TY - ICOMM T1 - Financial hardship drives unhappiness in people living with dementia, study finds Y1 - 2024 A1 - Fischer, Kristen KW - Dementia KW - Finances KW - Healthcare KW - Life Satisfaction PB - McKnights UR - https://www.mcknights.com/news/clinical-news/financial-hardship-drives-unhappiness-in-people-living-with-dementia-study-finds/ ER - TY - ICOMM T1 - Family caregiving doesn’t always mean poor mental health, study finds Y1 - 2023 A1 - Fischer, Kristen KW - Caregiving KW - depression KW - Mental Health PB - McKnights UR - https://www.mcknights.com/news/clinical-news/family-caregiving-doesnt-always-mean-poor-mental-health-study-finds/ ER - TY - JOUR T1 - From financial wealth shocks to ill-health: Allostatic load and overload. JF - Health Econ Y1 - 2023 A1 - French, Declan KW - Allostasis KW - Cholesterol KW - Humans KW - Retirement KW - Stress, Psychological KW - United States AB -

A number of studies have associated financial wealth changes with health-related outcomes arguing that the effect is due to psychological distress and is immediate. In this paper, I examine this relationship for cumulative shocks to the financial wealth of American retirees using the allostatic load model of pathways from stress to poor health. Wealth shocks are identified from Health and Retirement Study reports of stock ownership along with significant negative discontinuities in high-frequency S&P500 index data. I find that a one standard deviation increase in cumulative shocks over two years increases the probability of elevated blood pressure by 9.5%, increases waist circumference by 1.2% and the cholesterol ratio by 6.1% for those whose wealth is all in shares. My findings suggest that the combined effect of random shocks to financial wealth over time is salient for health outcomes. This is consistent with the allostatic load model in which repeated activation of stress responses leads to cumulative wear and tear on the body.

VL - 32 IS - 4 ER - TY - JOUR T1 - Functional Limitations and Access to Long-Term Services and Supports Among Sexual Minority Older Adults. JF - Journal of Applied Gerontology Y1 - 2022 A1 - Travers, Jasmine L A1 - Shippee, Tetyana P A1 - Flatt, Jason D A1 - Caceres, Billy A KW - Functional limitations KW - long-term support KW - sexual identity KW - sexual minorities AB -

Little is known about sexual minority (SM) older adults' activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations and their subsequent access to long-term services and supports (LTSS). We analyzed cross-sectional data from the 2016 Health and Retirement Study limited to individuals ≥50 years old. Bivariate analyses were performed to examine 1) sexual identity differences in the prevalence of ADL/IADL limitations and 2) associations of sexual identity with having ADL/IADL limitations and having access to help with ADL/IADL limitations. Our sample consisted of 3833 older adults, 6% ( = 213) were SM. Compared to heterosexual participants, bisexual older adults had greater reports of ADL/IADL limitations (20.9% vs. 35.9%, = 0.013). Among those who reported having ADL/IADL limitations ( = 803), there were no sexual identity differences in accessing help for ADL/IADL limitations ( = .901). Our findings contribute to the limited research on LTSS access among SM older adults.

VL - 41 IS - 9 ER - TY - JOUR T1 - Feature selection algorithms enhance the accuracy of frailty indexes as measures of biological age. JF - The Journals of Gerontology, Series A Y1 - 2021 A1 - Kim, Sangkyu A1 - Fuselier, Jessica A1 - Welsh, David A A1 - Cherry, Katie E A1 - Myers, Leann A1 - Jazwinski, S Michal KW - Biological age KW - DNA Methylation KW - frailty index KW - Mortality AB -

Biological age captures some of the variance in life expectancy for which chronological age is not accountable, and it quantifies the heterogeneity in the presentation of the aging phenotype in various individuals. Among the many quantitative measures of biological age, the mathematically uncomplicated frailty/deficit index is simply the proportion of the total health deficits in various health items surveyed in different individuals. We used three different statistical methods that are popular in machine learning to select 17-28 health items that together are highly predictive of survival/mortality, from independent study cohorts. From the selected sets, we calculated frailty indexes and Klemera-Doubal's biological age estimates, and then compared their mortality prediction performance using Cox proportional hazards regression models. Our results indicate that the frailty index outperforms age and Klemera-Doubal's biological age estimates, especially among the oldest old who are most prone to biological aging-caused mortality. We also showed that a DNA methylation index, which was generated by applying the frailty/deficit index calculation method to 38 CpG sites that were selected using the same machine learning algorithms, can predict mortality even better than the best performing frailty index constructed from health, function, and blood chemistry.

VL - 76 IS - 8 ER - TY - JOUR T1 - The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults JF - The Journals of Gerontology: Series B Y1 - 2021 A1 - Esther M Friedman A1 - Houle, Jason A1 - Kathleen A. Cagney A1 - Mary E Slaughter A1 - Regina A Shih KW - Cognitive decline KW - Community physical disorder KW - Community social cohesion KW - Foreclosures AB - Objectives While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition. Method This paper uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults’ cognitive health and the mechanisms responsible. Results We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship. Discussion This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults VL - 76 IS - 5 ER - TY - JOUR T1 - Frailty Changes Predict Mortality in 4 Longitudinal Studies of Aging JF - The Journals of Gerontology: Series A Y1 - 2021 A1 - Stolz, Erwin A1 - Emiel O Hoogendijk A1 - Mayerl, Hannes A1 - Wolfgang Freidl KW - ELSA KW - Epidemiology KW - Frailty KW - Mortality KW - Public Health KW - SHARE AB - Baseline frailty index (FI) values have been shown to predict mortality among older adults, but little is known about the effects of changes in FI on mortality.In a coordinated approach, we analyzed data from 4 population-based cohorts: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Survey of Ageing (ELSA), and the Longitudinal Aging Study Amsterdam (LASA), comprising a total of 24 961 respondents (65+), 95 897 observations, up to 9 repeated FI assessments, and up to 23 years of mortality follow-up. The effect of time-varying FI on mortality was modeled with joint regression models for longitudinal and time-to-event data.Differences (of 0.01) in current FI levels (hazard ratio [HR] = 1.04, 95% credible interval [CI] = 1.03–1.05) and baseline FI levels (HR = 1.03, 95% CI = 1.03–1.05) were consistently associated with mortality across studies. Importantly, individuals with steeper FI growth also had a higher mortality risk: An increase in annual FI growth by 0.01 was associated with an increased mortality risk of HR = 1.56 (95% CI = 1.49–1.63) in HRS, HR = 1.24 (95% CI = 1.13–1.35) in SHARE, HR = 1.40 (95% CI = 1.25–1.52) in ELSA, and HR = 1.71 (95% CI = 1.46–2.01) in LASA.FI changes predicted mortality independently of baseline FI differences. Repeated assessment of frailty and individual’s frailty trajectory could provide a means to anticipate further health deterioration and mortality and could thus support clinical decision making. VL - 76 SN - 1079-5006 IS - 9 ER - TY - RPRT T1 - Functional disability with systematic trends and uncertainty: A comparison between China and the U.S. Y1 - 2021 A1 - Fu, Yu A1 - Sherris, Michael A1 - Xu, Mengyi KW - functional disability KW - Life Expectancy KW - multi-state latent factor intensity model KW - systematic trend and uncertainty AB - China and the U.S. are two contrasting countries in terms of functional disability and long-term care. China is experiencing declining family support for long-term care and developing private long-term care insurance. The U.S. has more developed public aged care and private long-term care insurance than in China. Changes in the demand for longterm care are closely related to levels of and trends in mortality and functional disability. To understand future potential demand for long-term care, we compare mortality and functional disability experiences in both China and the U.S. using a multi-state latent factor intensity model to estimate time trends and systematic uncertainty in transition rates. The estimation results show that if trends continue, both countries will experience longevity improvement with morbidity compression and a declining proportion of the older population with a functional disability. Although the elderly Chinese have an estimated shorter life expectancy, they are expected to spend a smaller proportion of that future lifetime functionally disabled in contrast to the U.S. Systematic uncertainty is shown to be significant in future trends in disability rates and our model estimates higher uncertainty in trends for the Chinese elderly, especially for urban residents. JF - CEPAR Working Paper PB - ARC Centre of Excellence in Population Ageing Research UR - https://www.cepar.edu.au/sites/default/files/WP2021_21_Functional_disability.pdf ER - TY - JOUR T1 - Female vulnerability to the effects of smoking on health outcomes in older people JF - PloS one Y1 - 2020 A1 - Haghani, Amin A1 - Thalida E. Arpawong A1 - Jung K Kim A1 - Lewinger, Juan Pablo A1 - Caleb E Finch A1 - Eileen M. Crimmins KW - Cardiovascular disease KW - Smoking KW - Women's Health AB - Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity. VL - 15 SN - 1932-6203 UR - https://pubmed.ncbi.nlm.nih.gov/32497122 IS - 6 U1 - 32497122[pmid] U4 - PONE-D-20-03538[PII] JO - PLoS One ER - TY - JOUR T1 - Factors associated with becoming edentulous in the US Health and Retirement Study. JF - Journal of the American Geriatrics Society Y1 - 2019 A1 - Jane A Weintraub A1 - Orleans, Brian A1 - Mark Alan Fontana A1 - Phillips, Ceib A1 - Judith A Jones KW - Dental Care KW - Risk Factors KW - Smoking AB -

BACKGROUND/OBJECTIVE: To determine factors associated with older adults becoming edentulous (complete tooth loss).

DESIGN: Longitudinal study over a 6-year period.

SETTING: United States, 2006, 2012.

PARTICIPANTS: Nationally representative US sample of adults, aged 50 years and older (n = 9982), participating in the Health and Retirement Study in 2006 and 2012. At the outset, they were dentate and not institutionalized.

INTERVENTION: None.

MEASUREMENTS: Self-report of being dentate or edentulous, demographic variables, dental utilization and other health behaviors, self-rated general health, and incidence between 2006 and 2012 of comorbid medical conditions, functional limitations, and disabilities.

RESULTS: From 2006 to 2012, 563 individuals (5%) became edentulous and 9419 (95%) remained dentate. Adults who became edentulous by 2012 were more likely than those who remained dentate to be black/African American compared to white, to be less educated, were current smokers, had diabetes, and reported poorer self-rated general health, more functional limitations and disabilities, and fewer dental visits (all P < .0001), among other factors. Of those with regular dental visits (at least once every 2 years during the 6-year period), 2.3% became edentulous compared to 9.9% among those without regular dental visits. After adjusting for age and other potential confounders, there was a strong association with poor dental attendance and smoking. Nonregular dental attenders were more likely than regular attenders to become edentulous (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 2.12-3.53), and current smokers were more likely than never smokers to become edentulous (OR = 2.46; 95% CI = 1.74-3.46).

CONCLUSION: Although more contemporaneous data are needed to determine causality, regular dental utilization and smoking are modifiable factors that could prevent edentulism, even when many other comorbid conditions are present. J Am Geriatr Soc, 1-7, 2019.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/31335967?dopt=Abstract ER - TY - JOUR T1 - Food deserts and diet-related health outcomes of the elderly JF - Food Policy Y1 - 2019 A1 - Fitzpatrick, Katie A1 - Nadia Greenhalgh-Stanley A1 - Michele Ver Ploeg KW - Diet-related disease KW - Elderly KW - Food access KW - Food desert KW - United States AB - It is hypothesized that residents of neighborhoods with limited access to affordable and nutritious food face greater barriers to eating a healthy diet, which may in turn, result in worse health outcomes for them. Low-income elderly in urban areas may be uniquely affected by these so-called “food deserts” due to limited transportation options, strong attachments to local neighborhoods, fixed incomes, physical limitations in food shopping and meal preparation, and chronic health problems. Using the 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS), the association between the food environment of elderly individuals living in urban Census tracts and their diet-related health was examined. Within urban areas, we find little evidence that food deserts negatively impact the health of lower income elderly individuals. Policies to address the needs of elderly residents of food deserts should be narrowly targeted and carefully justified. VL - 87 UR - https://www.sciencedirect.com/science/article/pii/S0306919219305640?via%3Dihub ER - TY - NEWS T1 - Fact check: Deaths from a health care bill? T2 - Burlington Free Press Y1 - 2017 A1 - Lori Robertson A1 - Robert Farley KW - Medicare/Medicaid/Health Insurance KW - News JF - Burlington Free Press CY - Burlington, VT UR - https://www.burlingtonfreepress.com/story/news/politics/2017/07/07/fact-check-deaths-health-care-bill/460798001/ ER - TY - JOUR T1 - Functional limitations and health care resource utilization for individuals with cognitive impairment without dementia: Findings from a United States population-based survey. JF - Alzheimer's & Dementia Y1 - 2017 A1 - J. Scott Andrews A1 - Desai, Urvi A1 - Noam Y Kirson A1 - Caroline J. Enloe A1 - Ristovska, Ljubica A1 - King, Sarah A1 - Howard G. Birnbaum A1 - Adam S. Fleisher A1 - Ye, Wenyu A1 - Kahle-Wrobleski, Kristin KW - CIND KW - Cognitive Ability KW - Functional limitations KW - Older Adults AB -

INTRODUCTION: Little is known about functional limitations and health care resource utilization of people with cognitive impairment with no dementia (CIND).

METHODS: Respondents with stable or progressive cognitive impairment (CI) after the first (index) indication of CIND in 2000-2010 were identified from the Health and Retirement Study (HRS). Respondents never exhibiting CI were identified as potential controls. Propensity score-based optimal matching was used to adjust for differences in demographics and history of stroke. Differences between cohorts were assessed accounting for HRS survey design.

RESULTS: After matching, CIND respondents had more functional limitations (difficulty with ≥1 activities of daily living: 24% vs. 15%; ≥1 instrumental activities of daily living: 20% vs. 11%) and hospital stays (37% vs. 27%) than respondents with no CI (all P < .001). Seventy five percent of CIND respondents developed dementia in the observable follow-up (median time: ∼6 years).

DISCUSSION: Even before dementia onset, CI is associated with increased likelihood of functional limitations and greater health care resource use.

VL - 6 ER - TY - JOUR T1 - Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Esther M Friedman A1 - Margaret M Weden A1 - Regina A Shih A1 - Stephanie Kovalchik A1 - Singh, Reema A1 - José J Escarce KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognitive Dysfunction KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Population Dynamics KW - Residence Characteristics KW - United States AB -

OBJECTIVE: To examine whether the health and functioning of middle-aged and older adults are associated with an increased likelihood of community-based moves.

METHOD: Biennial data from adults aged 51 and older in the Health and Retirement Study (HRS) and discrete-time survival models were used to assess the likelihood of community-based moves from 2000 to 2010 as a function of 11 measures of health and functioning.

RESULTS: Respondents diagnosed with heart disease, stroke, hypertension, lung disease, and psychiatric problems were more likely to move during the study period than those with no such diagnosis. Changes in activities of daily living and instrumental activities of daily living functioning, cognitive impairment, and falls were also related to a greater likelihood of moving during the study period. Cancer and diabetes were not related to overall moves, although diabetes was associated with an increased likelihood of local moves. For the most part, it was longstanding not recent diagnoses that were significantly related to the likelihood of moving.

DISCUSSION: Although some health conditions precipitate moves among middle-aged and older adults, others do not. This work has important implications for understanding the role of different aspects of health and functioning in the likelihood of migration among older adults.

VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26450960?dopt=Abstract U4 - Activities of daily living/Aging/Cognition/Health/HEALTH STATUS/health condition/Migration ER - TY - JOUR T1 - Factors associated with cognitive evaluations in the United States. JF - Neurology Y1 - 2015 A1 - Vikas Kotagal A1 - Kenneth M. Langa A1 - Brenda L Plassman A1 - Gwenith G Fisher A1 - Bruno J Giordani A1 - Robert B Wallace A1 - James F. Burke A1 - David C Steffens A1 - Mohammed U Kabeto A1 - Roger L. Albin A1 - Norman L Foster KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Logistic Models KW - Male KW - Marital Status KW - Multivariate Analysis KW - Neuropsychological tests KW - Severity of Illness Index KW - United States AB -

OBJECTIVE: We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States.

METHODS: Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression.

RESULTS: Of the 297 participants with dementia in ADAMS, 55.2% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95% confidence interval: 1.10-6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia.

CONCLUSIONS: Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.

VL - 84 UR - http://www.neurology.org/cgi/doi/10.1212/WNL.0000000000001096 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25428689?dopt=Abstract JO - Neurology ER - TY - JOUR T1 - FASTKD2 is associated with memory and hippocampal structure in older adults. JF - Mol Psychiatry Y1 - 2015 A1 - Vijay K Ramanan A1 - Nho, Kwangsik A1 - Shen, Li A1 - Shannon L Risacher A1 - Brenna C McDonald A1 - Martin R Farlow A1 - Tatiana Foroud A1 - Gao, Sujuan A1 - Soininen, Hilkka A1 - Kloszewska, Iwona A1 - Mecocci, Patrizia A1 - Tsolaki, Magda A1 - Vellas, Bruno A1 - Lovestone, Simon A1 - Aisen, Paul S. A1 - Ronald C Petersen A1 - Jack, Clifford R. A1 - Shaw, Leslie M. A1 - Trojanowski, John Q. A1 - Weiner, Michael W. A1 - Green, Robert C. A1 - Arthur W. Toga A1 - Philip L de Jager A1 - Lei Yu A1 - David A Bennett A1 - Andrew J Saykin KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Female KW - Genetic Association Studies KW - Genome-Wide Association Study KW - Hippocampus KW - Humans KW - Longitudinal Studies KW - Male KW - Memory KW - Memory Disorders KW - Polymorphism, Single Nucleotide KW - Protein-Serine-Threonine Kinases KW - Structure-Activity Relationship AB -

Memory impairment is the cardinal early feature of Alzheimer's disease, a highly prevalent disorder whose causes remain only partially understood. To identify novel genetic predictors, we used an integrative genomics approach to perform the largest study to date of human memory (n=14 781). Using a genome-wide screen, we discovered a novel association of a polymorphism in the pro-apoptotic gene FASTKD2 (fas-activated serine/threonine kinase domains 2; rs7594645-G) with better memory performance and replicated this finding in independent samples. Consistent with a neuroprotective effect, rs7594645-G carriers exhibited increased hippocampal volume and gray matter density and decreased cerebrospinal fluid levels of apoptotic mediators. The MTOR (mechanistic target of rapamycin) gene and pathways related to endocytosis, cholinergic neurotransmission, epidermal growth factor receptor signaling and immune regulation, among others, also displayed association with memory. These findings nominate FASTKD2 as a target for modulating neurodegeneration and suggest potential mechanisms for therapies to combat memory loss in normal cognitive aging and dementia.

PB - 20 VL - 20 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25385369?dopt=Abstract U2 - PMC4427556 U4 - Genetic analysis/Alzheimer disease/Memory impairment/predictors/FASTKD2 ER - TY - JOUR T1 - Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending. JF - Health Affairs (Project Hope) Y1 - 2015 A1 - Melissa Favreault A1 - Gleckman, Howard A1 - Richard W. Johnson KW - Aged KW - Financing KW - Government KW - Humans KW - Insurance KW - Insurance Coverage KW - Long-term Care KW - Medicaid KW - Middle Aged KW - Policy Making KW - United States AB -

About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance's role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

VL - 34 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26572919?dopt=Abstract ER - TY - JOUR T1 - Functional limitations in older adults who have cognitive impairment without dementia. JF - J Geriatr Psychiatry Neurol Y1 - 2013 A1 - Tanya R Gure A1 - Kenneth M. Langa A1 - Gwenith G Fisher A1 - John D Piette A1 - Brenda L Plassman KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Dementia KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Severity of Illness Index KW - Surveys and Questionnaires AB -

OBJECTIVE: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).

METHODS: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.

RESULTS: Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%).

CONCLUSIONS: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.

VL - 26 IS - 2 N1 - NLM Title Abbreviation: J Geriatr Psychiatry Neurol U1 - http://www.ncbi.nlm.nih.gov/pubmed/23559664?dopt=Abstract U2 - PMC3726208 U4 - ADAMS/Cognitive Impairment/ADL and IADL Impairments/Physical health/Dementia/Functional limitation ER - TY - RPRT T1 - Functional Disabilities and Nursing Home Admittance Y1 - 2012 A1 - Joelle H Fong A1 - Benedict S K Koh A1 - Olivia S. Mitchell KW - Disabilities KW - Hospitalization KW - Long-term Care KW - Mortality KW - Older Adults AB - This paper examines how inability to perform activities of daily living relates to the risk of nursing home admission over older adults' life courses. Using longitudinal data on persons over age 50 from the Health and Retirement Study, we show that aging one year boosts the probability of having two or more disabilities by 9 to 12 percent in a multivariate logistic model. Moreover, at least three-fifths of all 65-year-old men and three-quarters of women will experience disability levels during their remaining lifetimes severe enough to trigger nursing home admission. Our analysis also suggests that certain types of disability are more important than others in predicting nursing home admittance and use, which has implications for the design and benefits triggers for long-term care insurance programs. JF - Pension Research Council Working Paper PB - Pension Research Council, University of Pennsylvania CY - Philadelphia, PA ER - TY - JOUR T1 - Functional impairment as a risk factor for urinary incontinence among older Americans. JF - Neurourol Urodyn Y1 - 2005 A1 - Kristi Rahrig Jenkins A1 - Fultz, Nancy H. KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disability Evaluation KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Motor Activity KW - Risk Factors KW - Socioeconomic factors KW - Urinary incontinence AB -

AIMS: Using a large nationally representative sample of older Americans we investigate four domains of functional impairment as possible risk factors for the subsequent development of urinary incontinence (UI) symptoms.

METHODS: Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics among the Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UI symptoms.

RESULTS: A greater number of serious chronic conditions and functional impairment in the lower body mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors that contributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, being represented by a proxy respondent, and functional impairment in the strength domain.

CONCLUSIONS: Understanding the possible relationship between functional impairment and UI is an important step toward developing appropriate interventions for the prevention, treatment, or management of urine loss.

PB - 24 VL - 24 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15578629?dopt=Abstract U4 - WOMEN/Epidemiology/DISABILITY/DISABILITY ER - TY - CHAP T1 - The Family, Social Security, and the Retirement Decision T2 - Social Security and the Family: Addressing Unmet Needs in an Underfunded System Y1 - 2002 A1 - Melissa Favreault A1 - Richard W. Johnson ED - Melissa Favreault ED - Sammartino, F. ED - Steuerle, C. Eugene KW - Adult children KW - Social Security JF - Social Security and the Family: Addressing Unmet Needs in an Underfunded System PB - The Urban Institute Press CY - Washington, DC N1 - RDA 1998-006 ProCite field 6 : Chapter 9 in ProCite field 8 : eds. U4 - Social Security/Family transfers, structure JO - The Family, Social Security, and the Retirement Decision ER - TY - RPRT T1 - Family Structure and Economic Well-Being of Black, Hispanic, and White Pre-Retirement Adults Y1 - 1998 A1 - Chenoa Flippen A1 - Tienda, Marta KW - Adult children KW - Net Worth and Assets KW - Women and Minorities AB - This paper examines how family structure is related to racial and ethnic inequality among older populations. We show that intergenerational living serves the economic needs of minority and unmarried female elders more than non-minority and married elders. The greater economic motivation for co-residence among minority and female elders was suggested both by their higher reliance on the income of co-resident kin and by their subjective evaluations of who benefited most from co-residence. However, when the contributions of co-resident kin are weighed against the additional costs they bring to the household, the inequality-reducing effect of extension falls considerably. The contributions per co-resident kin are smaller in minority households, and thus the economic well-being of elders living in extended households is often no better, and occasionally worse, than had they lived alone. Only unmarried women receive a substantial net boost from co-residence, primarily because adult offspring who co-reside with unmarried women contribute more than their counterparts in unmarried male or couple households. JF - Office of Population Research working paper PB - Princeton University CY - Princeton UR - https://ideas.repec.org/p/pri/opopre/opr9802.pdf.html U4 - Family Structure/Economic Status/Black Americans/Hispanic Americans ER - TY - RPRT T1 - Functional Limitation, Disability and Perceived Health of the Oldest Old: An examination of health status in AHEAD Y1 - 1998 A1 - Lee A. Lillard A1 - Farmer, Melissa M. KW - Disabilities KW - Health Conditions and Status AB - This research focuses on the effects of functional limitation and disability on perceived health status in those age 70 and older. It uses the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) and provides a new methodology for the solving methodological issues of threshold response indicators of limitations and disability and conditional wording of questions. The study provides support for the disability process model outlined by Verbrugge and Jette (1994) and also provided insight into the dynamics that operate between demographics, pathology, functional limitation, disability and perceived health status. For functional limitation, the two domains were confirmed: immobility and cognition. Disability also had two domains confirmed: personal care, and household management. Pathologies were found to have a substantial impact on all four domains as well as perceived health status. Controlling for immobility, personal care and household management were not significant predictors of perceived health status. U4 - Aged, 80 and Over/Disability/Disability/Health Status ER -