year = {2017}, pages = {122-137}, abstract = {Researchers have produced mixed findings regarding the relationship between military service, war-zone deployment, combat exposure, post-traumatic stress disorder (PTSD), and physical health at older ages. This article uses data drawn from the Health and Retirement Study (HRS) to estimate growth curve models that predict how self-rated health and life-threatening illness vary across groups of men defined as combat and non-combat veterans, compared to non-veterans. According to the findings, combat veterans have worse health than men who did not experience combat during the draft era decades after their service, while non-combat veterans have health that is similar to if not better than non-veterans. Combat veterans were less healthy than these other men based both on a subjective measure of self-rated health and on an objective count of life-threatening illnesses several decades after service. Studies that simply compare veterans to non-veterans may thus continue to produce mixed findings, because particular types of veterans serve in ways that relate differently to health.}, keywords = {Depressive symptoms, PTSD, Veterans}, doi = {10.14301/llcs.v8i2.427}, url = {http://www.llcsjournal.org/index.php/llcs/article/view/427}, author = {MacLean, Alair and Ryan D. Edwards} } @article {9613, title = {Mom and Dad We{\textquoteright}re Broke, Can You Help? A Comparative Study of Financial Transfers Within Families Before and After the Great Recession}, number = {WP$\#$2017-16}, year = {2017}, month = {11/2017}, pages = {2-36}, institution = {Center for Retirement Research at Boston College}, address = {Boston, MA}, abstract = {This paper examines financial transfers within families before and after the great recession. Transfers within families have historically been an important source of wealth accumulation for younger generations, but what happens to these transfers when incomes and wealth are distorted by a recession? We document patterns of financial transfers within families in the U.S. and Germany before and after the Great Recession. This paper uses data from the Health and Retirement Study (HRS) and the Survey of Health, Aging and Retirement in Europe (SHARE). Critical components of the analysis include the estimation of a difference-in-differences model to compare transfer behavior over time, and multiple triple-difference-in-differences models to further study how transfer behavior differs for different population groups. Key limitations are related to available data. The SHARE data used do not contain information for year 2007, which thus had to be excluded from the analysis. In addition, harmonizing both datasets might introduce some potential of errors. The paper found that: Transfers from parents to children are procyclical. Fewer U.S. and German parents made transfers to their adult children in 2009 than in 2005, and transfer rates appear to start recovering earlier in Germany than in the U.S. The estimated decline from 2005 to 2009 was 3 percentage points in the U.S. (8 percent) and 7.5 percentage points in Germany (29 percent).Households who did fairly well during the recession reduce transfers in the same way than households who were not hit by a financial shock.Households who experienced non-employment also did not reduce transfers compared to households who did not experience non-employment. The policy implications of the findings are: Private financial transfers are important for social policy because they may be an important source of economic security during recessions, especially in countries where the social safety net is less generous.Understanding how transfer behavior within family changes during recessions under different public safety nets can inform design of policies to promote economic security and equity.In terms of our study, we (for example) find no relationships between public transfers crowding out private transfers. This result can be used to make current public policies more efficient.}, keywords = {Family Roles/Relationships, Finances, Recession}, url = {http://crr.bc.edu/wp-content/uploads/2017/11/wp_2017-16-1.pdf}, author = {Mary K. Hamman and Daniela Hochfellner and Pia Homrighausen} } @article {8955, title = {More Americans say they{\textquoteright}re in pain. It{\textquoteright}s a fascinating and disturbing medical mystery.}, volume = {2017}, number = {03/16/2017}, year = {2017}, publisher = {Vox Media}, keywords = {Chronic pain, Health Conditions and Status, News, Older Adults}, url = {http://www.vox.com/science-and-health/2017/3/15/14903130/more-americans-pain-opioids-disturbing-medical-mystery}, author = {Frostenson, Sarah} } @article {9174, title = {More evidence that health insurance really does save lives}, journal = {PS Mag}, volume = {2017}, year = {2017}, publisher = {Pacific Standard}, keywords = {Commentary, Medicare/Medicaid/Health Insurance, News}, url = {https://psmag.com/news/health-insurance-saves-lives}, author = {Jacobs, Tom} } @article {9266, title = {More than half the middle-aged population to spend time in a nursing home, new RAND study shows. That{\textquoteright}s higher than earlier estimates.}, journal = {Pittsburgh Post-Gazette}, year = {2017}, address = {Pittsburgh, PA}, keywords = {Medical Expenses, News, Nursing homes}, url = {http://www.post-gazette.com/news/health/2017/08/28/Nursing-home-use-lifetime-need-estimate-RAND-research-study/stories/201708280083}, author = {Rotstein, Gary} } @article {8887, title = {More Women in Their 60s and 70s Are Having {\textquoteleft}Way Too Much Fun{\textquoteright} to Retire}, journal = {The New York Times}, volume = {February 12, 2017}, number = {A1}, year = {2017}, month = {02/12/2017}, chapter = {A}, address = {New York City}, keywords = {News, Older Adults, Retirement Planning and Satisfaction, Women and Minorities}, url = {https://www.nytimes.com/2017/02/11/upshot/more-women-in-their-60s-and-70s-are-having-way-too-much-fun-to-retire.html?_r=0}, author = {Claire Cain Miller} } @article {9415, title = {The Mortality Effects of Retirement: Evidence from Social Security Eligibility at Age 62}, number = {Working Paper No. 24127}, year = {2017}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Social Security eligibility begins at age 62, and approximately one third of Americans immediately claim at that age. We examine whether age 62 is associated with a discontinuous change in aggregate mortality, a key measure of population health. Using mortality data that covers the entire U.S. population and includes exact dates of birth and death, we document a robust two percent increase in male mortality immediately after age 62. The change in female mortality is smaller and imprecisely estimated. Additional analysis suggests that the increase in male mortality is connected to retirement from the labor force and associated lifestyle changes.}, keywords = {Mortality, Population Health, Social Security}, doi = {10.3386/w24127}, url = {http://www.nber.org/papers/w24127.pdf}, author = {Maria D Fitzpatrick and Moore, Timothy} } @article {9049, title = {Mortality selection in a genetic sample and implications for association studies.}, journal = {International Journal of Epidemiolpgy}, volume = {46}, year = {2017}, month = {08/2017}, abstract = {

Background: Mortality selection occurs when a non-random subset of a population of interest has died before data collection and is unobserved in the data. Mortality selection is of general concern in the social and health sciences, but has received little attention in genetic epidemiology. We tested the hypothesis that mortality selection may bias genetic association estimates, using data from the US-based Health and Retirement Study (HRS).

Methods: We tested mortality selection into the HRS genetic database by comparing HRS respondents who survive until genetic data collection in 2006 with those who do not. We next modelled mortality selection on demographic, health and social characteristics to calculate mortality selection probability weights. We analysed polygenic score associations with several traits before and after applying inverse-probability weighting to account for mortality selection. We tested simple associations and time-varying genetic associations (i.e. gene-by-cohort interactions).

Results: We observed mortality selection into the HRS genetic database on demographic, health and social characteristics. Correction for mortality selection using inverse probability weighting methods did not change simple association estimates. However, using these methods did change estimates of gene-by-cohort interaction effects. Correction for mortality selection changed gene-by-cohort interaction estimates in the opposite direction from increased mortality selection based on analysis of HRS respondents surviving through 2012.

Conclusions: Mortality selection may bias estimates of gene-by-cohort interaction effects. Analyses of HRS data can adjust for mortality selection associated with observables by including probability weights. Mortality selection is a potential confounder of genetic association studies, but the magnitude of confounding varies by trait.

}, keywords = {Genetics, GWAS, Mortality}, issn = {1464-3685}, doi = {10.1093/ije/dyx041}, author = {Benjamin W Domingue and Daniel W. Belsky and Harrati, Amal and Dalton C Conley and David R Weir and Jason D Boardman} } @article {9331, title = {The Most Amazing Retirement Chart You{\textquoteright}ll Ever See}, journal = {The Motley Fool}, volume = {2017}, year = {2017}, publisher = {The Motley Fool}, address = {Alexandria, VA}, keywords = {Happiness, Retirement Planning and Satisfaction}, url = {https://www.fool.com/retirement/2017/09/24/the-most-amazing-retirement-chart-youll-ever-see.aspx}, author = {Brian Stoffel} } @article {10893, title = {Multimorbidity: constellations of conditions across subgroups of midlife and older individuals, and related Medicare expenditures.}, journal = {J Comorbidity}, volume = {7}, year = {2017}, month = {2017}, pages = {33-43}, abstract = {

INTRODUCTION: The Department of Health and Human Services{\textquoteright} 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults.

OBJECTIVES: To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50-64 and >=65 years of age, respectively).

DESIGN: A cross-sectional study of the 2010 Health and Retirement Study (HRS; =17,912). The following measures were used: (1) count and combinations of CCMM, including (i) chronic conditions (hypertension, arthritis, heart disease, lung disease, stroke, diabetes, cancer, and psychiatric conditions), (ii) functional limitations (upper body limitations, lower body limitations, strength limitations, limitations in activities of daily living, and limitations in instrumental activities of daily living), and (iii) geriatric syndromes (cognitive impairment, depressive symptoms, incontinence, visual impairment, hearing impairment, severe pain, and dizziness); and (2) annualized 2011 Medicare expenditures for HRS participants who were Medicare fee-for-service beneficiaries (=5,677). Medicaid beneficiaries were also identified based on their self-reported insurance status.

RESULTS: No large representations of participants within specific CCMM categories were observed; however, functional limitations and geriatric syndromes were prominently present with higher CCMM counts. Among fee-for-service Medicare beneficiaries aged 50-64 years, 26.7\% of the participants presented with >=10 CCMM, but incurred 48\% of the expenditure. In those aged >=65 years, these percentages were 16.9\% and 34.4\%, respectively.

CONCLUSION: Functional limitations and geriatric syndromes considerably add to the MM burden in midlife and older adults. This burden is much higher than previously reported.

}, keywords = {Death, Medicare, Medicare claims data, multimorbidity}, issn = {2235-042X}, doi = {10.15256/joc.2017.7.91}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Jiayang Sun and Kurt C Stange and Charles W Given and Avi Dor} } @article {9019, title = {Multiple Chronic Conditions, Resilience, and Workforce Transitions in Later Life: A Socio-Ecological Model.}, journal = {The Gerontologist}, volume = {57}, year = {2017}, month = {2017 Apr 01}, pages = {269-281}, abstract = {

Purpose of the Study: Despite the growing prevalence of multiple chronic conditions (MCC), a problem that disproportionally affects older adults, few studies have examined the impact of MCC status on changes in workforce participation in later life. Recent research suggests that resilience, the ability to recover from adversity, may buffer the negative impact of chronic disease. Guided by an adapted socio-ecological risk and resilience conceptual model, this study examined the buffering effect of resilience on the relationship between individual and contextual risks, including MCC, and workforce transitions (i.e., leaving the workforce, working fewer hours, working the same hours, or working more hours).

Design and Methods: Using the Health and Retirement Study, this study pooled a sample of 4,861 older workers aged 51 and older with 2 consecutive biannual waves of data. Nonnested multinomial logistic regression analysis was applied.

Results: MCC are related to higher risk of transitioning out of the workforce. Resilience buffered the negative effects of MCC on workforce engagement and remained independently associated with increased probability of working the same or more hours compared with leaving work.

Implications: MCC are associated with movement out of the paid workforce in later life. Despite the challenges MCC impose on older workers, having higher levels of resilience may provide the psychological resources needed to sustain work engagement in the face of new deficits. These findings suggest that identifying ways to bolster resilience may enhance the longevity of productive workforce engagement.

}, keywords = {Comorbidity, Resilience, Retirement Planning and Satisfaction}, issn = {1758-5341}, doi = {10.1093/geront/gnv101}, author = {Kendra Jason and Dawn C Carr and Tiffany R Washington and Tandrea S Hilliard and Chivon A Mingo} } @article {8545, title = {Management of diabetes mellitus in older people with comorbidities.}, journal = {BMJ}, volume = {353}, year = {2016}, month = {2016 06 15}, pages = {i2200}, abstract = {

Diabetes mellitus is a chronic disease of aging that affects more than 20\% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.

}, keywords = {Aged, Aging, Blood Glucose, Comorbidity, Diabetes Mellitus, Type 2, Disease Management, Female, Glycemic Index, Guidelines as Topic, Health Services Needs and Demand, Humans, Hypoglycemic Agents, Male, Precision Medicine, Quality of Life}, issn = {1756-1833}, doi = {10.1136/bmj.i2200}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27307175}, author = {Huang, Elbert S} } @article {6438, title = {Mapping the Two Levels of Digital Divide: Internet Access and Social Network Site Adoption among Older Adults in the USA}, journal = {Information, Communication and Society}, volume = {19}, year = {2016}, pages = {1445-1464}, chapter = {1445}, abstract = {Older adults have increasingly adopted Internet and social network sites (SNSs), but little communication scholarship has explored systematic differences in access within this population. Using a nationally representative sample of Americans over the age of 50 years from the 2012 Health and Retirement Study, we examine Internet access (N?=?18,851) and SNS adoption patterns (N?=?869) among this sample and explore how these patterns vary by age. Regarding Internet access, results suggest that while the gender divide has reversed in favor of women, older adults who are economically, socioculturally, or physically disadvantaged are less likely to have reliable Internet access. In addition, the view that the various divides in Internet access are less of a concern for those who are younger is only partially supported, as some access-related divides do not vary by age or even decrease with age. For SNS adoption, we found that access to technological resources (diversity of online activities) positively predicts SNS use. Moreover, SNS users are more likely to be younger, female, widowed, and homemakers, perhaps because these individuals are more motivated to use SNSs to complement or compensate for their existing social status. These findings reveal unique challenges and motivations in relation to Internet access and SNS adoption patterns across the later life span.}, keywords = {Demographics, Health Conditions and Status}, doi = {10.1080/1369118X.2015.1109695}, url = {http://dx.doi.org/10.1080/1369118X.2015.1109695}, author = {Rebecca P. Yu and Nicole B. Ellison and Ryan J McCammon and Kenneth M. Langa} } @mastersthesis {8733, title = {Marital biography and chronic disease progression in mid- and late life}, volume = {Ph.D.}, year = {2016}, pages = {126}, school = {Michigan State University}, type = {Dissertation}, address = {East Lansing}, abstract = {In light of lengthening life expectancy with chronic disease and increasingly diverse marital experiences over the life course among older adults in the US, this dissertation investigates how marital biography is linked to chronic disease progression among older adults aged 50 years old and over in the US. I use three papers to address this overarching research question. The data are from the Health and Retirement Study (HRS), 1994{\textendash}2012, a national panel sample representative of noninstitutionalized civilian adults aged at least 50 years old in the US. My first paper evaluates how current marital status and current marriage duration are associated with the development of functional limitations among older adults diagnosed with diabetes, using multilevel growth curve models. The findings show that remarried, cohabiting and divorced/separated older adults with diabetes report significantly more functional limitations at age 50 than their peers who stay in their first marriage. Although widowed older adults with diabetes report significantly fewer functional limitations than the first-time married at age 50, they show a faster decline in their functional health over time. The never-married show a similar functional health trajectory as the first-time married. The second paper assesses the link between marital quality and functional limitations among older adults diagnosed with cardiovascular disease. Multilevel models are used to estimate the associations between marital quality and functional health and control for household-level clustering effects. My analyses show that while negative dimensions of marital quality are significantly associated with worse functional health subsequently in two years for both older men and women with cardiovascular disease, positive dimensions of marital quality are significantly linked to better functional health only for men. Additionally, improvements in positive marital quality over a four-year period are significantly associated with better functional health four years later. The third paper examines differential mortality risk by marital trajectories among older adults with cardiovascular disease, focusing on their lifetime exposure to marital losses with Cox regression models. The analyses show that among the remarried, only those who are one-time widowed exhibit a significantly higher mortality risk than the first-time married. Both the currently divorced/separated and widowed experience significant mortality disadvantage compared to their peers in their first marriage. Additionally, older cohabitors with cardiovascular disease also show a heightened mortality risk. The never-married, however, show comparable mortality risk to that of the first-time married. Overall, the findings from this dissertation point to the significance of marriage for maintaining physical functioning for older adults while they manage major chronic illnesses such as diabetes and cardiovascular disease. However, the benefits of marriage for chronic disease management are also contingent upon past marital experience and relationship quality. I expect the findings to have important implications for healthcare professionals working with chronic disease patients and public policies regarding chronic disease management.}, keywords = {Chronic disease, Divorce, Longevity, Marriage, Mortality, Older Adults}, isbn = {9781339966724}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1822210624?accountid=14667}, author = {Yu, Yan-Liang} } @article {8346, title = {Marital disruption is associated with shorter salivary telomere length in a probability sample of older adults}, journal = {Social Science and Medicine}, volume = {157}, year = {2016}, pages = {60-67}, publisher = {157}, abstract = {Rationale: Marital disruption (i.e., marital separation, divorce) is associated with a wide range of poor mental and physical health outcomes, including increased risk for all-cause mortality. One biological intermediary that may help explain the association between marital disruption and poor health is accelerated cellular aging. Objective: This study examines the association between marital disruption and salivary telomere length in a United States probability sample of adults 50 years of age. Method: Participants were 3526 individuals who participated in the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction (qPCR) on DNA extracted from saliva samples. Health and lifestyle factors, traumatic and stressful life events, and neuroticism were assessed via self-report. Linear regression analyses were conducted to examine the associations between predictor variables and salivary telomere length. Results: Based on their marital status data in the 2006 wave, people who were separated or divorced had shorter salivary telomeres than people who were continuously married or had never been married, and the association between marital disruption and salivary telomere length was not moderated by gender or neuroticism. Furthermore, the association between marital disruption and salivary telomere length remained statistically significant after adjusting for demographic and socioeconomic variables, neuroticism, cigarette use, body mass, traumatic life events, and other stressful life events. Additionally, results revealed that currently married adults with a history of divorce evidenced shorter salivary telomeres than people who were continuously married or never married. Conclusion: Accelerated cellular aging, as indexed by telomere shortening, may be one pathway through which marital disruption is associated with morbidity and mortality.}, keywords = {Adult children, Demographics}, doi = {10.1016/j.socscimed.2016.03.029}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616301290}, author = {Mark A Whisman and Robustelli, Briana L. and Sbarra, David A.} } @article {8373, title = {Marital Histories and Heavy Alcohol Use among Older Adults.}, journal = {J Health Soc Behav}, volume = {57}, year = {2016}, note = {Times Cited: 0 0}, month = {2016 Mar}, pages = {77-96}, publisher = {57}, abstract = {

We develop a gendered marital biography approach-which emphasizes the accumulating gendered experiences of singlehood, marriage, marital dissolution, and remarriage-to examine the relationship between marital statuses and transitions and heavy alcohol use. We test this approach using individual-level (n = 10,457) and couple-level (n = 2,170) longitudinal data from the Health and Retirement Study, and individual-level (n = 46) and couple-level (n = 42) in-depth interview data. Quantitative results show that marriage, including remarriage, reduces men{\textquoteright}s but increases women{\textquoteright}s drinking relative to being never married and previously married, whereas divorce increases men{\textquoteright}s but decrease women{\textquoteright}s drinking, with some variation by age. Our qualitative findings reveal that social control and convergence processes underlie quantitative results. We call attention to how men{\textquoteright}s and women{\textquoteright}s heavy drinking trajectories stop, start, and change direction as individuals move through their distinctive marital biography.

}, keywords = {Adult, Age Factors, Aged, Alcohol Drinking, Divorce, Female, Humans, Male, Marital Status, Marriage, Middle Aged, Models, Psychological, Socioeconomic factors}, issn = {2150-6000}, doi = {10.1177/0022146515628028}, author = {Reczek, Corinne and Tetyana Pudrovska and Deborah Carr and Thomeer, Mieke Beth and Debra Umberson} } @article {8696, title = {Marital history and survival after a heart attack.}, journal = {Soc Sci Med}, volume = {170}, year = {2016}, month = {2016 12}, pages = {114-123}, abstract = {

Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n~=~2197). We found that adults who were never married (odds ratio [OR]~=~1.73), currently divorced (OR~=~1.70), or widowed (OR~=~1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12\% for every additional marital loss and decreased by 7\% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Divorce, Female, Humans, Male, Marital Status, Myocardial Infarction, Prospective Studies, Retrospective Studies, Single Person, Spouses, Survivors, United States, Widowhood}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.10.013}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616305810}, author = {Matthew E Dupre and Nelson, Alicia} } @article {8339, title = {Marital Quality and Health in Middle and Later Adulthood: Dyadic Associations}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {71}, year = {2016}, pages = {154-164}, publisher = {71}, abstract = {Objectives. We investigated associations between positive marital quality and health among married persons aged 50 or older and their spouses. Prior research using data from married individuals has yielded inconsistent findings regarding the association between positive marital quality and global health outcomes. The present study involved married couples to examine how spouses positive marital quality affect their own and each other s health, and whether these effects vary by age.Methods. Using data from 3 waves of the Health and Retirement Study (2006, 2008, 2010), we estimated a series of actor partner interdependence models using mixed linear models.Results. Analyses found that over the 4-year period (2006 2010) increases in positive marital quality of both spouses were independently associated with increases in their self-rated health in midlife and old age as well as with declines in disability in old age. Increases in positive marital quality were also linked with declines in functional limitations for middle-aged and older adults.Discussion. Being perceived as a supportive spouse, as well as perceiving one s partner as such, has significant health implications. Overall, positive marital quality of both spouses contributes to health protection for middle-aged and older spouses.}, keywords = {Adult children, Health Conditions and Status, Methodology}, doi = {10.1093/geronb/gbu222}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/03/16/geronb.gbu222.abstract}, author = {Choi, Heejeong and Yorgason, Jeremy B. and Johnson, David R.} } @article {8585, title = {Marital quality, marital dissolution, and mortality risk during the later life course.}, journal = {Soc Sci Med}, volume = {165}, year = {2016}, month = {2016 09}, pages = {119-127}, abstract = {

This study examines the relationship between later-life marital quality, marital dissolution, and mortality using discrete-time event history models with data from nine waves (1992-2008) of the Health and Retirement Study (n~=~7388). Results show marital status is more important for men{\textquoteright}s mortality risk than women{\textquoteright}s, whereas marital quality is more important for women{\textquoteright}s survival than men{\textquoteright}s. Being widowed or divorced more than two years raises mortality risk for men, but later-life marital dissolution is not significantly associated with women{\textquoteright}s mortality risk, regardless of the type of dissolution or length of time since it occurred. Low-quality marital interaction is negatively related to women{\textquoteright}s odds of death, but none of the marital quality measures are significantly associated with mortality for men. Marital satisfaction moderates the relationship between widowhood and mortality for women, but the relationship between marital dissolution and mortality is similar for men regardless of marital quality prior to divorce/widowhood. Results suggest the importance of accounting for both marital status and marital quality when examining older individuals{\textquoteright} mortality risk.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Marital Status, Marriage, Middle Aged, Mortality, Retirement, Sex Factors}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.07.025}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616303860}, author = {Jennifer R. Bulanda and J Scott Brown and Takashi Yamashita} } @article {8338, title = {Marital Status as a Moderating Factor in the Process of Disablement}, journal = {Journal of Aging and Health}, volume = {28}, year = {2016}, pages = {139-164}, publisher = {28}, abstract = {Objective: To test current marital status as a moderator on the influence of depressive symptoms and chronic conditions on subsequent functional limitations. Method: Data come from the Health and Retirement Study (HRS; 1998-2010). Hierarchal linear modeling models tested differences in functional limitations among a sample of 20,215 people. Results: At baseline, married people suffered from fewer subsequent functional limitations than the unmarried. Moreover, limited evidence suggests the influence of depressive symptoms was greater for the married than the unmarried; however, the influence of chronic conditions was consistently attenuated for married people. Accounting for differences in prior health, work, socioeconomic status, and health behaviors did not explain the moderating influence of marital status on the associations between symptoms of depression and chronic conditions with functional limitations. Discussion: This research highlights the need to identify potential modifiers that may help disrupt the process of disablement among both the married and the unmarried alike.}, keywords = {Adult children, Disabilities, Health Conditions and Status, Other}, doi = {10.1177/0898264315589572}, url = {http://jah.sagepub.com/content/early/2015/07/03/0898264315589572.abstract}, author = {Ben Lennox Kail} } @article {8802, title = {Marital status, history linked to survival after stroke}, journal = {Reuters}, year = {2016}, month = {12/15/2016}, url = {http://www.reuters.com/article/us-health-stroke-marriage-idUSKBN1432T2?feedType=RSS\&feedName=healthNews\&utm_source=feedburner\&utm_medium=feed\&utm_campaign=Feed\%3A+reuters\%2FhealthNews+(Reuters+Health+News)}, author = {Crist, Carolyn} } @article {8361, title = {Measures of aging with disability in U.S. secondary data sets: Results of a scoping review}, journal = {Disability and Health Journal}, volume = {9}, year = {2016}, pages = {5-10}, publisher = {9}, abstract = {AbstractBackground There remain significant knowledge gaps in our understanding of aging with long-term disability. It is possible that important advances in knowledge could be gained using existing secondary data sets. However, little is known regarding which of the data sets available to researchers contain the age-related measures needed for this purpose, specifically age of onset and/or duration of disability measures. Objective To better understand the capacity to investigate aging with long-term disability (e.g. mobility limitation) and aging with long-term chronic conditions (e.g. spinal cord injury, multiple sclerosis) using extant data. Methods Public use national and regional data sets were identified through existing reports, web-based searches, and expert nomination. The age- and disability-related variables, including age of onset and duration of disability, were tabulated for data sets meeting inclusion criteria. Analysis was descriptive. Results A total of N = 44 data sets were reviewed. Of these, 22 contained both age and disability variables. Within these 22 data sets, 9 contained an age of onset or duration of disability variable. Six of the nine data sets contained age of diagnosis for a single or set of health conditions. Onset of functional limitation is in two, and onset of self-reported and/or employment disability is in four, of the nine data sets respectively. Conclusions There is some, but limited opportunity to investigate aging with long-term disability in extant U.S. public use secondary data sets.}, keywords = {Disabilities, Health Conditions and Status, Methodology}, doi = {10.1016/j.dhjo.2015.07.002}, url = {http://www.sciencedirect.com/science/article/pii/S1936657415000990}, author = {Putnam, Michelle and Molton, Ivan R. and Truitt, Anjali R. and Smith, Amanda E. and Jensen, Mark P.} } @mastersthesis {8985, title = {Measuring the Impact of Volunteering on Physical Activity Using Data from the Health and Retirement Study}, volume = {Ph.D.}, year = {2016}, school = {University of Illinois at Chicago}, type = {Dissertation}, address = {Chicago, Illinois}, abstract = {BACKGROUND: This study measures the impact of volunteering type and intensity on different aspects of physical activity including meeting recommended activity guidelines and level of intensity. METHODS: Four waves and eight years of longitudinal data on a nationally representative sample of Americans, 50 and older were used. RESULTS: As predicted, volunteering was associated with increased physical activity with respect to likelihood to meet guidelines and higher intensity of physical activity after adjusting for baseline age, gender, education, self-rated health and comorbidities and physical activity. Volunteers were more likely to meet physical activity guidelines and to maintain a higher likelihood of meeting guidelines than non-volunteers. In addition, volunteers were less likely to exhibit depressive symptoms, report decreases in functional limitation or decreases in self-rated health than those who did not volunteer. Number of hours of volunteering was significantly and positively associated with increased likelihood to meet guidelines. Finally, analyses found that older adults who volunteered with children had lower likelihood of depression and improvements in several psychosocial variables including social network and social support scores compared to older adults who volunteered but did not volunteer with children. CONCLUSIONS: Results suggest that volunteering could be a mechanism to help older adults meet and maintain the meeting of physical activity guidelines over time. Volunteering also appears to be associated with reduction of depressive symptoms, functional limitations and decreases in self-rated health over time. Finally, volunteering with children could act as a buffer to mediate lower social support and reports of negative familial support. The amount of volunteering required to confer maximum health benefits should be further explored. Future studies should also further examine the casual relationship between volunteering and physical activity.}, keywords = {Older Adults, Volunteerism}, url = {http://indigo.uic.edu/handle/10027/21292}, author = {Clark, Julia R.} } @article {8396, title = {Mechanisms of the Effect of Involuntary Retirement on Older Adults Self-Rated Health and Mental Health}, journal = {Journal of Gerontological Social Work}, volume = {59}, year = {2016}, pages = {35-55}, publisher = {59}, abstract = {This study examined mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 or older. Using two waves of the Health and Retirement Study (2006 and 2010), we selected a sample of 1,195 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves. Regression-based path analyses were conducted to test the mediating effects of financial control, positive and negative family relationships, and social integration on the relationship between involuntary retirement and self-rated health and mental health. Results of mediation analyses indicated that transition to involuntary retirement was directly negatively associated with subsequent self-rated health and indirectly negatively associated with mental health via perception of less financial control. Voluntary retirement was indirectly positively associated with both self-rated and mental health via perception of more financial control. No significant direct or indirect effects of retirement were found when retirement was measured with an aggregate measure without specifying its voluntariness. Findings emphasize the importance of specifying the voluntariness of retirement and recognizing the heterogeneity in the mechanisms of involuntary and voluntary retirement.}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, doi = {10.1080/01634372.2015.1128504}, url = {http://dx.doi.org/10.1080/01634372.2015.1128504}, author = {Min-Kyoung Rhee and Mich{\`a}lle E. Mor Barak and William T Gallo} } @article {8539, title = {Medicare Part D and Portfolio Choice {\textdagger}}, journal = {American Economic Review}, volume = {106}, year = {2016}, month = {Jan-05-2016}, pages = {339 - 342}, abstract = {Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk due to the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort.}, keywords = {Healthcare, Investing, Medicare/Medicaid/Health Insurance, Older Adults}, issn = {0002-8282}, doi = {10.1257/aer.p20161125}, url = {http://pubs.aeaweb.org/doi/10.1257/aer.p20161125}, author = {Padmaja Ayyagari and Daifeng He} } @article {8382, title = {The Mental and Physical Health Consequences of Changes in Private Insurance Before and After Early Retirement}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {71}, year = {2016}, pages = {358-368}, publisher = {71}, abstract = {Objectives. This study evaluated the impact of private insurance coverage on the symptoms of depression, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in the years leading up to Medicare eligibility focusing on the transition from full-time work to early full retirement.Method. The Health and Retirement Study was used to (a) estimate 2-stage selection equations of (i) the transition to retirement and (ii) current insurance status, and (b) the impact of insurance coverage on health, net of endogeneity associated retirement and insurance coverage.Results. Employment-based insurance coverage was generally associated with better health. Moreover, being without employment-based insurance was particularly problematic during the transition to retirement. Non-group insurance only moderated the association between losing employment-based insurance and IADLs.Discussion. Results indicated that private insurance coverage is an important contextual factor for the health of early retirees. Those who maintain steady coverage tend to fare the best in retirement. This highlights the dynamic nature of changes in health in later life.}, keywords = {Health Conditions and Status, Insurance, Retirement Planning and Satisfaction}, doi = {10.1093/geronb/gbv020}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/03/28/geronb.gbv020.abstract}, author = {Ben Lennox Kail} } @article {8885, title = {Meta-analysis identifies common and rare variants influencing blood pressure and overlapping with metabolic trait loci.}, journal = {Nat Genet}, volume = {48}, year = {2016}, month = {2016 Oct}, pages = {1162-70}, abstract = {

Meta-analyses of association results for blood pressure using exome-centric single-variant and gene-based tests identified 31 new loci in a discovery stage among 146,562 individuals, with follow-up and meta-analysis in 180,726 additional individuals (total n = 327,288). These blood pressure-associated loci are enriched for known variants for cardiometabolic traits. Associations were also observed for the aggregation of rare and low-frequency missense variants in three genes, NPR1, DBH, and PTPMT1. In addition, blood pressure associations at 39 previously reported loci were confirmed. The identified variants implicate biological pathways related to cardiometabolic traits, vascular function, and development. Several new variants are inferred to have roles in transcription or as hubs in protein-protein interaction networks. Genetic risk scores constructed from the identified variants were strongly associated with coronary disease and myocardial infarction. This large collection of blood pressure-associated loci suggests new therapeutic strategies for hypertension, emphasizing a link with cardiometabolic risk.

}, issn = {1546-1718}, doi = {10.1038/ng.3660}, author = {Liu, Chunyu and Kraja, Aldi T and Jennifer A Smith and Brody, Jennifer A and Franceschini, Nora and Joshua C. Bis and Kenneth Rice and Alanna C Morrison and Lu, Yingchang and Weiss, Stefan and Guo, Xiuqing and Walter R Palmas and Martin, Lisa W and Yii-Der I Chen and Surendran, Praveen and Drenos, Fotios and Cook, James P and Auer, Paul L and Chu, Audrey Y and Giri, Ayush and Wei Zhao and Jakobsdottir, Johanna and Lin, Li-An and Stafford, Jeanette M and Amin, Najaf and Mei, Hao and Yao, Jie and Voorman, Arend and Larson, Martin G and Grove, Megan L and Albert Vernon Smith and Hwang, Shih-Jen and Chen, Han and Huan, Tianxiao and Kosova, Gulum and Stitziel, Nathan O and Kathiresan, Sekar and Nilesh J Samani and Schunkert, Heribert and Deloukas, Panos and Li, Man and Fuchsberger, Christian and Pattaro, Cristian and Gorski, Mathias and Charles Kooperberg and George J Papanicolaou and Rossouw, Jacques E and Jessica Faul and Sharon L R Kardia and Bouchard, Claude and Raffel, Leslie J and Andr{\'e} G Uitterlinden and Franco, Oscar H and Ramachandran S Vasan and O{\textquoteright}Donnell, Christopher J and Kent D Taylor and Liu, Kiang and Erwin P Bottinger and Gottesman, Omri and Daw, E Warwick and Giulianini, Franco and Ganesh, Santhi and Salfati, Elias and Tamara B Harris and Lenore J Launer and D{\"o}rr, Marcus and Felix, Stephan B and Rettig, Rainer and V{\"o}lzke, Henry and Eric S Kim and Lee, Wen-Jane and Lee, I-Te and Sheu, Wayne H-H and Tsosie, Krystal S and Digna R Velez Edwards and Yongmei Liu and Correa, Adolfo and David R Weir and V{\"o}lker, Uwe and Ridker, Paul M and Boerwinkle, Eric and Gudnason, Vilmundur and Reiner, Alexander P and Cornelia M van Duijn and Ingrid B Borecki and Edwards, Todd L and Chakravarti, Aravinda and Rotter, Jerome I and Psaty, Bruce M and Ruth J F Loos and Myriam Fornage and Georg B Ehret and Newton-Cheh, Christopher and Levy, Daniel and Daniel I Chasman} } @article {8497, title = {A method to estimate the contribution of regional genetic associations to complex traits from summary association statistics.}, journal = {Sci Rep}, volume = {6}, year = {2016}, month = {2016 06 08}, pages = {27644}, abstract = {

Despite considerable efforts, known genetic associations only explain a small fraction of predicted heritability. Regional associations combine information from multiple contiguous genetic variants and can improve variance explained at established association loci. However, regional associations are not easily amenable to estimation using summary association statistics because of sensitivity to linkage disequilibrium (LD). We now propose a novel method, LD Adjusted Regional Genetic Variance (LARGV), to estimate phenotypic variance explained by regional associations using summary statistics while accounting for LD. Our method is asymptotically equivalent to a multiple linear regression model when no interaction or haplotype effects are present. It has several applications, such as ranking of genetic regions according to variance explained or comparison of variance explained by two or more regions. Using height and BMI data from the Health Retirement Study (N = 7,776), we show that most genetic variance lies in a small proportion of the genome and that previously identified linkage peaks have higher than expected regional variance.

}, keywords = {Algorithms, Genetic Association Studies, Genetic Linkage, Genetic Variation, Genome-Wide Association Study, Genotype, Humans, Linkage Disequilibrium, Models, Genetic, Models, Statistical, Multifactorial Inheritance, Phenotype, Polymorphism, Single Nucleotide}, issn = {2045-2322}, doi = {10.1038/srep27644}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27273519}, author = {Pare, Guillaume and Mao, Shihong and Wei Q. Deng} } @article {8392, title = {Methodological Aspects of Subjective Life Expectancy: Effects of Culture-Specific Reporting Heterogeneity Among Older Adults in the United States.}, journal = {The Journals of Gerontology: Series B}, volume = {71}, year = {2016}, pages = {558-568}, publisher = {71}, abstract = {

OBJECTIVES: Subjective life expectancy (SLE) has been suggested as a predictor of mortality and mortality-related behaviors. Although critical for culturally diverse societies, these findings do not consider cross-cultural methodological comparability. Culture-specific reporting heterogeneity is a well-known phenomenon introducing biases, and research on this issue with SLE is not established.

METHOD: Using data from the Health and Retirement Study, we examined reporting heterogeneity in SLE focusing on item nonresponse, focal points, and reports over time for five ethnic-cultural groups: non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic other races, English-interviewed Hispanics, and Spanish-interviewed Hispanics.

RESULTS: On item nonresponse, Spanish-interviewed Hispanics said, "I don{\textquoteright}t know," to SLE significantly more than any other groups. Nearly half of the respondents chose 0, 50, or 100, making them focal points. However, the focal points differed: 50 for Whites, 100 for Blacks, and 0 for Spanish-interviewed Hispanics. The relationship of SLE measured at two time points was higher for Whites than minorities. Moreover, those who said "I don{\textquoteright}t know" to SLE showed higher subsequent mortality than those who gave an answer. SLE was not a significant mortality predictor for Hispanics.

DISCUSSION: Overall, SLE is not free from culture-specific reporting heterogeneity. This warrants further research about its culture-relevant measurement mechanisms.

}, keywords = {Aged, Aged, 80 and over, Bias, Cross-Cultural Comparison, Cross-Sectional Studies, Diagnostic Self Evaluation, Ethnic Groups, Female, Frail Elderly, Humans, Language, Life Expectancy, Longitudinal Studies, Male, Middle Aged, Self Report, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbv048}, author = {Lee, Sunghee and Jacqui Smith} } @inbook {8550, title = {Military Service in Lives: Where Do We Go From Here?}, booktitle = {Handbook of the Life Course}, year = {2016}, pages = {277-300}, publisher = {Springer}, organization = {Springer}, abstract = {Although the military has enduring effects on the lives of service members and their families, it is often overlooked as an institutional force that shapes the life course. This chapter aims to bring military service to the attention of life-course scholars by: providing a conceptual model for understanding the impact of military service on lives that builds on the core principles of the life-course perspective; reviewing empirical evidence regarding how military service is related to childhood and adolescence, influences the transition to adulthood, and has long-term consequences for various outcomes in mid-to-late life; and identifying methodological challenges and relatively unexplored questions that should be the focus of future inquiry. In doing so, this chapter facilitates an understanding of military service in lives while also underscoring the role of social institutions in shaping the life course.}, keywords = {Military service, Older Adults, Veterans}, author = {Andrew S London and Janet M Wilmoth} } @mastersthesis {8737, title = {A mindfulness-based stress reduction program for lesbian, gay, bisexual, transgender older adults: A grant proposal}, volume = {M.S.W.}, year = {2016}, pages = {71}, school = {California State University, Long Beach}, type = {Thesis}, abstract = {As the population of those aged 65 and older increases, it is important to support programs designed to improve the well-being and quality of life for this population. The lesbian, gay, bisexual, and transgender (LGBT) community has a history of oppression, discrimination, and social isolation, and many older adults are significantly at risk for poorer health outcomes. The purpose of this project was to develop a Mindfulness Based Stress Reduction (MBSR) program for LGBT older adults currently receiving services at the LGBT Center in Long Beach, California. The proposed program will be an 8-week mindfulness based program focused on stress management in order to improve their overall well-being and quality of life. After a comprehensive search of funding agencies, the best fit of a funder for this program was the David Bohnett Foundation. The actual submission or funding of this grant was not required for the successful completion of this grant proposal.}, keywords = {Grant proposal, LGBTQ, Older Adults, Stress}, isbn = {9781339638171}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1783572946?accountid=14667}, author = {Alicia Flores} } @mastersthesis {8721, title = {Modeling longitudinal mediation of within-person changes}, volume = {M.A.}, year = {2016}, pages = {75}, school = {The University of North Carolina at Chapel Hill}, type = {Thesis}, address = {Chapel Hill}, abstract = {Mediation analysis concerns the discovery of mechanisms that transmit an effect from one variable to another. At times, social scientists propose hypotheses involving mediation of within-person changes (e.g., do within-person changes in cognitive ability mediate the relation between changes in depression and changes in disability?) The current manuscript introduces an approach within the latent change score (LCS) modeling framework to test such hypotheses. This approach is compared to existing methods, including the cross-lagged panel model (CLPM; Cole \& Maxwell, 2003) and the LCS mediation model (Selig \& Preacher, 2009). Results from (1) a single-replication simulation and (2) an empirical example utilizing data from the Health and Retirement study are presented.}, keywords = {Latent change score, Meta-analyses, Older Adults, Psychosocial, Self-reported health}, isbn = {9781369014662}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1829616915?accountid=14667}, author = {Henk, Corinne M.} } @article {8390, title = {Moderate Alcohol Consumption Is Not Associated with Reduced All-cause Mortality}, journal = {The American Journal of Medicine}, volume = {129}, year = {2016}, pages = {180 186.e4}, publisher = {129}, abstract = {Background A large body of research suggests that light or moderate alcohol consumption is associated with reduced all-cause mortality. However, concerns remain that the observed relationship is due to selection bias, misclassification of ex-drinkers, or residual confounding. Methods The association between alcohol consumption and all-cause mortality was analyzed using Cox regression. The analysis was performed using data from the Health and Retirement Study, a longitudinal cohort of 24,029 individuals from a nationally representative sample of US adults aged more than 50 years. Drinking level was based on alcohol consumption measured at 3 points over the 4 years before the start of follow-up. Occasional drinkers those who reported drinking on at least 1 occasion, but always less than once per week served as the reference category. There was extensive adjustment for sociodemographic variables, health status, and functional status. Results During 206,966 person-years of follow up, 7902 individuals died. No level of regular alcohol consumption was associated with reduced all-cause mortality. The hazard ratio and 95 confidence interval in fully adjusted analyses was 1.02 (0.94-1.11) for andlt;7 drinks/week, 1.14 (1.02-1.28) for 7 to andlt;14 drinks/week, 1.13 (0.96-1.35) for 14 to andlt;21 drinks/week, and 1.45 (1.16-1.81) for 21 drinks/week. Conclusions Moderate alcohol consumption is not associated with reduced all-cause mortality in older adults. The previously observed association may have been due to residual confounding.}, keywords = {Health Conditions and Status, Methodology}, doi = {10.1016/j.amjmed.2015.10.013}, url = {http://www.sciencedirect.com/science/article/pii/S0002934315010153}, author = {Goulden, Robert} } @article {8348, title = {Modifiable Risk Factors for New-Onset Slow Gait in Older Adults}, journal = {Journal of the American Medical Directors Association}, volume = {17}, year = {2016}, pages = {421-425}, publisher = {17}, abstract = {AbstractObjective Despite the growing importance of slow gait as a universal screen of health, systematic investigation of risk factors for incident slow gait is lacking. Our objective was to identify potentially modifiable risk factors for incident slow gait. Design Prospective cohort study. Setting The Health and Retirement Study, a nationally representative US sample. Participants A total of 2306 individuals age 65 and older (56.5 women) from the 2008 wave with timed walks at baseline and 4 years later. Measurements Incident slow gait (walking speed 1 SD below age and sex means) was the outcome. Fifteen potentially modifiable medical and lifestyle risk factors were examined as predictors. Results Incident slow gait developed in 243 participants (11 ) at 4 years. Physical inactivity (adjusted relative risk aRR 1.94), cognitive impairment (aRR 1.77), muscle weakness (aRR 1.48), pain (aRR 1.45), obesity (aRR 1.35), vision (aRR 1.36), and falls (aRR 1.32) predicted increased risk of developing incident slow gait. Together, these risk factors accounted for 77 (95 confidence interval 14 95) of the Population Attributable Risk for incident slow gait. Conclusion A limited set of potentially modifiable risk factors is associated with new-onset slow gait in older adults. These findings provide a foundation for developing clinical guidelines and preventive interventions for slow gait.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.1016/j.jamda.2016.01.017}, url = {http://www.sciencedirect.com/science/article/pii/S1525861016000554}, author = {Joe Verghese and Wang, Cuiling and Allali, Gilles and Holtzer, Roee and Emmeline Ayers} } @article {8378, title = {Modifiable risk factors for nursing home admission among individuals with high and low dementia risk}, journal = {Archives of Gerontology and Geriatrics}, volume = {65}, year = {2016}, pages = {140-145}, publisher = {65}, abstract = {AbstractBackground Strategies to prevent or delay nursing home admission in individuals with cognitive impairment are urgently needed. We hypothesized that physical inactivity, not consuming alcohol (as opposed to moderate alcohol use), and having a history of smoking predict nursing home admission among individuals with normal cognitive function, but these behavioral factors would have attenuated associations with nursing home admission among individuals with impaired cognition. Methods We performed a prospective cohort study among 7631 Health and Retirement Study participants aged 65 at baseline. Baseline dementia risk (high versus low, based on brief psychometric assessments and proxy reports) and modifiable risk factors (physical inactivity, ever smoking, and not consuming alcohol) were used to predict nursing home admission in pooled logistic regression models. We evaluated whether estimated effects of modifiable factors varied by dementia risk, comparing both relative and absolute effects using interaction terms between dementia risk and each modifiable risk factor. Results Low dementia probability was associated with lower nursing home admission risk (RR = 0.49; 95 CI: 0.41, 0.59). Physical inactivity (RR = 1.27; 95 CI: 1.15, 1.41), ever smoking (RR = 1.12; 95 CI: 1.01, 1.25), and not consuming alcohol (RR = 1.28; 95 CI: 1.13, 1.45) predicted increased relative risk of nursing home admission regardless of cognitive status. The relative effects of modifiable risk factors were similar for those with low and high dementia risk. Conclusion Although cognitive impairment associated with incipient dementia strongly predicts nursing home admission, this risk can be partially ameliorated with modifiable risk factors such as physical activity.}, keywords = {Health Conditions and Status, Healthcare, Risk Taking}, doi = {10.1016/j.archger.2016.03.016}, url = {http://www.sciencedirect.com/science/article/pii/S0167494316300565}, author = {Pamela M. Rist and Thu T Nguyen and Rachel A Whitmer and M. Maria Glymour} } @article {8533, title = {Mortality Inequality: The Good News from a County-Level Approach}, number = {Working Paper 22199}, year = {2016}, month = {04/2016}, pages = {1-54}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. However, we show that among infants, children, and young adults, mortality has been falling more quickly in poorer areas with the result that inequality in mortality has fallen substantially over time. This is an important result given the growing literature showing that good health in childhood predicts better health in adulthood and suggests that today{\textquoteright}s children are likely to face considerably less inequality in mortality as they age than current adults. We also show that there have been stunning declines in mortality rates for African-Americans between 1990 and 2010, especially for black men. The fact that inequality in mortality has been moving in opposite directions for the young and the old, as well as for some segments of the African-American and non-African-American populations argues against a single driver of trends in mortality inequality, such as rising income inequality. Rather, there are likely to be multiple specific causes affecting different segments of the population.}, keywords = {Childhood adversity, Life Expectancy, Mortality, Socioeconomic factors}, doi = {10.3386/w22199}, url = {http://www.nber.org/papers/w22199.pdf}, author = {Currie, Janet and Schwandt, Hannes} } @article {8525, title = {Motoric cognitive risk syndrome and risk of mortality in older adults.}, journal = {Alzheimers Dement}, volume = {12}, year = {2016}, month = {2016 05}, pages = {556-64}, abstract = {

INTRODUCTION: Cognitive impairment is associated with increased mortality. We examined the association between motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and cognitive complaints, and survival.

METHODS: A total of 11,867 nondemented participants aged >65 years from three established cohort studies in the United States and Europe were screened for MCR. Mortality risk of MCR was assessed with Cox and logistic regression models.

RESULTS: At baseline, 836 (7.0\%) participants had MCR. Over a median follow-up of 28~months, 1603 participants died (758 in first 2 years). MCR was associated with increased mortality overall (adjusted hazard ratio, 1.69; 95\% confidence interval [CI], 1.46-1.96) and 2-year mortality (adjusted odds ratio, 1.89; 95\% CI, 1.50-2.38). The association remained after accounting for established mortality risk factors as well as baseline gait speed and memory performance.

DISCUSSION: MCR is associated with increased mortality. Older adults should be screened for MCR to identify at-risk individuals for dementia and death.

}, keywords = {Age Factors, Aged, Cognition Disorders, Cohort Studies, Dementia, Early Diagnosis, Female, Gait, Humans, Male, Mortality, Risk Factors}, issn = {1552-5279}, doi = {10.1016/j.jalz.2015.08.167}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26545790}, author = {Emmeline Ayers and Joe Verghese} } @article {8409, title = {Multimorbidity Combinations and Disability in Older Adults}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {71}, year = {2016}, pages = {823-830}, publisher = {71}, abstract = {Background: Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults.Methods: Prospective cohort study using longitudinal Health and Retirement Study data (2010 2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score 4).Results: We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index.Conclusions: Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.}, keywords = {Disabilities, Health Conditions and Status}, doi = {10.1093/gerona/glw035}, url = {http://biomedgerontology.oxfordjournals.org/content/71/6/823.abstract}, author = {A. R. Quinones and Markwardt, Sheila and Anda Botoseneanu} } @article {8572, title = {Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study.}, journal = {Int J Geriatr Psychiatry}, volume = {31}, year = {2016}, month = {2016 10}, pages = {1105-15}, abstract = {

OBJECTIVES: The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms.

METHODS: A sample of 4219 participants (65 years or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models{\textquoteright} outcome was elevated anxiety (>=12 on five-item Beck Anxiety Inventory) or depressive symptoms (>=12 on eight-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of seven self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses.

RESULTS: Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95\% confidence interval: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of seven medical conditions, with the exception being stroke, were present in the majority of triads.

CONCLUSION: Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. As anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

}, keywords = {Aged, Aged, 80 and over, Anxiety Disorders, Chronic disease, Depressive Disorder, Female, Humans, Logistic Models, Male, multimorbidity, Retirement, United States}, issn = {1099-1166}, doi = {10.1002/gps.4532}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27441851}, author = {Christine E Gould and Ruth O{\textquoteright}Hara and Mary K. Goldstein and Sherry A. Beaudreau} } @article {8372, title = {Multiple Chronic Conditions, Spouse{\textquoteright}s Depressive Symptoms, and Gender within Marriage}, journal = {Journal of Health and Social Behavior}, volume = {57}, year = {2016}, note = {Times Cited: 0 0}, pages = {59-76}, publisher = {57}, abstract = {Multiple chronic conditions (i.e., multimorbidity) increase a person{\textquoteright}s depressive symptoms more than having one chronic condition. Little is known regarding whether multimorbidity similarly increases the depressive symptoms of one{\textquoteright}s spouse and whether this depends on type of condition, gender, or both spouses{\textquoteright} health status. Analysis of multiple waves of the Health and Retirement Study reveals husband{\textquoteright}s number of chronic conditions is positively related to wife{\textquoteright}s depressive symptoms when both spouses are chronically ill. The association between wife{\textquoteright}s chronic conditions and husband{\textquoteright}s depressive symptoms is weaker and less robust. Type of chronic condition also matters but which type depends on the gender and health status of both spouses. By highlighting key contexts where chronic conditions are connected to spousal depressive symptoms, this study identifies areas of vulnerability and urges researchers and clinicians to consider multimorbidity when designing and implementing interventions, along with gender, both spouses{\textquoteright} chronic conditions, and condition type.}, keywords = {Adult children, Health Conditions and Status}, doi = {10.1177/0022146516628179}, author = {Thomeer, Mieke Beth} } @article {9276, title = {Muscle Strength, Physical Activity, and Functional Limitations in Older Adults with Central Obesity.}, journal = {Journal of Aging Research}, volume = {2016}, year = {2016}, abstract = {Background. Obesity and muscle weakness are independently associated with increased risk of physical and functional impairment in older adults. It is unknown whether physical activity (PA) and muscle strength combined provide added protection against functional impairment. This study examines the association between muscle strength, PA, and functional outcomes in older adults with central obesity. Methods. Prevalence and odds of physical (PL), ADL, and IADL limitation were calculated for 6,388 community dwelling adults aged >= 60 with central obesity. Individuals were stratified by sex-specific hand grip tertiles and PA. Logistic models were adjusted for age, education, comorbidities, and body-mass index and weighted. Results. Overall prevalence of PL and ADL and IADL limitations were progressively lower by grip category. Within grip categories, prevalence was lower for individuals who were active than those who were inactive. Adjusted models showed significantly lower odds of PL OR 0.42 [0.31, 0.56]; ADL OR 0.60 [0.43, 0.84], and IADL OR 0.46 [0.35, 0.61] for those in the highest grip strength category as compared to those in the lowest grip category. Conclusion. Improving grip strength in obese elders who are not able to engage in traditional exercise is important for reducing odds of physical and functional impairment.}, keywords = {Activities of Daily Living, BMI, Disabilities, Obesity}, issn = {2090-2204}, doi = {10.1155/2016/8387324}, author = {Cassandra M Germain and John A. Batsis and Elizabeth Vasquez and Douglas R McQuoid} } @article {8309, title = {Marital bargaining in the demand for life insurance: evidence from the Health and Retirement Study}, journal = {Review of Economics of the Household}, volume = {13}, year = {2015}, note = {Times Cited: 0 0}, pages = {243-268}, publisher = {13}, abstract = {A vast literature explores life insurance from the perspective of a single individual. This paper considers an alternative approach by developing and testing a theoretical model for term life insurance demand by married households over age 50. Allowing for joint, cooperative decision making between spouses, empirical findings show that increasing the relative bargaining power of husbands results in reductions in the size of the insurance policies covering the lives of husbands in a manner consistent with theory. The intuition is that households reallocate resources to states of nature that husbands place greater weight by reducing the amount spent on purchasing insurance covering the lives of husbands. In contrast, marital bargaining power generally has a substantially smaller effect in the demand for life insurance covering the lives of wives. However, when bargaining power is shifted towards husbands, life insurance coverage increases among the subsample of wives who provide a large proportion of total household income and are more likely to require protection against lost future income in the event of death.}, keywords = {End of life decisions, Insurance, Net Worth and Assets, Other}, author = {Edwin S. Wong} } @mastersthesis {6041, title = {Marital History and Retirement Security: An Empirical Analysis of the Work, Family, and Gender Relationship}, year = {2015}, school = {University of Massachusetts}, address = {Boston}, abstract = {This dissertation investigates the relationship between marital history and individuals{\textquoteright} retirement resources, namely Social Security, employer-sponsored pensions, and non-housing wealth. Prior research provides a foundation for understanding marriage{\textquoteright}s positive relationship to retirement security, and suggests that marriage is financially beneficial and can even lessen some external factors that would otherwise damage a family{\textquoteright}s financial situation. Yet changing demographics, with fewer people in first marriages and rising numbers of individuals experiencing divorce and choosing to remain unmarried, suggest our understanding of this relationship for today{\textquoteright}s retirees may be limited. The purpose of this research is to identify which aspects of complex marital histories are associated with individuals{\textquoteright} retirement security, paying particular attention to gender differences. Using data from nine waves of the Health and Retirement Study (1992-2008), four facets of marital history are examined: marriage type, frequency, timing, and duration. Currently married and currently unmarried respondents are separated during the analyses in order to adequately capture the association between previous marital events and retirement resources. The results indicate that marital history is associated with Social Security, employer-sponsored pensions, and non-housing wealth differently, and that these relationships vary by gender and current marital status. The findings provide support for the argument that marital history, and in particular marital duration, has a strong relationship to retirement resources. Contrary to expectations, currently married women with longer marriages have less Social Security and pension income than married women who experienced shorter marriages. Marital history has no relationship to the retirement security of married men. For the unmarried groups, never married men have the lowest odds of receiving an employer-sponsored pension and have less non-housing wealth than both divorce and widowed men. Unmarried women{\textquoteright}s retirement security is associated with the type of disruption experienced; women with multiple past marriages have more resources if they are currently widowed but less if they are currently divorced. Further study is needed to understand how and why complex marital history factors have a relationship to retirement finances, and to expand our knowledge about certain understudied populations such as remarried women and never married men.}, keywords = {Adult children, Net Worth and Assets, Retirement Planning and Satisfaction}, author = {Palmer, Lauren A. Martin} } @article {8163, title = {Measurement Invariance of Cognitive Abilities Across Ethnicity, Gender, and Time Among Older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 May}, pages = {386-97}, publisher = {70}, abstract = {

OBJECTIVES: The aim of this research was to test the invariance of the cognitive variables in the Health and Retirement Study/Asset Health Dynamics Among the Oldest Old studies (HRS/AHEAD) across ethnicity, gender, and time.

METHOD: Analyses were conducted using a selected subsample of the HRS/AHEAD data set. The cognitive performance tests measuring episodic memory and mental status were used, and invariance of a two-factor structure was tested using confirmatory factor analyses and multilevel modeling for longitudinal data.

RESULTS: Results provided some support for "strict" factorial invariance of the episodic memory and mental status measures across ethnicity and gender. Further support of weak ("metric") measurement invariance was found across time.

DISCUSSION: Results of the research further our understanding of invariance of the HRS/AHEAD cognitive ability measures. Further implications are discussed.

}, keywords = {Aged, Aged, 80 and over, Black People, Female, Hispanic or Latino, Humans, Male, Memory, Episodic, Mental Processes, Middle Aged, Neuropsychological tests, Psychometrics, Psychomotor Performance, Reproducibility of Results, Sex Factors, Time Factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbt106}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2013/10/25/geronb.gbt106.abstract}, author = {A Nayena Blankson and John J McArdle} } @mastersthesis {6382, title = {The Mechanism of Ageism: The Relationship Between Perceived Ageism and Depressive Symptoms in Later Life}, volume = {Ph. D.}, year = {2015}, note = {

Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015

Last updated - 2016-01-07

}, month = {2015}, pages = {113}, school = {The Florida State University}, type = {Ph.D.}, abstract = {Extending the human life span has long been a desire of human beings. It seems the wish has been actualized. However, simply living a long life does not always seem to be a blessing. Older adults report a lower level of psychological well-being and quality of life and even have a higher rate of suicide, compared to the general population. Furthermore, as older adults are likely to experience the death of a loved one, deteriorating health, retirement, and changing relationships with others, older adults have a high risk of depression. Social work has a long history of providing social services to older adults. In particular, social work has provided older adults with a variety of services to enhance their quality of life and mental health status. Because ageism is one form of discrimination that social work has long been concerned with, this study focuses on the relationship between perceived ageism and depressive symptoms among older adults. Therefore, the purpose of this study is to examine the relationship between perceived ageism and depressive symptoms among older adults and to investigate the mechanism linking perceived ageism to late-life depression. Three primary effects were examined: the direct effect of perceived ageism on depressive symptoms in later life, the mediating effects of self-perception of aging and purpose in life on the relationship between perceived ageism and late-life depression, and the moderating effect of perceived ageism on the association between religiosity and depression among older adults. The stress process model was used to provide an overall idea to explain the three types of the effects related to the mechanism of ageism. Cooley{\textquoteright}s looking-glass self, Beck{\textquoteright}s cognitive theory of depression, and Levy{\textquoteright}s stress embodiment theory were used to explain the mediating effect of self-perception of aging, and Beck{\textquoteright}s cognitive theory of depression was applied again to clarify the mediating effect of purpose in life. The stress buffer theory and the life-span theory of control indicated the moderating effect of perceived ageism on the relationship between religiosity and depression. Secondary analysis of existing data was conducted using the Health and Retirement Study (HRS) datasets, a longitudinal panel study of the U.S. population ages 50 and over. The sample of this study was 3,991 participants, who were older adults ages 65 and over and whose answers were available for the study analyses. Descriptive and preliminary analyses were performed to roughly examine the relationships between variables. With regard to the direct effect of perceived ageism on depressive symptoms, multiple regression analyses were performed controlling for significant variables. With regard to the mediating effects of self-perception of aging and purpose in life, structural equation modeling (SEM) analyses using structural regression models were conducted. In respect to the moderating effect of perceived ageism on the relationship between religiosity and depression, SEM analyses with multiple groups were performed. Based on the results of the several different analyses, a direct relationship between perceived ageism and late-life depression was found. That is, older adults who perceive ageism are likely to have a higher level of depressive symptoms than their counterparts. This direct relationship between perceived ageism and late depressive symptoms among older adults, however, was not detected after controlling for self-perception of aging and purpose in life, indicating the full mediation effects of self-perception of aging and purpose in life. That is, older adults who perceive ageism are likely to have negative self-perception of aging, and this negative view of their own aging is likely to increase depressive symptoms. Additionally, older adults who have a negative view of their aging are likely to have a negative view of their future, and this lower purpose in life also increases depressive symptoms. The strength of the effect of religiosity on depression did not differ between the perceived age sm and the not perceived ageism groups, indicating no moderating effect of perceived ageism on the relationship between religiosity and depression. This study contributes to the existing body of knowledge by providing the information about the relationship between perceived ageism and depression and the mechanism of this relationship. Also, this study re-examined and supported established theories in the context of perceived ageism. Additionally, the current study suggests the necessity of anti-ageism policies and social work services and describes possible ways of providing such social policies and social work services at the micro, mezzo, and macro levels. The results of this study imply that more efforts and resources are necessary to reduce ageism and its negative effect on depression among older adults, and these efforts will eventually contribute to making a more just, better society.}, keywords = {Employment and Labor Force, Health Conditions and Status, Healthcare, Retirement Planning and Satisfaction}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1729637475?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+A\%26I\&rft_val_fmt=info:ofi/fmt:}, author = {Kim, Hyejin} } @article {8264, title = {Medicare Part D Coverage Gap: Race, Gender, and Cost-Related Medication Nonadherence}, journal = {Social Work in Public Health}, volume = {30}, year = {2015}, pages = {473}, publisher = {30}, abstract = {This study examined whether the Medicare Part D coverage gap directly and indirectly affects the relationship between race, gender, and cost-related nonadherence (CRN). Using a nationally representative sample (N = 1,157), this study found that racial disparities in CRN existed under Medicare Part D. However, reaching the coverage gap mediated differences in CRN between older Blacks and Whites. The coverage gap was associated with CRN and poorer health and lower income were associated with CRN after accounting for coverage gap status. Findings highlight the need to help vulnerable populations avoid CRN and for greater consideration of racial inequities in future policy decisions.}, keywords = {Medicare/Medicaid/Health Insurance}, author = {Bakk, Louanne} } @article {8299, title = {Mixture SNPs effect on phenotype in genome-wide association studies.}, journal = {BMC Genomics}, volume = {16}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Feb 03}, pages = {3}, publisher = {16}, abstract = {

BACKGROUND: Recently mixed linear models are used to address the issue of "missing" heritability in traditional Genome-wide association studies (GWAS). The models assume that all single-nucleotide polymorphisms (SNPs) are associated with the phenotypes of interest. However, it is more common that only a small proportion of SNPs have significant effects on the phenotypes, while most SNPs have no or very small effects. To incorporate this feature, we propose an efficient Hierarchical Bayesian Model (HBM) that extends the existing mixed models to enforce automatic selection of significant SNPs. The HBM models the SNP effects using a mixture distribution of a point mass at zero and a normal distribution, where the point mass corresponds to those non-associative SNPs.

RESULTS: We estimate the HBM using Gibbs sampling. The estimation performance of our method is first demonstrated through two simulation studies. We make the simulation setups realistic by using parameters fitted on the Framingham Heart Study (FHS) data. The simulation studies show that our method can accurately estimate the proportion of SNPs associated with the simulated phenotype and identify these SNPs, as well as adapt to certain model mis-specification than the standard mixed models. In addition, we analyze data from the FHS and the Health and Retirement Study (HRS) to study the association between Body Mass Index (BMI) and SNPs on Chromosome 16, and replicate the identified genetic associations. The analysis of the FHS data identifies 0.3\% SNPs on Chromosome 16 that affect BMI, including rs9939609 and rs9939973 on the FTO gene. These two SNPs are in strong linkage disequilibrium with rs1558902 (Rsq =0.901 for rs9939609 and Rsq =0.905 for rs9939973), which has been reported to be linked with obesity in previous GWAS. We then replicate the findings using the HRS data: the analysis finds 0.4\% of SNPs associated with BMI on Chromosome 16. Furthermore, around 25\% of the genes that are identified to be associated with BMI are common between the two studies.

CONCLUSIONS: The results demonstrate that the HBM and the associated estimation algorithm offer a powerful tool for identifying significant genetic associations with phenotypes of interest, among a large number of SNPs that are common in modern genetics studies.

}, keywords = {Algorithms, Alleles, Alpha-Ketoglutarate-Dependent Dioxygenase FTO, Bayes Theorem, Body Mass Index, Chromosomes, Human, Pair 16, Genome-Wide Association Study, Humans, Linkage Disequilibrium, Phenotype, Polymorphism, Single Nucleotide, Principal Component Analysis, Proteins}, issn = {1471-2164}, doi = {10.1186/1471-2164-16-3}, author = {Wang, Ling and Shen, Haipeng and Hexuan Liu and Guo, Guang} } @article {8191, title = {More Caregiving, Less Working: Caregiving Roles and Gender Difference}, journal = {Journal of Applied Gerontology}, volume = {34}, year = {2015}, pages = {465-483}, publisher = {34}, abstract = {This study examined the relationship of caregiving roles to labor force participation using the nationally representative data from the Health and Retirement Study. The sample was composed of men and women aged 50 to 61 years (N = 5,119). Caregiving roles included caregiving for spouse, parents, and grandchildren; a summary of three caregiving roles was used to indicate multiple caregiving roles. Bivariate analysis using chi-square and t tests and binary logistic regression models were applied. Results show that women caregivers for parents and/or grandchildren were less likely to be in the labor force than non-caregivers and that caregiving responsibility was not related to labor force participation for the sample of men. Findings have implication for supporting family caregivers, especially women, to balance work and caregiving commitments.}, keywords = {Adult children, Demographics, Employment and Labor Force, Healthcare}, doi = {10.1177/0733464813508649}, url = {http://jag.sagepub.com/content/early/2013/10/29/0733464813508649.abstract}, author = {Lee, Yeonjung and Tang, Fengyan} } @article {5864, title = {Mortality Heterogeneity and Systematic Mortality Improvement}, year = {2015}, institution = {Sydney, Australia, CEPAR - ARC Centre of Excellence in Population Ageing Research}, abstract = {Insurers and pension funds provide life annuities and pensions that are impacted by both aggregate mortality improvement and individual mortality heterogeneity. Aggregate population mortality trends have shown significant improvement over long periods of time. Individual mortality heterogeneity arises from differing risk characteristics across individuals. This paper assesses the extent that systematic mortality improvement varies with individual risk characteristics. To do this, a Lee-Carter model is used to assess if mortality improvement varies for groups of individuals with similar risk characteristics along with an individual mortality model that allows for heterogeneity with time trends to assess systematic risk. Data from the U.S. Health and Retirement Study (HRS) is used since this provides longitudinal, individual level data. Our results are highly relevant to life insurers, pension funds and regulators assessing the future impact of improvement trends in mortality on their premiums and liabilities. Mortality trends differ across individuals reflecting the different risk factors and particularly the prevalence of different diseases such as high blood pressure, cancer and heart problems. Models that are based on aggregate population level trends and differing only by gender and age are not adequate in quantifying mortality trends and risks.}, author = {Xu, Mengyi and Sherris, Michael and Meyricke, Ramona} } @article {8164, title = {Mothering alone: cross-national comparisons of later-life disability and health among women who were single mothers}, journal = {Journal of Epidemiology and Community Health}, volume = {69}, year = {2015}, pages = {865-872}, publisher = {69}, abstract = {Background Single motherhood is associated with poorer health, but whether this association varies between countries is not known. We examine associations between single motherhood and poor later-life health in the USA, England and 13 European countries.Methods Data came from 25 125 women aged 50 who participated in the US Health and Retirement Study, the English Longitudinal Study of Ageing and Survey of Health, Ageing and Retirement in Europe. We tested whether single motherhood at ages 16 49 was associated with increased risk of limitations with activities of daily living (ADL), instrumental ADL and fair/poor self-rated health in later life.Results 33 of American mothers had experienced single motherhood before age 50, versus 22 in England, 38 in Scandinavia, 22 in Western Europe and 10 in Southern Europe. Single mothers had higher risk of poorer health and disability in later life than married mothers, but associations varied between countries. For example, risk ratios for ADL limitations were 1.51 (95 CI 1.29 to 1.98) in England, 1.50 (1.10 to 2.05) in Scandinavia and 1.27 (1.17 to 1.40) in the USA, versus 1.09 (0.80 to 1.47) in Western Europe, 1.13 (0.80 to 1.60) in Southern Europe and 0.93 (0.66 to 1.31) in Eastern Europe. Women who were single mothers before age 20, for 8 years, or resulting from divorce or non-marital childbearing, were at particular risk.Conclusions Single motherhood during early-adulthood or mid-adulthood is associated with poorer health in later life. Risks were greatest in England, the USA and Scandinavia. Selection and causation mechanisms might both explain between-country variation.}, keywords = {Adult children, Cross-National, Disabilities, Health Conditions and Status, Methodology}, doi = {10.1136/jech-2014-205149}, url = {http://jech.bmj.com/content/early/2015/04/10/jech-2014-205149.abstract}, author = {Lisa F Berkman and Yuhui Zheng and M. Maria Glymour and Mauricio Avendano and Axel Borsch-Supan and Erika L. Sabbath} } @article {8154, title = {Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions.}, journal = {Prev Chronic Dis}, volume = {12}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr 23}, pages = {E55}, publisher = {12}, abstract = {

INTRODUCTION: Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS: We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS: All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95\% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION: Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Body Mass Index, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Data Interpretation, Statistical, ethnicity, Female, Health Status Indicators, Humans, Interviews as Topic, Male, Middle Aged, Mobility Limitation, Outcome Assessment, Health Care, Prospective Studies, Recurrence, Retirement, Self Report, Smoking, Social Class, Syndrome, United States, Vulnerable Populations}, issn = {1545-1151}, doi = {10.5888/pcd12.140478}, author = {Siran M Koroukian and David F Warner and Owusu, Cynthia and Charles W Given} } @article {8139, title = {Marital quality and diabetes: Results from the Health and Retirement Study}, journal = {Health Psychology}, volume = {33}, year = {2014}, pages = {832-840}, publisher = {33}, abstract = {Objective: Poor marital quality is associated with many different indicators of poor health, including immunologic and metabolic responses that have relevance for distal disease outcomes such as diabetes. We conducted this study to evaluate whether poor marital quality was associated with the prevalence of diabetes in a population-based sample of Americans over the age of 50. Method: Participants were married adults from the 2006 (N = 3,898) and 2008 (N = 3,452) waves of the Health and Retirement Study. Participants completed an interview and a self-report questionnaire, and current use of diabetes medication and glycosylated hemoglobin obtained from blood spot samples were used to index diabetes status. Marital quality was assessed with items regarding perceived frequency of positive and negative exchanges with partner. Results: Decreasing frequency of positive exchanges and increasing frequency of negative exchanges with one s spouse were associated with higher prevalence of diabetes among men, but not women at both waves; gender significantly moderated the associations between partner exchanges and diabetes status for the 2006 data. The association between frequency of partner exchanges and diabetes status generally remained significant in men after accounting for demographic characteristics and other risk factors (obesity, hypertension, low physical activity). Conclusion: Poor marital quality as operationalized by rates of positive and negative partner exchanges was associated with increased prevalence of diabetes in men. These results are consistent with prior work on marriage and health, and suggest that poor marital quality may be a unique risk factor for diabetes.}, keywords = {Adult children, Demographics, Health Conditions and Status}, doi = {10.1037/hea0000064}, author = {Mark A Whisman and Li, Angela and Sbarra, David A. and Raison, Charles L.} } @article {7977, title = {The Material Convoy After Age 50}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {69}, year = {2014}, pages = {442-450}, publisher = {69}, abstract = {Objectives. Possessions constitute a dynamic material convoy that accumulates across adulthood to furnish role enactments and the development of the self. Following a familiar life course arc, older people should hypothetically release the possessions that equipped the daily lives that they no longer have.Method. We use new survey data on possession divestment from the 2010 Health and Retirement Study to assess activity on behalf of the material convoy after age 50.Results. After age 50, people are progressively less likely to divest themselves of belongings. After age 70, about 30 of persons say that they have done nothing in the past year to clean out, give away, or donate things, and over 80 have sold nothing. We tested whether divestments diminish with age because they do not seem necessary or because of health limitations, but the age pattern is robust, suggesting retention of the material convoy in later life.Discussion. Further research on this age pattern might consider housing, the construction of the self, and social networks as explanations for retention. Inertia toward the material convoy maintains the availability and comfort of things, but it may also lead to a predicament wherein the collection becomes a worry for self and others.}, keywords = {Consumption and Savings, Event History/Life Cycle, Health Conditions and Status, Housing, Other}, doi = {10.1093/geronb/gbu003}, url = {http://psychsocgerontology.oxfordjournals.org/content/69/3/442.abstract}, author = {David J Ekerdt and Lindsey A Baker} } @mastersthesis {6010, title = {Mechanisms of Health Disparities in Inflammation: A Test of the Differential Stress Exposure and Differential Stress Vulnerability Hypotheses}, volume = {3623220}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-08-08 First page - n/a}, month = {2014}, pages = {225}, school = {University of California, Los Angeles}, type = {Ph.D.}, address = {Los Angeles}, abstract = {The current study sheds light on the mechanisms through which group differences in exposure to and the impact of discrimination generate disparities in cardiovascular diseases. The study specifically looks at its effects on C-reactive protein (i.e., CRP), a protein produced in response to exposure to stressors. It is a marker of systemic inflammation that is positively associated with cardiovascular diseases such as stroke, atherosclerosis, and myocardial infarction. The current study goes beyond a basic description of the population-level distribution of CRP by focusing on psychosocial factors that mediate and/or moderate these relationships. The specific aims of the dissertation are to investigate: (1) racial/ethnic and gender differences in CRP levels; (2) differential exposure to discrimination as an explanation for the social patterning of CRP; (3) differential vulnerability to discrimination; and (4) the extent to which coping resources dampens these effects. The dissertation uses data from the Health and Retirement Study (HRS), a multi-cohort longitudinal survey of a large and nationally representative sample of adults age 51 years and older. The HRS aims to identify and better understand the social, economic, psychosocial, and physical factors that influence and result from retirement. Since its inception in 1992, data have been collected every two years on the original HRS cohort and on subsequent cohorts added to the study. The "core" HRS interview is conducted face-to-face at baseline and collects data on demographic characteristics; housing and family structure; employment, income, assets, and insurance; health care, health status, cognition, and disability; and life expectations. Beginning in 2004, HRS respondents were asked to complete a psychosocial questionnaire that included measures of everyday and lifetime discrimination, among other factors, and in 2006 biomarkers--including CRP--were collected from one half of the study sample; biomarkers were collected from the other half in 2008. To maintain sufficient statistical power to detect differences in CRP, multivariate analyses are conducted with data from a hybrid 2006/2008 sample. The analysis involves statistical methods needed to appropriately adjust for the complex sampling design of HRS and to test the intricate causal pathways leading to race differences in CRP. In line with our hypotheses, African Americans have higher levels of CRP than non-Hispanic whites and reported greater exposure to everyday and lifetime discrimination. Hispanics do not significantly differ from non-Hispanic whites in CRP levels or in their reports or everyday and lifetime discrimination. In unadjusted models, everyday and major lifetime discrimination are positively associated with CRP. This association remains for lifetime discrimination in fully adjusted models but not for everyday discrimination. Both everyday and lifetime discrimination mediate racial/ethnic and gender differences in inflammation. Lifetime discrimination mediates these differences in and of itself, and in conjunction with other factors, particularly waist circumference. Everyday discrimination also mediates group differences in inflammation in conjunction with waist circumference. Vulnerability to discrimination does not differ by race/ethnicity or by gender, and the coping resources evaluated in this study do not buffer the effects of discrimination on inflammation. This study supports the presence of racial differences in CRP--an indicator of systemic inflammation and a clinical risk factor for cardiovascular diseases--on a population-level. The findings also suggest that exposure to discrimination, a chronic stressor that disproportionately affects racial minorities, is associated with higher levels of CRP and partially explains racial and gender differences in inflammation. In all, these findings provides further support for the significant contributions of the social environment on health and health disparities. (Abstract shortened by UMI.)}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status, Healthcare, Public Policy}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1550352556?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 = {Uchechi A Mitchell} } @mastersthesis {6016, title = {Medical Underwriting: A Factor in Long-Term Care Insurance Market Demand}, volume = {3646205}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-12-30 First page - n/a}, month = {2014}, pages = {178}, school = {Walden University}, type = {Ph.D.}, address = {Minneapolis}, abstract = {Medical underwriting policies are designed to prevent individuals from purchasing long-term care insurance (LTCI) at a time they are most likely to require these services. There is little agreement among researchers regarding the best way to increase the market demand for private LTCI, which would reduce the number of individuals at risk for high out-of-pocket costs. Researchers do tend to agree that Medicaid, premium cost, lack of awareness, and product complexities lower the demand for LTCI. The purpose of this quantitative study was to investigate the prevalence of health and lifestyle risk factors associated with medical underwriting, and the relationship of these factors to limiting the potential size of the private insurance market. The theoretical foundation for this study was both Andersen{\textquoteright}s model of health services utilization and Akerlof{\textquoteright}s asymmetric information theory. Data were gathered from Wave 10 of the Health and Retirement Study (HRS), a nationally representative dataset, using purposeful sampling to select 12,666 respondents and spouses, ages 51 and older, without LTCI. Descriptive analysis and a nonparametric 1-way chi-square test indicated the presence of at least 1 risk factor in 95.76\% of the sample, 2.72 risk factors per participant in the age group of 51-54, and 4.23 risk factors for participants in the age group of 74-84. Quantitative findings indicated that risk factors associated with medical underwriting affect a sizable proportion of US adults, ages 51 and older. The implications for social change include informing policymakers of the impact of medical underwriting on older adults seeking LTCI for financial security.}, keywords = {Event History/Life Cycle, Healthcare, Insurance, Medicare/Medicaid/Health Insurance, Public Policy}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1639141262?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+A\%26I\&rft_val_fmt=info:ofi/fmt:}, author = {Morgan, Joyce W.} } @article {7981, title = {Medicare spending, managed care and pre-Medicare insurance coverage and associated risks of mortality, deterioration of self-rated health and mental health after four years of Medicare coverage}, journal = {Journal of Hospital Administration}, volume = {3}, year = {2014}, pages = {20-33}, publisher = {3}, abstract = {National spending on Medicare keeps growing and managed care is reimbursed differently in the United States. Health returns from Medicare spending are not certain. This study aims to quantify the effects of Medicare spending in the first two years of Medicare coverage, managed care and insurance coverage before Medicare (pre-Medicare) on mortality, mental health and self-rated health status after first four years of Medicare coverage. Individuals, who were interviewed from age 65 to 68 years, without Medicare coverage before age 65 years, were included. Health spending (out-of-pocket, OOP) in the first two years of Medicare coverage, their pre-Medicare characteristics and Medicare managed care were used to predict associated risks of mortality, self-rated health status and mental health (Center for Epidemiologic Studies-Depression, CESD scale). Eligible Medicare enrollees (N = 3,503) in the Health and Retirement Study from 1992 to 2011 were chosen. Total health spending was associated with higher likelihood of worse mental health and self-rated health, but OOP spending was associated with risks of health deterioration (p .05 for all). More OOP health spending in the first two years of Medicare coverage was associated with slightly higher chance of more mental problems, but the magnitude of this association became smaller over time. Medicare managed care did not seem to be beneficial for mortality, mental health or self-rated health status. Expanding pre-Medicare health coverage (through the Affordable Care Act) may not influence health status after first four years of Medicare coverage. Preventing pre-Medicare health conditions may be the priority.}, keywords = {Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance}, doi = {10.5430/jha.v3n5p20}, author = {Yi-Sheng Chao} } @article {8022, title = {Mental work demands, retirement, and longitudinal trajectories of cognitive functioning.}, journal = {J Occup Health Psychol}, volume = {19}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Apr}, pages = {231-42}, publisher = {19}, abstract = {

Age-related changes in cognitive abilities are well-documented, and a very important indicator of health, functioning, and decline in later life. However, less is known about the course of cognitive functioning before and after retirement and specifically whether job characteristics during one{\textquoteright}s time of employment (i.e., higher vs. lower levels of mental work demands) moderate how cognition changes both before and after the transition to retirement. We used data from n = 4,182 (50\% women) individuals in the Health and Retirement Study, a nationally representative panel study in the United States, across an 18 year time span (1992-2010). Data were linked to the O*NET occupation codes to gather information about mental job demands to examine whether job characteristics during one{\textquoteright}s time of employment moderates level and rate of change in cognitive functioning (episodic memory and mental status) both before and after retirement. Results indicated that working in an occupation characterized by higher levels of mental demands was associated with higher levels of cognitive functioning before retirement, and a slower rate of cognitive decline after retirement. We controlled for a number of important covariates, including socioeconomic (education and income), demographic, and health variables. Our discussion focuses on pathways through which job characteristics may be associated with the course of cognitive functioning in relation to the important transition of retirement. Implications for job design as well as retirement are offered.

}, keywords = {Cognition, Employment, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Stress, Psychological}, issn = {1939-1307}, doi = {10.1037/a0035724}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84896104239andpartnerID=40andmd5=8a0c0422ba5b68927fdc926a3e8a25b4}, author = {Gwenith G Fisher and Stachowski, Alicia and Frank J Infurna and Jessica Faul and James Grosch and Lois E Tetrick} } @article {8041, title = {Midlife trends in activities and disability}, journal = {Journal of Aging and Health}, volume = {26}, year = {2014}, note = {Times Cited: 0}, pages = {178-206}, publisher = {26}, abstract = {Objectives: This is the first analysis that demonstrates empirically the likely tie between activities (time spent) and disability (health-related difficulty in activities). We compare trends in activities and disability for Americans ages 55 to 69 in recent years, and assess cross-sectional linkages of activities and disability. Methods: Data are from the Health and Retirement Study, a longitudinal survey of community-dwelling U.S. adults. Trends are estimated by mixed-effects regression models (MRMs) with time, age, and time-age interaction predictors. Links of activities and disability also use MRM. Results: For midlife adults, hobbies/leisure and sports/exercise increased, repairs/yard decreased, and several activities had convex patterns; by contrast, disability prevalence was stable. Personal care hours rise with disability, but most activities decline. Discussion: Activities are more dynamic than disability, and time use is associated with disability. Taken together, the results encourage broader activities in disability measures to capture better disability{\textquoteright}s scope and dynamics.}, keywords = {Demographics, Disabilities, Event History/Life Cycle, Health Conditions and Status, Methodology, Other}, doi = {10.1177/0898264313508189}, author = {Verbrugge, Lois M. and Xian Li} } @article {7987, title = {Mismeasurement of pensions before and after retirement: the mystery of the disappearing pensions with implications for the importance of Social Security as a source of retirement support}, journal = {Journal of Pension Economics and Finance}, volume = {13}, year = {2014}, pages = {1-26}, publisher = {13}, abstract = {A review of the literature suggests that when pension values are measured by the wealth equivalent of promised defined benefit pension benefits and defined contribution balances for those approaching retirement, pensions account for more support in retirement than is suggested when their contribution is measured by incomes received directly from pension plans by those who have already retired. Estimates from the Health and Retirement Study for respondents in their early fifties suggest that pension wealth is about 82 as valuable as Social Security wealth. In data from the Current Population Survey (CPS), for members of the same cohort, measured when they are 65-69, pension incomes are about 58 as valuable as incomes from Social Security. Our empirical analysis uses data from the HRS to examine the reasons for these differences in the contributions of pensions as measured in income and wealth data. Key factors accounting for these differences include: a difference in methodology between surveys affecting what is included in pension income; some pension wealth {\textquoteright}disappears{\textquoteright} at retirement because respondents change their pension into other forms that are not counted as pension income; and the form of annuitization may influence the measure of pension income. A series of caveats notwithstanding, the bottom line is that CPS data on pension incomes received in retirement understates the full contribution pensions make to supporting retirees. PUBLICATION ABSTRACT}, keywords = {Net Worth and Assets, Pensions, Public Policy, Retirement Planning and Satisfaction, Social Security}, author = {Alan L Gustman and Thomas L. Steinmeier and N. Tabatabai} } @article {7983, title = {Mortality and cardiovascular disease among older live kidney donors.}, journal = {Am J Transplant}, volume = {14}, year = {2014}, note = {Times Cited: 0}, month = {2014 Aug}, pages = {1853-61}, publisher = {14}, abstract = {

Over the past two decades, live kidney donation by older individuals (>=55 years) has become more common. Given the strong associations of older age with cardiovascular disease (CVD), nephrectomy could make older donors vulnerable to death and cardiovascular events. We performed a cohort study among older live kidney donors who were matched to healthy older individuals in the Health and Retirement Study. The primary outcome was mortality ascertained through national death registries. Secondary outcomes ascertained among pairs with Medicare coverage included death or CVD ascertained through Medicare claims data. During the period from 1996 to 2006, there were 5717 older donors in the United States. We matched 3368 donors 1:1 to older healthy nondonors. Among donors and matched pairs, the mean age was 59 years; 41\% were male and 7\% were black race. In median follow-up of 7.8 years, mortality was not different between donors and matched pairs (p = 0.21). Among donors with Medicare, the combined outcome of death/CVD (p = 0.70) was also not different between donors and nondonors. In summary, carefully selected older kidney donors do not face a higher risk of death or CVD. These findings should be provided to older individuals considering live kidney donation.

}, keywords = {Age Factors, Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Kidney Transplantation, Living Donors, Longitudinal Studies, Male, Medicare, Middle Aged, Nephrectomy, Quality of Life, Renal Insufficiency, Time Factors, Treatment Outcome, United States}, issn = {1600-6143}, doi = {10.1111/ajt.12822}, author = {P. P. Reese and R. D. Bloom and H. I. Feldman and Rosenbaum, P and Wang, W and P. Saynisch and Tarsi, N M and Mukherjee, N and Garg, A X and A. Mussell and J. Shults and Even-Shoshan, O and R. R. Townsend and J. H. Silber} } @article {8014, title = {A Multilevel Dyadic Study of the Impact of Retirement on Self-Rated Health: Does Retirement Predict Worse Health in Married Couples?}, journal = {Research on Aging}, volume = {36}, year = {2014}, note = {Date revised - 2014-12-01 Number of references - 58}, pages = {297-321}, publisher = {36}, abstract = {Objectives: This study examined the effects of retirement on self-rated health for married couples, using interdependence and social stratification theoretical frameworks. Method: Dyadic multilevel modeling of data (N = 2,213 non- Hispanic couples) from 1992 to 2010 of the Health and Retirement Survey. Results: Retirement was associated with worse self-ratings of health (SRH) short term (ST) for both husbands and wives during the first couple of years of retirement. In addition, the longer the husbands (but not wives) were retired, the worse was their SRH. Cross-spouse effects varied by gender: When wives retired, their husbands SRH improved ST, but when husbands retired their wives SRH improved long term. Spouse education moderated the relationship between years since spouses retirement and SRH for wives. Discussion: Practitioners can use this information to help married couples through retirement planning and transitions. Results suggest that models of retirement in couples should pay greater attention to gender and other social stratification factors, spousal interdependence, and length of time since retirement.}, keywords = {Adult children, Demographics, Health Conditions and Status, Healthcare, Methodology, Retirement Planning and Satisfaction}, doi = {10.1177/0164027513486900}, author = {Angela L Curl and Aloen L. Townsend} } @article {doi:10.1200/jco.2014.32.15_suppl.9542, title = {Multimorbidity and racial disparities in use of hospice by older patients dying from cancer.}, journal = {Journal of Clinical Oncology}, volume = {32}, year = {2014}, pages = {9542-9542}, abstract = {9542 Background: While previous studies have documented lower use of hospice by Non-Hispanic Blacks (NHBs) than by Non-Hispanic Whites (NHWs), racial variations have not been examined in the context of multimorbidity (MM), which affects minority patients disproportionately. We sought to determine the impact of MM severity on NHBs{\textquoteright} use of hospice in a U.S. representative sample of older adults. Methods: We used data from the linked 1991-2008 Health and Retirement Study (HRS), Medicare data, and the National Death Index (NDI). From the NDI, we identified fee-for-service patients >=65 years of age who died from cancer (n=812), and retrieved their demographic data, presence of comorbidities (COM), functional limitations (FL), and geriatric syndromes (GS) from their last HRS interview. We characterized severity of MM by 3 levels: none or only one of COM, FL, or GS (MM0/1); presence of two of COM, FL, or GS (MM2); or presence of all three of COM, FL, and GS (MM3). Hospice use was identified from Medicare claims data. We developed multivariable logistic regression models to analyze the association between race and hospice use, adjusting for MM and other patient covariates. Results: Nearly 12\% of the study population was NHB; 61.3\% of NHBs and 53.0\% of NHWs were identified in MM3 (p=0.057). Overall, 61\% of the patients received hospice care (63.7\% in NHWs, and 43.0\% in NHBs, p < 0.001). The distribution NHBs and NHWs by MM was similar across hospice users and non-users. Adjusting for MM and other confounders, NHBs were significantly less likely than NHWs to utilize hospice (Adjusted odds ratio: 0.42, 95\% Confidence Interval: 0.27-0.66, p < 0.001). Conclusions: Despite the greater representation of NHBs in the highest severity of MM category, NHBs remain significantly less likely than NHWs to use hospice, even after adjusting for MM. The findings carry important implications with regard to disparities in providing optimal, and cost effective quality of end-of-life care.}, keywords = {Cancer, Death, multimorbidity, National Death Index, race, race difference, race-ethnicity}, doi = {10.1200/jco.2014.32.15_suppl.9542}, author = {Siran M Koroukian and Nicholas K Schiltz and Warner, David and Charles W Given and Owusu, Cynthia and Mark Schluchter and Nathan A. Berger} } @mastersthesis {6233, title = {Managing retirement resources: evidence from the HRS}, volume = {PhD}, year = {2013}, school = {Texas Tech University}, address = {Lubbock, TX}, abstract = {Households are required to make a variety of decisions in pursuit of their retirement goals. These decisions are often complex and require the estimation and input of multiple factors when analyzing alternatives. Complexity and uncertainty have been found to lead to behavioral biases and a dependence on heuristics when making decisions. These deficiencies create a failure to incorporate valuable information, an overreliance on recent events, and inaccurate estimations of future outcomes. When these factors are combined with widespread low levels of financial sophistication and declining cognition the result is often behavior that is contradictory to rational expectations and detrimental to lifetime wealth and utility. Households are bound at a variety of levels by the limitations described above. Sophisticated households and those with higher levels of cognitive ability are more likely to participate in financial markets, enjoy higher returns on investments, and greater levels of wealth. Those with less sophistication and cognitive ability may fail to understand complex financial products, have less consistent preferences, and be more likely to engage in behavior that is inconsistent and detrimental to long-term goals and overall well-being. Given the variation in levels of financial sophistication and cognitive ability, we seek to evaluate how households make decisions in the face of market complexity, and in some cases how these decisions affect financial outcomes. Using the Health and Retirement Study (HRS) we give special focus to the decisions and behavior of older households. We look specifically at the impact of financial sophistication on individuals{\textquoteright} ability to accurately value life annuities, how cognitive ability is related to stock reallocations during the great recession, and how cognitive ability relates to the asset decumulation decisions of retirees.}, keywords = {Expectations, Health Conditions and Status, Net Worth and Assets, Retirement Planning and Satisfaction}, url = {http://hdl.handle.net/2346/58201}, author = {Chris Browning} } @article {7942, title = {Marital Processes around Depression: A Gendered and Relational Perspective}, journal = {Society and Mental Health}, volume = {3}, year = {2013}, pages = {151-169}, publisher = {3}, abstract = {Despite extensive evidence of the importance of marriage and marital processes for mental health, little is known about the interpersonal processes around depression within marriage and the extent to which these processes are gendered. We use a mixed-methods approach to explore the importance of gender in shaping processes around depression within marriage. We approach this in two ways: First, using quantitative longitudinal analysis of 2,601 couples from the Health and Retirement Study (HRS), we address whether depressive symptoms in one spouse shape the other spouse s depressive symptoms and whether men or women are more influential in this process. We find that a wife s depressive symptoms influence her husband s future depressive symptoms, but a husband s depressive symptoms do not influence his wife s future symptoms. Second, we conduct a qualitative analysis of in-depth interviews with 29 couples wherein one or both spouses experienced depression to provide additional insight into how gender impacts depression and reactions to depression within marriage. Our study points to the importance of cultural scripts of masculinity and femininity in shaping depression and emotional processes within marriage and highlights the importance of applying a gendered couple-level approach to better understand the mental health effects of marital processes.}, keywords = {Adult children, Demographics, Health Conditions and Status}, doi = {10.1177/2156869313487224}, url = {http://smh.sagepub.com/content/3/3/151.abstract}, author = {Thomeer, Mieke Beth and Debra Umberson and Tetyana Pudrovska} } @book {8650, title = {The Market for Financial Advice}, series = {Pension Research Council Series}, year = {2013}, pages = {368}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {Oxford, UK}, keywords = {Economics, Financial literacy, Market analyses, Older Adults, Retirement Planning and Satisfaction}, author = {Olivia S. Mitchell and Smetters, Kent} } @inbook {5253, title = {Marriage and Wealth Changes at Older Ages}, booktitle = {Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health}, year = {2013}, pages = {158-177}, publisher = {Stanford Economics and Finance}, organization = {Stanford Economics and Finance}, address = {Stanford, CA}, abstract = {This chapter presents an examination of the impact on net worth and savings of changes in family structure at older ages. The analysis demonstrates that married couples have more wealth than unmarried individuals primarily due to the higher lifetime earnings and lower mortality risk of married couples compared to unmarried individuals. Divorce at older ages both divides and consumes wealth and has negative and long-lasting consequences on wealth accumulation while remarriage rebuilds assets.}, keywords = {Adult children, Event History/Life Cycle, Health Conditions and Status, Income, Net Worth and Assets}, doi = {DOI:10.11126/stanford/9780804785853.003.0009}, author = {Julie M Zissimopoulos}, editor = {Kenneth A. Couch and Mary C. Daly and Julie M Zissimopoulos} } @article {7807, title = {Marriage, marital history, and Black-White wealth differentials among older women}, journal = {Journal of Marriage and Family}, volume = {75}, year = {2013}, pages = {342-362}, publisher = {75}, abstract = {This study investigated the impact of union history and marital transitions on wealth inequality between older Black and White women (N = 7,026). Cohort data from the Health and Retirement Study show large and increasing Black - White differences in wealth. Marital and relationship histories are associated with the wealth accumulation process among older women. Women who married and stay married accumulated levels of wealth that exceeded those of other women with disrupted family lives. The marriage - wealth nexus is sensitive to a woman{\textquoteright}s position in the wealth distribution. Quantile regression results revealed that racial differences in total wealth holdings between Black and White women exist throughout the wealth distribution, whereas the relationship between current union history and wealth differentials is significant at the lower tail and middle of the distribution. Decomposition analyses highlighted the nontrivial role of racial disparities in marital histories in accounting for the racial wealth gap. As members of the baby boom generation enter their retirement years, it will be more important than ever to monitor the wealth accumulation process among older single and racial/ethnic minority women.}, keywords = {Adult children, Older Adults, Racial/ethnic differences, Women and Minorities}, doi = {10.1111/jomf.12007}, url = {http://onlinelibrary.wiley.com/doi/10.1111/jomf.12007/abstract}, author = {Fenaba R. Addo and Lichter, Daniel T.} } @mastersthesis {6066, title = {Mechanisms of the effect of involuntary retirement on older adults{\textquoteright} health and mental health}, volume = {3609989}, year = {2013}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2014-03-18 First page - n/a}, month = {2013}, pages = {116}, school = {University of Southern California}, type = {Ph.D.}, address = {Los Angeles}, abstract = {The purpose of the present study is to provide in-depth information on older adults{\textquoteright} experience of involuntary retirement by examining mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 years or older. Although it is a normative expectation to perceive retirement as a phase of life in which older adults become disengaged from paid work, volunteer, and enjoy leisure time with family, not everyone has the luxury of maintaining control over their retirement decisions. Approximately one third of retirees perceive their retirement as forced rather than voluntary. Involuntary retirees are likely to face greater challenges than voluntary retirees during their postretirement adjustment period because they have multiple burdens of health, mental health, and job displacement issues that may have partially led them to involuntarily retire. The prevalence of involuntary retirement is likely to increase because older adults are expected to work longer due to increased financial responsibility despite the challenge of securing or maintaining employment. Although an expanding body of research has addressed various topics of retirement including preretirement planning and decision making, relatively few studies on retirement have focused on the voluntariness of retirement or its varied contexts. Research that has explored health and mental health outcomes after retirement without accounting for voluntariness has reported mixed findings. Considering the fact that retirement has become a more complex and diverse life transition, it is critical to consider the nature of retirement as well as its contexts. To fill this gap of knowledge in research and practice, this study had two specific aims: (1) to explore the prevalence of involuntary retirement among older adults and the extent to which the characteristics of involuntary retirees are different from voluntary retirees or those who did not retire, and (2) to investigate the mechanisms of the health and mental health effect of involuntary retirement by examining the potential mediating effects of financial control, positive and negative family relationships, and social integration. The research questions and hypotheses were formulated based on the life course perspective and latent deprivation theory. Using two waves of longitudinal data extracted from Health and Retirement Study (2006 and 2010), a final sample of 1,280 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves was selected. Univariate, bivariate, and regression-based path analyses were conducted using SPSS 18.0. This study employed a multiple mediation model that considered four mediators simultaneously and the model was estimated in three phases. Results of the study found that 29.3\% (n = 429) of the sample retired between 2006 and 2010, and 37.2\% (n = 155) of those individuals reported that they retired involuntarily. Results of Phase 1, a multiple mediator model that did not account for voluntariness of retirement using a binary independent variable (retired or not), indicated that there was no significant direct or indirect effects of retirement on self-rated health and mental health outcomes. In Phase 2, in which the same model was estimated using a multicategorical independent variable (involuntarily retired, voluntarily retired, not retired), involuntary retirement had an direct adverse health effect compared to not retiring, whereas voluntary retirement had an indirect positive health effect via financial control. In terms of mental health outcomes, the positive mental health effect of voluntary retirement was mediated by financial control, whereas involuntary retirement had no significant effect. Results of Phase 3, a model that considered retirees only, revealed direct adverse health effects of involuntary retirement compared to voluntary retirement. Involuntary retirement also had an indirect effect on mental health via financial control. Findings of this stu y indicate the significance of specifying the nature of retirement when conducting retirement research and the need to pay more attention to potential detrimental effects of involuntary retirement. Implications of the findings are discussed with regard to retirement policy, research, and social work.}, keywords = {Health Conditions and Status, Healthcare, Methodology, Other, Public Policy, Retirement Planning and Satisfaction}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1497284030?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+A\%26I\&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertat}, author = {Min-Kyoung Rhee} } @article {5952, title = {Medicaid Spend Down: Implications for Long-Term Services and Supports and Aging Policy}, year = {2013}, institution = {Long Beach, CA, The SCAN Foundation}, abstract = {Medicaid provides an important safety net for people who are poor or become poor, either because of the high costs of health and long-term services and supports, or for other reasons. The transition from non-Medicaid to Medicaid status can be difficult, especially since it is often associated with illness, disability, and declining income and assets. The high cost of long-term services and supports results in catastrophic out-of-pocket costs for many people needing services, some of whom spend down to Medicaid. For people who have been independent all of their lives, transitioning to Medicaid means depending on a means-tested welfare program for their health and long-term services and supports. Moreover, spending for people transitioning to Medicaid is a substantial portion of state Medicaid expenditures. This study examines transitions to Medicaid eligibility or Medicaid spend down by people age 50 and older over a 12-year period. Data for this study come from the 1996 to 2008 waves of the Health and Retirement Study, which has been merged with Medicare data to help establish Medicaid eligibility.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Other, Public Policy}, author = {Joshua M Wiener and Anderson, Wayne L. and Khatutsky, Galina and Kaganova, Yevgeniya and Janet O{\textquoteright}Keeffe} } @article {7889, title = {Medicare HMO coverage selection and its impact on the accumulated health spending over the first four years of Medicare coverage in the US}, journal = {Journal of Global Health Care Systems}, volume = {3}, year = {2013}, pages = {2}, publisher = {3}, abstract = {Introduction: this study aims 1) to determine the association between individual characteristics before Medicare coverage (pre-Medicare) and the selection into Medicare HMOs (health maintenance organizations) and 2) to quantify the financial impact of Medicare HMO coverage on total and out-of-pocket (OOP) health spending in the first four years of Medicare coverage. Methods: individuals eligible for Medicare because of age in the Health and Retirement Study from 1992 to 2008 were chosen. Individuals interviewed from age 65 to 68 years were included. Pre-Medicare characteristics were used to predict the propensity of selecting into Medicare HMOs and adjust its effect on health spending as well as to quantify the financial impact of Medicare HMO coverage in the first four years, compared to traditional Medicare from 1992 to 2008. There were 1,841 and 4,126 eligible Medicare enrollees included in total and OOP spending models. Results: The pre-Medicare characteristics that were significantly associated with selection into Medicare HMOs included blacks, Hispanic origin, regions of residence and pre-Medicare health plans. The results showed that the average HMO effect on total spending was insignificant, 2,651.0 less than the traditional Medicare plans (SE = 3,761.2, p = 0.46). The saving on OOP spending was significantly 1,411.5 (SE = 620.8, p = 0.03). Conclusion: the HMOs provide better financial protection in OOP health spending for Medicare enrollees in the first four years of Medicare coverage. However, this effect is not significant for total spending.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Methodology}, author = {Yi-Sheng Chao and Chao-Jung Wu} } @article {7877, title = {Mental and physical health consequences of spousal health shocks among older adults}, journal = {Journal of Aging and Health}, volume = {25}, year = {2013}, note = {Times Cited: 0}, pages = {1121-42}, publisher = {25}, abstract = {OBJECTIVE: To examine how the experience of a negative health event (i.e., onset of heart disease, diabetes, lung disease, cancer, or stroke) of one spouse affects the mental and physical well-being of the other partner as measured by depressive symptoms and self-reported health. METHODS: We employ latent growth curve analysis and examine adults 50 using six waves of data (1998-2008) from the Health and Retirement Study. RESULTS: One spouse{\textquoteright}s health shock affects the health of the other partner. Results indicate that a spouse{\textquoteright}s onset of a severe health condition worsens the mental health of women and the self-reported health of men. DISCUSSION: These findings illustrate that the family context of spouses is important to consider when examining health.}, keywords = {Demographics, Health Conditions and Status}, doi = {10.1177/0898264313494800}, author = {Valle, Giuseppina and Weeks, Janet A. and Miles G Taylor and Eberstein, Isaac W.} } @article {7895, title = {Mental retirement and schooling}, journal = {European Economic Review}, volume = {63}, year = {2013}, pages = {292-298}, publisher = {63}, abstract = {We assess the validity of differences in eligibility ages for early and old age pension benefits as instruments for estimating the effect of retirement on cognitive functioning. Because differences in eligibility ages across country and gender are correlated with differences in years of schooling, which affect cognitive functioning at old ages, they are invalid as instruments without controlling for schooling. We show by means of simulation and a replication study that unless the model incorporates schooling, the estimated effect of retirement is negatively biased. This explains a large part of the mental retirement effects which have recently been found.}, keywords = {Cross-National, Health Conditions and Status, Methodology, Other, Retirement Planning and Satisfaction}, doi = {http://dx.doi.org/10.1016/j.euroecorev.2013.01.004}, url = {http://www.sciencedirect.com/science/article/pii/S0014292113000111}, author = {Bingley, Paul and Martinello, Alessandro} } @article {5956, title = {Methods for Analysis of the Financing and Use of Long-Term Services and Supports}, year = {2013}, institution = {Washington, DC}, abstract = {This document describes the data and methods underlying the 23 exhibits presented in Congressional Budget Office, Rising Demand for Long-Term Services and Supports for Elderly People (June 2013). Most of the statistics presented in Rising Demand for Long-Term Services and Supports for Elderly People are based on tabulations of data from the Health and Retirement Study (HRS, http://hrsonline.isr.umich.edu/) and the Access to Care files of the Medicare Current Beneficiary Survey (MCBS, http://go.usa.gov/b7TP). The statistics are population-weighted averages of measurements taken from the data available in those surveys from 2000 to 2010.}, keywords = {Health Conditions and Status, Healthcare, Methodology, Public Policy}, url = {http://www.cbo.gov/publication/44363}, author = {United States Congressional Office} } @article {7868, title = {Modelling and predicting complex patterns of change using growth component models: An application to depression trajectories in cancer patients}, journal = {European Journal of Developmental Psychology}, volume = {10}, year = {2013}, note = {Times Cited: 0}, pages = {40-59}, publisher = {10}, abstract = {In this paper we present a general and flexible framework for constructively defining growth components to model complex change processes. Building on the concepts of the latent state-trait theory (LST theory; Steyer, Ferring, and Schmitt, 1992), we develop structural equation models containing latent variables that represent latent growth (change) components of interest. We formulate these models based on an approach presented by Mayer, Steyer and Mueller (2012). We discuss an application to the longitudinal course of depression in 2,794 individuals from the Health and Retirement Study, who experienced cancer diagnosis over the course of the study. We found that (1) on average, the depression trajectories showed a steep increase after diagnosis as well as an adaptation phase where levels returned back to levels prior to diagnosis, and (2) individual differences in change were large and could be partly explained by marital status and cognitive functioning.}, keywords = {Health Conditions and Status, Methodology, Public Policy}, doi = {10.1080/17405629.2012.732721}, author = {Axel Mayer and Geiser, Christian and Frank J Infurna and Fiege, Christiane} } @article {7798, title = {Monetary costs of dementia in the United States.}, journal = {N Engl J Med}, volume = {368}, year = {2013}, month = {2013 Apr 04}, pages = {1326-34}, publisher = {386}, abstract = {

BACKGROUND: Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase.

METHODS: In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers.

RESULTS: The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7\%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95\% confidence interval [CI], $42,746 to $69,834) or $41,689 (95\% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost.

CONCLUSIONS: Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).

}, keywords = {Aged, Aged, 80 and over, Cost of Illness, Dementia, Female, Health Care Costs, Home Care Services, Home Nursing, Humans, Longitudinal Studies, Male, Medicare, Middle Aged, Nursing homes, United States}, issn = {1533-4406}, doi = {10.1056/NEJMsa1204629}, url = {http://www.nejm.org/doi/full/10.1056/NEJMsa1204629}, author = {Michael D Hurd and Martorell, Paco and Delavande, Adeline and Kathleen J Mullen and Kenneth M. Langa} } @article {7790, title = {Motives for Care that Adult Children Provide to Parents: Evidence from Point Blank Survey Questions}, journal = {Journal of Comparative Family Studies}, volume = {44}, year = {2013}, note = {Times Cited: 0 Si}, publisher = {44}, abstract = {Adult children who care for aging parents. incur costs along psychic, monetary, emotional, and even physical dimensions. What motivates them? Is it altruism, guilt, obligation, or gratitude? Perhaps the anticipation of a bequest? Familial norms, or desire for recognition? Understanding motivation for care is high on the agenda of both economics and sociology. A primary focus of economics is the prospect that public transfers may supplant or stimulate private transfers, depending on the motivation of the private donor. Motives are usually inferred indirectly, on the basis of observed behavior. In contrast, sociologists focus on how familial bonds and networks might be forged and maintained. We depart from each of these approaches to focus on direct questions from a special module in the Health and Retirement Study, which contains questions on motivations for, and concerns about, the provision of familial assistance. Our (deliberately) simple descriptive work reveals abundant new information about motivation for familial transfers and care. These not always provided free of pressure from relatives, for example, and obligations and traditions appear to matter. Findings suggest that the standard economic considerations like utility interdependence or exchange provide an incomplete account of transfer behavior, and that insights from sociological models are essential. We also find that women are far more likely to provide care and take seriously family obligations. Past experience in the provision of financial help and care matters as well, sometimes in intriguingly anomalous ways. Though self-reported motivations must be interpreted carefully, we nonetheless conclude that point-blank questions provide a worthwhile complement to conventional methods for unraveling motivations for private, intergenerational transfers.}, keywords = {Adult children, Healthcare, Methodology, Other, Risk Taking, Social Security}, author = {Cox, Donald and Beth J Soldo} } @article {7952, title = {Moving Considerations: A Longitudinal Analysis of Parent-Child Residential Proximity for Older Americans}, journal = {Research on Aging}, volume = {35}, year = {2013}, note = {Times Cited: 0}, pages = {663-687}, publisher = {35}, abstract = {Residential proximity is an important indicator of family members{\textquoteright} availability to provide assistance to each other. We investigate proximity-enhancing moves by older parents and their children and the reasons for such moves. Using the 2000-2004 waves of the Health and Retirement Study, we fit multinomial logit models examining 2-year residential transitions for parents and children living 10 or more miles apart at baseline. Our results show that family members collectively adjust intergenerational proximity to facilitate mutual support. Despite the common assumption that older parents move closer to their children to receive assistance, more than two thirds of all proximity-enhancing moves are made by adult children. While greater anticipated longevity raises the probability that older parents will move closer to their children, parents{\textquoteright} anticipated longevity does not influence children{\textquoteright}s moving decisions. Including individual variability in anticipated longevity in the life course framework helps account for relocation that precedes declines in health or increases in the need for support.}, keywords = {Adult children, Demographics, Event History/Life Cycle, Expectations, Health Conditions and Status, Healthcare, Retirement Planning and Satisfaction}, doi = {10.1177/0164027512457787}, author = {Zhang, Yiduo and Michal Engelman and Emily M. Agree} } @article {7947, title = {Multidimensional Approaches to Examining Gender and Racial/Ethnic Stratification in Health}, journal = {Women, Gender, and Families of Color}, volume = {1}, year = {2013}, pages = {180-206}, publisher = {1}, abstract = {Extant research on health disparities has traditionally employed a unidimensional approach to stratification, focusing on gender and racial/ethnic inequality separately. Such studies implicitly assume that gender inequality is monolithic across racial/ethnic lines and that racial/ethnic stratification is similar for women and men. While informative, these traditional, unidimensional approaches artificially decouple gender and racial/ethnic inequality and, consequently, may obscure the gender-race/ethnicity-health relationship, thus limiting our understanding of the unique health experiences of women of color. This study extends prior research by using multidimensional approaches to examine whether gender and racial stratification combine in an additive or multiplicative fashion to shape functional health, consistent with double-jeopardy and intersectionality hypotheses, respectively. In addition, this study investigates the extent to which group differences in socioeconomic status (SES), health behaviors, and medical care explain gender-racial/ethnic disparities in health. We use data from the Health and Retirement Study, a nationally representative sample of older adults, to address these questions among a diverse sample of black, white, and Mexican American men and women. Results reveal that women of color have worse functional health than all other gender-racial/ethnic groups and that the joint impacts of gender and racial/ethnic oppression on functional health are additive among Mexican Americans and multiplicative among blacks. We find that multidimensional approaches namely, double-jeopardy and intersectionality as well as examination of various potential mediators of health disparities provide a better understanding of how health is shaped by multiple social locations.}, keywords = {Demographics, Healthcare, Women and Minorities}, author = {Tyson H Brown and Taylor W. Hargrove} } @article {7871, title = {A multistate transition model for analyzing diseases in elderly population}, journal = {World Applied Sciences Journal}, volume = {21}, year = {2013}, note = {Export Date: 24 September 2013 Source: Scopus}, pages = {1700-1707}, publisher = {21}, abstract = {In this study, a competing risk model is proposed to analyze the transitions to diseases among elderly people employing the proportional hazards model. This study provides important findings regarding the disease pattern among the elderly people and the factors associated with such transitions. The Health and Retirement Study data are considered for the period of 1992-2000. The major diseases or complications considered in this study are stroke, lung diseases, diabetes mellitus, blood pressure and arthritis. The transitions to different diseases or complications are explained by selected covariates such as gender, race, marital status, smoking, drinking, physical exercise and BMI. The results indicate that gender, race, smoking and BMI are significantly associated with transitions to different diseases or complications. The results are displayed for transitions to each disease or complication separately for competing risk framework as well as for the combined transition to any of the selected diseases or complications. This paper reveals some important health issues related to the transitions to the selected diseases or complications among the elderly people and the factors associated with such transitions are identified.}, keywords = {Demographics, Health Conditions and Status, Methodology, Other, Risk Taking}, doi = { 10.5829/idosi.wasj.2013.21.12.2570}, url = {http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.388.6381\&rep=rep1\&type=pdf}, author = {Noor, Norlida Mohd and M. Ataharul Islam and Zalila Ali} } @article {10437, title = {A Multistate Transition Model for Analyzing Longitudinal Depression Data}, year = {2013}, institution = {BULLETIN of the MALAYSIAN MATHEMATICAL SCIENCES SOCIETY}, abstract = {In longitudinal data analysis, there are many practical situations where we need to deal with transitions to a number of states and which are repeated over time generating a large number of trajectories from beginning to end of the study. This problem becomes increasingly difficult to model if the number of follow-ups is increased for a set of longitudinal data. A covariate-dependent Markov transition model is proposed using the logistic link function for polytomous outcome data. A generalized and more flexible approach of constructing the likelihood function for the first or higher order is demonstrated in this paper to deal with the branching of a number of transition types starting from no depression at the beginning of the study. The proposed method can be employed to resolve a longstanding problem in dealing with modeling for transitions, reverse transitions and repeated transitions by reducing the number of trajectories to a large extent resulting in estimating relatively few parameters. The problem of depression in elderly, in terms of short and longterm health and economic consequence, needs to be assessed more critically. This study uses the longitudinal data from the six waves of the Health and Retirement Survey to examine the transition to depression, reverse transition from depression to no depression and also repeated transition from no depression to depression after experiencing a reverse transition during a study period. The results indicate that age is negatively associated with reverse and repeated transitions, gender is negatively associated with transition and reverse transition indicating that females are more likely to experience both. The proposed method clearly provides a wider range of useful information in revealing the dynamics of the depression pattern among elderly. }, url = {http://www.kurims.kyoto-u.ac.jp/EMIS/journals/BMMSS/pdf/v36n3/v36n3p8.pdf}, author = {M. Ataharul Islam and Rafiqul I Chowdhury and Huda, Shahariar} } @mastersthesis {6244, title = {Multivariate fractional response models in a panel setting with an application to portfolio allocation}, volume = {3558362}, year = {2013}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-05-16 First page - n/a}, month = {2013}, pages = {131}, school = {Michigan State University}, type = {Ph.D.}, abstract = {Several papers use subjective survival probabilities as a measure of mortality risk in studying economic behavior. The first chapter "Wealth Holdings, Asset Allocation and Mortality: A Test of the Information Content of Subjective Survival Probabilities" studies whether subjective survival probability measures contain any additional information that can explain differential wealth holdings and asset allocation among households. We find some evidence that survival probabilities can explain differences in household wealth holding and allocation once we control for other factors that affect decision-making. We also find that the estimated impact of subjective survival is sensitive to the inclusion of reported survival probabilities of one. Some fractional response variables, like the proportion of financial wealth allocated across multiple assets, must satisfy an adding up restriction. In the second chapter "A Model for Multivariate Fractional Responses with an Application to Asset Allocation", we develop a twostep procedure where we estimate a model with multiple fractional response variables exploiting the fact that these variables sum to one in each period and are correlated over time. The first step entails estimation of the multivariate fractional responses using the multinomial quasi-likelihood function which explicitly imposes the adding-up restriction and the second step uses the Classical Minimum Distance estimator to account for serial correlation. Many panel data estimators implicitly assume that we have a balanced panel at our disposal. Unfortunately this is rarely the case and dropping observations is an unsatisfactory solution to the problem. Estimation of fractional responses in a panel requires assumptions about the distribution of the unobserved effect and its relationship with observables, which requires special treatment in an unbalanced panel. In the third chapter, "Estimation of a Multivariate Fractional Response Model with Unbalanced Panel Data", we extend the approach in Wooldridge (2010) to the case of multiple fractional responses and apply this to unbalanced panel data on the allocation of financial wealth across several assets.}, keywords = {Methodology, Net Worth and Assets}, author = {Carlton, Michael Anthony} } @article {7734, title = {Market Performance And The Timing Of Retirement}, journal = {Journal of Personal Finance}, volume = {11}, year = {2012}, pages = {10-48}, publisher = {11}, abstract = {This study is the first to utilize nine interview waves of the Health and Retirement Study and multilevel discrete-time survival analysis to investigate the effect of market returns on individual elective retirement decisions. Individuals who retire at a market peak have an increased risk of shortening the longevity of their retirement income. Unfortunately, market returns were found to have a significant positive effect on the probability of retirement. Researchers, employers, financial educators and financial practitioners should help pre-retirees overcome the stock market{\textquoteright}s influence on their decision-making to avoid the negative effect of market sequencing on their retirement wealth. PUBLICATION ABSTRACT}, keywords = {Consumption and Savings, Methodology, Net Worth and Assets, Retirement Planning and Satisfaction}, url = {https://ssrn.com/abstract=2740054}, author = {Yao, Rui and Park, Eric} } @article {10196, title = {A Markov Model for Analyzing Polytomous Outcome Data}, journal = {Pakistan Journal of Statistics and Operation Research}, volume = {8}, year = {2012}, pages = {593-603}, abstract = {This paper highlights the estimation and test procedures for multi-state Markov models with covariate dependences in higher orders. Logistic link functions are used to analyze the transition probabilities of three or more states of a Markov model emerging from a longitudinal study. For illustration purpose the models are used for analysis of panel data on Health and Retirement Study conducted in USA during 1992-2002. The applications use self reported data on perceived emotional health at each round of the nationwide survey conducted among the elderly people. Useful and detailed results on the change in the perceived emotional health status among the elderly people are obtained. }, keywords = {Covariate Dependence, Emotional Health, Higher Order, Logistic Regression, Markov Models, Multiple States}, doi = {10.18187/pjsor.v8i3.530}, author = {M. Ataharul Islam and Rafiqul I Chowdhury and Singh, K. P.} } @article {7735, title = {Marriage, gender and obesity in later life.}, journal = {Econ Hum Biol}, volume = {10}, year = {2012}, month = {2012 Dec}, pages = {431-53}, abstract = {

A large body of literature argues that marriage promotes health and increases longevity. But do these benefits extend to maintaining a healthy body weight, as the economic theory of health investment suggests they should? They do not. Using the Health and Retirement Study (HRS), I find that entry into marriage among both men and women aged 51-70 is associated with weight gain and exit from marriage with weight loss. I evaluate three additional theories with respect to the cross-sectional and longitudinal variation in the data. First, it may be that a broader set of shared risk factors (such as social obligations regarding meals) raises body mass for married couples. However, the shared risk factor model predicts that the intra-couple correlation should increase with respect to marital duration. Instead, it declines. Second, scholars have recently promoted a "crisis" model of marriage in which marital transitions, not marital status, determine differences in body mass. The crisis model is consistent with short-term effects seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood. And transition models, in general, cannot explain significant cross-sectional differences across marital states in a population that is no longer experiencing many transitions, nor can it account for the prominent gender differences (in late middle-age, the heaviest group is unmarried women and the lightest are unmarried men). Third, I argue that pressures of the marriage market, in combination with gendered preferences regarding partner BMI, can account for all the longitudinal and cross-sectional patterns found in the data.

}, keywords = {Age Factors, Aged, Body Mass Index, Female, Humans, Male, Marital Status, Middle Aged, Models, Statistical, Obesity, Sex Factors, United States, Weight Gain, Weight Loss}, issn = {1873-6130}, doi = {10.1016/j.ehb.2012.04.012}, author = {Sven E. Wilson} } @article {7760, title = {Maternal age and offspring adult health: evidence from the health and retirement study.}, journal = {Demography}, volume = {49}, year = {2012}, month = {2012 Nov}, pages = {1231-57}, abstract = {

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age-offspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25-34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age-offspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.

}, keywords = {Adolescent, Adult, Adult children, Aging, Body Weights and Measures, Educational Status, Female, Health Status, Humans, Maternal Age, Middle Aged, Mortality, Prospective Studies, Socioeconomic factors, Young Adult}, issn = {0070-3370}, doi = {10.1007/s13524-012-0132-x}, author = {Mikko Myrskyl{\"a} and Andrew Fenelon} } @article {7623, title = {Measurement equivalence in ADL and IADL difficulty across international surveys of aging: findings from the HRS, SHARE, and ELSA.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Jan}, pages = {121-32}, abstract = {

OBJECTIVE: To examine the measurement equivalence of items on disability across three international surveys of aging.

METHOD: Data for persons aged 65 and older were drawn from the Health and Retirement Survey (HRS, n = 10,905), English Longitudinal Study of Aging (ELSA, n = 5,437), and Survey of Health, Ageing and Retirement in Europe (SHARE, n = 13,408). Differential item functioning (DIF) was assessed using item response theory (IRT) methods for activities of daily living (ADL) and instrumental activities of daily living (IADL) items.

RESULTS: HRS and SHARE exhibited measurement equivalence, but 6 of 11 items in ELSA demonstrated meaningful DIF. At the scale level, this item-level DIF affected scores reflecting greater disability. IRT methods also spread out score distributions and shifted scores higher (toward greater disability). Results for mean disability differences by demographic characteristics, using original and DIF-adjusted scores, were the same overall but differed for some subgroup comparisons involving ELSA.

DISCUSSION: Testing and adjusting for DIF is one means of minimizing measurement error in cross-national survey comparisons. IRT methods were used to evaluate potential measurement bias in disability comparisons across three international surveys of aging. The analysis also suggested DIF was mitigated for scales including both ADL and IADL and that summary indexes (counts of limitations) likely underestimate mean disability in these international populations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Bias, Europe, Female, Health Surveys, Humans, Internationality, Longitudinal Studies, Male, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr133}, author = {Kitty S. Chan and Judith D Kasper and Jason Brandt and Liliana E Pezzin} } @article {7785, title = {Medicaid and the housing and asset decisions of the elderly: Evidence from estate recovery programs}, journal = {Journal of Urban Economics}, volume = {72}, year = {2012}, pages = {210-224}, publisher = {72}, abstract = {I examine the impact of Medicaid on elderly housing and portfolio decisions by using recent state-by-calendar-year level variation in the Medicaid treatment of owner-occupied housing assets from the adoption of Medicaid estate recovery programs. Prior to the adoption of these programs, the house, which represents the most important non-pension asset to the elderly, was exempt from determining Medicaid eligibility and served as both a place of residence and a store of wealth. Adoption of estate recovery programs changed the owner-occupied housing safety net by making the house eligible for recovery by the government, which increased the implicit tax of holding owner-occupied housing. Using data from 1993 to 2004 in the Health and Retirement Study on elderly individuals, I find that state adoption of estate recovery programs makes the elderly decrease homeownership by 4.6 , decrease home equity by 15 , and also decrease the housing share of the elderly wealth portfolio. State adoption of these programs results in elderly baseline homeowners being 33 less likely to own their homes at death and more likely to use a trust as a substitute to housing in order to preserve assets and carry out bequest motives at death. PUBLICATION ABSTRACT}, keywords = {Adult children, Housing, Medicare/Medicaid/Health Insurance, Net Worth and Assets, Public Policy}, doi = {10.1016/j.jue.2012.05.005}, author = {Nadia Greenhalgh-Stanley} } @article {5942, title = {Medicaid Insurance in Old Age}, number = {2012-278}, year = {2012}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {Medicaid was primarily designed to protect and insure the poor. However, the poor tend to live much shorter lifespans and thus incur much lower medical expenses before death. In this paper, we assess the insurance and redistributive properties of Medicaid, taking these dimensions of heterogeneity into account for single retirees. The Medicaid recipiency rate for those at the bottom income quintile stays around 60 -70 throughout their retirement. In contrast, Medicaid recipiency by higher-income retirees is much lower but increases by age, especially after age 90. Our preliminary results show that the annuity value of Medicaid payments is a hump-shaped function of permanent income. People in the middle of the income distribution receive more than those at the top or the bottom. Once one takes into account that the rich live longer, Medicaid is even less redistributive: in terms of present discounted value, the richest people receive almost as much the poorest ones, and the middle income people still benefit the most. Accounting for risk makes Medicaid less redistributive further still. Compensating differential calculations show that Medicaid insurance is valued most highly by the most rich, who have the most to lose.}, keywords = {Income, Medicare/Medicaid/Health Insurance, Public Policy}, url = {https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2192557}, author = {Mariacristina De Nardi and Eric French and John Bailey Jones} } @mastersthesis {6252, title = {Medicare expenditure growth and its health returns across cohorts}, volume = {Ph.D.}, year = {2012}, school = {Rutgers, The State University of New Jersey}, address = {New Brunswick, NJ}, abstract = {There are several key findings in the following chapters. In Chapter 2, the individual characteristics associated with higher spending growth over the period 1996 to 2008 were identified based on analyses with pooled cross-sectional data from the Medical Expenditure Panel Survey. The key factors that were associated with the adjusted growth rates higher than the actual Medicare spending growth rate (5.8\% annually) from 1996 to 2008 include races other than the whites and blacks, Hispanic origin, high income, residence in the West, and very good health status. Findings from Chapter 3 reveal that enrollment in HMOs under Medicare is not random, but is systematically related to characteristics of Medicare enrollees. Using the longitudinal Health and Retirement Study, there were factors associated with a higher likelihood of becoming enrolled in Medicare Advantage/Part C. Chapter 4 examines the relationship between health care spending and returns to health with regard to five dimensions of health: mortality, hypertension, arthritis, self-assessed health status and mental health status (Center for Epidemiologic Studies Depression scale, CESD scale). The pre-Medicare characteristics were used to predict the change in these five dimensions of health after four years of Medicare coverage. The results reveal that increases in Medicare total and out-of-pocket spending were associated with poor health outcomes. Total spending was associated with a higher likelihood of death, worse self-rated health status (five categories) and mental health status. The increase in out-of-pocket health expenditure was associated with a higher chance of getting a worse category in self-rated health status after controlling for health status and other characteristics before being enrolled in Medicare. The findings of these studies suggest that policies to constrain Medicare spending should recognize and target the multiple factors contributing to Medicare expenditure growth and the dubious returns to health, as well as target integrated care for Medicare enrollees and incentives for individuals to prevent the onset of chronic health conditions.}, keywords = {Consumption and Savings, Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Public Policy}, doi = {10.7282/T3R49PJ5}, author = {Yi-Sheng Chao} } @article {5939, title = {Mismeasurement of Pensions Before and After Retirement: The Mystery of the Disappearing Pensions with Implications for the Importance of Social Security as a Source of Retirement Support}, number = {WP 2012-268}, year = {2012}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {A review of the literature suggests that when pension values are measured by the wealth equivalent of promised DB pension benefits and DC balances for those approaching retirement, pensions account for more support in retirement than is suggested when their contribution is measured by incomes received directly from pension plans by those who have already retired. Estimates from the Health and Retirement Study (HRS) for respondents in their early fifties suggest that pension wealth is about 86 percent as valuable as Social Security wealth. In data from the Current Population Survey (CPS), for members of the same cohort, measured when they are 65 to 69, pension incomes are about 56 percent as valuable as incomes from Social Security. Our empirical analysis uses data from the Health and Retirement Study to examine the reasons for these differences in the contributions of pensions as measured in income and wealth data. A number of factors cause the contribution of pensions to be understated in retirement income data, especially data from the CPS. One factor is a difference in methodology between surveys affecting what is included in pension income, especially in the CPS, which ignores irregular payments from pensions. In CPS data on incomes of those ages 64 to 69 in 2006, pension values are 59 percent of the value of Social Security. For the same cohort, in HRS data, the pension value is 67 percent of the value of Social Security benefits. Some pension wealth disappears at retirement because respondents change their pension into other forms that are not counted as pension income in surveys of income. Altogether, 16 percent of pension wealth is transformed into some other form at the time of disposition. For those who had a defined benefit pension just before termination, the dominant plan type for current retirees, at termination 12 percent of the benefit was transformed into a state that would not count as pension income after retirement. For those who receive benefits soon after termination, there is a 3.5 percent reduction in DB pension value at termination compared to the year before termination. One reason may be the form of annuitization that is chosen. A series of caveats notwithstanding, the bottom line is that CPS data on pension incomes received in retirement understates the full contribution pensions make to supporting retirees.}, keywords = {Methodology, Net Worth and Assets, Pensions, Retirement Planning and Satisfaction}, url = {https://mrdrc.isr.umich.edu/pubs/mismeasurement-of-pensions-before-and-after-retirement-the-mystery-of-the-disappearing-pensions-with-implications-for-the-importance-of-social-security-as-a-source-of-retirement-support-2/}, author = {Alan L Gustman and Thomas L. Steinmeier and N. Tabatabai} } @article {7706, title = {The Motivation for Intergenerational Time and Financial Transfers}, journal = {Family and Consumer Sciences Research Journal}, volume = {40}, year = {2012}, pages = {373}, publisher = {40}, abstract = {This study investigated the motivation for intergenerational financial and time transfers between parents and adult children using data from the Health and Retirement Study. The results showed that emotional closeness between parents and adult children was significantly associated with both adult children to parent and parent to adult children transfers. In addition, parents and adult children who met frequently were more likely to help each other by making financial or time transfers. Also, financial transfers between parents and adult children were motivated by the donor{\textquoteright}s altruism to the disadvantaged adult children or parents. However, wealthier parents and adult children with full-time jobs were less likely to make time transfers. The results of this study help in understanding the motivation for various types of intergenerational transfers in an aging society. PUBLICATION ABSTRACT}, keywords = {Adult children, Health Conditions and Status}, doi = {10.1111/j.1552-3934.2012.02118.x}, author = {Saeeun Choi and Chatterjee, Swarn and Kim, Haejeong} } @article {5940, title = {Motives for Bequests within the Middle Class}, number = {WP 2012-275}, year = {2012}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {The life-cycle model of household behavior forms the basis for most economic analysis of Social Security, private pensions, and retirement. This project seeks to extend the usefulness of the life-cycle model by considering the role of middle-class inheritances and bequests. We use HRS data. Prior work by the authors identifies key information in the HRS on the sources of private intergenerational transfers, and it shows that the frequency of couples inheritances from both spouses family lines is higher than random behavior would imply. Using additional HRS data on the ratio of parent-to-child lifetime incomes, we analyze the motives behind HRS bequests. We find support for an unintentional transfer model in which bequests arise from residual, unspent parent life-cycle resources. And, we show that our model can account for the frequency of dual inheritances that earlier work revealed.}, keywords = {Adult children, Event History/Life Cycle}, url = {https://mrdrc.isr.umich.edu/pubs/motives-for-bequests-within-the-middle-class-3/}, author = {John Laitner and Amanda Sonnega} } @article {5912, title = {Macroeconomic Conditions and Updating of Expectations by Older Americans}, number = {WP 2011-259}, year = {2011}, institution = {The University of Michigan, Michigan Retirement Research Center}, address = {Ann Arbor, MI}, abstract = {Economic theory suggests that individual decisions about consumption, saving, and labor supply should be directly linked to subjective expectations about future events. This project uses panel data from the Health and Retirement Study from 1994-2008 merged to data on a number of local and high frequency macroeconomic indicators to estimate how individual expectations respond to fluctuations in the local and national macroeconomy. Our results suggest that individuals revise their expectations in response to both local and national macroeconomic fluctuations in ways that appear to make sense, and that this is stronger for respondents with higher levels of education.}, keywords = {Consumption and Savings, Employment and Labor Force, Expectations}, url = {https://mrdrc.isr.umich.edu/pubs/macroeconomic-conditions-and-updating-of-expectations-by-older-americans/}, author = {Purvi Sevak and Lucie Schmidt} } @article {7549, title = {Medical Expenditure Measures in the Health and Retirement Study.}, journal = {Forum Health Econ Policy}, volume = {14}, year = {2011}, month = {2011 Apr 01}, pages = {4}, publisher = {14}, abstract = {

This paper reviews out-of-pocket (OOP) medical expenditure measures collected in the Health and Retirement Study (HRS). Medical expenditures are an important cost of poor health. Medical expenditure measures are important for understanding retirement decisions, financial preparation for retirement, and predicting the consequences of health care reform, particularly Medicare reform. Despite the comprehensiveness of the HRS, there are always limitations to what can be learned from population interviews. To assess the quality of current HRS measures of OOP spending, we compare various measures of OOP spending across survey waves to the Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS), two surveys that expend considerable resources on measuring both OOP spending and total medical expenditures. Such comparisons make it possible to identify potential bias in the HRS data and to improve HRS measures of OOP. We find that the HRS produces good quality and useful data on OOP spending.

}, issn = {2194-6191}, doi = {10.2202/1558-9544.1267}, author = {Dana P Goldman and Julie M Zissimopoulos and Yang, Lu} } @article {7609, title = {Memory predicts changes in depressive symptoms in older adults: a bidirectional longitudinal analysis.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Sep}, pages = {571-81}, publisher = {66B}, abstract = {

OBJECTIVES: Although research indicates that depressive symptoms and memory performance are related in older adults, the temporal associations between these variables remain unclear. This study examined whether depressive symptoms predicted later memory change and whether memory predicted later change in depressive symptoms.

METHODS: The sample consisted of more than 14,000 adults from the Health and Retirement Study, a biannual longitudinal study of health and retirement in Americans older than age 50 years. Measures of delayed recall and depressive symptoms served as the main study variables. We included age, sex, education, and history of vascular diseases as covariates.

RESULTS: Using dynamic change models with latent difference scores, we found that memory performance predicted change in depressive symptoms 2 years later. Depressive symptoms did not predict later change in memory. The inclusion of vascular health variables diminished the size of the observed relationship, suggesting that biological processes may partially explain the effect of memory on depressive symptoms.

IMPLICATIONS: Future research should explore both biological and psychological processes that may explain the association between worse memory performance and subsequent increases in depressive symptoms.

}, keywords = {Aged, Aged, 80 and over, Comorbidity, Dementia, Vascular, depression, Female, Geriatric Assessment, Humans, Longitudinal Studies, Male, Mental Recall, Middle Aged, Models, Psychological, Retirement, Statistics as Topic, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr035}, author = {Jajodia, Archana and Borders, Ashley} } @mastersthesis {6181, title = {Modeling social participation as predictive of life satisfaction and social connectedness: Scale or index?}, volume = {Ph.D.}, year = {2011}, school = {University of Denver}, address = {Denver, CO}, abstract = {Social participation in late adulthood through activities such as volunteering with charities, playing sports, and joining clubs can increase life satisfaction, directly by providing enjoyable engagement and indirectly by increasing a person{\textquoteright}s sense of social connectedness. When reported levels of different types of activities are used to measure social participation, conventional measure development procedures based on classical test theory lead to a proliferation of small participation subscales that don{\textquoteright}t show good reliability, don{\textquoteright}t have theoretical power, and don{\textquoteright}t match researchers{\textquoteright} conceptions of the dimensions of participation. Based on the poor performance of conventional approaches, some researchers have suggested that social participation should be modeled as an index composed of its indicators rather than as a scale in which indicators reflect an underlying latent factor. Typical approaches in psychosocial research rely on reflective-indicator models, which correspond to scale development, rather than incorporating composite variables with causal indicators. The latter approach, where manifest indicators are specified as causing the unobserved construct, is sometimes known as formative measurement , since the construct of interest is formed by its indicators. This study compared a scale model of social participation based on reflective measurement to an index model based on formative measurement. Using a sample representative of community-dwelling U.S. adults over age 65 from the Health and Retirement Study{\textquoteright}s 2008 wave of data collection, two alternative measurement models of participation were constructed using sixteen items that recorded frequency of participation in different activities. Because patterns of participation differed for males and females, gender-specific models were developed. The scale models assigned participation items to subscales based on item intercorrelations. The index model assigned items to participation composites based on predictive associations with the outcomes of social connectedness and life satisfaction. The index construction process led to a unidimensional representation of participation, composed of six of the original sixteen participation activity items. The initial attempts to build a scale model led to structures with many small factors and poor predictive validity. Based on the findings of unidimensionality for the index model, a single-factor scale model was explored for female respondents only. Results showed that both index and scale approaches have the potential to produce participation models that are parsimonious, well-fitting, and externally valid even though conventional scale development rules-of-thumb and current conceptions of the domains of participation lead the researcher to non-parsimonious, poorly-fitting solutions lacking predictive capability. Participation measurement instrument developers often theorize the existence of three or more dimensions of participation. Whether they use conventional (reflective indicator) or more radical (formative indicator) models, they are advised, based on this study{\textquoteright}s results, to evaluate a single-dimensional structure among their candidate models.}, keywords = {Health Conditions and Status, Healthcare, Methodology, Retirement Planning and Satisfaction}, url = {https://digitalcommons.du.edu/cgi/viewcontent.cgi?article=1728\&context=etd}, author = {Zelenka, Anne T.} } @article {7659, title = {Mortgage delinquency and changes in access to health resources and depressive symptoms in a nationally representative cohort of Americans older than 50 years.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, month = {2011 Dec}, pages = {2293-8}, publisher = {101}, abstract = {

OBJECTIVES: We evaluated associations between mortgage delinquency and changes in health and health-relevant resources over 2 years, with data from the Health and Retirement Study, a longitudinal survey representative of US adults older than 50 years.

METHODS: In 2008, participants reported whether they had fallen behind on mortgage payments since 2006 (n = 2474). We used logistic regression to compare changes in health (incidence of elevated depressive symptoms, major declines in self-rated health) and access to health-relevant resources (food, prescription medications) between participants who fell behind on their mortgage payments and those who did not.

RESULTS: Compared with nondelinquent participants, the mortgage-delinquent group had worse health status and less access to health-relevant resources at baseline. They were also significantly more likely to develop incident depressive symptoms (odds ratio [OR] = 8.60; 95\% confidence interval [CI] = 3.38, 21.85), food insecurity (OR = 7.53; 95\% CI = 3.01, 18.84), and cost-related medication nonadherence (OR = 8.66; 95\% CI = 3.72, 20.16) during follow-up.

CONCLUSIONS: Mortgage delinquency was associated with significant elevations in the incidence of mental health impairments and health-relevant material disadvantage. Widespread mortgage default may have important public health implications.

}, keywords = {depression, Drug Costs, Economic Recession, Female, Health Services Accessibility, Health Status, Housing, Humans, Male, Medication Adherence, Middle Aged, Socioeconomic factors, Stress, Psychological, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2011.300245}, author = {Dawn E Alley and Jennifer Lloyd and Jos{\'e} A Pag{\'a}n and Craig E Pollack and Michelle Shardell and Carolyn Cannuscio} } @article {7636, title = {Multiple trajectories of depressive symptoms in middle and late life: racial/ethnic variations.}, journal = {Psychol Aging}, volume = {26}, year = {2011}, note = {Liang, Jersey Xu, Xiao Quinones, Ana R Bennett, Joan M Ye, Wen 5P30AG024824/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States UL1RR024986/RR/NCRR NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S. United States Psychology and aging Psychol Aging. 2011 Dec;26(4):761-77. Epub 2011 Aug 29.}, month = {2011 Dec}, pages = {761-77}, publisher = {26}, abstract = {

This research aims to identify distinct courses of depressive symptoms among middle-aged and older Americans and to ascertain how these courses vary by race/ethnicity. Data came from the 1995-2006 Health and Retirement Study which involved a national sample of 17,196 Americans over 50 years of age with up to six repeated observations. Depressive symptoms were measured by an abbreviated version of the Center for Epidemiologic Studies Depression scale. Semiparametric group based mixture models (Proc Traj) were used for data analysis. Six major trajectories were identified: (a) minimal depressive symptoms (15.9\%), (b) low depressive symptoms (36.3\%), (c) moderate and stable depressive symptoms (29.2\%), (d) high but decreasing depressive symptoms (6.6\%), (e) moderate but increasing depressive symptoms (8.3\%), and (f) persistently high depressive symptoms (3.6\%). Adjustment of time-varying covariates (e.g., income and health conditions) resulted in a similar set of distinct trajectories. Relative to White Americans, Black and Hispanic Americans were significantly more likely to be in trajectories of more elevated depressive symptoms. In addition, they were more likely to experience increasing and decreasing depressive symptoms. Racial and ethnic variations in trajectory groups were partially mediated by SES, marital status, and health conditions, particularly when both interpersonal and intrapersonal differences in these variables were taken into account.

}, keywords = {Age Factors, Aged, Black or African American, depression, disease progression, Female, Health Status Disparities, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Socioeconomic factors, Time Factors, United States, White People}, issn = {1939-1498}, doi = {10.1037/a0023945}, author = {Jersey Liang and Xiao Xu and Ana R Qui{\~n}ones and Joan M. Bennett and Wen Ye} } @article {7448, title = {Measuring How Risk Tradeoffs Adjust with Income}, journal = {Journal of Risk and Uncertainty}, volume = {40}, year = {2010}, note = {Journal Article}, pages = {33-55}, publisher = {40}, abstract = {Efforts to reconcile inconsistencies between theory and estimates of the income elasticity of the value of a statistical life (IEVSL) overlook important restrictions implied by a more complete description of the individual choice problem. We develop a more general model of the IEVSL that reconciles some of the observed discrepancies. Our framework describes how exogenous income shocks, such as unexpected medical expenditures, may affect labor supply decisions which in turn influence both the coefficient of relative risk aversion and the IEVSL. The presence of a consumption commitment, such as a home mortgage, also alters this labor supply adjustment. We use data from the Health and Retirement Study to explore the responsiveness of labor force exit decisions to spousal health shocks and the role of a home mortgage as a constraint on this response.}, keywords = {Consumption and Savings, Employment and Labor Force, Income, Other, Retirement Planning and Satisfaction, Risk Taking, Time Use}, doi = {10.1007/s11166-009-9085-x}, url = {URL:http://www.springerlink.com/link.asp?id=100299 Publisher{\textquoteright}sURL}, author = {Mary F. Evans} } @article {12837, title = {Measuring the Spillover to Disability Insurance Due to the Rise in the Full Retirement Age}, year = {2010}, institution = {Center for Retirement Research at Boston College}, abstract = {The increase in the full retirement age in the Social Security program provides exogenous variation in the generosity in the Social Security Disability Insurance (SSDI) program, based only on birth year. We exploit this variation to estimate how responsive SSDI applications are to the financial incentive to apply. We find that a 1-percentage-point decrease in the retirement-to-disability benefit ratio leads to a 0.25-percentage-point increase in the SSDI application rate for the sample, which represents an 8-percent increase in applications per two years. When weighted to account for sampling design, we estimate that this change in the financial incentive accounted for about 5 percent of the SSDI applications in 2009. However, we do not find a corresponding increase in SSDI receipt based on the financial incentives{\textellipsis}}, keywords = {Disability, disability insurance, Retirement Age}, url = {https://crr.bc.edu/working-papers/measuring-the-spillover-to-disability-insurance-due-to-the-rise-in-the-full-retirement-age/}, author = {Norma B Coe and Haverstick, Kelly} } @mastersthesis {6380, title = {Medicaid Crowd-Out of Long-Term Care Insurance with Endogenous Medicaid Enrollment}, volume = {Ph.D.}, year = {2010}, note = {ISBN: 9781124318059}, month = {2010}, school = {University of Pennsylvania}, type = {Dissertation}, abstract = {With states facing tightening Medicaid budgets, the high cost of financing long-term care for the elderly through Medicaid has prompted proposals to make private long-term care insurance (LTCI) more affordable through tax incentives. The effectiveness of tax incentives for stimulating LTCI demand depends in part on the availability of Medicaid, since it is considered a substitute for LTCI. This paper examines the impact of tax subsidies and Medicaid financing on the demand for LTCI by developing and estimating a stochastic dynamic model of the decision to purchase private long-term care insurance. A key contribution of this paper is that the model also incorporates and accounts for endogenous decisions on Medicaid enrollment, nursing home use, and asset holdings, which reduces the estimate of the Medicaid crowd-out effect on LTCI demand. State-specific Medicaid enrollment criteria are explicitly accounted for in modeling the Medicaid enrollment decision. The parameters of the model are estimated using individual level data from the Health and Retirement Study for the years 1998 to 2002 by simulated maximum likelihood. Using the estimated parameters, counterfactual policy experiments are performed to investigate the effects of tax policy and Medicaid on LTCI demand. The main finding is that both effects are small. The estimated price elasticity of the LTCI demand is -0.08, implying that tax subsidies are expected to have only a limited effect in reducing the number of uninsured. Eliminating the Medicaid program increases LTCI holding by only 5.3\%, implying that the demand for LTCI would remain small even without Medicaid.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Other, Public Policy}, author = {Kim, Geena} } @article {7496, title = {Mental Retirement.}, journal = {J Econ Perspect}, volume = {24}, year = {2010}, month = {2010 Winter}, pages = {119-138}, publisher = {24}, abstract = {

Some studies suggest that people can maintain their cognitive abilities through "mental exercise." This has not been unequivocally proven. Retirement is associated with a large change in a person{\textquoteright}s daily routine and environment. In this paper, we propose two mechanisms how retirement may lead to cognitive decline. For many people retirement leads to a less stimulating daily environment. In addition, the prospect of retirement reduces the incentive to engage in mentally stimulating activities on the job. We investigate the effect of retirement on cognition empirically using cross-nationally comparable surveys of older persons in the United States, England, and 11 European countries in 2004. We find that early retirement has a significant negative impact on the cognitive ability of people in their early 60s that is both quantitatively important and causal. Identification is achieved using national pension policies as instruments for endogenous retirement.

}, issn = {0895-3309}, doi = {10.1257/jep.24.1.119}, author = {Susann Rohwedder and Robert J. Willis} } @article {7514, title = {Migration and psychological well-being among older adults: a growth curve analysis based on panel data from the Health and Retirement Study, 1996-2006.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Oct}, pages = {882-913}, publisher = {22}, abstract = {

PURPOSE: A vibrant body of research examines migration among older adults. Existing research, however, grants scarce attention to the implications of later-life migration for the migrants themselves. Our research focuses on the impacts of migration on depressive symptomatology among older U.S. adults.

METHODS: Our analysis employs six waves of panel data from the Health and Retirement Study, 1996-2006. Growth curve modeling techniques are employed.

RESULTS: Net of other stressful life events, migration effects appear to vary significantly across persons. Findings highlight the particularly depressive impact of moves motivated by negative life events or circumstances. Results further suggest that later life moves may be especially stressful for women and as individuals age.

DISCUSSION: The stress of moving late in life may depend on social integration at destination. Further research should pursue this issue. Study limitations and additional directions for further research are delineated.

}, keywords = {Adaptation, Psychological, Age Factors, Aging, depression, Female, Happiness, Health Status, Humans, Life Change Events, Male, Mental Health, Middle Aged, Models, Psychological, Models, Theoretical, Multivariate Analysis, Psychometrics, Retirement, Stress, Psychological, Transients and Migrants}, issn = {1552-6887}, doi = {10.1177/0898264310368430}, author = {Don E Bradley and Van Willigen, Marieke} } @article {7516, title = {Military service and men{\textquoteright}s health trajectories in later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Nov}, pages = {744-55}, publisher = {65B}, abstract = {

OBJECTIVES: This study examines differences in the relationship between veteran status and men{\textquoteright}s trajectories of health conditions, activities of daily living limitations, and self-rated health.

METHODS: We use data on 12,631 men drawn from the 1992-2006 waves of the Health and Retirement Study to estimate growth curve models that examine differences in health trajectories between nonveterans and veterans, veterans with and without wartime service, and war service veterans who served during World War II, Korea, Vietnam, and multiple wars.

RESULTS: The results indicate that veterans have better health at the mean age of 66.2 years, but experience greater age-related changes in health than nonveterans. Similarly, men who served during wartime have better health at the mean age, but more age-related changes in health than men who did not serve during wartime. Among war veterans, Vietnam veterans are in poorer health at the mean age, but they experience less substantial age-related health changes than men who served during previous wars.

DISCUSSION: Although veterans experience better health relative to nonveterans around retirement age, they have poorer health than nonveterans among the oldest old. These findings inform our understanding of the veteran-nonveteran health-mortality paradox found in previous research and suggest a health crossover among veterans and nonveterans in later life.

}, keywords = {Activities of Daily Living, Aged, Aging, Health Status, Humans, Korean War, Male, Middle Aged, Military Personnel, Multivariate Analysis, Racial Groups, Self-Assessment, Veterans, Vietnam Conflict, World War II}, issn = {1758-5368}, doi = {10.1093/geronb/gbq072}, author = {Janet M Wilmoth and Andrew S London and Wendy M Parker} } @article {5818, title = {Military Service, Combat Exposure, and Health in Retirement}, year = {2010}, abstract = {Military service has traditionally been the domain of healthy, robust males, but service can also reflect risk preference and socioeconomic status. Service also raises the probability of exposure to violence through combat, a significant stressor, and it may represent other types of treatments as well, both positive and negative. We might expect to find an ambiguous relationship between military service and later-life health, and several recent studies support this. In this paper, we explore the relationship between combat exposure and health past age 50 in the Health and Retirement Study, a rich longitudinal panel including many male veterans that now asks about combat exposure in its core survey. Using regression analysis and an instrumental variables approach, we show that combat exposure harms mental health and emotional well-being and raises a biomarker of stress at older ages, but it appears often to have negligible effects on a wide array of physical health metrics.}, keywords = {Demographics, Risk Taking}, url = {http://www.groupwise.niu.edu/econ/graduate/Papers/edwards-maclean-combathealth-103010.pdf}, author = {Ryan D. Edwards and MacLean, Alair} } @inbook {5232, title = {Mind the Gap! Consumer Perceptions and Choices of Medicare Part D Prescription Drug Plans}, booktitle = {Research Findings in the Economics of Aging}, series = {The Economics of Aging}, year = {2010}, pages = {413-481}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, chapter = {14}, address = {Chicago}, abstract = {Medicare Part D provides prescription drug coverage through Medicare approved plans offered by private insurance companies and HMOs. In this paper, we study the role of current prescription drug use and health risks, related expectations, and subjective factors in the demand for prescription drug insurance. To characterize rational behavior in the complex Part D environment, we develop an intertemporal optimization model of enrollment decisions. We generally find that seniors{\textquoteright} choices respond to the incentives provided by their own health status and the market environment as predicted by the optimization model. The proportion of individuals who do not attain the optimal choice is small, but the margin for error is also small since enrollment is transparently optimal for most eligible seniors. Further, there is also evidence that seniors over-react to some salient features of the choice situation, do not take full account of the future benefit and cost consequences of their decisions, or the expected net benefits and risk properties of alternative plans.}, keywords = {End of life decisions, Healthcare, Medicare/Medicaid/Health Insurance}, isbn = {0-226-90306-0}, url = {https://www.nber.org/books-and-chapters/research-findings-economics-aging/mind-gap-consumer-perceptions-and-choices-medicare-part-d-prescription-drug-plans}, author = {Florian Heiss and Daniel McFadden and Joachim Winter}, editor = {David A Wise} } @article {7544, title = {Modifiable risk factors for incidence of pain in older adults.}, journal = {Pain}, volume = {151}, year = {2010}, month = {2010 Nov}, pages = {366-371}, publisher = {151}, abstract = {

Pain symptoms in aging populations have significant public health impact. The aim of this study was to determine risk factors for the incidence of pain in older adults, focusing on those factors that can be modified. Secondary analyses were performed of survey data from the nationally representative Health and Retirement Study of US adults older than 50 years. Generalized estimating equations logistic regressions were used to evaluate the effect of selected variables on the incidence of pain using biennial (1992 through 2006) data, determining the relationship between the incidence of pain and the potential risk factors. Of the 18,439 survey respondents in 2006, 34.1\% (95\% CI: 33.2\%, 35.0\%) reported that they were often troubled by pain; 24.3\% reported having moderate to severe pain; and 22.3\% reported that their daily life was affected by pain. Between 1992 and 2006, 7967 individuals reported new onset of pain in 169,762 person-years of follow-up, an incidence of 4.69 (4.59, 4.80) per 100 person-years. Depression and being overweight were independent predictors associated with an increased likelihood of incident pain. Current smoking increased the likelihood of incident pain only in those subjects who also reported depression. In conclusion, pain is a common symptom in older adults. Depression, smoking, and overweight are potentially modifiable risk factors and could be considered in the prevention and management of pain in older adults.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cross-Sectional Studies, Demography, depression, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Overweight, pain, Prevalence, Retrospective Studies, Risk Assessment, Risk Factors, Smoking, United States}, issn = {1872-6623}, doi = {10.1016/j.pain.2010.07.021}, author = {Yu Shi and Hooten, W Michael and Rosebud O. Roberts and David O. Warner} } @article {5834, title = {Mortality Differences in Windowhood}, year = {2010}, institution = {Philadelphia, PA, Population Studies Center, University of Pennsylvania}, abstract = {Being widowed elevates mortality risk, relative to married men or women of the same age. I investigate how risk varies by subpopulation of widows and widowers. Specifically, using data from the Health and Retirement Study, I test for differences in widowhood mortality by education, by number of children, and by how sudden or expected the death of the pre-decedent spouse was. Consistent with other studies, I find an increased hazard of mortality upon widowhood. In contrast with other studies but consistent with the larger literature on SES and mortality, education is protective in widowhood. Number of children has a u-shaped association with mortality in widowhood, with those having 3-4 children having the lowest levels of mortality after death of a spouse. Lingering deaths (deaths after a chronic condition) of the predecedent spouse are much for the surviving spouse than sudden deaths or other types of death. Important gender differences occur with each of these effects. These findings illuminate mechanisms through which mortality is affected by widowhood, and provide evidence on the power of SES and social support in vulnerable populations.}, keywords = {Adult children, Health Conditions and Status, Net Worth and Assets}, author = {Allison R Sullivan} } @article {7522, title = {Mortality Differentials and Religion in the U.S.: Religious Affiliation and Attendance.}, journal = {J Sci Study Relig}, volume = {49}, year = {2010}, month = {2010 Dec}, pages = {740-753}, publisher = {49}, abstract = {

Using data from the Health and Retirement Study, I examine the relationship between adult mortality and religious affiliation. I test whether mortality differences associated with religious affiliation can be attributed to differences in socioeconomic status (years of education and household wealth), attendance at religious services, or health behaviors, particularly cigarette and alcohol consumption. A baseline report of attendance at religious services is used to avoid confounding effects of deteriorating health. Socioeconomic status explains some but not all of the mortality difference. While Catholics, Evangelical Protestants, and Black Protestants benefit from favorable attendance patterns, attendance (or lack of) at services explains much of the higher mortality of those with no religious preference. Health behaviors do not mediate the relationship between mortality and religion, except among Evangelical Protestants. Not only does religion matter, but studies examining the effect of "religiosity" need to consider differences by religious affiliation.

}, issn = {0021-8294}, doi = {10.1111/j.1468-5906.2010.01543.x}, author = {Allison R Sullivan} } @article {7381, title = {Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample.}, journal = {Am J Obstet Gynecol}, volume = {201}, year = {2009}, month = {2009 Nov}, pages = {490.e1-7}, publisher = {201}, abstract = {

OBJECTIVE: To determine whether: (1) major depression is associated with increased risk for onset of urinary incontinence, and (2) urinary incontinence is associated with increased risk for onset of depression.

STUDY DESIGN: Longitudinal cohort study of female Health and Retirement Study participants completing baseline interviews at Wave 3 (1996-1997) and follow-up interviews at Waves 4-6 (1998-2003).

RESULTS: In a cohort of 5820 women with a mean age 59.3 (+/- 0.5) years, 6-year cumulative incidences of depression and incontinence were 11\% and 21\%, respectively. Major depression was associated with increased odds of incident incontinence (adjusted odds ratio, 1.46; 95\% confidence interval, 1.08-1.97) during follow-up compared with those without major depression at baseline. Conversely, incontinence was not associated with increased odds of incident depression (adjusted odds ratio, 1.03; 95\% confidence interval, 0.75-1.42) compared with those without incontinence at baseline.

CONCLUSION: Major depression predicted onset of urinary incontinence in a population-based sample of at-risk, community-dwelling women. Incontinence did not predict onset of depression.

}, keywords = {Depressive Disorder, Major, Female, Humans, Longitudinal Studies, Middle Aged, Risk Factors, Time Factors, Urinary incontinence}, issn = {1097-6868}, doi = {10.1016/j.ajog.2009.05.047}, author = {Jennifer L Melville and Fan, Ming-Yu and Rau, Holly and Ingrid E Nygaard and Wayne J Katon} } @article {7353, title = {Marital biography and health at mid-life.}, journal = {J Health Soc Behav}, volume = {50}, year = {2009}, month = {2009 Sep}, pages = {344-58}, publisher = {50}, abstract = {

This article develops a series of hypotheses about the long-term effects of one{\textquoteright}s history of marriage, divorce, and widowhood on health, and it tests those hypotheses using data from the Health and Retirement Study. We examine four dimensions of health at mid-life: chronic conditions, mobility limitations, self-rated health, and depressive symptoms. We find that the experience of marital disruption damages health, with the effects still evident years later; among the currently married, those who have ever been divorced show worse health on all dimensions. Both the divorced and widowed who do not remarry show worse health than the currently married on all dimensions. Dimensions of health that seem to develop slowly, such as chronic conditions and mobility limitations, show strong effects of past marital disruption, whereas others, such as depressive symptoms, seem more sensitive to current marital status. Those who spent more years divorced or widowed show more chronic conditions and mobility limitations.

}, keywords = {Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Marital Status, Middle Aged, United States}, issn = {0022-1465}, doi = {10.1177/002214650905000307}, author = {Mary Elizabeth Hughes and Linda J. Waite} } @article {7356, title = {Marital trajectories and mortality among US adults.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Sep 01}, pages = {546-55}, publisher = {170}, abstract = {

More than a century of empirical evidence links marital status to mortality. However, the hazards of dying associated with long-term marital trajectories and contributing risk factors are largely unknown. The authors used 1992-2006 prospective data from a cohort of US adults to investigate the impact of current marital status, marriage timing, divorce and widow transitions, and marital durations on mortality. Multivariate hazard ratios were significantly higher for adults currently divorced and widowed, married at young ages (< or =18 years), who accumulated divorce and widow transitions (among women), and who were divorced for 1-4 years. Results also showed significantly lower risks of mortality for men married after age 25 years compared with on time (ages 19-25 years) and among women experiencing > or =10 years of divorce and > or =5 years of widowhood relative to those without exposure to these statuses. For both sexes, accumulation of marriage duration was the most robust predictor of survival. Results from risk-adjusted models indicated that socioeconomic resources, health behaviors, and health status attenuated the associations in different ways for men and women. The study demonstrates that traditional measures oversimplify the relation between marital status and mortality and that sex differences are related to a nexus of marital experiences and associated health risks.

}, keywords = {Age Factors, Cohort Studies, Female, Health Behavior, Humans, Male, Marital Status, Middle Aged, Mortality, Retirement, Retrospective Studies, Risk Factors, Sex Factors, Time Factors, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwp194}, author = {Matthew E Dupre and Audrey N Beck and Sarah O. Meadows} } @book {5282, title = {Markov Models with Covariate Dependence for Repeated Measures}, year = {2009}, publisher = {Nova Science Publishers}, organization = {Nova Science Publishers}, address = {New York}, abstract = {During the recent past, there has been a great deal of interst in solving problems of repeated measures data employing the Markov chain models. Most of the researchers and users of such techniques are only transition probabilities of various orders to show relationships among various states. However, in the recent past, there are attempts to include covariates in order to analyse the transition probabilities. Due to lack of a book on this topic, it is difficult for the researchers, students, and other users to have a thorough understanding in applying the methods based on sound knowledge. In addition, there is a lack of suitable software to handle repeated measures for Markov model applications. The main purpose of the book is to provide a theoretical base to the readers who will be willing to use these techniques for real life situations as well as for those who intend to continue advanced research in this field. This book provides a comprehensive discussion and theoretical details of the techniques in this field along with their estimation and test procedures, application of the techniques to real life problems, and the computer programs for using the techniques.}, keywords = {Methodology}, author = {M. Ataharul Islam and Rafiqul I Chowdhury and Huda, Shahariar} } @article {7414, title = {Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age.}, journal = {Am J Public Health}, volume = {99 Suppl 3}, year = {2009}, month = {2009 Nov}, pages = {S693-701}, publisher = {99}, abstract = {

OBJECTIVES: We examined associations between material resources and late-life declines in health.

METHODS: We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15,441).

RESULTS: Disadvantages in health care (odds ratio [OR] = 1.39; 95\% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95\% CI = 1.29, 2.22), and housing (OR = 1.20; 95\% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95\% CI = 1.29, 1.58) and food (OR = 1.64; 95\% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.

CONCLUSIONS: Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.

}, keywords = {Aged, Female, Food Supply, Health Status Disparities, Health Surveys, Healthcare Disparities, Housing, Humans, Logistic Models, Male, Middle Aged, Poverty, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.161877}, author = {Dawn E Alley and Beth J Soldo and Jos{\'e} A Pag{\'a}n and John McCabe and deBlois, Madeleine and Samuel H Field and David A Asch and Carolyn Cannuscio} } @article {5749, title = {Measuring How Risk Tradeoffs Adjust With Income}, number = {15372}, year = {2009}, institution = {The National Bureau of Economic Research }, address = {Cambridge, MA}, abstract = {Efforts to reconcile inconsistencies between theory and estimates of the income elasticity of the value of a statistical life (IEVSL) overlook important restrictions implied by a more complete description of the individual choice problem. We develop a more general model of the IEVSL that reconciles some of the observed discrepancies. Our framework describes how exogenous income shocks, such as unexpected medical expenditures, may affect labor supply decisions which in turn influence both the coefficient of relative risk aversion and the IEVSL. The presence of a consumption commitment, such as a home mortgage, also alters this labor supply adjustment. We use data from the Health and Retirement Study to explore the responsiveness of labor force exit decisions to spousal health shocks and the role of a home mortgage as a constraint on this response.}, keywords = {Health Conditions and Status, Income, Medicare/Medicaid/Health Insurance}, doi = {10.3386/w15372}, author = {Mary F. Evans} } @article {7361, title = {Measuring socioeconomic differences in use of health care services by wealth versus by income.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Oct}, pages = {1849-55}, publisher = {99}, abstract = {

OBJECTIVES: We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator.

METHODS: We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries.

RESULTS: We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences.

CONCLUSIONS: We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population.

}, keywords = {Aged, Aged, 80 and over, Aging, Data collection, Europe, Female, Health Services, Health Services Accessibility, Health Status Disparities, Humans, Income, Male, Middle Aged, Odds Ratio, Pensions, Retirement, Socioeconomic factors, Statistics as Topic, United Kingdom}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.141499}, author = {Allin, Sara and Masseria, Cristina and Elias Mossialos} } @mastersthesis {6190, title = {The mediating effects of the sense of control on the financial well-being of older adults}, volume = {Ph.D.}, year = {2009}, pages = {228}, school = {University of Pennsylvania}, type = {Dissertation}, abstract = {Statement of the problem. The financial well-being of the older adult population has improved over the past few decades, but the outlook for future generations is not positive. As government and employers become less accountable for the provision of retirement income, adults are required to take greater responsibility for their financial circumstances as they age, yet they often have neither the skills nor ability to exercise this control. By not exercising adequate control over their different aspects of their lives, adults may be exposed to financial risk in retirement. Methods. A cross-sectional, quantitative analysis using survey data from two components of the Health and Retirement Study (HRS), the HRS Rand Data files and the Psychosocial Leave-Behind Participant Lifestyle Questionnaire, was conducted. These surveys were administered in 2006 to a sample of 7,549 adults over the age of 50 and merged to conduct this analysis. Statistical analyses used multi-stage statistical modeling to test the mediating effects of the general sense of control and domain-specific levels of control, also known as control beliefs, on the relationship between the general attributes of older adults and their financial well-being. Financial well-being was measured as financial satisfaction and wealth. Results. The control beliefs of older adults significantly influence the size and magnitudes of the linkages between their demographic attributes and financial outcomes. Control beliefs boosted explained variance in financial satisfaction by over 70 percent and they increased explained variance in wealth by 4.5 percent. The mediation analyses were consistent with these results. Conclusion. Control beliefs are more strongly influential over older adults{\textquoteright} sense of financial satisfaction than on their actual wealth levels. Accordingly, interventions that influence peoples{\textquoteright} sense of control may enhance their felt well-being but will be less influential on levels of wealth. This study can be considered the first of its kind to use the psychological construct of sense of control as a mediating factor on the relationship between the attributes of older adults and self-assessed financial satisfaction as well as actual wealth outcomes. In this way we contribute to the newly developing research stream evaluating the determinants of self-reported happiness.}, keywords = {Demographics, Methodology, Net Worth and Assets, Other, Retirement Planning and Satisfaction}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1956000501\&sid=1\&Fmt=2\&clientId=17822\&RQT=309\&VName=PQD}, author = {Karen A. Zurlo} } @article {7400, title = {Medicare savings programs: analyzing options for expanding eligibility.}, journal = {Inquiry}, volume = {46}, year = {2009}, note = {Journal Article}, month = {2009-2010 Winter}, pages = {391-404}, publisher = {46}, abstract = {

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

}, keywords = {Aged, Demography, Disabled Persons, Eligibility Determination, Female, Health Status, Humans, Income, Male, Medical Assistance, Medicare, Medicare Part D, Public Policy, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_46.4.391}, url = {URL:http://www.inquiryjournal.org Publisher{\textquoteright}s URL}, author = {Zuckerman, Stephen and Shang, Baoping and Timothy A Waidmann} } @article {7390, title = {Medicare Spending for Previously Uninsured Adults}, journal = {Annals of Internal Medicine}, volume = {151}, year = {2009}, note = {PMID: 19949141}, pages = {757-66}, publisher = {151}, abstract = {BACKGROUND: Medicare spending after age 65 years may be higher for previously uninsured adults if suboptimal care before this age leads to irreversible complications, persistently elevated clinical risks, or delay of costly elective procedures. OBJECTIVE: To compare Medicare spending for previously uninsured and insured adults by using Medicare claims data. DESIGN: Longitudinal survey data and linked Medicare claims data were used to compare Medicare spending for beneficiaries age 65 to 74 years who were previously insured or previously uninsured before age 65 years. An inverse-probability-of-treatment weighting technique was used to adjust for fixed and time-varying sociodemographic and health characteristics before age 65 years. Condition-specific hospitalizations were compared, and their contribution to differences in Medicare spending was estimated. SETTING: Nationally representative Health and Retirement Study, 1992 to 2006. PARTICIPANTS: 2951 continuously insured adults and 1616 adults who were continuously or intermittently uninsured before age 65 years. MEASUREMENTS: Mean adjusted annual Medicare spending (total and by type of service) and annual rates of condition-specific hospitalizations. RESULTS: Adjusted annual total Medicare spending was significantly higher for previously uninsured than previously insured adults ( 5796 vs. 4773; difference, 1023 95 CI, 29 to 2016 ; P = 0.044). Among relevant clinical subgroups, previously uninsured adults had higher adjusted annual hospitalization rates than previously insured adults for complications related to cardiovascular disease or diabetes (9.1 vs. 6.4 ; P = 0.002) and for joint replacements (2.5 vs. 1.3 ; P = 0.006). Differences in these hospitalizations accounted for 65.7 of the 644 difference in annual Medicare inpatient spending between all previously uninsured and insured adults. LIMITATION: Unobserved confounders could have explained spending differences. CONCLUSION: Costs of expanded coverage before age 65 years may be partially offset by subsequent reductions in Medicare spending after age 65 years, particularly for uninsured adults with cardiovascular disease, diabetes, or severe arthritis. PRIMARY FUNDING SOURCE: The Commonwealth Fund.}, keywords = {Healthcare, Insurance, Medicare/Medicaid/Health Insurance}, author = {J. Michael McWilliams and Meara, Ellen and Alan M. Zaslavsky and John Z. Ayanian} } @article {7396, title = {Memory and depressive symptoms are dynamically linked among married couples: longitudinal evidence from the AHEAD study.}, journal = {Dev Psychol}, volume = {45}, year = {2009}, note = {PMID: 19899917}, month = {2009 Nov}, pages = {1595-610}, publisher = {45}, abstract = {

This study examined dyadic interrelations between episodic memory and depressive symptom trajectories of change in old and advanced old age. The authors applied dynamic models to 10-year incomplete longitudinal data of initially 1,599 married couples from the study of Asset and Health Dynamics Among the Oldest Old (M(age) = 75 years at Time 1). The authors found domain-specific lead-lag associations (time lags of 2 years) among wives and husbands as well as between spouses. For memory, better performance among husbands protected against subsequent memory decline among wives, with no evidence of a directed effect in the other direction. For depressive symptoms, wives{\textquoteright} scores predicted subsequent depression increase and memory decline among husbands. Possible individual covariates (age, education, functional limitations) and spousal covariates (length of marriage, number of children, and whether the couple remained intact over the study period) did not account for differential lead-lag associations. The findings of antecedent-consequent relations between wives and husbands are consistent with life-span notions that individual development both influences and is influenced by contextual factors such as close social relationships.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Aging, Cognition, depression, Female, Health Status, Humans, Interpersonal Relations, Longitudinal Studies, Male, Marriage, Mental Recall, Models, Psychological, Quality of Life, Spouses}, issn = {1939-0599}, doi = {10.1037/a0016346}, author = {Denis Gerstorf and Christiane A Hoppmann and Kelly M Kadlec and John J McArdle} } @mastersthesis {6131, title = {Metabolic Syndrome and Psychosocial Factors}, year = {2009}, month = {2009}, school = {University of North Texas}, address = {United States}, abstract = {Metabolic syndrome is a constellation of risk factors, including abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose, that commonly cluster together and can result in cardiovascular disease. The prevalence of metabolic syndrome and the components that comprise the syndrome vary by age and by racial/ethnic group. In addition, previous research has indicated that the risk factors contributing to metabolic syndrome may be exacerbated by exposure to perceived stress. This study utilized data from the 2002, 2004, and 2006 Health and Retirement Study (HRS) and National Health and Nutrition Examination Survey (NHANES) data sets. It was hypothesized that depression and anxiety (conceptualized as stress in this study) increase the risk of presenting with metabolic syndrome while social support decreases the risk of metabolic syndrome. While results of cross-sectional analysis do not indicate a significant relationship between depression and metabolic syndrome ( t = -.84, ns), longitudinal analysis does indicate a significant relationship between depression and metabolic syndrome over time ( t = -5.20, p <.001). However, anxiety is not significantly related to metabolic syndrome when the relationship is examined through cross-sectional analysis ( t = -1.51, ns) and longitudinal analysis (? 2 = 13.83, ns). Similarly, social support is not significantly related to metabolic syndrome when examined in cross-sectional (? 2 = .63, ns) and longitudinal ( t = 1.53, ns) analysis. Although level of stress is not significantly related to metabolic syndrome as a whole, there is a significant relationship between stress and both triglyceride level ( t = -2.94, p = .003) and blood glucose level ( t = -3.26, p = .001).}, keywords = {Health Conditions and Status}, author = {Tweedy, Maureen P.} } @article {7401, title = {Methodological Innovations in Collecting Spending Data: The HRS Consumption and Activities Mail Survey.}, journal = {Fisc Stud}, volume = {30}, year = {2009}, note = {Journal Article}, month = {2009 Dec 01}, pages = {435-459}, publisher = {30}, abstract = {

It has traditionally been believed that collecting survey measures of total spending necessarily involved asking a large number of questions, too many for inclusion of a comprehensive spending measure in a general-purpose survey. In this paper we report on a supplemental survey to the Health and Retirement Study that took up this challenge. We discuss issues that arise designing a survey module to collect spending data with strict time constraints, describe how the implementation in the Consumption and Activities Mail Survey (CAMS) played out, and elicit anomalies that more detailed analysis of data quality revealed. We report how we addressed some of these anomalies in subsequent waves of CAMS. Other anomalies required conducting additional randomized experiments to find what explains the observed patterns. The results highlight the tension between asking about spending using a long time frame, which exacerbates recall bias, versus using a short time frame, which risks relying on an unrepresentative snapshot of a household{\textquoteright}s spending to proxy the total for the last 12 months. An important complicating factor in deciding which goods should be put into which time frames is that there is substantial heterogeneity in the frequency of spending across households even for the same category of spending.

}, issn = {0143-5671}, doi = {10.1111/j.1475-5890.2009.00103.x}, url = {URL:http://www.wiley.com/bw/journal.asp?ref=0143-5671 Publisher{\textquoteright}s URL}, author = {Michael D Hurd and Susann Rohwedder} } @article {5759, title = {Mode and Context Effects in Measuring Household Assets}, year = {2009}, note = {RAND Corporation Publications Department Working Paper}, institution = {RAND Corporation Publications Department Working Papers: 668}, abstract = {Differences in answers in Internet and traditional surveys can be due to selection, mode, or context effects. The authors exploit unique experimental data to analyze mode and context effects controlling for arbitrary selection. The Health and Retirement Study (HRS) surveys a random sample of the US 50 population, with CAPI or CATI core interviews once every two years. In 2003 and 2005, random samples were drawn from HRS respondents in 2002 and 2004 willing and able to participate in an Internet interview. Comparing core and Internet survey answers of the same people, the authors analyze mode and context effects, controlling for selection. They focus on household assets, for which mode effects in Internet surveys have rarely been studied. They find some large differences between the first Internet survey and the other three surveys which they interpret as a context and question wording effect rather than a pure mode effect.}, keywords = {Demographics, Methodology, Net Worth and Assets}, url = {URL:http://www.rand.org/pubs/working_papers/2009/RAND_WR668.pdf URL}, author = {Arthur H.O. vanSoest and Arie Kapteyn} } @article {5740, title = {Mode and Context Effects of Measuring Household Assets}, year = {2009}, institution = {Tilburg University, Center for Economic Research, Discussion Paper 2009-14}, abstract = {Differences in answers in Internet and traditional surveys can be due to selection, mode, or context effects. We exploit unique experimental data to analyze mode and context effects controlling for arbitrary selection. The Health and Retirement Study (HRS) surveys a random sample of the US 50 population, with CAPI or CATI core interviews once every two years. In 2003 and 2005, random samples were drawn from HRS respondents in 2002 and 2004 willing and able to participate in an Internet interview. Comparing core and Internet survey answers of the same people, we analyze mode and context effects, controlling for selection. We focus on household assets, for which mode effects in Internet surveys have rarely been studied. We find some large differences between the first Internet survey and the other three surveys which we interpret as a context and question wording effect rather than a pure mode effect.}, keywords = {Methodology, Net Worth and Assets}, author = {Arthur H.O. vanSoest and Arie Kapteyn} } @article {7377, title = {Mortality attributable to obesity among middle-aged adults in the United States.}, journal = {Demography}, volume = {46}, year = {2009}, month = {2009 Nov}, pages = {851-72}, publisher = {46}, abstract = {

Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI > or = or = 35.0 kg/m2) increases mortality by 40\% in females and 62\% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI > or = 35.0) is responsible for approximately 4\% of deaths among females and 3\% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36\% in females and 50\% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.

}, keywords = {Body Mass Index, Confidence Intervals, Confounding Factors, Epidemiologic, Female, Humans, Male, Middle Aged, Multivariate Analysis, Obesity, Proportional Hazards Models, Risk, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.0.0077}, author = {Neil K Mehta and Virginia W Chang} } @article {7335, title = {Moving the Nest: The Impact of Coresidential Children on Mobility in Later Midlife}, journal = {Journal of Family Issues}, volume = {30}, year = {2009}, pages = {837-851}, publisher = {30}, abstract = {Using data from the 1992-2000 waves of the Health and Retirement Study, this article examines the relationship between the presence and age of children in the home and parental mobility in midlife. Although a substantial literature evaluates the factors affecting the timing of children leaving (and returning) home, less attention has been paid to the residential changes that parents may experience during this stage of the family life cycle. As young adults leave home, family ties that keep their parents in a place may weaken, precipitating residential change. Results indicate that parents with no children or adult children at home are more likely to move, and move further, than those with children younger than 18 at home. These findings are discussed in the context of a life course view of family migration behavior that suggests that as children age and their potential for independent living increases, parental mobility may increase.}, keywords = {Adult children, Demographics}, doi = {https://doi.org/10.1177/0192513X09332349}, author = {Regina M. Bures} } @article {7383, title = {The Myth of the Coming Charitable Estate Windfall}, journal = {The American Review of Public Administration}, volume = {39}, year = {2009}, pages = {661-674}, publisher = {39}, abstract = {Media accounts, fund-raising periodicals, and some academic research have pointed to a coming windfall of charitable estate transfers driven by the graying of the population. Nonprofit managers and public agencies working with nonprofits or their beneficiaries may incorporate these expectations into their long-range planning. This article presents the first comparison of estate gifts (for both taxable and nontaxable estates) with the previous annual giving and volunteering of the deceased. An analysis of approximately 6,000 deceased panel members from the 1995 2006 Health and Retirement Study suggests that estate gifts are largely offset by the loss of current giving and volunteering previously provided by the deceased donors. Consequently, nonprofit managers who plan based on anticipated future charitable giving estate windfalls may make erroneous choices.}, keywords = {Adult children, Net Worth and Assets}, doi = {https://doi.org/10.1177/0275074008326188}, author = {Russell N. James III} } @article {7263, title = {Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans.}, journal = {Psychosom Med}, volume = {70}, year = {2008}, month = {2008 Nov}, pages = {993-1004}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Cohort Studies, Comorbidity, Confounding Factors, Epidemiologic, Culture, depression, Diabetes Mellitus, Educational Status, ethnicity, Factor Analysis, Statistical, Female, Heart Diseases, Humans, Hypertension, Interviews as Topic, Lung Diseases, Male, Self-Assessment, Sex Factors, Stroke, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0b013e31818ce4fa}, author = {Frances Margaret Yang and Richard N Jones} } @article {7267, title = {Measurement Error in Earnings Data in the Health and Retirement Study}, journal = {Journal of Economic and Social Measurement}, volume = {33}, year = {2008}, pages = {39-61}, publisher = {33}, abstract = {We provide new evidence on the extent of measurement error in respondent-reported earnings data by exploiting detailed W-2 records matched to older workers in the Health and Retirement Study (HRS). Our empirical findings are qualitatively consistent with the findings of previous studies. Mean measurement error in the 1991 HRS earnings data for men is somewhat larger than what has been found in other validation studies, but is still modest, averaging about 0.059 log points, approximately 5.9 percent, or 1,500. For women in 1991, it is 0.067 log points, approximately 6.7 percent, or 916. We find a negative correlation between the measurement error and the true value of earnings as measured by the W-2 records, which indicates the presence of non-classical measurement error. For men and women, this error shows little correlation with a standard set of cross-sectional earnings determinants. The one exception is that the measurement error rises with reported education. The bias on the OLS parameter estimate of the impact of having a college degree or higher (relative to a high school drop-out) from using the respondent-reported rather than the W-2 earnings is positive and estimated to be 0.071 log points, or roughly a bias of 7 percent.}, keywords = {Methodology, Social Security}, doi = {http://dx.doi.org/10.2139/ssrn.1297452}, author = {Bricker, Jesse and Gary V. Engelhardt} } @article {7258, title = {Memory decline and depressive symptoms in a nationally representative sample of older adults: the Health and Retirement Study (1998-2004).}, journal = {Dement Geriatr Cogn Disord}, volume = {25}, year = {2008}, month = {2008}, pages = {266-71}, publisher = {25}, abstract = {

BACKGROUND/AIMS: Inconsistencies in the relationship between depression and cognitive decline may exist because the expected cognitive domains at risk have not been specified in previous study designs. We aimed to examine the relationship between depressive symptoms and verbal episodic memory functioning over time.

METHODS: Data from a prospective cohort study (Health and Retirement Study; 1998-2004; n = 18,465), a multistage national probability sample of older adults in the United States, were analyzed. Verbal learning and memory of a 10-word list learning task were the main outcomes. Depressive symptoms (Center for Epidemiologic Studies - Depression Scale) constituted the main predictor.

RESULTS: Depressive symptoms were associated with significantly lower immediate (-0.05; p < 0.001) and delayed (-0.06; p < 0.001) word list recall scores after controlling for demographics and baseline and time-varying cardiovascular disease risks and diseases.

CONCLUSIONS: In this US national study of older adults, elevated depressive symptoms were associated with declines in episodic learning and memory over time. These associations were little affected by the demographic or medical conditions considered in this study. The results suggest that learning and memory decline may be a long-term feature associated with depressive symptoms among the nation{\textquoteright}s older adult population.

}, keywords = {Aged, Aged, 80 and over, depression, Female, Health Status, Humans, Incidence, Male, Memory Disorders, Neuropsychological tests, Prevalence, Retirement, United States}, issn = {1421-9824}, doi = {10.1159/000115976}, author = {Hector M Gonz{\'a}lez and Mary E Bowen and Gwenith G Fisher} } @article {5717, title = {A Micro-Level Analysis of Recent Increases in Labor Force Participation Among Older Workers}, number = {WP$\#$2008-8}, year = {2008}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {Aggregate data reveal a sizable increase in labor force participation rates since 2000 among American workers on the cusp of retirement, reverting back to levels for older men not seen since the 1970s. While these aggregate numbers are useful in that they document overall trends, they do not elucidate the reasons behind workers decisions. The Health and Retirement Study (HRS), a nationally-representative, longitudinal survey of older Americans that spans 1992 to 2004, provides micro-level data regarding these retirement trends. Moreover, the HRS contains detailed information about the types of jobs older Americans are taking (e.g., full-time versus part-time, self-employed versus wage-and-salary, low-paying versus high-paying, blue collar versus white collar). This study capitalizes on the richness of the HRS data and explores labor force determinants and outcomes of older Americans, with an emphasis on retirees{\textquoteright} choices in recent years. We present a cross-sectional and longitudinal description of the financial, health, and employment situation of older Americans. We then explore retirement determinants using multinomial logistic regression to model gradual retirement and logistic and OLS regression to model the work-leisure (whether to work) and hours intensity (how much to work) decisions of older workers. Evidence suggests that the majority of older Americans retire gradually, in stages, and that younger retirees continue to respond to financial incentives just as their predecessors did. In addition, the retirement decisions of younger and middle-aged retirees appear similar in the face of macro-level changes in the early part of this decade.}, keywords = {Employment and Labor Force, Retirement Planning and Satisfaction}, url = {https://crr.bc.edu/working-papers/a-micro-level-analysis-of-recent-increases-in-labor-force-participation-among-older-workers/}, author = {Kevin E. Cahill and Michael D. Giandrea and Joseph F. Quinn} } @mastersthesis {6328, title = {Modeling aging processes: Social activities, partner influence, and individual well-being}, year = {2008}, month = {2008}, pages = {Ph.D.}, school = {The University of Chicago}, type = {3322590}, address = {United States -- Illinois}, abstract = {The past decade has witnessed a growing interest in longitudinal studies of aging. The perspective of cumulative advantage/adversity was employed to explain health disparities in later life. In terms of methodology, recent advances in the statistical theory of growth curve models have enabled important breakthroughs in the study of correlates of change. Moreover, moving beyond single-trajectory growth curve analysis, a combination of the longitudinal model for individual change and the cross-sectional model for matched pairs makes it possible to estimate dual aging trajectories of marital dyads. Hence, this dissertation focuses on effects from social activities and partner influences that affect aging. Using the Health and Retirement Study (HRS) and the Asset and Health Dynamics among the Oldest Old (AHEAD) data, I conduct three studies in this dissertation. In first two studies, I perform growth curve analyses to examine how activities such as volunteering, helping and late-life employment influence aging trajectories for mid-old aged and older adults. In the third study, I extend growth curve models into family and marriage research to estimate dual aging trajectories for marital dyads and to examine cross-partner interactive processes. The results suggest that social activity and marital context do influence aging processes after midlife. Findings also confirm the existence of selection mechanisms that may drive healthy individuals into activity and similar individuals into a marital relationship. In total, causal relations between activities and partner influence and the effects on later aging trajectories are established. Moreover, these studies predict that, to the extent that the changes accumulate, the above mechanisms will keep shaping older adults{\textquoteright} health trajectories over time. This suggests a mutually reinforcing cumulative process of selection and causal mechanisms.}, keywords = {Healthcare, Methodology}, author = {Hao, Yanni} } @article {7279, title = {Money on the table: Some evidence on the role of liquidity constraints in 401(k) saving}, journal = {Economics Letters}, volume = {99}, year = {2008}, pages = {402-404}, publisher = {99}, abstract = {Using Health and Retirement Study data on contributions, earnings, and pension plans, we examine the role of liquidity constraints in explaining why employees fail to take full advantage of employer matching contributions in 401(k) plans, leaving money on the table.}, keywords = {Consumption and Savings, Other, Pensions}, doi = {https://doi.org/10.1016/j.econlet.2007.09.005}, author = {Gary V. Engelhardt and Kumar, Anil} } @article {7196, title = {Mortality, Heterogeneity and the Distributional Consequences of Mandatory Annuitization}, journal = {Journal of Risk and Insurance}, volume = {75}, year = {2008}, pages = {1055-79}, publisher = {75}, abstract = {This article investigates the distributional consequences of mandatory annuitization. Using data from the Health and Retirement Study (HRS), we calculate the relationship between socio-economic status and a utility based measure of annuity value. We find considerable variation between groups once we take account of not only socio-economic differences in mortality, but also pre-annuitized wealth and longevity risk pooling in marriage. Using HRS data on subjective survival probabilities, we then construct a subjective life table for each individual in the HRS. We show that these tables vary appropriately between groups and aggregate closely to group level averages. We calculate the value each household would place on annuitization, based on the husband and wife{\textquoteright}s subjective life tables, and the household{\textquoteright}s degree of risk-aversion and proportion of pre-annuitized wealth. A significant minority would perceive themselves as suffering a net loss from mandatory annuitization.}, keywords = {Demographics, Expectations, Health Conditions and Status, Net Worth and Assets}, doi = {https://doi.org/10.1111/j.1539-6975.2008.00297.x}, author = {Gong, Guan and Anthony Webb} } @article {7200, title = {A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Feb}, pages = {862-72}, publisher = {66}, abstract = {

The associations between neighborhood context and various indicators of health are receiving growing empirical attention, but much of this research is regionally circumscribed or assumes similar effects across the life course. This study utilizes a U.S. national sample to investigate the association between urban neighborhood socioeconomic disadvantage and health specifically among older adults. Data are from 3442 participants aged 70 years and older in the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, and the 1990 U.S. Census. Our approach underscores the importance of multiple dimensions of health (self-reported physician-diagnosed cardiovascular disease [CVD], functional status, and self-rated health) as well as multiple dimensions of neighborhood disadvantage, which are conceptualized as environmental hazards that may lead to a physiologically consequential stress response. We find that individual-level factors attenuate the association between neighborhood disadvantage and both CVD and functional status, but not self-rated health. Net of covariates, high neighborhood socioeconomic disadvantage is significantly associated with reporting poor health. In late life, neighborhood socioeconomic disadvantage is more consequential to subjective appraisals of health than diagnosed CVD or functional limitations.

}, keywords = {Aged, Female, Health Behavior, Health Status Disparities, Humans, Male, Poverty, Small-Area Analysis, Socioeconomic factors, United States, Urban Population}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.11.002}, author = {Richard G Wight and Janet R. Cummings and Miller-Martinez, Dana and Arun S Karlamangla and Teresa Seeman and Carol S Aneshensel} } @mastersthesis {6007, title = {Mammography Use among Older Women in the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study}, year = {2007}, month = {2007}, school = {University of Iowa}, abstract = {Mammography is an accepted secondary prevention tool for detecting breast cancer, the second leading cause of cancer deaths among women. Although Medicare began covering screening mammography in 1991, its use among older women is not without controversy and there is a lack of uniform guidelines. Understanding the factors associated with mammography among older women, therefore, is important from a clinical and policy perspective. This dissertation used a comprehensive array of demographic, socioeconomic, and health-related variables to examine mammography among Medicare beneficiaries in the Asset and Health Dynamics Among the Oldest Old study. Progressive model building using multivariable logistic and multinomial regression was performed and several sensitivity analyses were conducted. The research objectives included: to determine the prevalence of mammography based on self-reports and claims information, assess the concordance between self-reported mammography and Medicare claims, identify the characteristics associated with concordance, and determine the risk factors associated with mammography among older women. The prevalence of self-reported mammography (54\%) was twice the prevalence of mammography identified from Medicare claims data (27\%). The concordance between self-reported and claims-based mammography use was poor; African Americans and women on Medicaid had significantly lower odds of concordance, primarily due to overreporting. Based on claims data, continuity of care was the factor most strongly associated with mammography use and this finding was extensively explored. Women with at least a high school education, with 2 or more children, and women who participated in regular vigorous activity also were more likely to have had a mammogram. The odds of receiving screening mammography decreased with a woman{\textquoteright}s age and were lower for women with a decline in self-rated health. Although income and wealth were not independently associated with mammography use, self-expectations about future financial position were. The study of mammography among older women will continue to be an essential research agenda because of increases in life expectancy and health-related quality of life improvements, advances in imaging and therapies, controversy regarding the efficacy and cost-effectiveness of mammography, and Medicare policies to subsidize these services.}, keywords = {Health Conditions and Status, Healthcare}, author = {Thomas R Miller} } @article {7149, title = {Managed Care and the Near-Elderly: Effects of plan enrollment on functionality}, journal = {Applied Economics}, volume = {39}, year = {2007}, pages = {2027}, publisher = {39}, abstract = {This paper examines the effects of enrollment in a health maintenance organization (HMO) or a preferred provider organization (PPO) on the functional status of near-elderly adults (aged 55-64), compared to traditional fee-for-service (FFS) plans. A sample of 1306 near-elderly adults with employer-sponsored health insurance are drawn from the 2000-2002 waves of the Health and Retirement Study, a nationally representative panel survey of community-dwelling adults. Regression models are estimated to assess the effects of different types of insurance plans on functionality, as measured by whether or not the individual has any functional limitations. The potential influence of selection bias into alternative types of plans is addressed by limiting the sample to near-elders without a choice of health plans. The effects of HMOs on functionality are shown to be comparable to those of FFS plans among the general near-elderly population. However, significant adverse effects of HMO enrollment on functional status are observed among near-elders with chronic conditions. PPO enrollees have similar functional outcome to FFS enrollees, even among those with chronic conditions. The observed differences in functional outcome across plans have important implications for the practicality of managed care plans serving older adults.}, keywords = {Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance}, doi = {https://doi.org/10.1080/00036840600707217}, author = {Xiao Xu and Gail A Jensen} } @article {5691, title = {Managing the Risk of Life}, number = {UM WP 2007-167}, year = {2007}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {This study analyzes the role of individual s and spouse s survival expectations and knowledge about Social Security rules on the expected Social Security claiming age, taking into account the various incentives single and married individuals face. There is substantial heterogeneity in the level of knowledge about SS rules according to demographic characteristics. We find that single men and women who expect to be longlived plan on delaying Social Security claiming. When we allow for differential effects of survival on knowledge about Social Security rules, subjective survivals matter only for single women who are knowledgeable. For single men, knowledge is not so important in their decisions. The claiming decision of married individuals is more complicated, because they are entitled to spouse s and survivor s benefits. Consistent with the incentives provided by Social Security rules, we find that married men base their expected claiming age on their spouse s survival expectations but not on their own survival. For married women, both own and spouse s subjective survivals positively influence the timing of claiming. Knowledge about Social Security rules affects the expected claiming age of both married men and women.}, keywords = {Expectations, Social Security}, url = {https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1082051}, author = {Delavande, Adeline and Robert J. Willis} } @article {5684, title = {Measuring Dissaving Out of Retirement Wealth}, year = {2007}, institution = {Social Science Research Network}, abstract = {The approaching retirement of the baby boomers, accelerating trend from DB to DC pension plans, and growing uncertainty over the solvency of Social Security all raise important questions about the ability of households to finance their retirement years with liquid assets, rather than annuities. We use data from four waves of the HRS to investigate how households spend down their retirement wealth, and, in particular, whether they appear to run down their retirement accounts too quickly. We find no evidence of excessive dissaving over the period 1998 to 2004. Indeed, the annuitized value of total wealth rose for most households over this period, suggesting that households are not running down their assets too fast, given their remaining life expectancies.}, keywords = {Consumption and Savings, Health Conditions and Status, Net Worth and Assets}, doi = {http://dx.doi.org/10.2139/ssrn.968431}, author = {Love, David A. and Paul A Smith} } @inbook {5215, title = {Measuring Pension Wealth}, booktitle = {Redefining Retirement: How Will Boomers Fare?}, year = {2007}, note = {ProCite field 6 : In ProCite field 8 : eds}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {New York, NY}, abstract = {Pension wealth plays a critical role in older individuals{\textquoteright} retirement behavior and financial security. Accordingly, the magnitude and distribution of pension wealth is important in the ongoing debate about whether Baby Boomers have adequate retirement savings. This chapter summarizes the results of a long-term effort to develop an improved calculator to measure defined contribution pension wealth of older Americans, implemented using the Health and Retirement Study. Results show that pension wealth resulting from voluntary saving (and accrued earnings thereon) comprises half of DC pension wealth calculated for HRS respondents with matched summary plan descriptions. These are lower mean estimates of DC pension wealth than previously found, mainly resulting from changes for the wealthiest tail of the pension-wealth distribution. The findings imply that researchers must think more carefully about the economic assumptions underlying pension measures.}, keywords = {Income, Net Worth and Assets, Pensions}, doi = {DOI:10.1093/acprof:oso/9780199230778.003.0010}, author = {Christopher R. Cunningham and Gary V. Engelhardt and Kumar, Anil} } @mastersthesis {6394, title = {Measuring the Impact of Technological Progress on the Household}, year = {2007}, month = {2007}, school = {University of Rochester}, abstract = {In each of the following chapters, macro models are developed to explore the impact of technological progress on the household. Chapter 1 focuses on the impact of technological progress in transportation on suburbanization. In this chapter, a model of a city is developed in which agents choose both whether or not to own a car, and where to live. Focusing on the period 1910 to 1970, the model is calibrated to match the fall in automobile prices, the rise in real incomes, and the rise in the cost of commuting by public transportation relative to commuting by car. Under the baseline calibration the model predicts both a rise in car-ownership and decentralization. In Chapter 2, a model with leisure production and endogenous retirement is used to explain the declining labor-force participation rates of elderly males. Using the Health and Retirement Study, the model is calibrated to cross-sectional data on the labor-force participation rates of elderly US males by age and their average drop in market consumption in the year 2000. Running the calibrated model for the period 1850 to 2000, a prediction of the evolution of the cross-section is obtained and compared with data. The model is able to predict both the increase in retirement since 1850 and the observed drop in market consumption at the moment of retirement. The increase in retirement is driven by rising real wages and a falling price of leisure goods over time. Finally, in Chapter 3, the welfare gain from technological progress in personal computer production is measured by constructing a simple model of computer demand. The innovation of the model is in the agent{\textquoteright}s utility function. Preferences are defined such that the marginal utility of zero computer consumption is finite. Thus the model can predict the zero demand for computers observed in the data and generate a finite welfare gain from their introduction into the market. The model is calibrated using data on computer expenditures. The model suggests that the welfare gain from technological progress in personal computers is approximately 4 percent of total consumption expenditure.}, keywords = {Consumption and Savings, Demographics, Employment and Labor Force}, author = {Kopecky, Karen A.} } @article {7168, title = {Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study.}, journal = {Arch Intern Med}, volume = {167}, year = {2007}, month = {2007 Sep 24}, pages = {1853-60}, publisher = {167}, abstract = {

BACKGROUND: Mechanisms for racial/ethnic disparities in glycemic control are poorly understood.

METHODS: A nationally representative sample of 1901 respondents 55 years or older with diabetes mellitus completed a mailed survey in 2003; 1233 respondents completed valid at-home hemoglobin A(1c) (HbA(1c)) kits. We constructed multivariate regression models with survey weights to examine racial/ethnic differences in HbA(1c) control and to explore the association of HbA(1c) level with sociodemographic and clinical factors, access to and quality of diabetes health care, and self-management behaviors and attitudes.

RESULTS: There were no significant racial/ethnic differences in HbA(1c) levels in respondents not taking antihyperglycemic medications. In 1034 respondents taking medications, the mean HbA(1c) value (expressed as percentage of total hemoglobin) was 8.07\% in black respondents and 8.14\% in Latino respondents compared with 7.22\% in white respondents (P < .001). Black respondents had worse medication adherence than white respondents, and Latino respondents had more diabetes-specific emotional distress (P < .001). Adjusting for hypothesized mechanisms accounted for 14.0\% of the higher HbA(1c) levels in black respondents and 19.0\% in Latinos, with the full model explaining 22.0\% of the variance. Besides black and Latino ethnicity, only insulin use (P < .001), age younger than 65 years (P = .007), longer diabetes duration (P = .004), and lower self-reported medication adherence (P = .04) were independently associated with higher HbA(1c) levels.

CONCLUSIONS: Latino and African American respondents had worse glycemic control than white respondents. Socioeconomic, clinical, health care, and self-management measures explained approximately a fifth of the HbA(1c) differences. One potentially modifiable factor for which there were racial disparities--medication adherence--was among the most significant independent predictors of glycemic control.

}, keywords = {Aged, Aged, 80 and over, Black People, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Services Accessibility, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Patient Compliance, Socioeconomic factors, Treatment Refusal, United States, White People}, issn = {0003-9926}, doi = {10.1001/archinte.167.17.1853}, author = {Michele M Heisler and Jessica Faul and Rodney A. Hayward and Kenneth M. Langa and Caroline S Blaum and David R Weir} } @article {7180, title = {Mechanisms of Structural Models: The Case of the Mickey Mantle Effect}, journal = {American Economic Review, Papers and Proceedings}, volume = {May}, year = {2007}, note = {http://www.econ.duke.edu/ hf14/publication/mickey-mantle/mickey_mantle_aer_pub.pdf}, pages = {53-9}, publisher = {May}, keywords = {Health Conditions and Status, Medicare/Medicaid/Health Insurance}, url = {https://www.jstor.org/stable/30034420}, author = {Fang, Hanming and Keane, Michael P. and Ahmed Khwaja and Salm, Martin and Daniel S. Silverman} } @article {5703, title = {Medicaid Long-Term Care: Few Transferred Assets before Applying for Nursing Home Coverage; Impact of Deficit Reduction Act on Eligibility is Uncertain}, year = {2007}, institution = {U.S. Government Accountability Office}, address = {Ann Arbor, MI}, abstract = {Question: There is some concern that individuals transfer assets (at less than fair market value) in order to be eligible for Medicaid. Since Medicaid paid nearly one-half of the nation s total long-term care expenditures in 2004, analysis was needed to determine how prevalent this practice was. Finding: Using the NIA-funded Health and Retirement Study, GAO found that few elderly individuals had resources to support even a year s worth of private-pay nursing home care at the time they entered a nursing home. Medicaid-covered nursing home residents were less likely to have reported transferring cash than non-Medicaid-covered residents.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Net Worth and Assets, Public Policy}, url = {https://www.gao.gov/products/GAO-07-280}, author = {United States Governmental Office} } @article {7120, title = {Medicaid{\textquoteright}s Nursing Home Coverage and Asset Transfers}, journal = {Public Finance Review}, volume = {35}, year = {2007}, pages = {414-439}, publisher = {35}, abstract = {Medicaid covers the costs of a long nursing home stay. This coverage may create an incentive for the elderly to transfer their assets to their children to qualify for Medicaid before entering a nursing home. Previous researchers had found little evidence that such behavior was widespread or that asset transfers were large. However, data from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD) suggest that the self-assessed probability of entering a nursing home is a significant determinant of the likelihood of making an asset transfer. The budgetary implications of these Medicaid-induced asset transfers were probably fairly small at the time of the study, but not insignificant, and are likely to have risen steadily since.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Net Worth and Assets}, url = {http://www.federalreserve.gov/pubs/feds/2004/200415/200415pap.pdf}, author = {Bassett, William F.} } @article {5631, title = {Medical Expenditure Risk and Household Portfolio Choice}, number = {WR-325-1}, year = {2007}, institution = {RAND Labor and Population Program}, address = {Santa Monica, CA}, abstract = {As health care costs continue to rise, medical expenses have become an increasingly important contributor to financial risk. Economic theory suggests that when background risk rises, individuals will reduce their exposure to other risks. This paper presents a test of this theory by examining the effect of medical expenditure risk on the willingness of elderly Medicare beneficiaries to hold risky assets. The authors measure exposure to medical expenditure risk by whether an individual is covered by supplemental insurance through Medigap, an employer, or a Medicare HMO. They account for the endogeneity of insurance choice by using county variation in Medigap prices and non-Medicare HMO market penetration. They find that having Medigap or an employer policy increases risky asset holding by 6 percentage points relative to those enrolled in only Medicare Parts A and B. HMO participation increases risky asset holding by 12 percentage points. Given that just 50 percent of their sample holds risky assets, these are economically sizable effects. It also suggests an important link between the availability and pricing of health insurance and the financial behavior of the elderly.}, keywords = {Medicare/Medicaid/Health Insurance, Risk Taking}, doi = {https://doi.org/10.7249/WR325-1}, author = {Dana P Goldman and Nicole Maestas} } @mastersthesis {6170, title = {Medicare Supplemental Insurance Purchasing Decisions and Ownership}, volume = {Doctor of Philosophy}, year = {2007}, month = {2007}, school = {Case Western Reserve University}, address = {Cleveland, OH}, abstract = {The majority of Medicare beneficiaries rely on supplemental insurance to help fill the gaps in Medicare{\textquoteright}s benefit package and to protect themselves from large, unanticipated health care expenses. Medigap is the only supplemental insurance available to all beneficiaries in the private health insurance market. Although numerous studies have been conducted on Medigap ownership, few attempts have been made to explore the decision-making process for purchasing Medigap. This dissertation examined decision factors in the dynamics of private supplemental insurance purchases by Medicare beneficiaries. Simon{\textquoteright}s Bounded Rationality Theory was utilized to develop a conceptual framework for this study. This study is a secondary analysis, using longitudinal data from the Asset and Health Dynamics Among the Oldest-Old Survey (AHEAD). The sample consisted of 2,756 non-Hispanic Medicare beneficiaries who had Medicare coverage and were 70 and over at the 1993 baseline interview. This sample was followed at Wave II and Wave III in the 1995 and 1998 surveys. Multilevel modeling was used to examine the time-dependent relationship of the Medigap purchasing decision. The analysis revealed that for the oldest old, Medigap purchases were related to socio-demographic and economic factors, while limited by cognitive functioning and influenced by environmental factors. Beneficiaries with Medigap coverage are better educated, more likely to be white and financially advantaged, and more likely to have better cognitive functioning. However, the beneficiaries{\textquoteright} need for services---self-reported health status and chronic disease conditions---was not found to have impact on Medigap purchases. The findings of this study have implications for Medicare policies that are designed to enhance health care coverage while containing health care costs through market competition. These findings are also important for public agencies and other entities helping the disadvantaged elderly make informed enrollment decisions, and for furthering empirical knowledge and research methodology on the behavioral modeling with respect to health insurance purchases.}, keywords = {Medicare/Medicaid/Health Insurance}, author = {Yan Yang} } @mastersthesis {6057, title = {Modifiable factors for disability: Is there potential for reducing racial disparities in disability in older age?}, volume = {Doctor of Philosophy}, year = {2007}, month = {2007}, school = {University of South Florida}, address = {Tampa, FL}, abstract = {White-Black disparities in disability in the older population are consistently reported in the literature, and are usually ascribed to differences in socio-economic, health, and cognitive status. However, the role of modifiable influences on disability, such as health and lifestyle behaviors or health care utilization on these differences is less clear. This dissertation examines: (1) longitudinal White-Black differences in disability and the potential contributions of distinct health behaviors to these differences; (2) White-Black differences in the effects of health care utilization on trajectories of disability; and (3) whether cognition mediates the effects of health behaviors on disability in Whites and in Blacks, independent of established confounders for these relationships. This dissertation uses longitudinal data from the Asset and Health Dynamics among the Oldest Old study (AHEAD). Trajectories of disability in basic (ADL) and instrumental (IADL) activities of daily living are fit using mixed effects models with time-varying predictors. The mediation effect is tested using a multilevel mediation model. Results indicate that health behaviors close the residual White-Black gap in IADL trajectories but not the residual gap in ADL trajectories. Physical activity participation and maintenance of a normal weight or overweight status resulted in lower ADL and IADL disability levels over time among Whites. None of the health behaviors influenced longitudinal trajectories of disability in Blacks. Short-stay nursing home and home health care utilization was associated with lower ADL and IADL disability levels over time among Blacks. Cognition mediated the effect of physical activity participation on ADL and cognitive IADL in Whites but not in Blacks. That is, physical activity participation had positive effects on ADL and IADL disability both directly, and indirectly through beneficial effects on cognition. Modifiable influences on disability, such as health and lifestyle behaviors and health care utilization should be targeted by intervention programs and regulatory policies in order to narrow or eliminate the White-Black disability disparities. Such interventions may represent effective avenues for achieving the goals of Healthy People 2010 .}, keywords = {Demographics, Disabilities, Health Conditions and Status, Healthcare}, url = {https://scholarcommons.usf.edu/etd/2324/}, author = {Mihaela A. Popa} } @article {5695, title = {A Multistage Model for Analyzing Repeated Observations on Depression in Elderly}, year = {2007}, abstract = {The problem of depression in elderly, in terms of short and long-term health and economic consequence, needs to be assessed more critically. This study uses the longitudinal data from the six waves of the Health and Retirement Survey to examine the transition to depression, reverse transition from depression to no depression and also repeated transition from no depression to depression after experiencing a reverse transition during a study period. Covariate-dependent Markov models are proposed using the logistic link function based on the Chapman-Kolmogorov equation. A simplified and more flexible approach of constructing the likelihood function is demonstrated in this paper to deal with the branching of a number of transition types starting from a group of subjects with no depression at the beginning of the study.}, keywords = {Demographics, Health Conditions and Status}, author = {M. Ataharul Islam and Rafiqul I Chowdhury and Huda, Shahariar} } @article {7084, title = {Marital History and the Burden of Cardiovascular Disease in Midlife}, journal = {The Gerontologist}, volume = {46}, year = {2006}, pages = {266-70}, publisher = {46}, abstract = {This study examines the effects of marital history on the burden of cardiovascular disease in midlife. With use of data from the 1992 Health and Retirement Study, a series of nested logistic regression models was used to estimate the association between marital history and the likelihood of cardiovascular disease. Results suggest that, in midlife, the continuously married and the never married are among the healthiest in cardiovascular outcomes. People with multiple marital losses are the most vulnerable group. People with multiple marital losses have a higher likelihood of cardiovascular disease and will need significant formal and informal care as they advance into old age.}, keywords = {Adult children, Health Conditions and Status}, author = {Zhang, Zhenmei} } @mastersthesis {6234, title = {Marriage in Later Life: The Relationship between Marital Quality, Health, and Divorce}, year = {2006}, month = {2006}, school = {Bowling Green State University}, keywords = {Adult children, Health Conditions and Status}, author = {Jennifer R. Bulanda} } @article {7071, title = {Medicaid and Family Wealth Transfer}, journal = {The Gerontologist}, volume = {46}, year = {2006}, pages = {6-13}, publisher = {46}, abstract = {Purpose: This study examines whether the relationship between making familial wealth transfers and becoming a Medicaid recipient sheds light on the current debate about Medicaid estate planning, whereby some elders transfer their assets to their families to qualify for Medicaid. Design and Methods: Using the Health and Retirement Study, we tracked a national sample of community-based elders who did not receive Medicaid at the 1993 baseline interview but became Medicaid recipients during a 10-year time period and examined wealth transfers for these new Medicaid beneficiaries. Results: Among elders aged 70 or older who did not receive Medicaid in 1993, 16.4 became Medicaid recipients over 10 years. Among these new Medicaid recipients, 17.9 transferred their wealth to family members before receiving Medicaid benefits, with an average transfer amount of 8,507 during the 2 years prior to receiving Medicaid benefits. In addition, 15.2 of community-residing elders entered a nursing home during the 10-year period, and 26.3 of these were covered by Medicaid. Of these new Medicaid recipients living in nursing homes, 12.6 transferred wealth to their families in the mean amount of 4,112. Implications: Familial wealth transfers do occur before changes in Medicaid eligibility in a small, but nontrivial, number of cases, but the amount transferred is modest, especially among nursing home residents. This finding implies that policies to reduce Medicaid long-term-care expenditures by limiting such transfers may not be very effective.}, keywords = {Adult children, Medicare/Medicaid/Health Insurance}, url = {http://gerontologist.gerontologyjournals.org/}, author = {Jinkook Lee and Hyungsoo Kim and Tanenbaum, Sandra} } @article {5672, title = {Men With Health Insurance and the Women Who Love Them: the Effect of a Husband{\textquoteright}s Retirement on His Wife{\textquoteright}s Health Insurance Coverage}, year = {2006}, institution = {The University of Michigan, Michigan Retirement Research Center}, abstract = {Health insurance coverage in the years prior to retirement is particularly important because it protects the household from the financial risks of uninsurance as well as the health consequences of delaying care while uninsured. While results from the retirement job lock literature show that those who would lack coverage after retirement continue to work to maintain benefits, little work has explored the types of health insurance choices made by couples after retirement. It may be difficult for a married man to coordinate continuous coverage for a younger wife whose primary source of coverage has been from the husband, and thus households may pay more for non-group coverage or be exposed to the risks of uninsurance. This paper studies a panel of married couples from the 1992-2004 waves of the Health and Retirement Study (HRS) to study the types of health insurance decisions households make around the time of retirement. Results indicate that households seem to do well at avoiding uninsurance at the time of retirement, but may make high cost choices in order to insure the wife. Men switch into Medicare or coverage from their wife at retirement if they lose their own coverage, but a large fraction of women take-up privately purchased coverage. In fact, the transition from husband s coverage to privately purchased coverage is twice as large in periods when the husband retires than otherwise. Transitions to uninsurance are lower in periods of retirement than at other times, suggesting that men continue to work if either spouse would lose coverage. Though less risky, insurance purchased in the non-group market is expensive relative to employer-sponsored coverage. Thus, married households may need to increase savings to pay for health insurance that bridges the gap until the wife can claim Medicare at age 65.}, keywords = {Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, url = {http://www.mrrc.isr.umich.edu/publications/papers}, author = {Jody Schimmel} } @article {7081, title = {Military Service and (Dis)Continuity in the Life Course: Evidence on Disadvantage and Mortality from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest Old}, journal = {Research on Aging}, volume = {28}, year = {2006}, pages = {135}, publisher = {28}, abstract = {This study uses a life-course framework and data from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest-Old to examine three hypotheses related to (dis)continuity in the effects of early-life disadvantage (African American race and low paternal education) and military service on later-life mortality. Specifically, the authors consider whether military service (and age at enlistment) mediates or moderates the effects of early-life disadvantage on later-life mortality and whether mid- to late-life marital status, socioeconomic status, health status, and health behaviors mediate the effects of military service on mortality. The authors find very little evidence to support the notion that any mortality benefits accrue to men as a consequence of military service overall or enlistment at any particular age. Most of the evidence is consistent with life-course disruption and continuity of disadvantage interpretations.}, keywords = {Demographics, Event History/Life Cycle, Health Conditions and Status}, author = {Andrew S London and Janet M Wilmoth} } @article {5661, title = {Moral Hazard, Adverse Selection and Health Expenditures: A semiparametric analysis}, year = {2006}, institution = {Cambridge, MA, National Bureau of Economic Research}, abstract = {Theoretical models predict asymmetric information in health insurance markets may generate inefficient outcomes due to adverse selection and moral hazard. However, previous empirical research has found it difficult to disentangle adverse selection from moral hazard in health care. We empirically study this question by using data from the Health and Retirement Study to estimate a structural model of the demand for health insurance and medical care. Using a two-step semi-parametric estimation strategy we find significant evidence of moral hazard, but not of adverse selection.}, keywords = {Medicare/Medicaid/Health Insurance, Methodology}, author = {Bajari, Patrick and Hong, Han and Ahmed Khwaja} } @article {7109, title = {Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market}, journal = {American Economic Review}, volume = {96}, year = {2006}, pages = {938-58}, publisher = {96}, abstract = {We demonstrate the existence of multiple dimensions of private information in the long-term care insurance market. Two types of people purchase insurance: individuals with private information that they are high risk and individuals with private information that they have strong taste for insurance. Ex post, the former are higher risk than insurance companies expect, while the latter are lower risk. In aggregate, those with more insurance are not higher risk. Our results demonstrate that insurance markets may suffer from asymmetric information even absent a positive correlation between insurance coverage and risk occurrence. The results also suggest a general test for asymmetric information.}, keywords = {Insurance, Medicare/Medicaid/Health Insurance, Risk Taking}, author = {Finkelstein, Amy and Kathleen McGarry} } @article {7047, title = {Is marriage good for male health in retirement?}, journal = {The Gerontologist}, volume = {45}, year = {2005}, pages = {584 -585}, publisher = {45}, keywords = {Adult children}, author = {Lauren Hersch Nicholas and Kelly, B.} } @article {5616, title = {Medicaid: Transfers of Assets by Elderly Individuals to Obtain Long-Term Care Coverage}, number = {GAO-05-968}, year = {2005}, institution = {U.S. Government Accountability Office}, address = {Washington, DC}, abstract = {In fiscal year 2004, the Medicaid program financed about $93 billion for long-term care services. To qualify for Medicaid, individuals{\textquoteright} assets (income and resources) must be below certain limits. Because long-term care services can be costly, those who pay privately may quickly deplete their assets and become eligible for Medicaid. In some cases, individuals might transfer assets to spouses or other family members to become financially eligible for Medicaid. Those who transfer assets for less than fair market value may be subject to a penalty period that can delay their eligibility for Medicaid. GAO was asked to provide data on transfers of assets. GAO reviewed (1) the level of assets held and transferred by the elderly, (2) methods used to transfer assets that may result in penalties, (3) how states determined financial eligibility for Medicaid long-term care, and (4) guidance the Centers for Medicare \& Medicaid Services (CMS) has provided states regarding the treatment of asset transfers. GAO analyzed data on levels of assets and cash transfers made by the elderly from the 2002 Health and Retirement Study (HRS), a national panel survey; analyzed states{\textquoteright} Medicaid applications; and interviewed officials from nine states about their eligibility determination processes. In 2002, over 80 percent of the approximately 28 million elderly households (those where at least one person was aged 65 or over) had annual incomes of $50,000 or less, and about one-half had nonhousing resources, which excluded the primary residence, of $50,000 or less. About 6 million elderly households (22 percent) reported transferring cash, with amounts that varied depending on the households{\textquoteright} income and resource levels. In general, the higher the household{\textquoteright}s asset level, the more likely it was to have transferred cash during the 2 years prior to the HRS study. Overall, disabled elderly households--who are at higher risk of needing long-term care--were less likely to transfer cash than nondisabled elderly households. Certain methods to reduce assets, such as spending money to pay off debt or make home modifications, do not result in penalty periods. Other methods, such as giving gifts, transferring property ownership, and using certain financial instruments, could result in penalty periods, depending on state policy and the specific arrangements made. None of the nine states GAO contacted tracked or analyzed data on asset transfers or penalties applied. These states required applicants to provide documentation of assets but varied in the amount of documentation required and the extent to which they verified the assets reported. These states generally relied on applicants{\textquoteright} self-reporting of transfers of assets, and officials from these states informed GAO that transfers not reported were difficult to identify. To help states comply with requirements related to asset transfers, CMS has issued guidance primarily through the State Medicaid Manual. CMS released a special study in 2005 to help states address the issue of using annuities as a means of sheltering assets. Additionally, CMS officials provide ongoing technical assistance in response to state questions, but noted the challenge of issuing guidance applicable to all situations given the constantly changing methods used to transfer assets in an attempt to avoid a penalty period. In commenting on a draft of this report, CMS noted the complexity of the current law and commented that data on the precise extent and cost of asset transfers to the Medicaid program have been difficult to gather.}, keywords = {Adult children, Healthcare, Medicare/Medicaid/Health Insurance, Net Worth and Assets}, url = {http://www.gao.gov/cgi-bin/getrpt?GAO-05-968}, author = {United States Governmental Office} } @article {7060, title = {Medical Diagnosis Can Induce Depressive Symptoms}, journal = {The American Journal of Nursing}, volume = {105}, year = {2005}, pages = {72J}, publisher = {105}, abstract = {Researchers used the data from the Health and Retirement Study to assess symptoms of depression in those between the age of 51 and 61 who were not depressive at the beginning of the study. The state of each subject{\textquoteright}s emotions was evaluated periodically with specific attention paid to the connection between their emotions and a recent medical diagnosis.}, keywords = {Health Conditions and Status, Healthcare}, author = {Kayalli, Andrea} } @article {7051, title = {Men who work at age 70 or older.}, journal = {J Gerontol Soc Work}, volume = {45}, year = {2005}, month = {2005}, pages = {41-63}, publisher = {45}, abstract = {

The federal policy on older workers has shifted from the encouragement of early withdrawal from the labor force to the encouragement of continuous participation in the labor force. In this light, it is instructive to investigate the backgrounds of elderly people who work at age 70 or older. This article presents the findings of a study, using data from the 1993 Asset and Health Dynamics of the Oldest Old Study, that investigated the effects of health, economic conditions (net worth, employer-provided pensions, and supplemental medical insurance coverage), education, and spouse{\textquoteright}s work status on the probability of working among men aged 70 or older. The study addressed the probability of working, the probability of working fulltime and of working part-time, and the probability of being self-employed and of being employed by others. Implications for policy are discussed.

}, keywords = {Aged, Employment, Health Status, Humans, Logistic Models, Male, Multivariate Analysis, Public Policy, Socioeconomic factors, United States}, issn = {0163-4372}, doi = {10.1300/J083v45n04_04}, author = {Martha N. Ozawa and Terry Y S Lum} } @mastersthesis {5626, title = {The Microeconomic Effect of Longevity on Savings: Evidence from the Health and Retirement Study}, year = {2005}, school = {Department of Economics, Harvard College}, abstract = {This paper seeks to address the microeconomic link between health, particularly longevity, and savings rates. Using the expansive Health and Retirement Study, a microeconomic model for savings is generated. Both ordinary least squares and two stage least squares regressions, with height as an instrument for life expectancy estimates found in the survey, show a tentative positive link between longevity and savings. In the grander scheme, these results underscore the returns to an economy from investment in health care, decreased morbidity and increased longevity.}, keywords = {Consumption and Savings, Health Conditions and Status}, author = {Reed, Edward} } @article {6969, title = {Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms.}, journal = {Psychol Med}, volume = {34}, year = {2004}, month = {2004 May}, pages = {623-34}, publisher = {34}, abstract = {

BACKGROUND: Although major depression is a common condition across the age range, there is some evidence from clinical studies that it may be more persistent and disabling in older adults. This study examined the demographic, socio-economic and clinical factors associated with major depression and with persistence of depressive symptoms at 2- and 4-year follow-ups in a large population sample of middle-aged and older adults.

METHOD: In a sample of 9747 participants aged over 50 in the 1996 wave of the US Health and Retirement Study, the authors assessed the 12-month prevalence of major depression using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Significant depressive symptoms at the time of 1996, 1998 and 2000 interviews were assessed using a short form of the Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS: The 12-month prevalence of CIDI-SF major depression was 6.6\%. With age, prevalence declined, but the likelihood of significant depressive symptoms at follow-ups increased. Both prevalence and persistence of significant depressive symptoms at follow-ups were associated with socio-economic disadvantage and physical illness. Persistence of depressive symptoms at follow-ups was also associated with symptoms of anhedonia, feelings of worthlessness, and thoughts of death at baseline.

CONCLUSIONS: Sociodemographic, physical health and a specific profile of depressive symptoms are associated with a poorer course of major depression in the middle-aged and older adults. These indicators may identify a subgroup of patients in need of more careful follow-up and intensive treatment.

}, keywords = {Age Factors, Aged, Depressive Disorder, Major, Female, Follow-Up Studies, Health Status, Humans, Logistic Models, Male, Middle Aged, Prevalence, Residence Characteristics, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {0033-2917}, doi = {10.1017/S0033291703001764}, author = {Ramin Mojtabai and Mark Olfson} } @article {5608, title = {The Marginal Propensity to Spend on Adult Children}, year = {2004}, institution = {New Haven, Connecticut, Yale University}, abstract = {We examine how much of an extra dollar of parental lifetime resources will ultimately be passed on to adult children in the form of intervivos transfers and bequests. We infer bequests from the stock of wealth late in life. We use mortality rates and age specific estimates of the response of transfers and wealth to permanent income to compute the expected present discounted values of these responses to permanent income. Our estimates imply parents pass on between 2 and 3 cents out of an extra dollar of expected lifetime resources in bequests and about 1 cent in transfers. The estimates increase with parental income and are smaller for nonwhites. They imply that about 15 percent of the effect of parental income on lifetime resources of adult children is through transfers and bequests and about 85 percent is through the intergenerational correlation in earnings, although these estimates are sensitive to assumptions about the intergenerational earnings correlation, taxes, and the number of children. We compare our estimates to rough estimates of the marginal propensity to spend on children under 18 and higher education.}, keywords = {Adult children, Net Worth and Assets}, author = {Joseph G Altonji and Villanueva, Ernesto and Department of Economics} } @mastersthesis {6145, title = {Marital Status Differences in Working Life after Age 50: A sex-stratified analysis}, year = {2004}, month = {2004}, school = {The Pennsylvania State University}, address = {United States -- Pennsylvania}, abstract = {Although retirement is a prominent feature of the modern life course, prior research has largely focused on the experiences of men or married couples. However, rising female labor force participation and decreasing marital stability means that many women are entering later-life with substantial work histories, but also without the economic protections of marriage. Men too are increasingly entering later-life nonmarried. Given the rapidly aging population, it is imperative to understand the implications of these demographic shifts for the organization of working life in the later-years for men and women. Drawing on data from the 1992-2000 waves of the Health and Retirement Study (HRS), this research expands on prior studies by examining marital status differences in working life and retirement for both men and women. The HRS is a nationally representative sample of noninstitutionalized adults over the age of 50. Population-based working life tables are estimated using discrete-time hazard models. Results indicate that older men are more likely to be in the labor force than are women, due to both lower exit risks and higher reentry risks. Among men, the married have longer working lives and lower retirement risks than divorced, widowed and never married men. Never married men have the shortest working life. The opposite is true for women; married women have shorter working lives and higher risks of retirement than divorced widowed and never married women. Divorced and never married women spend the most remaining years in the labor force. Both nonmarried men and women spend more years disabled than the married. Differences in socioeconomic resources, primarily, mediate some, but not all, of the effect of divorced and widowhood on the risk of retirement for women. Differences in socioeconomic resources, health and current family context do not account for the higher risk of retirement for divorced, widowed and never married men relative to the married. In fact, if nonmarried men had the characteristics of married men, they would be even more likely to retire.}, keywords = {Adult children, Demographics, Employment and Labor Force, Healthcare}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=845711461\&Fmt=7\&clientId=17822\&RQT=309\&VName=PQD}, author = {David F Warner} } @article {5609, title = {Minimum Hours Constraints, Job Requirements and Retirement}, number = {10876}, year = {2004}, note = {ProCite field 3 : Unlisted; Unlisted}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {A structural retirement model estimated with data from the Health and Retirement Study is used to simulate the effects of policies firms might adopt to improve employment conditions for older workers and thereby encourage delayed retirement. Firm policies that effectively abolished minimum hours constraints would strongly increase the number partially retired, while reducing full time work and full retirement, resulting in only a small net increase in full time equivalent employment. Reducing physical and mental requirements of jobs would have much weaker effects on retirement than was suggested by work with the 1970s Retirement History Study. Reducing informal pressures to retire, increasing employer accommodations to health problems, and reducing the prevalence of layoffs and retirement windows would have only small effects on retirement outcomes.}, keywords = {Consumption and Savings, Disabilities, Employment and Labor Force, Pensions, Public Policy, Retirement Planning and Satisfaction, Social Security}, doi = {10.3386/w10876}, author = {Alan L Gustman and Thomas L. Steinmeier} } @article {5606, title = {Modeling Lifetime Earnings Paths: Hypothetical versus Actual Workers}, year = {2004}, institution = {University of Pennsylvania, Boettner Center for Pe, Pension Research Council WP 2004-3}, abstract = {To assess the distributional effects of social security reform proposals, it is essential to have good information on real-world workers lifetime earnings trajectories. Until recently, however, policymakers have relied on hypothetical earnings profiles for policy analysis. We use actual lifetime earnings data from the Health and Retirement Study (HRS) to compare actual workers covered earnings profiles to these hypothetical profiles. We show that the hypothetical profiles do not track earnings patterns of current retirees; thus lifetime pay levels are much higher than for most HRS workers. Therefore, using hypothetical profiles could misrepresent benefits paid and taxes collected under such reforms.}, keywords = {Net Worth and Assets, Pensions, Social Security}, author = {Olivia S. Mitchell and John W R Phillips and Au, Andrew} } @article {6977, title = {Moderate and severe obesity have large differences in health care costs.}, journal = {Obes Res}, volume = {12}, year = {2004}, month = {2004 Dec}, pages = {1936-43}, publisher = {12}, abstract = {

OBJECTIVE: To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old.

RESEARCH METHODS AND PROCEDURES: Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days.

RESULTS: The results indicated that there were large differences in obesity-related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50\% increase) than a BMI of 30 to 35 (about a 25\% increase); a BMI of over 40 doubled health care costs (approximately 100\% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services.

DISCUSSION: Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.

}, keywords = {Aged, Ambulatory Care, Body Mass Index, Body Weight, Female, Health Care Costs, Hospitalization, Humans, Male, Middle Aged, Obesity, Sex Characteristics}, issn = {1071-7323}, doi = {10.1038/oby.2004.243}, author = {Andreyeva, Tatiana and Sturm, Roland and Ringel, Jeanne S.} } @article {5590, title = {Motivation for Money and Care that Adult Children Provide for Parents: Evidence from Point Blank Survey Questions}, number = {2004-17}, year = {2004}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {When adult children provide care for their aging parents, they often do so at great expense to themselves incurring psychic, monetary, emotional, and even physical costs, in conjunction with care that is labor intensive and, at the extreme, unrelenting. While the nature of parent care and the profile of care giving children are well described in the literatures of the social sciences, we still lack insight into why adult children undertake parent care without compensation or compulsion. In this paper, we adopt a novel, direct-question approach using newly available data from a special module fielded in the 2000 Health and Retirement Study that included questions on motivations for, and concerns with, the provision of familial assistance. We discover several new things about the provision of care in families. Transfers are not always provided free of pressure from other family members, for example, and familial norms of obligations and traditions appear to matter for many respondents. These findings suggest that the standard set of economic considerations utility interdependence, budget constraints, exchange, and the like are insufficient for a complete understanding of private transfer behavior. Though one must always be skeptical about reading too much into what people say about why they do the things they do (or think they will do) we nonetheless conclude that point-blank questions offer, at the very least, a worthwhile complement to the more conventional methods for unraveling motivations for private, intergenerational transfers.}, keywords = {Adult children, Healthcare}, url = {https://crr.bc.edu/working-papers/motivation-for-money-and-care-that-adult-children-provide-for-parents-evidence-from-qpoint-blankq-s/}, author = {Cox, Donald and Beth J Soldo} } @article {5549, title = {The Marginal Propensity to Spend on Adult Children}, number = {9811}, year = {2003}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {We examine how much of an extra dollar of parental lifetime resources will ultimately be passed on to adult children in the form of inter vivos transfers and bequests. We infer bequests from the stock of wealth late in life. We use mortality rates and age specific estimates of the response of transfers and wealth to permanent income to compute the expected present discounted values of these responses to permanent income. Our estimates imply that parents pass on between 2 and 3 cents out of an extra dollar of expected lifetime resources in bequests and about 2 cents in transfers. The estimates increase with parental income and are smaller for nonwhites. They imply that about 15 percent of the effect of parental income on lifetime resources of adult children is through transfers and bequests and about 85 percent is through the intergenerational correlation in earnings, although these estimates are sensitive to assumptions about the intergenerational earnings correlation, taxes, and the number of children. We compare our estimates to the implications of alternative computable benchmark models of savings behavior in order to assess the likely importance of intended bequests for the wealth/income relationship.}, keywords = {Adult children, Health Conditions and Status}, doi = {10.3386/w9811}, author = {Joseph G Altonji and Villanueva, Ernesto} } @article {5554, title = {Measuring Pension Wealth in the HRS: Employer and Self-Reports}, year = {2003}, note = {ProCite field 8 : RAND and University College London}, institution = {RAND}, keywords = {Methodology, Net Worth and Assets}, author = {Susann Rohwedder} } @article {5551, title = {Measuring the Optimal Income Replacement Rate: A Panel Data Analysis}, year = {2003}, institution = {Sungkyunkwan University, Korea; Dept. of Economics}, abstract = {In order to analyze welfare of retirees, this paper investigates the optimal income replace rate and analyzes how retirement decision affects the post- and pre-retirement consumption. The data analysis using the HRS shows that consumption decreased after retirement for both early and late retirement groups. The post- and pre-retirement consumption ratio (CRATIO) is computed to be 0.922, which implies that the optimal income replacement rate for all retirees is 92.2 . We investigate the interdependence of the decisions on when to retire and how much to consume after retirement (or CRATIO) by using the switching regression model, which tests the hypothesis that early retirement and short labor period induces the low post-retirement income and low post-retirement consumption. The empirical results from the switching regression model show that early retirement decision may affect the post-retirement consumption. After deciding to retire early, retirees would have consumed less than they actually have. The estimation results that used CRATIO as a dependent variables are similar to the results that used post-retirement consumption as a dependent variable.}, keywords = {Consumption and Savings, Retirement Planning and Satisfaction}, author = {An, Chong-Bum and Jeon, Seung-Hoon} } @article {6883, title = {Medication costs, adherence, and health outcomes among Medicare beneficiaries.}, journal = {Health Aff (Millwood)}, volume = {22}, year = {2003}, month = {2003 Jul-Aug}, pages = {220-9}, publisher = {22}, abstract = {

In a two-year period more than two million elderly Medicare beneficiaries did not adhere to drug treatment regimens because of cost. This poor adherence tended to be more common among beneficiaries with no or partial medication coverage and was associated with poorer health and higher rates of hospitalization. The risk for cost-related poor adherence was especially pronounced among lower-income beneficiaries with high out-of-pocket drug spending. We argue that this pattern of cost-related poor medication adherence should inform the design of Medicare prescription drug benefit legislation.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Continuity of Patient Care, Family Characteristics, Female, Financing, Personal, Health Services Research, Humans, Income, Insurance, Pharmaceutical Services, Longitudinal Studies, Male, Medicare, Patient Compliance, Prevalence, Probability, Self Administration, Treatment Outcome, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.22.4.220}, author = {Ramin Mojtabai and Mark Olfson} } @article {6843, title = {The Mismatch Between Life Insurance Holdings and Financial Vulnerabilities: Evidence from the Health and Retirement Study}, journal = {American Economic Review}, volume = {93}, year = {2003}, note = {RDA 1999-006}, pages = {354-365}, publisher = {93}, abstract = {This study examines life insurance holdings and financial vulnerabilities among couples approaching retirement age. Two separate concerns motivate our analysis. First, there are reasons to suspect that life insurance coverage may be poorly correlated with underlying financial vulnerabilities. A well-known insurance industry adage holds that life insurance is {\textquotedblleft}sold and not bought.{\textquotedblright} Alternatively, households may purchase long-term policies relatively early in life, and subsequently fail to adjust coverage appropriately because of inertia and/or other psychological considerations. Second, households that purchase little or no life insurance may leave either or both spouses at risk of serious financial consequences}, keywords = {Insurance, Net Worth and Assets}, doi = {10.1257/000282803321455340}, author = {Bernheim, B. Douglas and Forni, Lorenzo and Gokhale, Jagadeesh and Laurence J. Kotlikoff} } @article {5499, title = {A Medicare Buy In for the Near Elderly: Design Issues and Potential Effects on Coverage}, year = {2002}, institution = {Henry J. Kaiser Family Foundation}, address = {Washington, D.C.}, abstract = {A Medicare buy-in allowing persons below the age of full eligibility to purchase Medicare coverage has been discussed as one way to help uninsured near-elderly persons obtain health insurance coverage. This report describes estimates of participation rates in Medicare buy-ins and measures the potential impact of buy-in plans on uninsurance. The report also examines some key issues that arise in designing buy-in plans. The results suggest that many near-elderly Americans would purchase Medicare coverage, but the introduction of a buy-in would substantially reduce uninsurance rates only if premiums were related to income. }, keywords = {Demographics, Medicare/Medicaid/Health Insurance}, url = {http://files.kff.org/attachment/report-A-Medicare-Buy-In-for-the-Near-Elderly-Design-Issues-and-Potential-Effects-on-Coverage}, author = {Richard W. Johnson and Marilyn Moon and Davidoff, Amy J.} } @article {5505, title = {Medicare, Retirement Costs, and Labor Supply at Older Ages}, number = {WP$\#$2002-8}, year = {2002}, note = {RDA 1998-006}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {When workers retire, they forego the wages and many of the benefits they received while employed. By providing subsidized health insurance coverage to virtually every American at age 65, Medicare reduces the cost of retiring for workers who receive health benefits from their employers, especially when those benefits do not continue after retirement. As a result, an increase in the age of Medicare eligibility may lead many workers to delay retirement. This paper examines how a potential increase in the age of Medicare eligibility might affect retirement behavior by relating the health insurance costs of retirement to labor supply decisions. The insurance cost of retirement is the increase in health insurance premiums that workers face after they retire, relative to what they pay when working. We measure the effect of insurance costs on labor force withdrawals by including the net present value of premium costs in a multivariate model of retirement. We then simulate the impact of changes in the Medicare eligibility age by re-computing premium costs under the assumption that individuals could not receive Medicare coverage until age 67. We find that health insurance costs significantly discourage retirement, and that an increase in the age of Medicare eligibility would reduce retirement rates.}, keywords = {Employment and Labor Force, Medicare/Medicaid/Health Insurance}, url = {https://crr.bc.edu/working-papers/medicare-retirement-costs-and-labor-supply-at-older-ages/}, author = {Richard W. Johnson} } @mastersthesis {6110, title = {Mental Health and Labor Market Outcomes}, year = {2002}, month = {2002}, school = {University of Michigan}, abstract = {This dissertation consists of three essays on the relationship between mental health (the Center for Epidemiologic Studies Depression Scale) and labor market behaviors--employment, hours worked, wages, welfare program participation, and retirement. Using the National Longitudinal Survey of Youth 1979 cohort (individuals in their thirties), I find that high levels of psychological distress are associated with a lower probability of employment for men and women, fewer hours worked among men that work, and lower wages among women that work. Women with high levels of psychological distress were more likely to use welfare and had longer spells of recipiency. Using panel data techniques, these effects are examined across time and remain significant as far as five years in the future. The third chapter uses the Health and Retirement Survey to examine the relationship between psychological distress and early retirement. Among men and women aged 50 to 61 at baseline, those with above-average levels of psychological distress were more likely to not be working at baseline and, if working, to leave the labor force during the following six years. The analysis uses the Stock and Wise option value of work theoretical framework, and the retirement decision is modeled as a sequential probit, with decisions across years correlated through an individual random effect. Comparisons are made to the effect of physical health (a scale of self-reported functioning limitations), which has a larger impact on labor force withdrawal than psychological distress. The time series properties of physical and mental health are estimated by a model with a persistent component (following an autoregressive process of order one) and a transitory component. Physical and mental health have similar persistent components but mental health has a more variable transitory component. Physical and mental health have similar indirect effects on retirement, except for earnings where physical health has a larger effect. These differences are not large enough to explain the larger impact of physical health on retirement timing. The theoretical model leaves one explanation\—that physical limitations have a larger negative impact on the non-pecuniary utility from work relative to retirement than psychological distress.}, keywords = {Employment and Labor Force, Health Conditions and Status}, isbn = { 0-493-88669-9}, author = {Steffick, Diane E.} } @article {12182, title = {Minorities and the Health and Retirement Survey: Future Analytic Opportunities and Data Requirements}, year = {2002}, publisher = {National Institute on Aging}, address = {Bethesda, MD}, keywords = {administrative data, health, minorities}, author = {Tienda, Marta} } @article {5525, title = {Modeling Income in the Near Term: Revised Projections of Retirement Income Through 2020 for the 1931-1960 Birth Cohorts}, year = {2002}, note = {RDA 1998-006}, institution = {The Urban Institute}, address = {Washington, D.C.}, abstract = {The Division of Policy Evaluation (DPE) of the Social Security Administration (SSA) has entered into two contracts with the Urban Institute to help it develop a new tool for analyzing the distributional consequences of Social Security reform proposals. The first, awarded in 1998, led to the development of Modeling Income in the Near Term (MINT), a tool for simulating the retirement incomes of members of the Baby Boom and neighboring cohorts. The second, awarded in 2000, was to expand and improve on the first version of MINT. In all phases of the project, members of the research staff at SSA/DPE collaborated closely with the contractors. The Brookings Institution served as a subcontractor to the Urban Institute under both contracts and the RAND Corporation participated in the development of the initial version of MINT under a separate contract. This report describes the work of the researchers at Urban and Brookings under the second contract.}, keywords = {Disabilities, Net Worth and Assets, Pensions, Social Security}, url = {http://www.urban.org/UploadedPDF/410609_ModelingIncome.pdf}, author = {Toder, Eric and Thompson, Lawrence H. and Melissa Favreault and Richard W. Johnson and Perese, Kevin and Ratcliffe, Caroline and Karen E. Smith and Cori E. Uccello and Timothy A Waidmann and Berk, Jillian and Woldemariam, Romina and Gary T. Burtless and Claudia R Sahm and Douglas A. Wolf} } @article {8455, title = {Money Matters: Beyond the Nest Egg}, journal = {The Wall Street Journal}, year = {2002}, month = {Sept. 30, 2002}, pages = {R4}, publisher = {The Wall Street Journal}, chapter = {Special Section, "A Guide to Retirement Planning and Living"}, address = {New York, NY}, keywords = {Retirement Planning and Satisfaction}, author = {Greene, Kelly} } @article {5433, title = {Medicare and Retirement Decisions}, year = {2001}, institution = {The Urban Institute}, keywords = {Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, author = {Richard W. Johnson} } @article {5466, title = {Modeling Behavioral Responses to Changes in Social Security: A Life-Cycle Framework}, year = {2001}, institution = {University of Maryland}, abstract = {The life cycle model can be used to provide detailed predictions of the behavioral responses to wide range of hypothetical changes in Social Security policy. I provide a concrete illustration of how this is done by using a preliminary calibrated version of the life cycle model to predict the behavioral responses of a change in the Social Security Disability Insurance (SSDI) program known internally within the Social Security Administration as the 1 for 2 benefit offset proposal .}, keywords = {Event History/Life Cycle, Social Security}, author = {Rust, John} } @article {5463, title = {Modeling Retirement Behavior: A Test of the Option-Value Model Using the Health and Retirement Study}, year = {2001}, note = {RDA 1998-003}, institution = {Congressional Budget Office}, abstract = {This study outlines a latent variable model for consistently estimating the effects of health and other characteristics on the labor force transitions of older, working-aged adults. This model deals explicitly with both the potential endogeneity of global self-reported health measures and with the measurement error inherent in quantifying health status. We estimate the model using the longitudinal Health and Retirement Study and evaluate its properties by testing its underlying assumptions. We intend our results to inform work that uses the kinds of latent variable models we have been using in our own research as well as other research using the health variables available on the HRS.}, keywords = {Pensions, Retirement Planning and Satisfaction, Social Security}, author = {Harris, Amy Rehder} } @article {8445, title = {More Women Over 50 Working Full Time}, journal = {Boston Globe}, year = {2001}, month = {2001}, pages = {G2}, publisher = {Boston Globe}, chapter = {Boston Works}, address = {Boston, MA}, keywords = {Demographics, Employment and Labor Force, Women and Minorities}, author = {Lewis, Diane E.} } @article {6722, title = {Measuring morbidity: disease counts, binary variables, and statistical power.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 May}, pages = {S173-89}, publisher = {55B}, abstract = {

OBJECTIVES: This study compares the use of the binary disease variables with counts of the same conditions in models of self-rated health to better understand the advantages and disadvantages of each approach. In particular, the analysis seeks to determine if statistical power is adequate for the binary variable approach.

METHODS: Morbidity measures from adults in 2 large national surveys were used in both cross-sectional and longitudinal analyses.

RESULTS: Although differences across the approaches are modest, the binary variable approach offers greater explanatory power and slightly higher R2 values. Despite these advantages, statistical power is insufficient in some cases, especially for conditions that are relatively rare and/or that manifest modest differences on the outcome variable.

DISCUSSION: Statistical power estimates are advisable when using the binary variable approach, especially if the list of diseases and health conditions is extensive. Although a simple count of diseases may be useful in some research applications, separate counts for serious and nonserious conditions should be more useful in many research projects while avoiding the risk of inadequate statistical power.

}, keywords = {Adult, Aged, Chronic disease, Cross-Sectional Studies, Female, Geriatric Assessment, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, United States}, issn = {1079-5014}, doi = {10.1093/geronb/55.3.s173}, author = {Kenneth F Ferraro and Janet M Wilmoth} } @article {6701, title = {Memory complaint in a community sample aged 70 and older.}, journal = {J Am Geriatr Soc}, volume = {48}, year = {2000}, month = {2000 Nov}, pages = {1435-41}, publisher = {48}, abstract = {

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as "metamemory," has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person{\textquoteright}s metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged > or = 70.

DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart.

SETTING: A nationwide random sample of community-dwelling older persons.

PARTICIPANTS: A total of 5,444 community-dwelling persons aged > or = 70 and their spouses.

MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini-Mental Status Exam.

RESULTS: In general, people{\textquoteright}s assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures.

CONCLUSIONS: The conditions that skew people{\textquoteright}s self-assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cognition, Depressive Disorder, Educational Status, Female, Geriatric Assessment, Humans, Longitudinal Studies, Male, Marital Status, Memory, Self-Assessment}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2000.tb02634.x}, author = {Carolyn L. Turvey and Schultz, Susan K. and Arndt, Stephan and Robert B Wallace and A. Regula Herzog} } @article {5416, title = {Micro Determinants of Labor Force Status Among Older Americans}, year = {2000}, institution = {SUNY-Stony Brook}, abstract = {This paper uses the first three waves of the Health and Retirement Survey (HRS) to investigate the determinants of labor force status among older Americans. Using transitions at two-year intervals we find that after being retired or unemployed, those who are actively searching for a job have a higher probability of returning to work. We also find that being in good physical and mental health measured by objective and subjective variables increases the chances of becoming employed, as does having worked in the last twelve months. Those who are receiving disability payments are less likely to make this transition. If we focus on those who are married, we find a preference for joint leisure through the influence of the labor force status, health and age of the respondent s partner on the transition decisions. We investigate transitions in and out of employment and self-employment, and for subsamples of males and females. Using monthly employment dummies for the period 1989-97, we analyze monthly, quarterly, semi-annual and annual transitions and find that most of our conclusions are independent of the periodicity but that the effects of the variables vary across specifications.}, keywords = {Employment and Labor Force, Retirement Planning and Satisfaction}, url = {https://www.stonybrook.edu/commcms/economics/research/papers/2000/00-07.pdf}, author = {Hugo Ben{\'\i}tez-Silva} } @article {5407, title = {Microdata Panel Data and Public Policy: National and Cross-National Perspectives}, number = {23}, year = {2000}, institution = {Syracuse University}, address = {Syracuse, NY}, abstract = {This paper focuses on the movement of data-based social policy analysis from a single country cross-sectional frame to a multicountry panel frame. It provides examples of policy insights this movement to panel data has permitted, both with respect to economic well-being and behavior-using data from the PSID (Panel Study of Income Dynamics), the BHPS (British Household Panel Study), the GSOEP (German Socio-Economic Panel), and the HRS (Health and Retirement Study). It also suggests fruitful areas for future panel data-based policy research.}, keywords = {Methodology, Public Policy}, issn = {1525-3066 }, url = {https://surface.syr.edu/cgi/viewcontent.cgi?article=1129\&context=cpr}, author = {R.V. Burkhauser and Smeeding, Timothy M.} } @inbook {5120, title = {Minorities Face Retirement: Worklife Disparities Repeated?}, booktitle = {Forecasting Retirement Needs and Retirement Wealth}, year = {2000}, note = {ProCite field[3]: CUNYProCite field[6]: InProCite field[8]: eds.}, pages = {235-52}, publisher = {University of Pennsylvania Press}, organization = {University of Pennsylvania Press}, chapter = {8}, address = {Philadelphia}, keywords = {Consumption and Savings, Retirement Planning and Satisfaction, Women and Minorities}, url = {https://pensionresearchcouncil.wharton.upenn.edu/publications/books/forecasting-retirement-needs-and-retirement-wealth/}, author = {Honig, Marjorie}, editor = {Olivia S. Mitchell and P. Brett Hammond and Anna M. Rappaport} } @article {5425, title = {Modeling the Effect of Health on Retirement}, year = {2000}, note = {RDA 2000-007}, institution = {National Bureau of Economic Research}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, author = {John Bound and Michael Schoenbaum and Todd R. Stinebrickner and Timothy A Waidmann} } @article {8628, title = {Mortality Risk, Inflation Risk, and Annuity Products}, number = {7812}, year = {2000}, month = {07/2000}, pages = {1-34}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {As growing numbers of retirees reach retirement age with substantial balances in self-directed retirement plans, annuities are likely to become increasingly important instruments for drawing down retirement savings. This study explores recent trends in the pricing of single-premium annuity products in the United States. Virtually all of the annuity products currently available in the United States offer fixed nominal payouts, rather than an inflation-linked payout stream. After describing the money{\textquoteright}s worth{\textquoteright} of the various types of nominal annuity products, this study considers the extent to which existing U.S. private annuity markets provide retirees with inflation-protected retirement income flows. Although there is effectively no market yet for inflation-indexed annuities in the United States, such products are available in other countries. The paper concludes by summarizing recent data on the pricing of both nominal and inflation-linked annuities in the United Kingdom and several other nations.}, keywords = {Annuitization, Mortality, Older Adults, Risk Factors}, url = {https://www.nber.org/papers/w7812.pdf}, author = {Brown, Jeffrey R. and Olivia S. Mitchell and James M. Poterba} } @article {6671, title = {Measuring disability with parsimony.}, journal = {Disabil Rehabil}, volume = {21}, year = {1999}, month = {1999 May-Jun}, pages = {295-306}, publisher = {21}, abstract = {

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

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

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

}, keywords = {Activities of Daily Living, Disability Evaluation, Disabled Persons, Health Status Indicators, Health Surveys, Humans, Surveys and Questionnaires}, issn = {0963-8288}, doi = {10.1080/096382899297729}, url = {https://pubmed.ncbi.nlm.nih.gov/10381242}, author = {Verbrugge, Lois M. and Merrill, Susan S. and Xian Li} } @mastersthesis {6211, title = {Medicaid, Financial Transfers, and Expectations of the Elderly}, year = {1999}, month = {1999}, school = {Brown University}, abstract = {This dissertation is an empirical evaluation of several issues in the economics of aging. In the first two chapters, I use data from the Study of Assets and Health Dynamics of the Oldest Old (AHEAD) and information about the generosity of state Medicaid programs to study the incentives created by the Medicaid program{\textquoteright}s coverage of the costs associated with a long nursing home stay. The household{\textquoteright}s expectations of future nursing home use and the state{\textquoteright}s asset threshold for Medicaid eligibility are used to identify the relationship between inter-vivos asset transfers and the Medicaid nursing home benefit. These factors have small but significant effects on the incidence of transfers between elderly parents and their children and much larger effects on the total amount of transfers. In the final two chapters, my co-author and I focus on the accuracy of expectations provided by respondents, and the usefulness of these expectations in economic modeling. Specifically, we examine whether we can use the entire spectrum of subjective responses by each individual, rather than just the question (or questions) of interest, in order to glean additional information about the underlying true probabilities. We find evidence of a significant, unobserved, individual-specific component in answers to subjective probability questions in both AHEAD and the companion Health and Retirement Study. We then show that controlling for this individual component can lead to significant differences in inference when modeling the relationship between the baseline subjective responses and observed outcomes from later waves of the survey.}, keywords = {Healthcare, Other}, author = {Bassett, William F.} } @article {6660, title = {Multiple roles and well-being among midlife women: testing role strain and role enhancement theories.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {54}, year = {1999}, month = {1999 Nov}, pages = {S329-38}, publisher = {54B}, abstract = {

OBJECTIVE: Research on women{\textquoteright}s multiple roles frequently adopts one of two perspectives: role strain, which argues that assuming multiple roles is detrimental to mental well-being, or role enhancement, which argues that engaging in multiple roles enhances mental well-being. We argue that the relationship between role occupancy and well-being is manifested through multiple dimensions of role experiences. We investigate the association between depressive symptomatology and various dimensions of the roles of wife, mother, paid worker, and informal caregiver to aging parents.

METHODS: Data are from the 1992 wave of the Health and Retirement Study. Depressive symptomatology, measured by a subset of the CES-D scale, is the dependent variable. To assess the robustness of findings relative to different functional forms of the dependent variable, we estimate multiple regression, log-linear regression, and multinomial logit models. Independent variables include demographic characteristics, measures of role occupancy, role demands, and role satisfaction.

RESULTS: Although the number of roles women assume affects their reports of depressive symptoms, once the demand and satisfaction associated with these roles is controlled, number has no effect; that is, the effect of the number of roles is indirect.

DISCUSSION: Our results highlight the importance of women{\textquoteright}s perceptions of the quality of their roles in relation to their overall well-being. Future investigations of women{\textquoteright}s multiple roles should examine how roles may provide rewards, impose constraints, or generate conflict, as well as the extent to which the willingness to assume multiple roles and the reported levels of role satisfaction and mental well-being may be jointly endogenous.

}, keywords = {Caregivers, depression, Employment, Female, Humans, Marriage, Middle Aged, Personal Satisfaction, Psychological Theory, Role, Women{\textquoteright}s Health}, issn = {1079-5014}, doi = {10.1093/geronb/54b.6.s329}, url = {https://pubmed.ncbi.nlm.nih.gov/10625968/}, author = {Reid, Jennifer and Melissa A. Hardy} } @article {6600, title = {Married Women{\textquoteright}s Retirement Expectations: Do Pensions and Social Security Matter?}, journal = {American Economic Review}, volume = {88}, year = {1998}, note = {ProCite field 3 : Hunter College and Graduate School, CUNY}, pages = {202-206}, publisher = {88}, keywords = {Methodology, Pensions, Retirement Planning and Satisfaction, Social Security, Women and Minorities}, url = {https://ideas.repec.org/a/aea/aecrev/v88y1998i2p202-06.html}, author = {Honig, Marjorie} } @article {5357, title = {The Microeconomics of the Retirement Decision in the United States}, year = {1998}, keywords = {Methodology, Retirement Planning and Satisfaction}, url = {https://www.researchgate.net/publication/4922743_The_Microeconomics_of_the_Retirement_Decision_in_the_United_States}, author = {Joseph F. Quinn and R.V. Burkhauser and Kevin E. Cahill and Robert R. Weathers II} } @article {5377, title = {Moving the Nest: A Look at the Effects of Family and Work Status Change in Later Mid-Life}, year = {1998}, institution = {University of Chicago - Population Research Center}, abstract = {Using data from the first two Waves of the Health and Retirement Survey (HRS), this research examines the relationship between migration, family change, and work status change in later mid-life. The results suggest that both family and work status change have significant effects on mobility in later mid-life. The findings for work status change appear consistent with theories of labor force migration: Individuals who worked full-time at both waves were significantly less likely to move long distances than nearly every other group. Departure from the labor force increased the likelihood that an individual experienced a move, either locally and interstate. Changes in the number of adult children resident in a household are found to have strong and significant effects on mobility in later mid-life. Adult children returning home are positively associated with both local and interstate moves. Children leaving home have an even greater impact on mobility. A previously unreported finding is that adult children leaving home have a significant positive effect on long-distance mobility. These findings extend the migration literature by seeking to explain mobility and migration in the context of family and work change over the life course.}, keywords = {Adult children, Demographics, Employment and Labor Force, Health Conditions and Status, Retirement Planning and Satisfaction}, url = {http://www.src.uchicago.edu/prc/publications20thc.php 1998}, author = {Regina M. Bures} } @article {5368, title = {The Multidimensional Configuration of Functional Disability: Patterning by Age, Sex, Race, and Health Status}, year = {1998}, institution = {University of South Carolina, Dept. of Sociology}, keywords = {Disabilities, Methodology}, author = {Lamb, V.L. and Faust, K.} } @article {6577, title = {On the Measurement of Expectations, Uncertainty, and Preferences}, journal = {The Journals of Gerontology: Social Sciences}, volume = {52B}, year = {1997}, pages = {S237-9}, publisher = {52B}, keywords = {Demographics, Employment and Labor Force, Expectations, Healthcare, Retirement Planning and Satisfaction}, url = {https://watermark.silverchair.com/52B-5-S237.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAoAwggJ8BgkqhkiG9w0BBwagggJtMIICaQIBADCCAmIGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMiCgceswiPk9X8uhtAgEQgIICM11WTEF-TxPFAjJjpJPFejebIu7VU6ZC9MEME_GUKqX0}, author = {Juster, F. Thomas} } @article {6584, title = {Measures of cognitive functioning in the AHEAD Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {37-48}, publisher = {52B}, abstract = {

Decline in cognitive functioning and onset of cognitive impairment are potentially important predictors of elderly persons needing informal assistance and formal health care. This article describes the measures of cognitive functioning that were developed for the Asset and Health Dynamics Among the Oldest Old (AHEAD) study of some 6,500 Americans aged 70 years and older. The study was designed to investigate the impact of health on disbursement of family and economic resources. Evaluation of the cognitive measures in terms of psychometric properties and missing data, telephone administration, and formation of an aggregate index is encouraging. Their construct validity is evidenced by their correlations with sociodemographic characteristics and health indicators that replicate existing findings as well as by their prediction of IADL and ADL functioning that are consistent with theory.

}, keywords = {Aged, Aged, 80 and over, Cognition, Geriatric Assessment, Health Status, Health Surveys, Humans, Longitudinal Studies, Memory, Mental Status Schedule, Psychological Tests, Socioeconomic factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.37}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9215356}, author = {A. Regula Herzog and Robert B Wallace} } @article {6588, title = {Medical insurance and the use of health care services by the elderly.}, journal = {J Health Econ}, volume = {16}, year = {1997}, month = {1997 Apr}, pages = {129-54}, publisher = {16}, abstract = {

The objective of this paper is to find how health insurance influences the use of health care services by the elderly. On the basis of the first wave of the Asset and Health Dynamics Survey, we find that those who are the most heavily insured use the most health care services. Because our data show little relationship between observable health measures and either the propensity to hold or to purchase private insurance, we interpret this as an effect of the incentives embodied in the insurance, rather than as the result of adverse selection in the purchase of insurance.

}, keywords = {Activities of Daily Living, Aged, Health Care Surveys, Health Services for the Aged, Health Status Indicators, Hospitalization, Humans, Insurance, Health, Medicare, Office Visits, Patient Acceptance of Health Care, Private Sector, Probability, United States}, issn = {0167-6296}, doi = {10.1016/s0167-6296(96)00515-2}, url = {https://www.ncbi.nlm.nih.gov/pubmed/10169091}, author = {Michael D Hurd and Kathleen McGarry} } @article {5331, title = {Measurement and the Redistribution of Resources Within the Family}, year = {1996}, institution = {RAND, Reprint Series 96-11}, abstract = {Recent work by a number of economists has opened a debate about the role played by intergenerational transfers. Using the new Health and Retirement Study (HRS), we are better able to address the issues involved. Contrary to the current literature on bequests, we do not find that parents give transfers, respondents give greater financial assistance to their less well off children than to their children with higher incomes.}, keywords = {Adult children, Income}, url = {http://ideas.repec.org/p/fth/randrs/96-11.html}, author = {Kathleen McGarry and Robert F. Schoeni} } @article {6548, title = {Minority perspectives from the Health and Retirement Study. Introduction: health and retirement among ethnic and racial minority groups.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {282-4}, publisher = {36}, keywords = {Aged, Health Status, Humans, Minority Groups, Prospective Studies, Quality of Life, Retirement, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.282}, author = {James S Jackson and Lockery, Shirley A. and Juster, F. Thomas} } @article {5309, title = {Marriage, Assets, and Savings}, year = {1995}, institution = {Santa Monica, CA., RAND Corporation}, abstract = {No}, keywords = {Adult children, Consumption and Savings, Net Worth and Assets}, author = {James P Smith} } @article {6533, title = {Musculoskeletal Conditions and Employment}, journal = {Arthritis Care and Research}, volume = {8}, year = {1995}, pages = {311-7}, publisher = {8}, abstract = {OBJECTIVE: To describe the prevalence, incidence, and correlates of work disability among persons with musculoskeletal conditions. METHODS: Literature review and analysis of the Health and Retirement Survey, a national, probability sample of community-based adults ages 51-61. RESULTS: Clinical samples of persons with RA report work disability rates of 51 to 60 . Community-based studies of persons with a broad range of musculoskeletal conditions find work disability rates of 38 to 71 , depending on the mix of symptoms and particular sampling strategy. Persons with musculoskeletal conditions and comorbidity are particularly prone to work loss, with three-quarters leaving work prior to the normal age of retirement. In multivariate models, after adjusting for demographic and functional characteristics, persons with musculoskeletal conditions actually are more likely to work than those without. CONCLUSIONS: Persons with musculoskeletal conditions have high rates of work disability, but given their level of impairment, are more likely to work than persons without musculoskeletal conditions.}, keywords = {Demographics, Disabilities, Employment and Labor Force, Health Conditions and Status, Methodology}, doi = {10.1002/art.1790080417}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1002/art.1790080417}, author = {Yelin, Edward} } @article {8418, title = {Many in 50s Face Hard Years}, journal = {USA Today}, year = {1993}, month = {June 18, 1993}, pages = {A1}, publisher = {USA Today}, chapter = {A}, keywords = {Retirement Planning and Satisfaction}, author = {Snider, Mike} }