TY - RPRT T1 - 2016 HCAP Weighting Summary Y1 - Forthcoming A1 - Richard N Jones ER - TY - JOUR T1 - Associations between psychological resilience and epigenetic clocks in the health and retirement study. JF - GeroScience Y1 - Forthcoming A1 - Zhang, Aijie A1 - Zhang, Yasi A1 - Meng, Yaxian A1 - Ji, Qianqian A1 - Ye, Meijie A1 - Zhou, Liqiong A1 - Liu, Miao A1 - Yi, Chao A1 - Karlsson, Ida K A1 - Fang, Fang A1 - Hägg, Sara A1 - Zhan, Yiqiang KW - ; DNA methylation KW - Agin KW - epigenetic clock KW - Resilience AB -

The aim of this study was to evaluate the associations between psychological resilience and epigenetic clocks assessed by DNA methylation age predictions. We used data from 4018 participants in the Health and Retirement Study. Multivariable linear regression models were used to estimate the association between psychological resilience and epigenetic clocks adjusted for age, sex, race, body mass index, smoking status, and years of education. Thirteen epigenetic clocks were used in our analysis and were highly correlated with one another. A higher psychological resilience score was associated with slower DNA methylation age acceleration for the majority of epigenetic clocks after multivariable adjustment. These findings imply that people with a higher level of psychological resilience may experience slower DNA methylation age acceleration and biological aging.

ER - TY - JOUR T1 - A Care Paradox: The Relationship Between Older Adults' Caregiving Arrangements and Institutionalization and Mortality. JF - Res Aging Y1 - Forthcoming A1 - Jordan, Meggan A1 - Latham-Mintus, Kenzie A1 - Patterson, Sarah E KW - Caregiving KW - Family caregiving KW - Mortality KW - Nursing homes AB -

We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004-2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care.

ER - TY - JOUR T1 - Chronic Disease and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19 JF - medRxiv Y1 - Forthcoming A1 - Rodlescia S. Sneed A1 - Stubblefield, Alexander A1 - Gardner, Graham A1 - Jordan, Tamara A1 - Briana Mezuk KW - Chronic disease KW - COVID-19 KW - health policy KW - Medicaid AB - As the COVID-19 pandemic wanes, states may reintroduce Medicaid work requirements to reduce enrollment. Using the Health and Retirement Study, we evaluated chronic disease burden among beneficiaries aged >50 (n=1460) who might be impacted by work requirements (i.e. working <20 hours per week). Seven of eight chronic conditions evaluated were associated with reduced workforce participation, including history of stroke (OR: 7.35; 95% CI: 2.98-18.14) and lung disease (OR: 4.39; 95% CI: 2.97-7.47). Those with more severe disease were also more likely to work fewer hours. Medicaid work requirements would likely have great impact on older beneficiaries with significant disease burden.Key PointsChronic disease linked to reduced work among older Medicaid beneficiaries.Work requirements would greatly impact those aged >50 with chronic conditions.Coverage loss would have negative implications for long-term disease management.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by the Robert Wood Johnson Foundation’s (RWJF) Policies for Action program under grant number 77342. This is a secondary analysis that uses data from the Health and Retirement Study, (2016 HRS Core and RAND HRS Longitudinal File 2018), sponsored by the National Institute on Aging under grant number NIA U01AG009740 and conducted by the University of Michigan.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study involved only openly available human data, which can be obtained from: https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 and https://hrsdata.isr.umich.edu/data-products/2016-hrs-coreI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data are available online at: https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 and https://hrsdata.isr.umich.edu/data-products/2016-hrs-core ER - TY - JOUR T1 - Comparative Analysis of Gender and Age Patterns in Informal Care Received among Disabled Older Adults: A Cross-National Study across the United States, Mexico, China, and Indonesia. JF - journal of Cross Cultural Gerontology Y1 - Forthcoming A1 - Jain, Urvashi A1 - Sheehan, Connor M KW - Cross-country comparisons KW - Disability KW - Family caregiving KW - Informal care AB -

This paper examines cross-national differences by gender and age in receipt and sources of help for limitations with activities of daily living or instrumental activities of daily living among older adults in the United States, Mexico, China, and Indonesia. Respondents aged 50 + from the Health and Retirement Study, Mexican Health and Aging Study, China Health and Retirement Longitudinal Study, and Indonesia Family Life Survey are included. Descriptive methods, logistic and multinomial regression analyses are used to examine patterns in any help received and main source of help respectively. After controlling for age, marital status, and co-residence with child(ren), it is found that men in all four countries overwhelmingly relied on their spouse for care, while children are more likely to be the main source of care for women. Children as the main source of care increased with age in each country and among men and women, surpassing spouse in China and Indonesia, and to a lesser extent in Mexico, but not in the United States where spouse was found to be more likely to be main caregiver even among the oldest age groups. Caregiving for the disabled is important for the well-being of the care recipient and for caregivers. Our results shed light on the asymmetric burden of caregiving on female spouses, across four diverse and aging countries.

ER - TY - JOUR T1 - Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia. JF - JAMA Internal Medicine Y1 - Forthcoming A1 - Deardorff, W James A1 - Jeon, Sun Y A1 - Barnes, Deborah E A1 - Boscardin, W John A1 - Kenneth M. Langa A1 - Covinsky, Kenneth E A1 - Mitchell, Susan L A1 - Lee, Sei J A1 - Smith, Alexander K KW - Community-dwelling KW - Dementia KW - home care KW - Nursing AB -

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

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

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

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

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

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

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

ER - TY - JOUR T1 - Factor structure of the Harmonized Cognitive Assessment Protocol neuropsychological battery in the Health and Retirement Study JF - Neuropsychology Y1 - Forthcoming A1 - Richard N Jones A1 - Jennifer J Manly A1 - Kenneth M. Langa A1 - Lindsay H Ryan A1 - Deborah A Levine A1 - Ryan J McCammon A1 - David R Weir KW - Cognitive Ability KW - Confirmatory Factor Analysis KW - HCAP KW - Older Adults AB - Objectives: The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS).Method: The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically-driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data. Results: For the eight domains of cognitive functioning identified theoretically (orientation, memory [immediate, delayed, & recognition], set shifting, attention/speed, language/fluency, andvisuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where good fit is axiomatic. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94). Discussion: The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used as anchors for calibrating cross-national studies of cognitive performance, and to identify persons performing atthe low end as part of an algorithmic classification of probable dementia ER - TY - JOUR T1 - Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs). JF - medRxiv Y1 - Forthcoming A1 - Gross, Alden L A1 - LI, CHIHUA A1 - Briceño, Emily M A1 - Rentería, Miguel Arce A1 - Richard N Jones A1 - Kenneth M. Langa A1 - Jennifer J Manly A1 - Nichols, Emma L A1 - David R Weir A1 - Wong, Rebeca A1 - Berkman, Lisa A1 - Lee, Jinkook A1 - Lindsay C Kobayashi KW - Cognition KW - Education KW - harmonization KW - HCAP AB -

BACKGROUND: The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores.

METHODS: We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment.

FINDINGS: IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment.

INTERPRETATION: We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes.

FUNDING: National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).

ER - TY - JOUR T1 - Loneliness and Depressive Symptoms Are High Among Older Adults With Digestive Disease and Associated With Lower Perceived Health. JF - Clin Gastroenterol Hepatol Y1 - Forthcoming A1 - Cohen-Mekelburg, Shirley A1 - Jordan, Ariel A1 - Kenney, Brooke A1 - Burgess, Helen J A1 - Chang, Joy W A1 - Hu, Hsou Mei A1 - Tapper, Elliot A1 - Kenneth M. Langa A1 - Levine, Deborah A A1 - Waljee, Akbar K KW - Epidemiology KW - General Practice KW - Outcomes Research KW - Psychiatric Disorders AB -

BACKGROUND & AIMS: Current approaches to managing digestive disease in older adults fail to consider the psychosocial factors contributing to a person's health. We aimed to compare the frequency of loneliness, depression, and social isolation in older adults with and without a digestive disease and to quantify their association with poor health.

METHODS: We conducted an analysis of Health and Retirement Study data from 2008 to 2016, a nationally representative panel study of participants 50 years and older and their spouses. Bivariate analyses examined differences in loneliness, depression, and social isolation among patients with and without a digestive disease. We also examined the relationship between these factors and health.

RESULTS: We identified 3979 (56.0%) respondents with and 3131 (44.0%) without a digestive disease. Overall, 60.4% and 55.6% of respondents with and without a digestive disease reported loneliness (P < .001), 12.7% and 7.5% reported severe depression (P < .001), and 8.9% and 8.7% reported social isolation (P = NS), respectively. After adjusting for covariates, those with a digestive disease were more likely to report poor or fair health than those without a digestive disease (odds ratio [OR], 1.25; 95% CI, 1.11-1.41). Among patients with a digestive disease, loneliness (OR, 1.43; 95% CI, 1.22-1.69) and moderate and severe depression (OR, 2.93; 95% CI, 2.48-3.47; and OR, 8.96; 95% CI, 6.91-11.63, respectively) were associated with greater odds of poor or fair health.

CONCLUSIONS: Older adults with a digestive disease were more likely than those without a digestive disease to endorse loneliness and moderate to severe depression and these conditions are associated with poor or fair health. Gastroenterologists should feel empowered to screen patients for depression and loneliness symptoms and establish care pathways for mental health treatment.

ER - TY - JOUR T1 - Memory trajectories and disability among older couples: the mediating role of depressive symptoms. JF - Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences Y1 - Forthcoming A1 - Kong, Dexia A1 - Lu, Peiyi A1 - Jiang, Da A1 - Chan, Helen Yue Lai KW - Dyad research KW - latent class growth analysis KW - Memory KW - Older couples KW - trajectory AB -

OBJECTIVE: Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands' and wives' 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'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'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's low and rapid decline trajectory was associated with her own and her husband'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' depressive symptoms and, ultimately, disability risks.

ER - TY - JOUR T1 - A naturally occurring variant of SHLP2 is a protective factor in Parkinson's disease. JF - Molecular Psychiatry Y1 - Forthcoming A1 - Kim, Su-Jeong A1 - Miller, Brendan A1 - Hartel, Nicolas G A1 - Ramirez, Ricardo A1 - Braniff, Regina Gonzalez A1 - Leelaprachakul, Naphada A1 - Huang, Amy A1 - Wang, Yuzhu A1 - Arpawong, Thalida Em A1 - Crimmins, Eileen M A1 - Wang, Penglong A1 - Sun, Xianbang A1 - Liu, Chunyu A1 - Levy, Daniel A1 - Yen, Kelvin A1 - Petzinger, Giselle M A1 - Graham, Nicholas A A1 - Jakowec, Michael W A1 - Cohen, Pinchas KW - DNA KW - Parkinson Disease AB -

Mitochondrial DNA single nucleotide polymorphisms (mtSNPs) have been associated with a reduced risk of developing Parkinson's disease (PD), yet the underlying mechanisms remain elusive. In this study, we investigate the functional role of a PD-associated mtSNP that impacts the mitochondrial-derived peptide (MDP) Small Humanin-like Peptide 2 (SHLP2). We identify m.2158 T > C, a mtSNP associated with reduced PD risk, within the small open reading frame encoding SHLP2. This mtSNP results in an alternative form of SHLP2 (lysine 4 replaced with arginine; K4R). Using targeted mass spectrometry, we detect specific tryptic fragments of SHLP2 in neuronal cells and demonstrate its binding to mitochondrial complex 1. Notably, we observe that the K4R variant, associated with reduced PD risk, exhibits increased stability compared to WT SHLP2. Additionally, both WT and K4R SHLP2 show enhanced protection against mitochondrial dysfunction in in vitro experiments and confer protection against a PD-inducing toxin, a mitochondrial complex 1 inhibitor, in a mouse model. This study sheds light on the functional consequences of the m.2158 T > C mtSNP on SHLP2 and provides insights into the potential mechanisms by which this mtSNP may reduce the risk of PD.

ER - TY - JOUR T1 - An outcome-wide analysis of the effects of diagnostic labeling of Alzheimer's disease and related dementias on social relationships. JF - Alzheimers & dementia: the journal of the Alzheimer's Association Y1 - Forthcoming A1 - Amano, Takashi A1 - Halvorsen, Cal J A1 - Kim, Seoyoun A1 - Reynolds, Addam A1 - Scher, Clara A1 - Jia, Yuane KW - diagnostic label of dementia KW - Health and Retirement Study (HRS) KW - outcome-wide analysis KW - Propensity score analysis KW - social engagement KW - social network KW - Social Support AB -

INTRODUCTION: This study examines how receiving a dementia diagnosis influences social relationships by race and ethnicity.

METHODS: Using data from the Health and Retirement Study (10 waves; 7,159 observations) of adults 70 years and older predicted to have dementia using Gianattasio-Power scores (91% accuracy), this study assessed changes in social support, engagement, and networks after a dementia diagnosis. We utilized quasi-experimental methods to estimate treatment effects and subgroup analyses by race/ethnicity.

RESULTS: A diagnostic label significantly increased the likelihood of gaining social support but reduced social engagement and one measure of social networks. With some exceptions, the results were similar by race and ethnicity.

DISCUSSION: Results suggest that among older adults with assumed dementia, being diagnosed by a doctor may influence social relationships in both support-seeking and socially withdrawn ways. This suggests that discussing services and supports at the time of diagnosis is important for healthcare professionals.

ER - TY - JOUR T1 - Perceived discrimination and nativity status: risk of cognitive impairment among Latin American older adults. JF - International Psychogeriatrics Y1 - Forthcoming A1 - Tibiriçá, Lize A1 - Jester, Dylan J A1 - Kohn, Jordan N A1 - Williams, Allison P A1 - McEvoy, Linda K A1 - Palmer, Barton W KW - Cognition KW - Discrimination KW - Latinx KW - nativity status AB -

OBJECTIVES: We examined the association between perceived discrimination and the risk of cognitive impairment with no dementia (CIND) and Alzheimer's disease and related dementias (ADRD) while considering the potential effects of nativity status.

DESIGN: A prospective analysis of discrimination and nativity status with dementia and cognitive impairment was conducted among Latinx adults aged 51 years and older who participated in the Health and Retirement Study.

SETTING: A national representative sample.

PARTICIPANTS: A sample of 1,175 Latinx adults aged 51 years and older.

MEASUREMENTS: Demographics, cognitive functioning, perceived discrimination, and nativity status (US-born vs. non-US born) were assessed. Traditional survival analysis methods (Fine and gray models) were used to account for the semi-competing risk of death with up to 10 years of follow-up.

RESULTS: According to our results, neither everyday discrimination nor nativity status on their own had a statistically significant association with CIND/ADRD; however, non-US-born Latinx adults who reported no discrimination had a 42% lower risk of CIND/ADRD (SHR = 0.58 [0.41, 0.83], = .003) than US-born adults.

CONCLUSIONS: These results highlight the need for healthcare providers to assess for discrimination and provide support and resources for those experiencing discrimination. It also highlights the need for better policies that address discrimination and reduce health disparities.

ER - TY - JOUR T1 - Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States. JF - JDR Clinical & Translational Research Y1 - Forthcoming A1 - Preisser, J S A1 - Moss, K A1 - Finlayson, T L A1 - Jones, J A A1 - Weintraub, J A KW - Epidemiology KW - Geriatrics KW - Incidence KW - Oral Health KW - Tooth Loss AB -

INTRODUCTION: Edentulism affects health and quality of life.

OBJECTIVES: Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model.

METHODS: The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth?" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set ( = 4,288) was split into selection (70%, = 3,002) and test data (30%, = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training ( = 1,716) and validation ( = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95% confidence interval using 1,000 bootstrap samples.

RESULTS: From 2006 to 2018, 9.7% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate ( = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95% confidence interval, 0.715-0.781), modestly improving prediction. Negligible improvement was gained from adding more variables.

CONCLUSION: Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors.

KNOWLEDGE TRANSFER STATEMENT: This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults.

ER - TY - JOUR T1 - Profiles of Caregiving Arrangements of Community-dwelling People Living with Probable Dementia. JF - Journal of Aging & Social Policy Y1 - Forthcoming A1 - Jutkowitz, Eric A1 - Lauren L Mitchell A1 - Barbara H. Bardenheier A1 - Joseph E Gaugler KW - Caregiving KW - Dementia KW - Long-term Care AB -

People living with dementia receive care from multiple caregivers, but little is known about the structure of their caregiving arrangements. This study used the Health and Retirement Study and latent class analyses to identify subgroups of caregiving arrangements based on caregiving hours received from spouses, children, other family/friends, and paid individuals among married (n = 361) and unmarried (n = 473) community-dwelling people with probable dementia. Three classes in the married sample (class 1 "low hours with shared care," class 2 "spouse-dominant care," and class 3 "children-dominant care") were identified. In class 1, spouses, children, and paid individuals provided 53%, 22%, and 26% of the caregiving hours, respectively. Three classes in the unmarried sample (class 1 "low hours with shared care," class 2 "children-dominant care," and class 3 "paid-dominant care") were identified. In unmarried class 1, children, other family/friends, and paid individuals provided 35%, 41% and 24% of the caregiving hours, respectively.

ER - TY - RPRT T1 - Protocols for Missing Data in HCAP Y1 - Forthcoming A1 - Richard N Jones ER - TY - JOUR T1 - Purpose in Life Links Positive Aging Views to Life Satisfaction: A Within-Person Analysis Spanning 13 Years. JF - Journal of Applied Gerontology Y1 - Forthcoming A1 - Joshanloo, Mohsen KW - Aging KW - Older Adults KW - Purpose in life KW - Satisfaction AB -

This study aimed to examine the relationship between positive perceptions of aging, purpose in life, and life satisfaction in older adults. It was hypothesized that purpose in life mediates the relationship between positive perceptions of one's aging and life satisfaction. This hypothesis was tested in a sample of older American adults from four waves of the Health and Retirement Study collected at 4-year intervals between 2008 and 2020 ( = 11,546, mean age in 2008 = 62.772). The random intercept cross-lagged panel model was used to separate within-person and between-person sources of variance. Mediation was tested at the longitudinal within-person level and was supported. Results suggest that an increase in positive perceptions of aging is associated with a future increase in purpose in life, which in turn is associated with higher future levels of life satisfaction. The findings inform interventions promoting positive aging, purpose, and life satisfaction in older adults.

ER - TY - JOUR T1 - Race-Ethnic Differences in the Effects of COVID-19 on the Work, Stress, and Financial Outcomes of Older Adults. JF - Journal of Aging and Health Y1 - Forthcoming A1 - Jason, Kendra A1 - Carr, Dawn A1 - Chen, Zhao KW - COVID-19 KW - financial KW - psychological resilience KW - race KW - Stress AB -

OBJECTIVES: This study investigates race-ethnic differences among older non-Hispanic Black, non-Hispanic White, and Hispanic adults' financial, employment, and stress consequences of COVID-19.

METHODS: We use data from the Health and Retirement Study, including the 2020 COVID-panel, to evaluate a sample of 2,929 adults using a combination of bivariate tests, OLS regression analysis, and moderation tests.

RESULTS: Hispanic and non-Hispanic Black older adults experienced more financial hardships, higher levels of COVID-19 stress, and higher rates of job loss associated with COVID-19 relative to their Non-Hispanic White counterparts. Non-Hispanic Black and Hispanic adults reported significantly higher levels of COVID-19 resilience resources, yet, these resources were not protective of the consequences of COVID-19.

DISCUSSION: Understanding how the experiences of managing and coping with COVID-19 stressors differ by race-ethnicity can better inform intervention design and support services.

ER - TY - JOUR T1 - Racial inequality in functional trajectories between Black and White U.S. veterans. JF - Journal of the American Geriatrics Society Y1 - Forthcoming A1 - Jacobs, Josephine C A1 - Bowling, Christopher Barrett A1 - Brown, Tyson A1 - Smith, Valerie A A1 - Decosimo, Kasey A1 - Wilson, Sarah M A1 - Hastings, Susan Nicole A1 - Shepherd-Banigan, Megan A1 - Allen, Kelli A1 - Van Houtven, Courtney KW - Functional limitations KW - psychosocial stressors KW - racial inequity KW - Veterans AB -

BACKGROUND: Racial inequality in functional trajectories has been well documented in the U.S. civilian population but has not been explored among Veterans. Our objectives were to: (1) assess how functional trajectories differed for Black and White Veterans aged ≥50 and (2) explore how socioeconomic, psychosocial, and health-related factors altered the relationship between race and function.

METHODS: We conducted a prospective, longitudinal analysis using the 2006-2016 Health and Retirement Study. The study cohort included 3700 Veterans who self-identified as Black or White, responded to baseline psychosocial questionnaires, and were community-dwelling on first observation. We used stepwise and stratified linear mixed effects models of biannually assessed functional limitations. The outcome measure was as a count of functional limitations. Race was measured as respondent self-identification as Black or White. Demographic measures included gender and age. Socioeconomic resources included partnership status, education, income, and wealth. Psychosocial stressors included exposure to day-to-day and major discrimination, traumatic life events, stressful life events, and financial strain. Health measures included chronic and mental health diagnoses, smoking, rurality, and use of Veterans Affairs services.

RESULTS: Black Veterans developed functional limitations at earlier ages and experienced faster functional decline than White Veterans between the ages of 50 and 70, with convergence occurring at age 85. Once we accounted for economic resources and psychosocial stressors in multivariable analyses, the association between race and the number of functional limitations was no longer statistically significant. Lower wealth, greater financial strain, and traumatic life events were significantly associated with functional decline.

CONCLUSIONS: Health systems should consider how to track Veterans' function earlier in the life course to ensure that Black Veterans are able to get timely access to services that may slow premature functional decline. Providers may benefit from training about the role of economic resources and psychosocial stressors in physical health outcomes.

ER - TY - JOUR T1 - The role of smoking, obesity and physical inactivity in cognitive performance and decline: a multi-cohort study. JF - The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences Y1 - Forthcoming A1 - Hong, Chenlu A1 - Liu, Zhaorui A1 - Liu, Yating A1 - Jin, Yinzi A1 - Luo, Yanan KW - birth cohort KW - Cognitive decline KW - lifestyles. AB -

BACKGROUND: Unhealthy lifestyles are recognized contributors to cognitive decline, yet limited evidence focuses on their roles in cognitive decline rate. This study examined the role of smoking, obesity and physical inactivity in cognitive performance and rate of cognitive decline by birth cohort on a global scale.

METHODS: Utilizing data from four prospective cohort studies (CHARLS; ELSA; HRS; and SHARE) across 14 countries, a multi-cohort study was performed. Eligible participants were aged 50 years and older. Linear mixed models were employed to detect the role of smoking, obesity, and physical inactivity in cognitive function domains (epidemic memory, working memory, and time orientation).

RESULTS: Higher scores of cognitive functions were found in participants who engaged in more vigorous physical activity, were non-current smokers, and maintained underweight (e.g., for episodic memory scores in females at 60 years, vigorous physical activity: 0.47, 95%CI: 0.46, 0.49). In addition, a slower rate of cognitive decline was also found in individuals who engaged in moderate or vigorous physical activity, were non-current smokers, and maintained not underweight (e.g., for episodic memory scores changing from 50-70 years old in females, vigorous physical activity: from 0.54 (95%CI: 0.51, 0.57) to 0.40 (95%CI: 0.37, 0.44) and in males from 0.33 (95%CI: 0.30, 0.36) to 0.11 (95%CI: 0.08, 0.14)).

CONCLUSIONS: We confirmed the beneficial impact of healthy lifestyles in preventing cognitive decline and promoting healthy aging. Urgent measures are needed to identify and encourage healthy lifestyles, such as strengthening tobacco control, developing policy on physical activity promotion, and preventing underweight, to minimize worldwide levels of cognitive decline.

ER - TY - JOUR T1 - Using Medicare claims in identifying Alzheimer's disease and related dementias. JF - Alzheimer's & Dementia Y1 - Forthcoming A1 - Jain, Siddharth A1 - Rosenbaum, Paul R A1 - Reiter, Joseph G A1 - Geoffrey J Hoffman A1 - Small, Dylan S A1 - Ha, Jinkyung A1 - Hill, Alexander S A1 - Wolk, David A A1 - Timothy G. Gaulton A1 - Mark D Neuman A1 - Roderic G Eckenhoff A1 - Fleisher, Lee A A1 - Jeffrey H Silber KW - administrative data KW - Alzheimer's disease KW - cognitive impairment KW - Dementia KW - Medicare AB -

INTRODUCTION: This study develops a measure of Alzheimer's disease and related dementias (ADRD) using Medicare claims.

METHODS: Validation resembles the approach of the American Psychological Association, including (1) content validity, (2) construct validity, and (3) predictive validity.

RESULTS: We found that four items-a Medicare claim recording ADRD 1 year ago, 2 years ago, 3 years ago, and a total stay of 6 months in a nursing home-exhibit a pattern of association consistent with a single underlying ADRD construct, and presence of any two of these four items predict a direct measure of cognitive function and also future claims for ADRD.

DISCUSSION: Our four items are internally consistent with the measurement of a single quantity. The presence of any two items do a better job than a single claim when predicting both a direct measure of cognitive function and future ADRD claims.

ER - TY - JOUR T1 - The impact of informal caregiving on U.S. Veterans Health Administration utilization and expenditures. JF - Social Science & Medicine (1982) Y1 - 2024 A1 - Jacobs, Josephine C A1 - Lo, Jeanie A1 - Van Houtven, Courtney H A1 - Wagner, Todd H KW - Adult KW - Adult children KW - Health Expenditures KW - Humans KW - Inpatients KW - Investments KW - Veterans Health AB -

Few studies have examined the effect of informal care receipt on health care utilization and expenditures while accounting for the potentially endogenous relationship between informal and formal care, and none have examined these relationships for U.S. Veterans. With rapidly increasing investments in caregiver supports over the past decade, including stipends for caregivers, the U.S. Department of Veterans Affairs (VA) needs to better understand the costs and benefits of informal care provision. Using a unique data linkage between the 1998-2010 Health and Retirement Study and VA administrative data (n = 2083 Veterans with 9511 person-wave observations), we applied instrumental variable techniques to understand the effect of care from an adult child on Veterans' two-year VA utilization and expenditures. We found that informal care decreased overall utilization by 53 percentage points (p < 0.001) and expenditures by $19,977 (p < 0.01). These reductions can be explained by informal care decreasing the probability of inpatient utilization by 17 percentage points (p < 0.001), outpatient utilization by 57 percentage points (p < 0.001), and institutional long-term care by 3 percentage points (p < 0.05). There were no changes in the probability of non-institutional long-term care use, though these expenditures decreased by $882 (p < 0.05). Expenditure decreases were greatest amongst medically complex patients. Our results indicate relative alignment between VA's stipend payments, which are based on replacement cost methods, and the monetary benefits derived through VA cost avoidances due to informal care. For health systems considering similar caregiver stipend payments, our findings suggest that the cost of these programs may be offset by informal care substituting for formal care, particularly for higher need patients.

VL - 344 U1 - http://www.ncbi.nlm.nih.gov/pubmed/38324974?dopt=Abstract ER - TY - JOUR T1 - The Mediating Role of Sense of Control in the Associations Between Remote Contacts and Loneliness Among Older Adults. JF - Research on Aging Y1 - 2024 A1 - Yoon, Dokyung A1 - Gallo, Haley A1 - Gassoumis, Zachary D A1 - Joo, Susanna KW - isolated older adults KW - Loneliness KW - path analysis KW - remote contact KW - Sense of control AB -

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.

VL - 46 IS - 2 ER - TY - JOUR T1 - Within-person associations between personality traits and loneliness controlling for negative affect JF - Personality and Individual Differences Y1 - 2024 A1 - Mohsen Joshanloo KW - Big Five KW - Loneliness KW - longitudinal KW - Negative affect KW - personality trait KW - RI-CLPM AB - Despite cross-sectional evidence of significant associations between loneliness and the Big Five personality traits, elucidating the directionality of these associations requires further longitudinal investigation. To address this gap, the present study examined the longitudinal relationship between loneliness and personality traits, controlling for negative affect. Data were drawn from the Health and Retirement Study collected in 2012, 2016, and 2020 (N = 9671). The random intercept cross-lagged panel model was used, enabling the examination of within-person associations. Results showed that loneliness predicted subsequent declines in extraversion, agreeableness, and conscientiousness. Furthermore, neuroticism was found to be a positive predictor of future loneliness, whereas the other personality traits were negative predictors. In addition, negative affect had bidirectional associations with neuroticism and predicted future loneliness. Overall, these results show that these variables are unidirectionally or bidirectionally linked at the within-person level. These findings also highlight the need for multifaceted interventions that include a range of approaches, such as promoting positive personality traits, managing negative affect, and enhancing social skills. VL - 223 ER - TY - JOUR T1 - Advance Care Planning Among Older Adults with Cognitive Impairment. JF - The American Journal of Hospice and Palliative Care Y1 - 2023 A1 - Rahemi, Zahra A1 - Malatyali, Ayse A1 - Adams, Swann A A1 - Jarrín, Olga F A1 - Demiris, George A1 - Parker, Veronica A1 - Ghaiumy Anaraky, Reza A1 - Dye, Cheryl J KW - Advance care planning KW - Alzheimer KW - Dementia KW - End-of-life care AB -

In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers.

VL - 40 IS - 11 ER - TY - JOUR T1 - Age-Related Trajectories of General Fluid Cognition and Functional Decline in the Health and Retirement Study: A Bivariate Latent Growth Analysis. JF - J Intell Y1 - 2023 A1 - Handing, Elizabeth P A1 - Jiao, Yuqin A1 - Aichele, Stephen AB -

There have been few studies on associations between age-related declines in fluid cognition and functional ability in population-representative samples of middle-aged and older adults. We used a two-stage process (longitudinal factor analysis followed by structural growth modeling) to estimate bivariate trajectories of age-related changes in general fluid cognition (numeracy, category fluency, executive functioning, and recall memory) and functional limitation (difficulties in daily activities, instrumental activities, and mobility). Data came from the Health and Retirement Study (Waves 2010-2016; N = 14,489; ages 50-85 years). Cognitive ability declined on average by -0.05 SD between ages 50-70 years, then -0.28 SD from 70-85 years. Functional limitation increased on average by +0.22 SD between ages 50-70 years, then +0.68 SD from 70-85 years. Significant individual variation in cognitive and functional changes was observed across age windows. Importantly, cognitive decline in middle age (pre-age 70 years) was strongly correlated with increasing functional limitation ( = -.49, < .001). After middle age, cognition declined independently of change in functional limitation. To our knowledge, this is the first study to estimate age-related changes in fluid cognitive measures introduced in the HRS between 2010-2016.

VL - 11 IS - 4 ER - TY - JOUR T1 - Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices. JF - Aging Ment Health Y1 - 2023 A1 - Choi, Shinae L A1 - Choi, Jaimie M A1 - McDonough, Ian M A1 - Jiang, Zhehan A1 - Black, Sheila R KW - Depressive symptoms KW - financial insecurity KW - Living Alone KW - social isolation KW - Social Support AB -

OBJECTIVES: This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression.

METHODS: Data were from the Leave-Behind Questionnaire in the 2016 ( = 4293) and 2018 ( = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples.

RESULTS: Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders.

CONCLUSION: This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.

ER - TY - JOUR T1 - [Analysis of healthy life expectancy and related socioeconomic influencing factors among the middle-aged and elderly in China, the United States, and the European Union]. JF - Zhonghua Liu Xing Bing Xue Za Zhi Y1 - 2023 A1 - Hou, X D A1 - Luo, Y N A1 - Jin, Y Z A1 - Zheng, Z J KW - Activities of Daily Living KW - Aged KW - China KW - European Union KW - Female KW - Healthy life expectancy KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Socioeconomic factors KW - United States AB -

To calculate and compare the healthy life expectancy (HLE) of the middle-aged and elderly in China, the United States, and developing and developed countries in the European Union(EU) and analyze the impact of socioeconomic factors on HLE in different countries or regions. Four surveys from 2010 to 2019 were brought into the research. The data were collected from the China Health and Retirement Longitudinal Study, Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. Developed and developing countries in the EU were divided into two groups for calculation. Education level, total family wealth, and work retirement status were selected to measure socioeconomic status, and activities of daily living were used as health status indicators. We used the multi-state life cycle table method to calculate the transition probability between different health states and estimate life expectancy and HLE. A total of 69 544 samples were included in the study. In terms of age, the middle-aged and elderly in the United States and developed countries of the EU have higher HLE in all age groups. In terms of gender, only Chinese women have lower HLE than men. Regarding socioeconomic factors, the middle-aged and elderly with higher education levels and total family wealth level have higher HLE. In China, working seniors have higher HLE, while for USA women and developed countries of the EU, retired or unemployed seniors have higher HLE. Demographic and socioeconomic factors impact HLE in different countries or regions. China should pay more attention to the health of women and the middle-aged and elderly retired with lower education and less total family wealth.

VL - 44 IS - 6 ER - TY - JOUR T1 - Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations. JF - Alzheimers Dement Y1 - 2023 A1 - Llibre-Guerra, Jorge J A1 - Li, Jing A1 - Qian, Yuting A1 - Llibre-Rodriguez, Juan de Jesús A1 - Jiménez-Velázquez, Ivonne Z A1 - Acosta, Daisy A1 - Salas, Aquiles A1 - Llibre-Guerra, Juan Carlos A1 - Valvuerdi, Adolfo A1 - Harrati, Amal A1 - Weiss, Jordan A1 - Liu, Mao-Mei A1 - Dow, William H KW - Aged KW - Alleles KW - Alzheimer disease KW - Apolipoprotein E4 KW - Apolipoproteins E KW - Caribbean Region KW - Female KW - Genotype KW - Hispanic or Latino KW - Humans KW - Male AB -

INTRODUCTION: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations.

METHODS: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample.

RESULTS: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%-25.4%), but was substantially higher in AAs (33.6%; P < 0.001). APOE ε4 carriers had higher dementia prevalence across all groups.

DISCUSSION: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

VL - 19 IS - 2 ER - TY - JOUR T1 - Are some people more consistent? Examining the stability and underlying processes of personality profile consistency. JF - Journal of Personality and Social Psychology Y1 - 2023 A1 - Wright, Amanda J A1 - Jackson, Joshua J KW - Big Five KW - ipsative consistency KW - person-centered KW - Personality Development KW - profile correlations AB -

Personality traits are relatively consistent across time, as indicated by test-retest correlations. However, ipsative consistency approaches suggest there are individual differences in this consistency. Despite this, it is unknown whether these differences are due to person-level characteristics (i.e., some people are just more consistent) or exogenous forces (i.e., lack of consistency is due to environmental changes). Moreover, it is unclear whether the processes promoting long-term consistency are the same across people. We examine these two questions using item-level profile correlations across four to nine waves of data with four data sets ( = 21,616) with multilevel asymptotic growth models. Results indicated that there were, on average, high levels of profile consistency. However, there were notable individual differences in initial profile correlation values as well as in changes in levels of consistency across time, indicating that some people are more consistent than others. Moreover, the directions of people's trajectories across increasing time intervals suggest that the mechanisms responsible for reinforcing personality consistency vary across people. These effects were typically moderated by age at 30 years old, maturity-related traits, and education level. Overall, findings indicate some people are more consistent than others, such that this stable level of (in)consistency is a dispositional factor. Additionally, individual differences in profile consistency are shaped by different levels of three processes. On average, stochastic factors are not impactful for most individuals, and transactional processes have an important role in increasing consistency for a sizable amount of people-nuances not previously revealed when focusing on rank-order stability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

VL - 124 IS - 6 ER - TY - JOUR T1 - Associations of Food Insecurity and Memory Function Among Middle to Older-Aged Adults in the Health and Retirement Study. JF - JAMA Netw Open Y1 - 2023 A1 - Lu, Peiyi A1 - Kezios, Katrina A1 - Jawadekar, Neal A1 - Swift, Samuel A1 - Vable, Anusha A1 - Zeki Al Hazzouri, Adina KW - Adult KW - Aged KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Food insecurity KW - Food Supply KW - Humans KW - Male KW - Memory Disorders KW - Middle Aged KW - Retirement AB -

IMPORTANCE: Food insecurity is a leading public health issue in the US. Research on food insecurity and cognitive aging is scarce, and is mostly cross-sectional. Food insecurity status and cognition both can change over the life course, but their longitudinal relationship remains unexplored.

OBJECTIVE: To examine the longitudinal association between food insecurity and changes in memory function during a period of 18 years among middle to older-aged adults in the US.

DESIGN, SETTING, AND PARTICIPANTS: The Health and Retirement Study is an ongoing population-based cohort study of individuals aged 50 years or older. Participants with nonmissing information on their food insecurity in 1998 who contributed information on memory function at least once over the study period (1998-2016) were included. To account for time-varying confounding and censoring, marginal structural models were created, using inverse probability weighting. Data analyses were conducted between May 9 and November 30, 2022.

MAIN OUTCOMES AND MEASURES: In each biennial interview, food insecurity status (yes/no) was assessed by asking respondents whether they had enough money to buy food or ate less than they felt they should. Memory function was a composite score based on self-completed immediate and delayed word recall task of a 10-word list and proxy-assessed validated instruments.

RESULTS: The analytic sample included 12 609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60%] women, 10 277 [81.51%] non-Hispanic White), including 11 951 food-secure and 658 food-insecure individuals in 1998. Over time, the memory function of the food-secure respondents decreased by 0.045 SD units annually (β for time, -0.045; 95% CI, -0.046 to -0.045 SD units). The memory decline rate was faster among food-insecure respondents than food-secure respondents, although the magnitude of the coefficient was small (β for food insecurity × time, -0.0030; 95% CI, -0.0062 to -0.00018 SD units), which translates to an estimated 0.67 additional (ie, excess) years of memory aging over a 10-year period for food-insecure respondents compared with food-secure respondents.

CONCLUSIONS AND RELEVANCE: In this cohort study of middle to older-aged individuals, food insecurity was associated with slightly faster memory decline, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.

VL - 6 IS - 7 ER - TY - JOUR T1 - The Associations of Pulse Pressure and Mean Arterial Pressure on Physical Function in Older Americans. JF - Geriatrics (Basel) Y1 - 2023 A1 - Pleiss, Abigail A1 - Jurivich, Donald A1 - Dahl, Lindsey A1 - McGrath, Brenda A1 - Kin, Daniela A1 - McGrath, Ryan KW - mean arterial pressure KW - Older Americans KW - pulse pressure AB -

BACKGROUND: We sought to examine the associations of pulse pressure (PP) and mean arterial pressure (MAP) on physical function in older Americans.

METHODS: Our analytic sample included 10,478 adults aged ≥65 years from the 2006-2016 Health and Retirement Study. Handgrip strength, gait speed, and standing balance were collected using relatively standard protocols. PP and MAP were calculated from blood pressure measurements.

RESULTS: Older Americans with any abnormality in PP had 1.15 (95% confidence interval (CI): 1.05-1.25) greater odds for slowness and 1.14 (CI: 1.05-1.24) greater odds for poorer standing balance. Persons with any abnormality in MAP had 0.90 (CI: 0.82-0.98) decreased odds for weakness and 1.10 (CI: 1.01-1.20) greater odds for poorer standing balance. Those with low PP had 1.19 (CI: 1.03-1.36) greater odds for slow gait speed, while persons with low MAP had 1.50 (CI: 1.09-2.05) greater odds for weakness and 1.45 (CI: 1.03-2.04) greater odds for slowness. Older Americans with high PP had 1.13 (CI: 1.03-1.25) greater odds for slowness and 1.21 (CI: 1.10-1.32) greater odds for poorer balance, whereas those with high MAP had 0.87 (CI: 0.80-0.95) decreased odds for weakness.

CONCLUSIONS: Cardiovascular dysfunction, as observed by PP and MAP, may help to explain some of our findings.

VL - 8 IS - 2 ER - TY - RPRT T1 - BMI, waist circumferences and urinary incontinence in older women compared with older men: findings from three prospective longitudinal cohort studies Y1 - 2023 A1 - Xiyin Chen A1 - Shaoxiang Jiang A1 - Yao Yao KW - BMI AB - Background Obesity and urinary incontinence (UI) among older people, particularly older men, are yet to be fully explored. Utilising multiple nationwide prospective longitudinal cohorts representative of the US, UK, and European samples, we examined the association of body mass index (BMI) and waist circumference (WC) with UI among both older women and men. Methods We derived the data from the Health and Retirement Study (HRS, 2010-2018), the English Longitudinal Study of Aging (ELSA, 2011-2019), and the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004-2010) that surveyed UI. Participants were asked if they had experienced urine leakage within the past 12 months (HRS and ELSA) or within the past six months (SHARE). The measure of obesity was based on BMI and WC. We employed a random-effect logistic model to associate BMI and WC with UI, adjusting for covariates including age, race, education, residence area, marital status, number of children, smoking, drinking, hypertension, diabetes, cancer, stroke, functional ability, and cognitive impairment. We visualised the associations by using restricted cubic spline curves. Findings A total of 200,717 participants with 718,822 observations (207,805 in HRS; 98,158 in ELSA; 412,859 in SHARE) were included in the baseline analysis. The 12-months prevalence of UI among female and male participants were 15.6% and 6.6% in the HRS, 10.6% and 4.4% in the ELSA. The 6-months prevalence of UI were 2.8% and 1.4% in the SHARE’s female and male participants. Compared to those without UI, both female and male participants with UI demonstrated a higher BMI and WC. Among females, the fully adjusted models showed linear associations between BMI, WC, and UI (Ps<0.001) in three cohorts. However, we observed U-shaped associations of BMI, WC with UI among males. The lowest likelihood of having UI was found among male participants with a BMI between 24 and 35 kg/m2 . Interpretation Findings from our study revealed that the associations of obesity indices with UI varied among older men compared to older women. As a result, weight loss interventions could be applied to older women rather than older men as a means of treating UI. Interventions aimed at preventing UI among older adults must take sex into account. ER - TY - JOUR T1 - Can markers of disease severity improve the predictive power of claims-based multimorbidity indices? JF - Journal of the American Geriatrics Society Y1 - 2023 A1 - Rizzo, Anael A1 - Jing, Bocheng A1 - Boscardin, W John A1 - Shah, Sachin J A1 - Steinman, Michael A KW - Hospitalization KW - Medicare KW - multimorbidity KW - Patient Acuity AB -

BACKGROUND: Claims-based measures of multimorbidity, which evaluate the presence of a defined list of diseases, are limited in their ability to predict future outcomes. We evaluated whether claims-based markers of disease severity could improve assessments of multimorbid burden.

METHODS: We developed 7 dichotomous markers of disease severity which could be applied to a range of diseases using claims data. These markers were based on the number of disease-associated outpatient visits, emergency department visits, and hospitalizations made by an individual over a defined interval; whether an individual with a given disease had outpatient visits to a specialist who typically treats that disease; and ICD-9 codes which connote more versus less advanced or symptomatic manifestations of a disease. Using Medicare claims linked with Health and Retirement Study data, we tested whether including these markers improved ability to predict ADL decline, IADL decline, hospitalization, and death compared to equivalent models which only included the presence or absence of diseases.

RESULTS: Of 5012 subjects, median age was 76 years and 58% were female. For a majority of diseases tested individually, adding each of the 7 severity markers yielded minimal increase in c-statistic (≤0.002) for outcomes of ADL decline and mortality compared to models considering only the presence versus absence of disease. Gains in predictive power were more substantial for a small number of individual diseases. Inclusion of the most promising marker in multi-disease multimorbidity indices yielded minimal gains in c-statistics (<0.001-0.007) for predicting ADL decline, IADL decline, hospitalization, and death compared to indices without these markers.

CONCLUSIONS: Claims-based markers of disease severity did not contribute meaningfully to the ability of multimorbidity indices to predict ADL decline, mortality, and other important outcomes.

VL - 71 IS - 3 ER - TY - JOUR T1 - Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study. JF - The Lancet. Healthy Longevity Y1 - 2023 A1 - Jin, Yinzi A1 - Liang, Jersey A1 - Hong, Chenlu A1 - Liang, Richard A1 - Luo, Yanan KW - cardiometabolic multimorbidity KW - CHARLS KW - Cognition KW - ELSA KW - SHARE AB -

BACKGROUND: Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association.

METHODS: We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores.

FINDINGS: The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years  (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, β=-0·15 [95% CI -0·17 to -0·13]; two diseases, β=-0·37 [-0·40 to -0·34]; three diseases, β=-0·57 [-0·64 to -0·50]), with comorbid diabetes and stroke (β=-0·23 [-0·29 to -0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888).

INTERPRETATION: These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people.

FUNDING: Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.

VL - 4 IS - 6 ER - TY - JOUR T1 - Childhood Adversity and Passive Suicidal Ideation in Later Life in the United States: Does Religious Attendance Matter? JF - Journal of religion and health Y1 - 2023 A1 - Jung, Jong Hyun A1 - Lee, Haena KW - Childhood adversity; Passive suicidal ideation; Religion; Stress process model AB -

This study examines whether adverse childhood experiences are associated with passive suicidal ideation in later life and whether religious attendance moderates this association among U.S. older adults. To this end, logistic regression analyses were conducted using data from the 2016 Health and Retirement Study. The results show that poor childhood health, lack of parental affection, and childhood trauma are all positively associated with passive suicidal ideation in later life. However, religious attendance modifies the association between childhood health and passive suicidal ideation. For instance, poor childhood health is associated with greater odds of passive suicidal ideation only for older adults who never attend religious services, while this is not the case for those who attend religious services. Yet, the associations of parental affection and childhood trauma with passive suicidal ideation do not appear to differ by religious attendance. We discuss the theoretical implications of these findings for views about childhood adversity, religion, and suicide risk in later life.

VL - 62 IS - 6 ER - TY - JOUR T1 - Chronic Disease, Functional Limitations, and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19. JF - J Aging Soc Policy Y1 - 2023 A1 - Sneed, Rodlescia S A1 - Stubblefield, Alexander A1 - Gardner, Graham A1 - Jordan, Tamara A1 - Mezuk, Briana KW - Chronic disease KW - Medicaid work requirements KW - workforce participation AB -

From 2018-2020, 19 states enacted Medicaid work requirements as a strategy for reducing program enrollment and overall cost. While these requirements were later rescinded, strategies to reduce Medicaid costs are likely to reemerge as states attempt to recover economically from the COVID-19 pandemic. Here, we evaluated the impact of Medicaid work requirements on adults aged > 50, a group that likely faces significant age-related chronic disease burden. Using 2016 Health and Retirement Study data, we evaluated the chronic disease burden of adult Medicaid beneficiaries aged 51-64 years ( = 1460) who would be at risk of losing their Medicaid coverage due to work requirements. We compared Medicaid beneficiaries working <20 hours per week (i.e. those at risk of coverage loss) to those working at least 20 hours per week on eight chronic health conditions, adjusting for demographic characteristics. Among those with chronic health conditions, we also evaluated differences in disease severity based on hours worked per week. Among those working fewer than 20 hours per week, odds of disease were greater for seven of eight chronic conditions, including history of stroke (OR: 5.66; 95% CI: 2.22-14.43) and lung disease (OR: 3.79; 95% CI: 2.10-6.85). Further, those with greater disease severity were likely to work fewer hours. Thus, the introduction of Medicaid work requirements would likely result in coverage loss and lower access to care among older Medicaid beneficiaries with multiple chronic health conditions.

ER - TY - JOUR T1 - Cognitive activity at work and the risk of dementia. JF - Health Econ Y1 - 2023 A1 - Martin-Bassols, Nicolau A1 - de New, Sonja C A1 - Johnston, David W A1 - Shields, Michael A KW - Cognition KW - Dementia KW - Humans KW - Occupations KW - Retirement KW - Risk Factors AB -

Dementia prevalence is projected to rise steeply in coming decades, producing tremendous burdens on families, and health and social services. Motivated by the need for further robust evidence on modifiable risk factors, we investigate the relationship between cognitive activity at work and later-life dementia. Using data from the US Health and Retirement Study matched to the O*NET occupational database, we find that a one standard deviation increase in the cognitive activity associated with one's longest held occupation is associated with a 0.9 percentage point reduction in (predicted) dementia, or a 24% reduction relative to the mean. This relationship is consistently found across model specifications and robustness tests. When controlling for individual fixed-effects we find that the association between dementia and work cognitive activity increases with age. Overall, our results provide some evidence in support of the inclusion of cognitive activity at work as a recognized modifiable risk factor for dementia.

VL - 32 IS - 7 ER - TY - JOUR T1 - A cultural neuropsychological approach to harmonization of cognitive data across culturally and linguistically diverse older adult populations. JF - Neuropsychology Y1 - 2023 A1 - Briceño, Emily M A1 - Arce Rentería, Miguel A1 - Gross, Alden L A1 - Richard N Jones A1 - Gonzalez, Christopher A1 - Wong, Rebeca A1 - David R Weir A1 - Kenneth M. Langa A1 - Jennifer J Manly KW - cognitive data KW - HCAP KW - Mex-Cog KW - neuropsychology AB -

OBJECTIVE: To describe a cultural neuropsychological approach to prestatistical harmonization of cognitive data across the United States (U.S.) and Mexico with the Harmonized Cognitive Assessment Protocol (HCAP).

METHOD: We performed a comprehensive review of the administration, scoring, and coding procedures for each cognitive test item administered across the English and Spanish versions of the HCAP in the Health and Retirement Study (HRS) in the U.S. and the Ancillary Study on Cognitive Aging in Mexico (Mex-Cog). For items that were potentially equivalent across studies, we compared each cognitive test item for linguistic and cultural equivalence and classified items as confident or tentative linking items, based on the degree of confidence in their comparability across cohorts and language groups. We evaluated these classifications using differential item functioning techniques.

RESULTS: We evaluated 132 test items among 21 cognitive instruments in the HCAP across the HRS and Mex-Cog. We identified 72 confident linking items, 46 tentative linking items, and 14 items that were not comparable across cohorts. Measurement invariance analysis revealed that 64% of the confident linking items and 83% of the tentative linking items showed statistical evidence of measurement differences across cohorts.

CONCLUSIONS: Prestatistical harmonization of cognitive data, performed by a multidisciplinary and multilingual team including cultural neuropsychologists, can identify differences in cognitive construct measurement across languages and cultures that may not be identified by statistical procedures alone. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

VL - 37 IS - 3 ER - TY - JOUR T1 - Development and validation of novel multimorbidity indices for older adults. JF - Journal of the American Geriatrics Society Y1 - 2023 A1 - Steinman, Michael A A1 - Jing, Bocheng A1 - Shah, Sachin J A1 - Rizzo, Anael A1 - Lee, Sei J A1 - Covinsky, Kenneth E A1 - Ritchie, Christine S A1 - Boscardin, W John KW - claims data KW - functional impairment KW - multimorbidity KW - prognostic models AB -

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

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

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

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

VL - 71 IS - 1 ER - TY - JOUR T1 - Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults. JF - Am J Psychiatry Y1 - 2023 A1 - Jester, Dylan J A1 - Kohn, Jordan N A1 - Tibiriçá, Lize A1 - Thomas, Michael L A1 - Brown, Lauren L A1 - Murphy, James D A1 - Jeste, Dilip V AB -

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

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

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

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

ER - TY - JOUR T1 - Edentulism Predicts Cognitive Decline in the US Health and Retirement Cohort Study. JF - J Dent Res Y1 - 2023 A1 - Jones, J A A1 - Moss, K A1 - Finlayson, T L A1 - Preisser, J S A1 - Weintraub, J A AB -

This longitudinal cohort study examines if 1) cognitive decline varies by birth cohort, adjusting for covariates, and 2) edentulism and nonuse of dental care predict 10-y cognitive decline (2008-2018). The Health and Retirement Study (HRS) features a representative sample of US adults over age 50. Eligibility criteria included having cognitive interview data available and responding to the question, "Have you lost all of your upper and lower natural permanent teeth?" at 2+ time points between 2006 and 2018. Use of dental care in the past 2 y was assessed. Linear mixed models for repeated measures estimated the trajectories of mean cognition over time for the birth cohorts, adjusted for baseline cognition, dentition status, dental care use, and covariates (demographic characteristics, health behaviors, and medical conditions). Cohort-by-time interaction terms were included to assess if cognitive decline varied by birth cohort. Ten-year change in cognition status (measured by HRS Cogtot27)-categorized as dementia (<7); cognitive impairment, not demented (7-11) 7≤Cogtot27<12; and normal (≥12)-was also investigated according to birth cohort, dentition status, and dental care use. Mean (SD) baseline age was 63.4 (10.1) y ( = 22,728). Older birth cohorts had greater cognitive decline than younger cohorts. Linear mixed-model estimates and 95% confidence intervals for protective factors for cognitive decline included higher baseline cognition (HRS Cogtot27) (0.49; 0.48-0.50), use of dental care in the past 2 y (0.17; 0.10-0.23), and covariates such as greater household wealth and being married. Risk increased with being edentulous (-0.42; -0.56 to -0.28), history of stroke or diabetes, less education, Medicaid recipient, current smoker, loneliness, and poor/fair self-rated health. Edentulism and irregular dental care are among important predictors of cognitive decline. Tooth retention and regular dental care throughout life appear to be important for maintaining oral and cognitive health.

ER - TY - JOUR T1 - The Effects of Increasing State Minimum Wage on Family and Paid Caregiving JF - Journal of Applied Gerontology Y1 - 2023 A1 - Eric Jutkowitz A1 - Derek Lake A1 - Peter Shewmaker A1 - Joseph E. Gaugler KW - Caregivers KW - state minimum wage AB - Older adults may receive either or a combination of unpaid family/friend and paid caregiving. The consumption of family/friend and paid caregiving may be sensitive to minimum wage policies. We used data (n = 11,698 unique respondents) from the Health and Retirement Study and a difference-in-differences design to evaluate associations between increases in state minimum wage between 2010 and 2014 and family/friend and paid caregiving consumed by adults age 65+ years. We also examined responses to increases in minimum wage for respondents with dementia or Medicaid beneficiaries. People living in states that increased their minimum wage did not consume substantially different hours of family/friend, paid, or any family/friend or paid caregiving. We did not observe differential responses between increases in minimum wage and hours of family/friend or paid caregiving among people with dementia or Medicaid beneficiaries. Increases in state minimum wage were not associated with changes in caregiving consumed by adults age 65+. VL - 42 IS - 4 ER - TY - JOUR T1 - Estimating the Prevalence of Dementia in India Using a Semi-Supervised Machine Learning Approach. JF - Neuroepidemiology Y1 - 2023 A1 - Jin, Haomiao A1 - Crimmins, Eileen A1 - Kenneth M. Langa A1 - Dey, A B A1 - Lee, Jinkook KW - Aged KW - Aging KW - Dementia KW - Female KW - Humans KW - India KW - Male KW - Middle Aged KW - Prevalence KW - supervised machine learning AB -

INTRODUCTION: Accurate estimation of dementia prevalence is essential for making effective public and social care policy to support individuals and families suffering from the disease. The purpose of this paper is to estimate the prevalence of dementia in India using a semi-supervised machine learning approach based on a large nationally representative sample.

METHODS: The sample of this study is adults 60 years or older in the wave 1 (2017-2019) of the Longitudinal Aging Study in India (LASI). A subsample in LASI received extensive cognitive assessment and clinical consensus ratings and therefore has diagnoses of dementia. A semi-supervised machine learning model was developed to predict the status of dementia for LASI participants without diagnoses. After obtaining the predictions, sampling weights and age standardization to the World Health Organization (WHO) standard population were applied to generate the estimate for prevalence of dementia in India.

RESULTS: The prevalence of dementia for those aged 60 years and older in India was 8.44% (95% CI: 7.89%-9.01%). The age-standardized prevalence was estimated to be 8.94% (95% CI: 8.36%-9.55%). The prevalence of dementia was greater for those who were older, were females, received no education, and lived in rural areas.

DISCUSSION: The prevalence of dementia in India may be higher than prior estimates derived from local studies. These prevalence estimates provide the information necessary for making long-term planning of public and social care policy. The semi-supervised machine learning approach adopted in this paper may also be useful for other large population aging studies that have a similar data structure.

VL - 57 IS - 1 ER - TY - JOUR T1 - Examining the role of different weakness categories for mobility and future falls in older Americans. JF - Aging Clin Exp Res Y1 - 2023 A1 - McGrath, Ryan A1 - Jurivich, Donald A A1 - Christensen, Bryan K A1 - Choi, Bong-Jin A1 - Langford, Matthew A1 - Rhee, Yeong A1 - Tomkinson, Grant R A1 - Hackney, Kyle J KW - mobility KW - Older Americans AB -

BACKGROUND: Recently developed absolute and body size normalized handgrip strength (HGS) cut-points could be used individually and collectively to predict mobility problems and falls.

AIMS: We examined the associations of (1) each absolute and normalized weakness cut-point, (2) collective weakness categories, and (3) changes in weakness status on future falls in older Americans.

METHODS: The analytic sample included 11,675 participants from the 2006-2018 waves of the Health and Retirement Study. Falls were self-reported. Men were classified as weak if their HGS was < 35.5-kg (absolute), < 0.45 kg/kg (body mass normalized), or < 1.05 kg/kg/m (body mass index normalized). While, women were considered weak if their HGS was < 20.0-kg, < 0.337 kg/kg, or < 0.79 kg/kg/m. Collective weakness categorized those below 1, 2, or all 3 cut-points. The collective weakness categories were also used to observe changes in weakness status over time.

RESULTS: Older Americans below each absolute and normalized cut-point had greater odds for future falls: 1.23 (95% confidence interval (CI): 1.15-1.32) for absolute weakness, 1.20 (CI 1.11-1.29) for body mass index normalized weakness, and 1.26 (CI 1.17-1.34) for body mass normalized weakness. Persons below 1, 2, or all 3 weakness cut-points had 1.17 (CI 1.07-1.27), 1.29 (CI 1.18-1.40), and 1.36 (CI 1.24-1.48) greater odds for future falls, respectively. Those in some changing weakness categories had greater odds for future falls: 1.26 (CI 1.08-1.48) for persistent and 1.31 (CI 1.11-1.55) for progressive.

DISCUSSION: Collectively using these weakness cut-points may improve their predictive value.

CONCLUSION: We recommend HGS be evaluated in mobility and fall risk assessments.

ER - TY - JOUR T1 - Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. JF - Alzheimers Res Ther Y1 - 2023 A1 - Mattke, Soeren A1 - Jun, Hankyung A1 - Chen, Emily A1 - Liu, Ying A1 - Becker, Andrew A1 - Wallick, Christopher KW - cognitive impairment KW - Medicare KW - United States AB -

BACKGROUND: With the emergence of disease-modifying Alzheimer's treatments, timely detection of early-stage disease is more important than ever, as the treatment will not be indicated for later stages. Contemporary population-level data for detection rates of mild cognitive impairment (MCI), the stage at which treatment would ideally start, are lacking, and detection rates for dementia are only available for subsets of the Medicare population. We sought to compare documented diagnosis rates of MCI and dementia in the full Medicare population with expected rates based on a predictive model.

METHODS: We performed an observational analysis of Medicare beneficiaries aged 65 and older with a near-continuous enrollment over a 3-year observation window or until death using 100% of the Medicare fee-for-service or Medicare Advantage Plans beneficiaries from 2015 to 2019. Actual diagnoses for MCI and dementia were derived from ICD-10 codes documented in those data. We used the 2000-2016 data of the Health and Retirement Study to develop a prediction model for expected diagnoses for the included population. The ratios between actually diagnosed cases of MCI and dementia over number of cases expected, the observed over expected ratio, reflects the detection rate.

RESULTS: Although detection rates for MCI cases increased from 2015 to 2019 (0.062 to 0.079), the results mean that 7.4 of 8 million (92%) expected MCI cases remained undiagnosed. The detection rate for MCI was 0.039 and 0.048 in Black and Hispanic beneficiaries, respectively, compared with 0.098 in non-Hispanic White beneficiaries. Individuals dually eligible for Medicare and Medicaid had lower estimated detection rates than their Medicare-only counterparts for MCI (0.056 vs 0.085). Dementia was diagnosed more frequently than expected (1.086 to 1.104) from 2015 to 2019, mostly in non-Hispanic White beneficiaries (1.367) compared with 0.696 in Black beneficiaries and 0.758 in Hispanic beneficiaries.

CONCLUSIONS: These results highlight the need to increase the overall detection rates of MCI and of dementia particularly in socioeconomically disadvantaged groups.

VL - 15 IS - 1 ER - TY - JOUR T1 - Expected vs Diagnosed Rates of Mild Cognitive Impairment and Dementia in the US Medicare Population (S15.010) JF - Neurology Y1 - 2023 A1 - Soeren Mattke A1 - Hankyung Jun A1 - Emily Chen A1 - Ying Liu A1 - Andrew Becker A1 - Chris Wallick AB - Objective: We sought to derive contemporary population-level diagnosis rates of mild cognitive impairment (MCI) and dementia from US Medicare data and compare those rates to expected rates based on a predictive model.Background: Cognitive impairment is common in elderly populations but remains under diagnosed.Design/Methods: We analyzed data from 2017–2019 100% samples for Medicare fee-for-service and Medicare Advantage; diagnoses were identified based on ICD-10 codes. To estimate the expected prevalence of MCI and dementia, we used the Health and Retirement Study, a nationally representative, longitudinal survey of older US adults, which includes formal cognitive assessments. We predicted MCI, dementia, and any cognitive impairment based on age, sex, race/ethnicity, dual eligibility status (ie, individuals covered by both Medicare and Medicaid), and a continuous linear trend to account for the secular decline in dementia incidence with a probit model. The model was calibrated using 2000–2014 data, validated using 2016 data, and applied to 2017–2019 Medicare data to generate expected diagnosis rates.Results: The prediction model performed well, with areas under the curve of 0.7128 (MCI), 0.8156 (dementia), and 0.7449 (any cognitive impairment). Differences between model-predicted rates and observed diagnosis rates were 0.2013 (MCI), 0.015 (dementia), and 0.1487 (MCI or dementia). A total of 7,291,008 MCI cases and 483,649 dementia cases were undiagnosed.Conclusions: Dementia is diagnosed in the US Medicare population at approximately the expected rate; however, MCI remains substantially underdiagnosed. If failure to diagnose is not addressed, it will have negative implications for timely access to a disease-modifying treatment for Alzheimer’s disease.Disclosure: Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for C2N. Dr. Mattke has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Senscio Systems. The institution of Dr. Mattke has received research support from various companies, CMS. Dr. Jun has nothing to disclose. Ms. Chen has nothing to disclose. Dr. Liu has nothing to disclose. Mr. Becker has received personal compensation for serving as an employee of University of Southern California. Chris Wallick has nothing to disclose. VL - 100 ER - TY - JOUR T1 - Food Insecurity Among Older Adults with a History of Incarceration JF - Journal of Applied Gerontology Y1 - 2023 A1 - Jordan, Tamara A1 - Rodlescia S. Sneed KW - Food insecurity KW - incarceration KW - justice involvement AB - Objectives To examine the association between history of incarceration (HOI) and food insecurity (FI) among older adults.Methods This is a secondary analysis utilizing data from 12,702 respondents aged 51+ who participated in the 2012 and 2014 waves of The Health and Retirement Study. Multiple logistic regression was used to estimate the association between HOI and FI, adjusting for demographic variables using odds ratios (OR) and 95% confidence intervals (CI).Results In our sample, 12.8% of participants reported FI. Having a HOI increased odds of FI (OR 1.83; 95% CI 1.52-2.21), especially among Blacks (OR 1.78; 95% CI 1.29-2.46) and Whites (OR 2.27; 95% CI 1.74-2.97), but not Hispanics (OR 1.11; 95% CI 0.69-1.77) or other racial/ethnic groups (OR 1.79; 95% CI 0.71-4.52).Discussion FI is an important issue among older adults with a HOI. Stronger linkages between formerly incarcerated older adults and existing food assistance programs are needed.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis project was funded by Michigan Center for Urban African-American Aging Center through a grant from the National Institutes of Health (grant number P30 AG015281). This analysis uses data from the Health and Retirement Study (2012 HRS Core, 2014 HRS Core, and RAND HRS Longitudinal File 2018), sponsored by the National Institute on Aging (grant number NIA U01AG009740) and conducted by the University of Michigan.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This current study was exempt from Michigan State University IRB review (STUDY00006614).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data are available online at: https://hrsdata.isr.umich.edu/data-products/2012-hrs-core, https://hrsdata.isr.umich.edu/data-products/2014-hrs-core, and https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 VL - 42 IS - 5 ER - TY - JOUR T1 - Genetically and environmentally predicted obesity in relation to cardiovascular disease: a nationwide cohort study JF - The Lancet Y1 - 2023 A1 - Ojalehto, Elsa A1 - Zhan, Yiquiang A1 - Jylhava, Juulia A1 - Reynolds, Chandra A1 - Anna K. Dahl Aslan A1 - Karlsson, Ida KW - BMI KW - Cardiovascular disease KW - Obesity KW - polygenic score KW - Twins AB - Background Evidence indicates that the adverse health effects of obesity differ between genetically and environmentally influenced obesity. We examined differences in the association between obesity and cardiovascular disease (CVD) between individuals with a genetically predicted low, medium, or high body mass index (BMI). Methods We used cohort data from Swedish twins born before 1959 who had BMI measured between the ages of 40–64 years (midlife) or at the age of 65 years or later (late-life), or both, and prospective CVD information from nationwide register linkage through 2016. A polygenic score for BMI (PGSBMI) was used to define genetically predicted BMI. Individuals missing BMI or covariate data, or diagnosed with CVD at first BMI measure, were excluded, leaving an analysis sample of 17,988 individuals. We applied Cox proportional hazard models to examine the association between BMI category and incident CVD, stratified by the PGSBMI. Co-twin control models were applied to adjust for genetic influences not captured by the PGSBMI. Findings Between 1984 and 2010, the 17,988 participants were enrolled in sub-studies of the Swedish Twin Registry. Midlife obesity was associated with a higher risk of CVD across all PGSBMI categories, but the association was stronger with genetically predicted lower BMI (hazard ratio from 1.55 to 2.08 for those with high and low PGSBMI, respectively). Within monozygotic twin pairs, the association did not differ by genetically predicted BMI, indicating genetic confounding not captured by the PGSBMI. Results were similar when obesity was measured in late-life, but suffered from low power. Interpretation Obesity was associated with CVD regardless of PGSBMI category, but obesity influenced by genetic predisposition (genetically predicted high BMI) was less harmful than obesity influenced by environmental factors (obesity despite genetically predicted low BMI). However, additional genetic factors, not captured by the PGSBMI, still influence the associations. ER - TY - JOUR T1 - Harmonization of cognitive screening tools for dementia across diverse samples: A simulation study. JF - Alzheimers Dement (Amst) Y1 - 2023 A1 - Gavett, Brandon E A1 - Ilango, Sindana D A1 - Koscik, Rebecca A1 - Ma, Yue A1 - Helfand, Benjamin A1 - Eng, Chloe W A1 - Gross, Alden A1 - Trittschuh, Emily H A1 - Richard N Jones A1 - Mungas, Dan KW - cognitive screening KW - Dementia KW - Simulation AB -

INTRODUCTION: Research focusing on cognitive aging and dementia is a global endeavor. However, cross-national differences in cognition are embedded in other sociocultural differences, precluding direct comparisons of test scores. Such comparisons can be facilitated by co-calibration using item response theory (IRT). The goal of this study was to explore, using simulation, the necessary conditions for accurate harmonization of cognitive data.

METHOD: Neuropsychological test scores from the US Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) were subjected to IRT analysis to estimate item parameters and sample means and standard deviations. These estimates were used to generate simulated item response patterns under 10 scenarios that adjusted the quality and quantity of linking items used in harmonization. IRT-derived factor scores were compared to the known population values to assess bias, efficiency, accuracy, and reliability of the harmonized data.

RESULTS: The current configuration of HRS and MHAS data was not suitable for harmonization, as poor linking item quality led to large bias in both cohorts. Scenarios with more numerous and higher quality linking items led to less biased and more accurate harmonization.

DISCUSSION: Linking items must possess low measurement error across the range of latent ability for co-calibration to be successful.

HIGHLIGHTS: We developed a statistical simulation platform to evaluate the degree to which cross-sample harmonization accuracy varies as a function of the quality and quantity of linking items.Two large studies of aging-one in Mexico and one in the United States-use three common items to measure cognition.These three common items have weak correspondence with the ability being measured and are all low in difficulty.Harmonized scores derived from the three common linking items will provide biased and inaccurate estimates of cognitive ability.Harmonization accuracy is greatest when linking items vary in difficulty and are strongly related to the ability being measured.

VL - 15 IS - 2 ER - TY - JOUR T1 - Health trajectories of individuals who quit active religious attendance: analysis of four prospective cohort studies in the United States. JF - Soc Psychiatry Psychiatr Epidemiol Y1 - 2023 A1 - Jokela, Markus A1 - Laakasuo, Michael AB -

PURPOSE: To examine whether trajectories of health (depressive symptoms, psychological wellbeing, self-rated health, and body mass index) and health behaviors (smoking, heavy alcohol consumption, physical inactivity, and cannabis use) changed for individuals who first reported at least monthly religious attendance and then in subsequent study waves reported no active religious attendance.

METHODS: Data were from four cohort studies from the United States collected between 1996 and 2018: National Longitudinal Survey of 1997 (NLSY1997); National Longitudinal Survey of Young Adults (NLSY-YA); Transition to Adulthood Supplement of the Panel Study of Income Dynamics (PSID-TA); and Health and Retirement Study (HRS) with a total n = 6592 individuals and 37,743 person-observations.

RESULTS: None of the 10-year trajectories of health or health behaviors changed for the worse after the change from active to inactive religious attendance. Instead, the adverse trends were observed already during the time of active religious attendance.

CONCLUSION: These results suggest that religious disengagement is a correlate-not a cause-of a life course characterized by poorer health and health behaviors. The religious decline caused by people leaving their religion is unlikely to influence population health.

ER - TY - JOUR T1 - Identifying the Relationships between Types of Leisure Activities and Cognitive Functions in Older Adults JF - American Journal of Health Behavior Y1 - 2023 A1 - Kim, Junhyoung A1 - Lee, Jungjoo A1 - Rodriguez, Miriam A1 - Han, Areum A1 - Ju, Hyo-Jin KW - cognitive functions KW - healthy aging KW - Leisure activities KW - Older Adults KW - Successful aging AB - Objectives: We investigated the relationship between types of leisure-time physical activity (LTPA) activities, intellectually stimulating activities, and community-based activities and the cognitive functions of older adults. Methods: We extracted 3,767 samples from the 2020 Health and Retirement Study (N=15,723). We defined cognitive functions as: (1) memory as assessed by both immediate and delayed recall tests, (2) working memory measured by a subtraction-by-7 test, and (3) attention and processing speed assessment through the use of the counting backward test. We used hierarchical regression analysis to assess the relationships between types of leisure and cognitive functions. Results: LTPA, intellectual leisure, and community-based leisure were significantly associated with improved memory function. Intellectual activity was significantly associated with improved working memory, and improved attention and processing speed. Conclusion: These findings provide data-based implications for the design and implementation of various types of leisure activities for older adults by healthcare providers and therapists. © 2023 PNG Publications. All rights reserved. VL - 47 ER - TY - JOUR T1 - Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults. JF - J Am Geriatr Soc Y1 - 2023 A1 - Jester, Dylan J A1 - Palmer, Barton W A1 - Thomas, Michael L A1 - Brown, Lauren L A1 - Tibiriçá, Lize A1 - Jeste, Dilip V A1 - Gilmer, Todd AB -

BACKGROUND: The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality.

METHODS: We examined 20,311 Black, Latinx, and White adults aged 51-100 from the Health and Retirement Study (2008-2016). Telephone Interview for Cognitive Status-27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (≥12 vs. <12 years). Selected social determinants of health, all-cause mortality, time-varying health and healthcare utilization characteristics, and study wave were included as covariates.

RESULTS: On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non-linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher-educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age.

CONCLUSIONS: The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher-educated White adults received a greater benefit than higher-educated Black or Latinx adults.

ER - TY - JOUR T1 - Income-Related Inequalities in Physical and Cognitive Health Domains Over the Later Life Course: Longitudinal Evidence From the U.S. (1992-2016). JF - Res Aging Y1 - 2023 A1 - Cheng, Mengling A1 - Sommet, Nicolas A1 - Jopp, Daniela S A1 - Spini, Dario KW - cognitive KW - Income KW - inequalities KW - physical AB -

This study aims to investigate changes in the income-health gradient over the later life course. We test the age-as-leveler, the cumulative advantage/disadvantage, and the persistent inequality pattern for physical and cognitive health domains, and analyze whether these patterns are gendered. We used HRS data (1992-2016) and Poisson growth curve models to predict multimorbidity (33,860 participants) as an indicator of physical health and memory (25,291 participants) as an indicator of cognitive health. We disentangled the within-participant from the between-participant effects. For multimorbidity, the income-health gradient weakened as individuals aged; whereas for memory, the income-health gradient strengthened as individuals aged. The cumulative advantage/disadvantage of higher/lower income on memory may be more pronounced among women than men. Findings were confirmed by sensitivity analyses. Findings suggest that the support for the age-as-leveler or cumulative advantage/disadvantage pattern may depend on health domains and the effect strength may depend on gender.

ER - TY - JOUR T1 - Individual and Dyadic Health-Related Quality of Life of People Living with Dementia and their Caregivers Y1 - 2023 A1 - Mauricio Lopez-Mendez A1 - Rowan Iskandar A1 - Eric Jutkowitz KW - Caregivers KW - Dementia AB - Many interventions target dyads of people living with Alzheimer’s disease and related dementias (ADRD) and their caregivers. Without a dyadic measure of health-related quality of life (HRQOL), cost-utility analyses of these interventions require using the HRQOL of people with ADRD and caregivers, separately. We developed a dyadic measure of HRQOL that incorporates the interdependence between HRQOL of people living with ADRD and their caregivers and measures the dyad’s collective benefits. First, we estimated dyadic HRQOL time trade-off-weights (TTO-weights), a dyadic preference-based measure of HRQOL. Second, we estimated the association between ADRD clinical features and TTO-weights. We used the Aging, Demographics, and Memory Study to identify people living with ADRD (n = 308) and their caregivers (n = 160 dyads) and predict their TTO-weights. We estimated dyadic TTO-weights using an Archimedean bivariate utility copula with a quadratic generating function. Finally, we used adjusted linear regression to examine the association between predicted TTO-weights and ADRD clinical features. Average (standard deviation) TTO-weights of people living with ADRD, and caregivers were 0.67 (0.14) and 0.83 (0.09), respectively. Average dyadic TTO-weight was 0.75(0.05). When the dyadic TTO-weight was ≤ 0.60, an increase in the TTO-weight of the dyad-member with the lowest HRQOL resulted in a larger gain in the dyadic TTO-weight than a similar increase in the TTO-weight for the dyad-member with the higher baseline TTO-weight (i.e., non-proportional tradeoffs). When the dyadic TTO-weight is > 0.60, an increase in the TTO-weight for either member of the dyad increases the dyad TTO-weight equally (constant tradeoffs). An additional functional limitation resulted in more than twice the decline in the TTO-weight of people living with ADRD compared to an additional behavioral symptom (-0.008 vs. -0.003). Behavioral symptoms were significantly associated with a decline in caregivers’ and dyadic TTO-weights. The HRQOL of people living with ADRD and their caregivers are correlated. The dyadic TTO-weights for people living with ADRD and their caregivers can be used in cost-utility analyses to assess the collective gains in HRQOL and tradeoffs of interventions that target members of the dyad. ER - TY - JOUR T1 - Medication misuse and overuse in community-dwelling persons with dementia. JF - J Am Geriatr Soc Y1 - 2023 A1 - Deardorff, W James A1 - Jing, Bocheng A1 - Growdon, Matthew E A1 - Yaffe, Kristine A1 - Boscardin, W John A1 - Boockvar, Kenneth S A1 - Steinman, Michael A AB -

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.

ER - TY - JOUR T1 - Memory and language cognitive data harmonization across the United States and Mexico. JF - Alzheimer's & Dementia (Amsterdam, Netherlands) Y1 - 2023 A1 - Arce Rentería, Miguel A1 - Briceño, Emily M A1 - Chen, Diefei A1 - Saenz, Joseph A1 - Lindsay C Kobayashi A1 - Gonzalez, Christopher A1 - Vonk, Jet M J A1 - Richard N Jones A1 - Jennifer J Manly A1 - Wong, Rebeca A1 - David R Weir A1 - Kenneth M. Langa A1 - Gross, Alden L KW - Alzheimer's disease KW - cognitive aging KW - cross‐cultural KW - cultural neuropsychology KW - harmonization AB -

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's disease and related dementias.

VL - 15 IS - 3 ER - TY - JOUR T1 - Oral health issues of early baby boomers. JF - Spec Care Dentist Y1 - 2023 A1 - Jones, Judith A A1 - Moss, Kevin A1 - Weintraub, Jane A KW - Dental Caries KW - Humans KW - Nutrition Surveys KW - Oral Health AB -

OBJECTIVES: The purpose of this article is to detail the oral health status of early baby boomers and how it is affected by the cultural influences after World War II.

METHODS: National data on clinically and self-assessed oral conditions from the 2021 NIDCR Oral Health in America Report, National Health and Nutrition Examination Survey (2011-2014), Center for Disease Control and Prevention, National Cancer Institute (2018), the Indian Health Service (2022), and the Health and Retirement Study (2018) were tabulated and compared (where available) to similar data for older and younger cohorts.

RESULTS: Data analyses show that there is more tooth retention overall. There are higher levels of tooth loss, unrestored caries, and periodontitis among Black, American Indian, Alaskan Native, and Hispanic baby boomers, and the poor. Smokers had higher rates of periodontitis.

CONCLUSION: A life course approach to oral health care is warranted. Only by regular access and preventive care throughout life can avoidable, unnecessary, overly complex, and invasive procedures be prevented.

VL - 43 IS - 3 ER - TY - JOUR T1 - Positive Self-perceptions of Aging Increase Physical Resilience to Facilitate Social Re-engagement of Older Adults Who Fall: Analysis Based on Health and Retirement Study Data. JF - Arch Phys Med Rehabil Y1 - 2023 A1 - Zhang, Zeyi A1 - Wang, Jingjing A1 - Ma, Bin A1 - Wang, Jingyi A1 - Jia, Yuanmin A1 - Chen, Ou KW - Aging KW - Older Adults KW - physical resilience AB -

OBJECTIVE: To determine whether self-perceptions of aging (SPAs) predict physical resilience after a fall and whether SPA and physical resilience affect subsequent social engagement in older adults with a fall.

DESIGN: Prospective cohort study.

SETTING: General community.

PARTICIPANTS: Older adults who reported a fall within 2 years after baseline data collection (N=1707, mean age 72.9 years, 60.9% women).

MAIN OUTCOME MEASURE: Physical resilience indicates the ability to resist or recover from functional decline from a stressor. The change in frailty status from directly after the fall to up to 2 years of follow-up was used to generate 4 physical resilience phenotypes. Social engagement was dichotomized based on the presence at 1 of the 5 social activities at least once a month. The 8-item Attitudes Toward Own Aging Scale was used to assess SPA at baseline. Multinomial logistic regression and nonlinear mediation analysis were used.

RESULTS: Positive prefall SPA predicted more resilient phenotypes after a fall. Both positive SPA and physical resilience affected subsequent social engagement. Physical resilience partially mediated the association between SPA and social re-engagement (mediated percentage of 14.5%, P=.004). This mediation effect was fully driven by those with previous falls.

CONCLUSION: Positive SPA promotes physical resilience in older adults with a fall, both of which affect subsequent social engagement. Physical resilience partially mediated the effect of SPA on social engagement but only for previous fallers. Multidimensional recovery incorporating psychological, physiological, and social aspects should be stressed in the rehabilitation of older adults who fall.

ER - TY - JOUR T1 - Predictive Models of Life Satisfaction in Older People: A Machine Learning Approach. JF - Int J Environ Res Public Health Y1 - 2023 A1 - Shen, Xiaofang A1 - Yin, Fei A1 - Jiao, Can KW - Aged KW - Humans KW - Linear Models KW - Machine learning KW - Middle Aged KW - Personal Satisfaction AB -

Studies of life satisfaction in older adults have been conducted extensively through empirical research, questionnaires, and theoretical analysis, with the majority of these studies basing their analyses on simple linear relationships between variables. However, most real-life relationships are complex and cannot be approximated with simple correlations. Here, we first investigate predictors correlated with life satisfaction in older adults. Then, machine learning is used to generate several predictive models based on a large sample of older adults (age ≥ 50 years; = 34,630) from the RAND Health and Retirement Study. Results show that subjective social status, positive emotions, and negative emotions are the most critical predictors of life satisfaction. The Support Vector Regression (SVR) model exhibited the highest prediction accuracy for life satisfaction in older individuals among several models, including Multiple Linear Regression (MLR), Ridge Regression (RR), Least Absolute Shrinkage and Selection Operator Regression (LASSO), K Nearest Neighbors (KNN), and Decision Tree Regression (DT) models. Although the KNN and DT models exhibited better model fitting than MLR, RR, and LASSO, their performances were poor in terms of model validation and model generalization. These results indicate that machine learning is superior to simple correlations for understanding life satisfaction among older adults.

VL - 20 IS - 3 ER - TY - JOUR T1 - Predictors of Multiwave Opioid Use Among Older American Adults. JF - Innovation and Aging Y1 - 2023 A1 - Fennell, Gillian A1 - Jacobson, Mireille A1 - Grol-Prokopczyk, Hanna KW - Acute opioid use KW - CDC guidelines KW - Chronic pain KW - Doctor visits KW - Long-term opioid therapy KW - Lung disease KW - Region AB -

BACKGROUND AND OBJECTIVES: Despite limited analgesic benefits, long-term opioid therapy (L-TOT) is common among older adults with chronic pain. Extended opioid use poses a threat to older adults as aging metabolisms retain opioids for longer, increasing the risk of injury, overdose, and other negative health outcomes. In contrast to predictors of general opioid use, predictors of L-TOT in older adults are not well documented. We aimed to identify such predictors using all available data on self-reported opioid use in the Health and Retirement Study.

RESEARCH DESIGN AND METHODS: Using 5 waves of data, respondents ( = 10,713) aged 51 and older were identified as reporting no opioid use ( = 8,621), a single wave of use ( = 1,410), or multiple waves of use ( = 682). We conducted a multinomial logistic regression to predict both single- and multiwave opioid use relative to no use. Demographic, socioeconomic, geographic, health, and health care-related factors were included in our model.

RESULTS: Multivariable findings show that, relative to nonusers, both single- and multiwave users were significantly more likely to be younger (relative risk ratio [RRR] = 1.33; RRR = 2.88); report lower household wealth (RRR = 1.47; RRR = 2.88); live in the U.S. Midwest (RRR = 1.29; RRR = 1.56), South (RRR = 1.34; RRR = 1.58), or West (RRR = 1.46; RRR = 2.34); experience interfering pain (RRR = 1.59; RRR = 3.39), back pain (RRR = 1.35; RRR = 1.53), or arthritic pain (RRR = 1.46; RRR = 2.32); and see the doctor frequently (RRR = 1.50; RRR = 2.02). Multiwave users were less likely to be Black (RRR = 0.69) or Hispanic (RRR = 0.45), and less likely to be never married (RRR = 0.52).

DISCUSSION AND IMPLICATIONS: We identified demographic, socioeconomic, geographic, and health care-related predictors of chronic multiyear opioid use. Our focus on individuals taking opioids for this extended duration is novel. Differences in opioid use by geographic region and frequency of doctor visits particularly warrant attention from policy-makers and researchers. We make additional recommendations based on a sensitivity analysis limited to 2016-2020 data.

VL - 7 IS - 10 ER - TY - JOUR T1 - Prevalence and health outcomes in community-dwelling older adults with comorbid cancer and dementia: A longitudinal analysis. JF - Aging & Mental Health Y1 - 2023 A1 - Parajuli, Jyotsana A1 - Berish, Diane A1 - Jao, Ying-Ling A1 - Liao, Yo-Jen A1 - Johnson, Lee Ann A1 - Walsh, Amanda KW - Cancer KW - comorbid cancer-dementia KW - Dementia KW - health outcomes AB -

OBJECTIVES: To examine health outcomes in community-dwelling older adults with: dementia only, cancer only, and comorbid cancer and dementia.

METHODS: Longitudinal analysis was conducted using data from 2010 to 2016 waves of the Health and Retirement Study. Health outcomes included mortality, limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), nursing home utilization, hospital stay, homecare use, self-rated health, and out-of-pocket medical expenditure. Panel regression was used for statistical analysis.

RESULTS: The prevalence of comorbid cancer and dementia ranged from 2.56% to 2.97%. Individuals with comorbid cancer and dementia demonstrated a higher likelihood of nursing home utilization and poorer self-rated health but a lower likelihood of hospital stay, homecare use, and out-of-pocket expenditures, compared to the cancer only or dementia only groups. The differences in mortality and ADL and IADL limitations were not statistically significant.

CONCLUSION: Comorbid cancer and dementia predicted longer nursing home utilization and poorer self-rated health. The results help guide care planning for individuals with comorbid cancer and dementia.

ER - TY - JOUR T1 - Prevalence and Trends of Basic Activities of Daily Living Limitations in Middle-Aged and Older Adults in the United States. JF - Epidemiologia (Basel, Switzerland) Y1 - 2023 A1 - Heimbuch, Halli A1 - Rhee, Yeong A1 - Douglas, Marty A1 - Juhl, Kirsten A1 - Knoll, Kelly A1 - Stastny, Sherri A1 - McGrath, Ryan KW - Epidemiology KW - Geriatrics KW - Population Surveillance KW - self-care AB -

BACKGROUND: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States.

METHODS: The analytic sample included 30,418 Americans aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed.

RESULTS: Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8-17.2) in 2018, there were no changes in limitations during the study period ( = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults ( < 0.001). While older persons experienced a declining trend of ADL limitations ( < 0.001), middle-aged persons had an increasing trend ( < 0.001). Males had a lower ADL limitation prevalence than females ( < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White ( < 0.001).

CONCLUSIONS: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.

VL - 4 IS - 4 ER - TY - JOUR T1 - The Prevalence and Trends of Instrumental Activities of Daily Living Impairments in the United States from 2008-2018. JF - J Alzheimers Dis Rep Y1 - 2023 A1 - Knoll, Kelly A1 - Rhee, Yeong A1 - Hamm, Jeremy M A1 - Hammer, Kimberly D P A1 - Heimbuch, Halli A1 - Holloway, Jeremy A1 - Jurivich, Donald A1 - Lahr, Peyton A1 - McGrath, Brenda A1 - Parker, Kelly A1 - Robinson-Lane, Sheria A1 - Stover, Emily A1 - Tomkinson, Grant R A1 - McGrath, Ryan AB -

BACKGROUND: Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States.

OBJECTIVE: This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans.

METHODS: A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged≥50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates.

RESULTS: Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period ( < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks.

CONCLUSION: IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy.

VL - 7 IS - 1 ER - TY - JOUR T1 - Propensity Scores in Health Disparities Research: The Example of Cognitive Aging and the Hispanic Paradox. JF - Epidemiology Y1 - 2023 A1 - Kezios, Katrina L A1 - Zimmerman, Scott C A1 - Zhang, Adina A1 - Calonico, Sebastian A1 - Jawadekar, Neal A1 - Glymour, M Maria A1 - Zeki Al Hazzouri, Adina KW - Adult KW - cognitive aging KW - Hispanic or Latino KW - Humans KW - Mexican Americans KW - Propensity Score KW - Risk Factors KW - United States AB -

BACKGROUND: Individuals of Mexican ancestry in the United States experience substantial socioeconomic disadvantages compared with non-Hispanic white individuals; however, some studies show these groups have similar dementia risk. Evaluating whether migration selection factors (e.g., education) associated with risk of Alzheimer disease and related dementia (ADRD) explain this paradoxical finding presents statistical challenges. Intercorrelation of risk factors, common with social determinants, could make certain covariate patterns very likely or unlikely to occur for particular groups, which complicates their comparison. Propensity score (PS) methods could be leveraged here to diagnose nonoverlap and help balance exposure groups.

METHODS: We compare conventional and PS-based methods to examine differences in cognitive trajectories between foreign-born Mexican American, US-born Mexican American, and US-born non-Hispanic white individuals in the Health and Retirement Study (1994-2018). We examined cognition using a global measure. We estimated trajectories of cognitive decline from linear mixed models adjusted for migration selection factors also associated with ADRD risk conventionally or with inverse probability weighting. We also employed PS trimming and match weighting.

RESULTS: In the full sample, where PS overlap was poor, unadjusted analyses showed both Mexican ancestry groups had worse baseline cognitive scores but similar or slower rates of decline compared with non-Hispanic white adults; adjusted findings were similar, regardless of method. Focusing analyses on populations where PS overlap was improved (PS trimming and match weighting) did not alter conclusions.

CONCLUSIONS: Attempting to equalize groups on migration selection and ADRD risk factors did not explain paradoxical findings for Mexican ancestry groups in our study.

VL - 34 IS - 4 ER - TY - RPRT T1 - Racial Differences in Depression Indicators Before and After 2008 Financial Crisis in a Sample of Older Adults Y1 - 2023 A1 - Angelina E. Jackson KW - Financial crisis KW - Gerontology KW - Mental Health KW - Racial Disparities AB - The present study was designed to examine patterns of mental health outcomes in older Black and White adults after the national 2008 financial crisis. The data was acquired from the University of Michigan Health and Retirement Study, a publicly available dataset. This longitudinal study has obtained data from a representative sample of approximately 20,000 older adults in America, aged 55 and older. The hypotheses were (1) rates of mental health indicators related to symptoms of depression will increase after the 2008 financial crisis and (2) that increase will be significantly higher in Black respondents compared to White respondents. The analysis revealed that Black participants displayed higher levels of the indicators of depression. However, the financial crisis had no significant influence on indicators of depression in this sample of older adults. Implications of the findings are discussed in terms of highlighting discrepancies in mental health for Black individuals. PB - Georgia Southern University UR - https://digitalcommons.georgiasouthern.edu/etd/2556 ER - TY - JOUR T1 - Racial Differences in Employment and Poverty Histories and Health in Older Age. JF - Am J Prev Med Y1 - 2023 A1 - Lu, Peiyi A1 - Kezios, Katrina A1 - Milazzo, Floriana A1 - Jawadekar, Neal A1 - Shelley, Mack A1 - Zeki Al Hazzouri, Adina KW - Aged KW - Black or African American KW - Employment KW - Humans KW - Middle Aged KW - Poverty KW - Race Factors KW - White AB -

INTRODUCTION: Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health.

METHODS: Respondents born in 1948-1953 and enrolled in the 2004 Health and Retirement Study (N=555, N=2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021-2022.

RESULTS: More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= -0.55 standardized units, 95% CI= -0.81, -0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= -0.35, 95% CI= -0.46, -0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents.

CONCLUSIONS: Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.

VL - 64 IS - 4 ER - TY - RPRT T1 - Retirement Trajectories and Social Security’s Retirement Earnings Test Y1 - 2023 A1 - Bob Joondeph A1 - Nancy J. Altman A1 - Jagadeesh Gokhale A1 - Amy Shuart KW - benefits KW - FRA KW - RET KW - Social Security JF - Research Portfolio on Retirement PB - Social Security Advisory Board CY - Washington, DC UR - https://www.ssab.gov/research/retirement-trajectories-and-social-security-retirement-earnings-test/?mc_cid=8bc0768a81&mc_eid=4b82b179ac ER - TY - JOUR T1 - The Role of Different Weakness Cut-Points for Future Cognitive Impairment in Older Americans. JF - Journal of the American Directors Association Y1 - 2023 A1 - McGrath, Ryan A1 - Tomkinson, Grant R A1 - Hamm, Jeremy M A1 - Juhl, Kirsten A1 - Knoll, Kelly A1 - Parker, Kelly A1 - Smith, Ashleigh E A1 - Rhee, Yeong KW - Aged KW - Body Mass Index KW - Cognition KW - Cognitive Dysfunction KW - Female KW - Geriatric Assessment KW - Hand Strength KW - Humans KW - Male AB -

OBJECTIVES: New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans.

DESIGN: Longitudinal panel.

SETTING AND PARTICIPANTS: The analytic sample included 11,116 participants aged ≥65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews.

METHODS: The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations.

RESULTS: Persons considered weak under the absolute cut-point had 1.62 (95% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points.

CONCLUSIONS AND IMPLICATIONS: Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.

VL - 24 IS - 12 ER - TY - JOUR T1 - A semiparametric alternative to the Heckman correction: application with left-censored data on parental transfers JF - Empirical Economics Y1 - 2023 A1 - Wang, Lu A1 - Jiang, Yixiao A1 - He, Zhaochen KW - Earning income tax credit (EITC) KW - Heteroskedasticity KW - Inter Vivos Transfers AB - Using a semiparametric estimator developed by Klein and Vella (J Appl Econom 24(5):735–762, 2009b), we study the motives for parental wealth transfers to living children using left-censored data from the Health and Retirement Study. We confirm the presence of heteroskedastic errors in our data and show that the inverse Mills ratio approach employed by the Heckman correction would be biased in such a setting. Using the more flexible semiparametic approach, we find evidence of a nonlinear relationship between amount of inter vivo transfers and recipient children’s household incomes, suggesting that parents’ motives for transferring wealth may vary depending on their child’s income level. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. ER - TY - JOUR T1 - Sex differences in cognitive aging and the role of socioeconomic status: Evidence from multi-cohort studies. JF - Psychiatry Res Y1 - 2023 A1 - Jin, Yinzi A1 - Hong, Chenlu A1 - Luo, Yanan KW - Aged, 80 and over KW - Aging KW - cognitive aging KW - Cohort Studies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Sex Characteristics KW - Social Class KW - Socioeconomic factors AB -

BACKGROUND: Sex differences exist in cognitive function, and socioeconomic status (SES) may play a role in changing these discrepancies. This study investigated the role of SES in contributing to sex differences in cognitive function.

METHODS: We conducted a pooled multi-cohort study on the basis of four comparative cohort studies from the UK, the US, Europe and China to assess sex differences and the role of SES in cognitive decline by birth cohort (1930-1938, 1939-1945, 1946-1968). Cognitive function was measured in three domains based on the mean and SD of the corresponding tests: episodic memory, working memory, and time orientation. SES was the summed scores of education and household wealth.

FINDINGS: 61,019 individuals were involved. Cognitive function of women declined faster than those of men as growing old (particularly after 80 years old). As SES increased, cognitive function increased more for women than for men in most cases among later-born cohorts (1930-1938, 1939-1945, 1946-1968) (e.g., episodic memory scores at 60 years old: women exhibited an increase from -0.09 [95%CI -0.12, -0.07] in low SES to 0.89 [0.86, 0.92] in high SES; men from -0.16 [-0.19, -0.14] to 0.59 [0.56, 0.62]). However, sex-specific cognitive benefits were absent in the oldest birth cohort (1895-1929).

INTERPRETATION: These findings highlight the importance of considering the role of SES in the discrepancy of sex difference in cognitive aging.

VL - 321 ER - TY - JOUR T1 - Shifting of Cognitive Assessments Between Face-to-Face and Telephone Administration: Measurement Considerations. JF - The Journals of Gerontology, Series B Y1 - 2023 A1 - Smith, Jason R A1 - Gibbons, Laura E A1 - Crane, Paul K A1 - Mungas, Dan M A1 - Glymour, M Maria A1 - Jennifer J Manly A1 - Zahodne, Laura B A1 - Mayeda, Elizabeth Rose A1 - Richard N Jones A1 - Gross, Alden L KW - Cognition KW - Mode effects KW - Psychometrics KW - Telephone AB -

OBJECTIVES: Telephone-administered cognitive assessments are a cost-effective and sometimes necessary alternative to face-to-face assessments. There is limited information in large studies concerning mode effects, or differences in cognition attributable to assessment method, as a potential measurement threat. We evaluated mode effects on cognitive scores using a population-based sample of community-living older adults.

METHODS: We used data from participants aged 65-79 in the 2014 Health and Retirement Study for whom interview mode was randomized (n=6825). We assessed mode differences in test means, whether mode modifies associations of cognition with criterion variables, and formal measurement invariance testing.

RESULTS: Relative to face-to-face assessment, telephone assessment was associated with higher scores for memory and calculation (0.06 to 0.013 standard deviations (SD)) and lower scores for non-memory items (-0.09 to -0.01 SD). Cognition was significantly differentially related to IADL difficulty depending on assessment mode. Measurement invariance testing identified evidence of mode differences in certain tests as a function of mode: adjusting for underlying cognition, the largest mode differences in memory and attention: immediate noun recall, delayed word recall, and serial-7s scores were higher given telephone administration.

DISCUSSION: Differences by mode of administration are apparent in cognitive measurement in older adults albeit to a small degree in our study, and most pronounced for tests of memory and attention. The importance of accounting for mode differences ultimately depends on one's research question and study sample: not all associations may be affected by mode differences and such modification may only be apparent among those with lower cognitive functioning.

VL - 78 IS - 2 ER - TY - JOUR T1 - Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults. JF - Proc Natl Acad Sci U S A Y1 - 2023 A1 - Shah, Sachin J A1 - Oreper, Sandra A1 - Jeon, Sun Young A1 - Boscardin, W John A1 - Fang, Margaret C A1 - Covinsky, Kenneth E KW - Aged KW - Child KW - Frailty KW - Humans KW - Longitudinal Studies KW - Retirement KW - Sociological Factors AB -

While social characteristics are well-known predictors of mortality, prediction models rely almost exclusively on demographics, medical comorbidities, and function. Lacking an efficient way to summarize the prognostic impact of social factor, many studies exclude social factors altogether. Our objective was to develop and validate a summary measure of social risk and determine its ability to risk-stratify beyond traditional risk models. We examined participants in the Health and Retirement Study, a longitudinal, survey of US older adults. We developed the model from a comprehensive inventory of 183 social characteristics using least absolute shrinkage and selection operator, a penalized regression approach. Then, we assessed the predictive capacity of the model and its ability to improve on traditional prediction models. We studied 8,250 adults aged ≥65 y. Within 4 y of the baseline interview, 22% had died. Drawn from 183 possible predictors, the Social Frailty Index included age, gender, and eight social predictors: neighborhood cleanliness, perceived control over financial situation, meeting with children less than yearly, not working for pay, active with children, volunteering, feeling isolated, and being treated with less courtesy or respect. In the validation cohort, predicted and observed mortality were strongly correlated. Additionally, the Social Frailty Index meaningfully risk-stratified participants beyond the Charlson score (medical comorbidity index) and the Lee Index (comorbidity and function model). The Social Frailty Index includes age, gender, and eight social characteristics and accurately risk-stratifies older adults. The model improves upon commonly used risk prediction tools and has application in clinical, population health, and research settings.

VL - 120 IS - 7 ER - TY - JOUR T1 - Spousal synchrony in allostatic load among older couples in the Health and Retirement Study. JF - Psychosom Med Y1 - 2023 A1 - Yu, Yan-Liang A1 - Juster, Robert-Paul AB -

OBJECTIVES: Using national data from the Health and Retirement Study, this study examined interpartner associations of allostatic load (AL) among 2,338 different-sex couples (N = 4,676 individuals) over a four-year period among older American couples from a dyadic approach.

METHODS: AL was indexed by immune (c-reactive protein), metabolic (high-density lipoprotein cholesterol, total cholesterol and glycosylated hemoglobin), renal (cystatin C), cardiovascular (systolic and diastolic blood pressures, pulse rate) and anthropometric (waist and body mass index) parameters using the traditional count-based formulation. Actor-partner interdependence models were used to assess interpartner concordance in AL.

RESULTS: Higher partners' baseline AL was significantly associated with higher own AL both at baseline and four years later. Additionally, partners' baseline AL was significantly associated with own AL four years later only in women but not men. Lastly, we did not observe any significant moderating effect of relationship quality on interpartner AL concordance.

CONCLUSIONS: The findings suggest that older couples' physiological responses to environmental stress are not only linked concurrently, but the associations persist after four years, alluding to long-term impacts of couples' psychosocial context and physiology on each other.

ER - TY - JOUR T1 - Urbanicity and cognitive functioning in later life. JF - Alzheimers Dement (Amst) Y1 - 2023 A1 - Lawrence, Elizabeth A1 - John, Samantha E A1 - Bhatta, Tirth AB -

INTRODUCTION: Prior research has shown disparities in cognitive functioning across the rural-urban continuum. We examine individual- and contextual-level factors to understand how and why urbanicity shapes cognitive functioning across older adulthood.

METHODS: Using a nationally representative sample from 1996 to 2016 waves of the Health and Retirement Study (HRS) and growth curve models, we assess urban-suburban-exurban differences in older adult cognitive functioning.

RESULTS: Results demonstrate that older adult men and women living in exurban areas, and older adult men in suburban areas, have lower cognitive functioning scores compared to their urban peers. Educational attainment and marital status contribute to but do not fully explain these differences. There were no differences in the trajectory over age, suggesting that urbanicity disparities in cognition occur earlier in life, with average differences remaining the same across older adulthood.

DISCUSSION: Differences in cognitive functioning across urbanicity are likely due to factors accumulating prior to older adulthood.

VL - 15 IS - 2 ER - TY - JOUR T1 - The value of Medicare coverage on depressive symptoms among older immigrants. JF - Gerontologist Y1 - 2023 A1 - Jun, Hankyung A1 - Mattke, Soeren A1 - Chen, Alice A1 - Aguila, Emma KW - depression KW - Disparities KW - Health Insurance AB -

BACKGROUND AND OBJECTIVES: The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the U.S.

RESEARCH DESIGN AND METHODS: Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity.

RESULTS: Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants - Black, Hispanic, and Asian/Pacific Islander - even when holding socioeconomic status constant.

DISCUSSION AND IMPLICATIONS: Our findings imply that immigration policies that expand healthcare protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.

ER - TY - JOUR T1 - Who Benefits From Helping? Moderators of the Association Between Informal Helping and Mortality. JF - Ann Behav Med Y1 - 2023 A1 - Nakamura, Julia S A1 - Shiba, Koichiro A1 - Jensen, Sofie M A1 - VanderWeele, Tyler J A1 - Kim, Eric S KW - informal helping KW - Mortality AB -

BACKGROUND: While informal helping has been linked to a reduced risk of mortality, it remains unclear if this association persists across different levels of key social structural moderators.

PURPOSE: To examine whether the longitudinal association between informal helping and all-cause mortality differs by specific social structural moderators (including age, gender, race/ethnicity, wealth, income, and education) in a large, prospective, national, and diverse sample of older U.S. adults.

METHODS: We analyzed data from the Health and Retirement Study, a national sample of U.S. adults aged >50 (N = 9,662). Using multivariable Poisson regression, we assessed effect modification by six social structural moderators (age, gender, race/ethnicity, wealth, income, and education) for the informal helping (2006/2008) to mortality (2010-2016/2012-2018) association on the additive and multiplicative scales.

RESULTS: Participants who reported ≥100 hr/year of informal helping (vs. 0 hr/year), had a lower mortality risk. Those who engaged in 1-49 hr/year most consistently displayed lower mortality risk across moderators, while those who engaged in 50-99 and ≥100 hr/year only showed decreased mortality risk across some moderators. When formally testing effect modification, there was evidence that the informal helping-mortality associations were stronger among women and the wealthiest.

CONCLUSIONS: Informal helping is associated with decreased mortality. Yet, there appear to be key differences in who benefits from higher amounts of informal helping across social structural moderators. Further research is needed to evaluate how the associations between informal helping and health and well-being are patterned across key social structural moderators.

ER - TY - JOUR T1 - Age at Immigration and Depression: The Mediating Role of Contemporary Relationships with Adult Children among Older Immigrants. JF - The Journals of Gerontology: Series B Y1 - 2022 A1 - Heejung Jang A1 - Pilkauskas, Natasha V A1 - Tang, Fenyan KW - depression KW - Intergenerational Relations KW - Later-life immigration KW - Migration AB -

OBJECTIVES: For the growing population of older immigrants in the United States, both age at immigration and familial relationships are important factors affecting psychological well-being. This study explores how age at immigration and contemporary relationships with adult children combine to explain older immigrants' depressive symptoms.

METHOD: This study uses 2014 Health and Retirement Study data from a sample of 759 immigrants age 65 and older who have at least one adult child age 21 or older. A series of ordinary least squares regressions and mediational analyses were conducted.

RESULTS: Findings indicate that structural solidarity significantly mediates the association between age at immigration and depressive symptoms. Specifically, immigrating in later life was associated with a lower level of depressive symptoms through its relationship with structural solidarity. In addition, giving monetary support to children and providing care for grandchildren may alleviate depressive symptoms for older immigrants.

DISCUSSION: This study suggests that relationships with adult children may differ with age at immigration. The types of support that older immigrants provide to their adult children may be crucial because such support may instill a sense of obligation and reciprocity that may be beneficial to the psychological well-being of older immigrants.

VL - 77 IS - 2 ER - TY - JOUR T1 - The Apportionment of Pharmacogenomic Variation: Race, Ethnicity, and Adverse Drug Reactions JF - Medical Research Archives Y1 - 2022 A1 - I. Jordan A1 - Shivam Sharma A1 - Shashwat Nagar A1 - Leonardo Mariño-Ramírez KW - drug reactions KW - race and ethnicity AB - Fifty years ago, Richard Lewontin found that the vast majority of human genetic variation falls within ( 85%) rather than between ( 15%) racial groups.  This result has been replicated numerous times since and is widely taken to support the notion that genetic differences between racial groups are trivial and thus irrelevant for clinical decision-making.  The aim of this study was to consider how the apportionment of pharmacogenomic variation within and between racial and ethnic groups relates to risk disparities for adverse drug reactions.  We confirmed that the majority of pharmacogenomic variation falls within (97.3%) rather than between (2.78%) the three largest racial and ethnic groups in the United States: Black, Hispanic, and White.  Nevertheless, pharmacogenomic variants showing far greater within than between-group variation can have high predictive value for adverse drug reactions, particularly for minority racial and ethnic groups.  We predicted excess adverse drug reactions for minority Black and Hispanic groups, compared to the majority White group, and considered these results in light of the apportionment of genetic variation within and between groups.  For 85% within and 15% between group variation, there are 700 excess adverse drug reactions per 1,000 patients predicted for a recessive effect model and 300 for a dominant model.  We found high numbers of predicted Black and Hispanic excess adverse drug reactions for widely prescribed platinum chemotherapy compounds, such as cisplatin and oxaliplatin, as well as controlled narcotics, including fentanyl and tramadol.  Our results indicate that race and ethnicity, while imprecise proxies for genetic diversity, correlate with patterns of pharmacogenomic variation in a way that is clearly relevant to medical treatment decisions.  The effects of this variation is particularly pronounced for Black and Hispanic minority groups, owing to genetic differences from the majority White group.  Treatment decisions that are made based on (assumed) White pharmacogenomic variant frequencies can be harmful for minority groups.  Ignoring clinically relevant genetic differences among racial and ethnic groups, however well-intentioned, will exacerbate rather than ameliorate health disparities.    VL - 10 UR - https://esmed.org/MRA/mra/article/view/2986 IS - 9 ER - TY - JOUR T1 - Association Between Racial Wealth Inequities and Racial Disparities in Longevity Among US Adults and Role of Reparations Payments, 1992 to 2018. JF - JAMA Network Open Y1 - 2022 A1 - Himmelstein, Kathryn E W A1 - Lawrence, Jourdyn A A1 - Jahn, Jaquelyn L A1 - Ceasar, Joniqua N A1 - Morse, Michelle A1 - Bassett, Mary T A1 - Wispelwey, Bram P A1 - Darity, William A A1 - Venkataramani, Atheendar S KW - Black People KW - ethnicity KW - Income KW - Socioeconomic factors AB -

IMPORTANCE: In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. The role of wealth inequality in mediating racial health inequities is unclear.

OBJECTIVE: To assess the contribution of wealth inequities to the longevity gap that exists between Black and White individuals in the US and to model the potential effects of reparations payments on this gap.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study, a nationally representative panel study of community-dwelling noninstitutionalized US adults 50 years or older that assessed data collected from April 1992 to July 2019. Participants included 7339 non-Hispanic Black (hereinafter Black) and 26 162 non-Hispanic White (hereinafter White) respondents. Data were analyzed from January 1 to September 17, 2022.

EXPOSURES: Household wealth, the sum of all assets (including real estate, vehicles, and investments), minus the value of debts.

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality by the end of survey follow-up in 2018. Using parametric survival models, the associations among household wealth, race, and survival were evaluated, adjusting for age, sex, number of household members, and marital status. Additional models controlled for educational level and income. The survival effects of eliminating the current mean wealth gap with reparations payments ($828 055 per household) were simulated.

RESULTS: Of the 33 501 individuals in the sample, a weighted 50.1% were women, and weighted mean (SD) age at study entry was 59.3 (11.1) years. Black participants' median life expectancy was 77.5 (95% CI, 77.0-78.2) years, 4 years shorter than the median life expectancy for White participants (81.5 [95% CI, 81.2-81.8] years). Adjusting for demographic variables, Black participants had a hazard ratio for death of 1.26 (95% CI, 1.18-1.34) compared with White participants. After adjusting for differences in wealth, survival did not differ significantly by race (hazard ratio, 1.00 [95% CI, 0.92-1.08]). In simulations, reparations to close the mean racial wealth gap were associated with reductions in the longevity gap by 65.0% to 102.5%.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that differences in wealth are associated with the longevity gap that exists between Black and White individuals in the US. Reparations payments to eliminate the racial wealth gap might substantially narrow racial inequities in mortality.

VL - 5 IS - 11 ER - TY - JOUR T1 - Association between the domestic use of solid cooking fuel and increased prevalence of depression and cognitive impairment in a big developing country: A large-scale population-based study. JF - Frontiers in Public Health Y1 - 2022 A1 - Jin, Yuming A1 - Zhou, Xianghong A1 - Deng, Linghui A1 - Xiong, Xingyu A1 - Li, Yifan A1 - Wei, Qiang A1 - Dong, Birong A1 - Qiu, Shi KW - Aging KW - Cognitive Dysfunction KW - Educational Status KW - Prevalence KW - Research AB -

BACKGROUND: Previous studies have suggested that air pollution affects physiological and psychological health. Using solid fuel at home is a significant source of indoor air pollution. The associations between solid fuel use and depressive symptoms and cognitive health were unclear among older adults from low- and middle-income countries (LMICs).

METHODS: To evaluate the association of solid fuel use with depressive symptoms and cognitive health among older adults, we obtained data from the Longitudinal Aging Study in India (LASI) and excluded subjects younger than 60 years and without critical data (solid fuel use, depressive symptoms, and cognitive health). The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depressive symptoms, with more than ten indicative of depression. Cognitive health was assessed using measures from the Health and Retirement Study (HRS), and subjects with the lowest 10th percentile were considered to have cognitive impairment. The participants' responses defined solid fuel use. Multivariable logistic regression, linear regression, subgroup analysis, and interaction tests were performed to appraise the relationship between solid fuel use and depression and cognitive impairment.

RESULTS: A total of 29,789 participants over 60 years old were involved in this study. Almost half of the participants (47.5%) reported using solid fuel for home cooking. Compared with clean fuel use, solid fuel use was related to an increased prevalence of depression [odds ratio (OR) 1.09, 95% CI 1.03-1.16] and higher CES-D-10 scores (β 0.23, 95% CI 0.12-0.35) after fully adjusted covariables. Using solid fuel was also related to a higher risk of cognitive impairment (OR 1.21, 95% CI 1.11-1.32) and a lower cognitive score (β -0.63, 95% CI -0.79 to -0.47) compared with those who used clean fuel. In the subgroup analysis, the prevalence of depression increased in females and non-smokers. The association of solid fuel use with depression and cognitive impairment exists in subgroups of BMI, economic status, caste, living area, education, and drinking.

CONCLUSIONS: The use of solid fuel at home was associated with an increased prevalence of depression and cognitive impairment among older adults in India.

VL - 10 ER - TY - JOUR T1 - Association of Long-Term Body Weight Variability With Dementia: A Prospective Study. JF - The Journals of Gerontology, Series A Y1 - 2022 A1 - Chen, Hui A1 - Zhou, Tianjing A1 - Guo, Jie A1 - Ji, John S A1 - Huang, Liyan A1 - Xu, Weili A1 - Zuo, Guangmin A1 - Lv, Xiaozhen A1 - Zheng, Yan A1 - Hofman, Albert A1 - Ma, Yuan A1 - Yuan, Changzheng KW - Body Weight KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Weight Loss AB -

BACKGROUND: Body weight variability (BWV) refers to intraindividual weight loss and gain over a period. The association of long-term BWV with dementia remains unclear and whether this association is beyond body weight change is undetermined.

METHODS: In the Health and Retirement Study, a total of 5 547 dementia-free participants (56.7% women; mean [SD] age, 71.1 [3.2] years) at baseline (2008) were followed up to 8 years (mean = 6.8 years) to detect incident dementia. Body weight was self-reported biennially from 1992 to 2008. BWV was measured as the coefficient of variation utilizing the body weight reported 9 times across 16 years before baseline. Cox-proportional hazard model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS: Among the 5 547 participants, a total of 427 incident dementia cases were identified during follow-up. Greater long-term BWV was significantly associated with a higher risk of dementia (HR comparing extreme quartiles: 2.01, 95% CI: 1.48-2.72; HR of each SD increment: 1.21, 95% CI: 1.10-1.32; p-trend < .001) independent of mean body weight and body weight change. This significant association was even observed for BWV estimated approximately 15 years preceding dementia diagnosis (HR of each SD increment: 1.13, 95% CI: 1.03-1.23) and was more pronounced for that closer to diagnosis.

CONCLUSION: Our prospective study suggested that greater BWV may be a novel risk factor for dementia.

VL - 77 IS - 10 ER - TY - JOUR T1 - Beyond Hours Worked and Dollars Earned: Multidimensional EQ, Retirement Trajectories and Health in Later Life JF - Work Aging and Retirement Y1 - 2022 A1 - Sarah B. Andrea A1 - Eisenberg-Guyot, Jerzy A1 - Vanessa M Oddo A1 - Peckham, Trevor A1 - Jacoby, Daniel A1 - Hajat, Anjum KW - employment quality KW - health KW - Retirement AB - The working lives of Americans have become less stable over the past several decades and older adults may be particularly vulnerable to these changes in employment quality (EQ). We aimed to develop a multidimensional indicator of EQ among older adults and identify EQ and retirement trajectories in the United States. Using longitudinal data on employment stability, material rewards, workers’ rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study (HRS), we used principal component analysis to construct an EQ score. Then, we used sequence analysis to identify late-career EQ trajectories (age 50–70 years; N = 11,958 respondents), overall and by sociodemographics (race, gender, educational attainment, marital status). We subsequently examined the sociodemographic, employment, and health profiles of these trajectories. We identified 10 EQ trajectories; the most prevalent trajectories were Minimally Attached and Wealthy (13.9%) and Good EQ to Well-off Retirement (13.7%), however, 42% of respondents were classified into suboptimal trajectories. Those in suboptimal trajectories were disproportionately women, people of color, and less-educated. Individuals in the Poor EQ to Delayed and Poor Retirement and Unattached and Poor clusters self-reported the greatest prevalence of poor health and depression, while individuals in the Wealthy Business Owners and Great EQ to Well-off Retirement clusters self-reported the lowest prevalence of poor health and depression at baseline. Trajectories were substantially constrained for women of color. Although our study demonstrates EQ is inequitably distributed in later life, labor organizing and policy change may afford opportunities to improve EQ and retirement among marginalized populations. VL - 8 SN - 2054-4650 IS - 1 ER - TY - JOUR T1 - A Brief Report on Older Working Caregivers: Developing a Typology of Work Environments. JF - The Journal of Gerontology, Series B Y1 - 2022 A1 - Dawn C Carr A1 - Kendra Jason A1 - Taylor, Miles A1 - Tiffany R Washington KW - latent class KW - Older workers KW - productive engagement AB -

OBJECTIVES: A growing proportion of the US labor force juggles paid work with family caregiving of older adults. However, no research has examined caregivers' work environments. The purpose of this brief report is to develop typologies of the work environments of family caregivers.

METHODS: This study used data drawn from the 2008-2012 waves of the Health and Retirement Study. Our sample includes employed individuals who also provided regular help with daily activities to a parent or spouse (n=976). We used latent class analysis to develop caregiver work environment typologies.

RESULTS: Our analyses revealed four typologies among caregivers: a) high quality work environments (n=340; 35%); b) average work environments with high job lock (n=293; 30%); c) low-quality work environments (n=203; 21%), and d) high personal interference in supportive work environments (n=140; 14%). Although only 21% of working caregivers were in a low-quality work environment (Type C), descriptive results suggest that these workers were most likely to be minorities who needed to work for financial reasons, reporting the highest number of health problems, and the most work hours.

DISCUSSION: Our findings provide insights into the types of environments that caregivers work in, and the characteristics of individuals in those environments. We discuss implications of our findings for future research and work-based policy development.

VL - 77 IS - 7 ER - TY - JOUR T1 - Challenges for Patients Dying of Heart Failure and Cancer. JF - Circulation. Heart Failure Y1 - 2022 A1 - Orlovic, Martina A1 - Mossialos, Elias A1 - Orkaby, Ariela R A1 - Joseph, Jacob A1 - Gaziano, J Michael A1 - Skarf, Lara M A1 - Nohria, Anju A1 - Warraich, Haider J KW - Activities of Daily Living KW - Heart Failure KW - Hospice Care KW - Neoplasms KW - Palliative care KW - Terminal Care AB -

BACKGROUND: Hospice and palliative care were originally implemented for patients dying of cancer, both of which continue to be underused in patients with heart failure (HF). The objective of this study was to understand the unique challenges faced by patients dying of HF compared with cancer.

METHODS: We assessed differences in demographics, health status, and financial burden between patients dying of HF and cancer from the Health and Retirement Study.

RESULTS: The analysis included 3203 individuals who died of cancer and 3555 individuals who died of HF between 1994 and 2014. Compared with patients dying of cancer, patients dying of HF were older (80 years versus 76 years), had poorer self-reported health, and had greater difficulty with all activities of daily living while receiving less informal help. Their death was far more likely to be considered unexpected (39% versus 70%) and they were much more likely to have died without warning or within 1 to 2 hours (20% versus 1%). They were more likely to die in a hospital or nursing home than at home or in hospice. Both groups faced similarly high total healthcare out-of-pockets costs ($9988 versus $9595, =0.6) though patients dying of HF had less wealth ($29 895 versus $39 008), thereby experiencing greater financial burden.

CONCLUSIONS: Compared with patients dying of cancer, those dying from HF are older, have greater difficulty with activities of daily living, are more likely to die suddenly, in a hospital or nursing home rather than home or hospice, and had worse financial burden.

VL - 15 IS - 12 ER - TY - JOUR T1 - Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference? JF - BMC Health Services Research Y1 - 2022 A1 - Kim, Narae A1 - Jacobson, Mireille KW - Health Expenditures KW - Humans KW - KLoSA KW - Medicare KW - Poverty AB -

BACKGROUND: Medical spending rises sharply with age. Even with universal health insurance, older adults may be at risk of catastrophic out-of-pocket medical spending. We aimed to compare catastrophic out-of-pocket medical spending among adults ages 65 and older in the United States, where seniors have near-universal coverage through Medicare, versus South Korea, where all residents have national health insurance.

METHODS: We used the 2016 Health and Retirement Study and the Korean Longitudinal Study of Aging. The study population were adults ages 65 and over in the US (n = 9,909) and South Korea (n = 4,450; N = 14,359). The primary outcome of interest was older adults' exposure to catastrophic out-of-pocket medical expenditure, defined as out-of-pocket medical spending over the past two years that exceeded 50% of annual household income. To examine the factors affecting catastrophic out-of-pocket medical spending of older adults in both countries, we performed logistic regression analyses. To compare the contribution of demographic factors versus health system-level factors to catastrophic out-of-pocket medical spending, we performed a Blinder-Oaxaca decomposition.

RESULTS: The proportion of respondents with catastrophic out-of-pocket medical expenditure was 5.8% and 3.0% in the US and South Korea, respectively. A Blinder-Oaxaca decomposition showed that the difference in the rate of catastrophic out-of-pocket medical expenditure spending between the two countries was attributable largely to unobservable system-level factors, rather than observed differences in the sociodemographic characteristics.

CONCLUSIONS: Exposure to catastrophic out-of-pocket medical spending is considerably higher in the US than South Korea. Most of the difference can be attributed to unobserved health system-level factors.

VL - 22 IS - 1 ER - TY - JOUR T1 - Cost-utility and cost-benefit analysis of TAVR availability in the US severe symptomatic aortic stenosis patient population. JF - Journal of Medical Economics Y1 - 2022 A1 - Sevilla, J P A1 - Klusty, Jessica M A1 - Song, Younghwan A1 - Russo, Mark J A1 - Thompson, Christin A A1 - Jiao, Xiayu A1 - Clancy, Seth J A1 - Bloom, David E KW - Aortic Valve KW - Aortic Valve Stenosis KW - Cost-Benefit Analysis KW - Health Care Costs KW - Heart Valve Prosthesis Implantation KW - Risk Factors KW - Transcatheter Aortic Valve Replacement KW - Treatment Outcome AB -

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

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

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

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

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

VL - 25 IS - 1 ER - TY - JOUR T1 - Cross-national harmonization of cognitive measures across HRS HCAP (USA) and LASI-DAD (India). JF - PLoS One Y1 - 2022 A1 - Vonk, Jet M J A1 - Gross, Alden L A1 - Zammit, Andrea R A1 - Bertola, Laiss A1 - Avila, Justina F A1 - Jutten, Roos J A1 - Gaynor, Leslie S A1 - Suemoto, Claudia K A1 - Lindsay C Kobayashi A1 - O'Connell, Megan E A1 - Elugbadebo, Olufisayo A1 - Amofa, Priscilla A A1 - Staffaroni, Adam M A1 - Arce Rentería, Miguel A1 - Turney, Indira C A1 - Richard N Jones A1 - Jennifer J Manly A1 - Lee, Jinkook A1 - Zahodne, Laura B KW - Cognition KW - cognitive aging KW - Episodic KW - HCAP KW - India KW - Language KW - LASI-DAD KW - Memory KW - Neuropsychological tests AB -

BACKGROUND: As global populations age, cross-national comparisons of cognitive health and dementia risk are increasingly valuable. It remains unclear, however, whether country-level differences in cognitive function are attributable to population differences or bias due to incommensurate measurement. To demonstrate an effective method for cross-national comparison studies, we aimed to statistically harmonize measures of episodic memory and language function across two population-based cohorts of older adults in the United States (HRS HCAP) and India (LASI-DAD).

METHODS: Data for 3,496 HRS HCAP (≥65 years) and 3,152 LASI-DAD (≥60 years) participants were statistically harmonized for episodic memory and language performance using confirmatory factor analysis (CFA) methods. Episodic memory and language factor variables were investigated for differential item functioning (DIF) and precision.

RESULTS: CFA models estimating episodic memory and language domains based on a priori adjudication of comparable items fit the data well. DIF analyses revealed that four out of ten episodic memory items and five out of twelve language items measured the underlying construct comparably across samples. DIF-modified episodic memory and language factor scores showed comparable patterns of precision across the range of the latent trait for each sample.

CONCLUSIONS: Harmonization of cognitive measures will facilitate future investigation of cross-national differences in cognitive performance and differential effects of risk factors, policies, and treatments, reducing study-level measurement and administrative influences. As international aging studies become more widely available, advanced statistical methods such as those described in this study will become increasingly central to making universal generalizations and drawing valid conclusions about cognitive aging of the global population.

VL - 17 IS - 2 ER - TY - JOUR T1 - Death of a child, religion, and mental health in later life. JF - Aging & Mental Health Y1 - 2022 A1 - Jung, Jong Hyun A1 - Lee, Hyo Jung KW - Bereavement KW - divine beliefs KW - Mental Health KW - Religion AB -

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

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

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

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

VL - 26 IS - 3 ER - TY - JOUR T1 - Deaths, Disparities, and Cumulative (Dis)Advantage: How Social Inequities Produce an Impairment Paradox in Later Life. JF - The Journals of Gerontology, Series A Y1 - 2022 A1 - Heide Jackson A1 - Michal Engelman KW - Disablement Process KW - Minority aging KW - socio-economic issues AB -

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

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

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

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

VL - 77 IS - 2 ER - TY - JOUR T1 - Decreased Risk of 2-Year Incidence of Alzheimer’s Disease Among Older Adults Who Report Sleep Symptoms JF - Sleep Y1 - 2022 A1 - Mason, Brooke A1 - Wills, Chloe A1 - Tubbs, Andrew A1 - Seixas, Azizi A1 - Turner, Arlener A1 - Jean-Louis, Girardin A1 - Killgore, William A1 - Grandner, Michael KW - Alzheimer disease KW - cognitive-behavioral therapy KW - Dementia KW - Depressive Disorder KW - ethnic group KW - insomnia KW - pharmacotherapy KW - sleep disorders AB - Introduction Those with dementia or Alzheimer’s Disease report an elevated amount of sleep difficulties compared to age-matched controls. Sleep-based interventions may be especially useful for this group, such as cognitive behavioral therapy for insomnia or pharmacological interventions. Therefore, it is important to expand the current understanding of the nature of sleep difficulties in those with Alzheimer’s Disease. Methods Data from the 2018 Health and Retirement Survey was collected from 17,146 older adults. Poisson regression analyses were used to explore the relationship between Alzheimer’s Disease as diagnosed by a doctor and sleep difficulties. Individuals who reported no Alzheimer’s Disease in the previous wave (N=16,751) were asked if they had since become diagnosed. N=101 individuals reported incident Alzheimer’s Disease in the 2-year gap between assessments. Sleep difficulties were assessed by asking participants if they had difficulties initiating or maintaining sleep, waking up too early, and how rested they felt upon awakening. All 4 of these symptoms were coded as “never,” “sometimes,” or “often.” Results Unexpectedly, there was a significant decreased risk of developing Alzheimer’s Disease among those who reported difficulties maintaining sleep (IRR=0.9962; 95%CI[0.9936,0.9988]; p=0.004), and early morning awakenings (IRR=0.9961; 95%CI[0.9938,0.9984]; p=0.001) “sometimes”. When the model was adjusted for sex, race, ethnicity, age, and depression, a similar finding of decreased risk for Alzheimer’s Disease for those who reported difficulties maintaining sleep (IRR=0.9953; 95%CI[0.9927,0.9980]; p<0.001), and early morning awakenings (IRR=0.9954; 95%CI[0.9930,0.9978]; p=0.001), “sometimes” were maintained. Conclusion Although previous studies have shown that poor sleep may lead to increased risk of Alzheimer’s and related dementias, the present study, which examined longitudinal data from a large, national sample of older adults, found that there was no association between frequent sleep disturbances and 2-year incidence of Alzheimer’s Disease, and a small association between more mild symptoms and decreased risk. It is possible that the 2-year observation window was insufficient to detect effects. Also, there is a risk of measurement error in collecting self-reported data on sleep and Alzheimer’s diagnoses. VL - 45 UR - https://doi.org/10.1093/sleep/zsac079.270 IS - Suppl _1 ER - TY - JOUR T1 - Dementia Spousal Caregiving JF - Alzheimer's & Dementia Y1 - 2022 A1 - Florence U Johnson A1 - Sheria G Robinson-Lane A1 - Philip Veliz KW - Caregiving KW - Dementia KW - spouse AB - Introduction Dementia family caregiving has been linked to depression, anxiety, insomnia, and other negative mental health symptoms, particularly among spousal caregivers who are most likely to have higher levels of caregiving hours. Further, depressive symptoms often present differently based on caregiver race and ethnicity. This study aimed to examine the association between spousal caregiving hours and self-reported depressive symptoms as well as identify any racial/ethnic disparities in depression self-reporting. Method Data was drawn from Wave 9 (2008) of the Health and Retirement Study and included 10,120 participants. Linear regression was used to evaluate the relationships between caregiving hours and depression symptoms. Further, a negative binomial model was used to test whether race/ ethnicity moderated the relationship between caregiving hours and self-reported depressive symptoms. Results As expected, self-reported depressive symptoms increased as caregiving hours increased (1.65, SD = 2.02, p <0.01). Among the racial and ethnic groups evaluated, Latinx participants experienced the highest levels of depressive symptoms relative to caregiving hours. Discussion Dementia affects families. Care and consideration of the family are as important as the care of the individual affected by a dementia-related diagnosis. Depression is a serious anticipated mental health outcome linked to dementia family caregiving responsibilities. As such, there is a need for increased culturally responsive professional screening and treatment for depression among family caregivers. Relatedly, primary care providers play an important role in identifying patients serving as family caregivers and offering necessary supports and referrals. VL - 18 IS - S9 ER - TY - JOUR T1 - The destabilization and destandardization of social roles across the adult life course: Considering aggregate social role instability and its variability from a historical-developmental perspective. JF - Developmental Psychology Publisher: American Psychological Association Y1 - 2022 A1 - Jager, Justin A1 - Amy Rauer A1 - Staff, Jeremy A1 - Lansford, Jennifer E A1 - Pettit, Gregory S A1 - Schulenberg, John E KW - life course KW - social roles AB -

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

VL - 58 IS - 3 ER - TY - JOUR T1 - Development and External Validation of a Mortality Prediction Model for Community-Dwelling Older Adults With Dementia. JF - JAMA Internal Medicine Y1 - 2022 A1 - Deardorff, W James A1 - Barnes, Deborah E A1 - Jeon, Sun Y A1 - Boscardin, W John A1 - Kenneth M. Langa A1 - Covinsky, Kenneth E A1 - Mitchell, Susan L A1 - Whitlock, Elizabeth L A1 - Smith, Alexander K A1 - Lee, Sei J KW - community dwelling KW - Dementia KW - mortality risk AB -

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

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

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

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

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

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

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

VL - 182 IS - 11 ER - TY - JOUR T1 - Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study. JF - BMC Geriatrics Y1 - 2022 A1 - Chen, Shanquan A1 - Jones, Linda A A1 - Jiang, Shan A1 - Jin, Huajie A1 - Dong, Dong A1 - Chen, Xi A1 - Wang, Dan A1 - Zhang, Yun A1 - Xiang, Li A1 - Zhu, Anna A1 - Cardinal, Rudolf N KW - Activities of Daily Living KW - COVID-19 KW - Domiciliary care KW - Living Alone AB -

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

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

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

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

VL - 22 IS - 1 ER - TY - JOUR T1 - Digital exclusion and functional dependence in older people: Findings from five longitudinal cohort studies. JF - eClinicalMedicine Y1 - 2022 A1 - Lu, Xinran A1 - Yao, Yao A1 - Jin, Yinzi KW - CHARLS KW - Digital exclusion KW - ELSA KW - Functional dependency KW - IADLS KW - instrumental activities of daily living KW - MHAS KW - SHARE AB -

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

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

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

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

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

VL - 54 ER - TY - ICOMM T1 - Does Genetic Predisposition to Alzheimer Disease Contribute to Midlife Depression? Y1 - 2022 A1 - Jacobs, Sheila KW - Alzheimer disease KW - depression KW - genetic data PB - NeurologyAdvisor UR - https://www.neurologyadvisor.com/topics/alzheimers-disease-and-dementia/genetic-predisposition-alzheimer-disease-midlife-depression/ ER - TY - JOUR T1 - END-OF-LIFE CARE PLANNING AND SATISFACTION AMONG THE HEALTH AND RETIREMENT STUDY DECEDENTS JF - Innovation in Aging Y1 - 2022 A1 - Rahemi, Zahra A1 - Malatyali, Ayse A1 - Cidav, Tom A1 - Jarrin, Olga A1 - Dye, Cheryl A1 - McMahan, Christopher KW - End-of-life (EOL) care and planning KW - Satisfaction AB - The frequency and timing of advance care planning among individuals living with cognitive impairments vary by race/ethnicity and other sociodemographic factors. This study examined relationships between advance care planning and end-of-life care satisfaction among participants in the Health and Retirement Study (Exit files 2002-2018). Among decedents with cognitive impairment (n=3,102), Black and Hispanic participants were less likely to have a living will (OR=0.22, 0.19) and less likely to discuss end-of-life care (OR=0.422, 0.544) compared to White and non-Hispanic participants, respectively. Black and Hispanic participants were more likely to prefer all possible end-of-life care (OR=3.29, 3.34) and less likely to refuse extensive-care measures (OR=0.34, 0.48) compared to White and non-Hispanic participants. Participants dissatisfied with end-of-life care were 48% less likely to have a living will. End-of-life care planning disparities among racial/ethnic groups can inform interventional and educational programs to improve equity in end-of-life care. VL - 6 IS - Suppl 1 ER - TY - JOUR T1 - The estimated prevalence of no reported dementia-related diagnosis in older Americans living with possible dementia by healthcare utilization. JF - Aging Clinical and Experimental Research Y1 - 2022 A1 - Parker, Kelly A1 - Brenda Vincent A1 - Rhee, Yeong A1 - Choi, Bong-Jin A1 - Sheria G Robinson-Lane A1 - Hamm, Jeremy M A1 - Klawitter, Lukus A1 - Donald A Jurivich A1 - Ryan P McGrath KW - Alzheimer disease KW - Geriatric Assessment KW - Geriatrics KW - Mental Status and Dementia Tests AB -

BACKGROUND: Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis.

AIMS: This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization.

METHODS: The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years.

RESULTS: The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%-93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1-90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1-91.4%).

DISCUSSION: Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless.

CONCLUSIONS: We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.

VL - 34 IS - 2 ER - TY - JOUR T1 - Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project JF - JAMA Neurology Y1 - 2022 A1 - Jennifer J Manly A1 - Richard N Jones A1 - Kenneth M. Langa A1 - Ryan, Lindsay H. A1 - Levine, Deborah A. A1 - McCammon, Ryan A1 - Heeringa, Steven G. A1 - David R Weir KW - Dementia KW - HCAP KW - mild cognitive impairment AB - Nationally representative data are critical for understanding the causes, costs, and outcomes associated with dementia and mild cognitive impairment (MCI) in the US and can inform policies aimed at reducing the impact of these conditions on patients, families, and public programs. The nationally representative Health and Retirement Study (HRS) is an essential resource for such data, but the HRS substudy providing dementia diagnostic information was fielded more than 20 years ago and more recent data are needed.The Harmonized Cognitive Assessment Protocol (HCAP) was developed to update national estimates of the prevalence of MCI and dementia in the US and examine differences by age, race, ethnicity, and sex.HRS is an ongoing longitudinal nationally representative study of people 51 years and older with staggered entry dates from 1992 to 2022 and follow-up ranging from 4 to 30 years. HCAP is a cross-sectional random sample of individuals in HRS who were 65 years or older in 2016. Of 9972 age-eligible HRS participants, 4425 were randomly selected for HCAP, and 3496 completed a comprehensive neuropsychological test battery and informant interview, none of whom were excluded. Dementia and MCI were classified using an algorithm based on standard diagnostic criteria and comparing test performance to a robust normative sample.Groups were stratified by age, sex, education, race, and ethnicity.National prevalence estimates using population weights.The mean (SD) age of the study population sample (N = 3496) was 76.4 (7.6) years, and 2095 participants (60\%) were female. There were 551 participants who self-identified as Black and not Hispanic (16\%), 382 who self-identified as Hispanic regardless of race (16\%), 2483 who self-identified as White and not Hispanic (71\%), and 80 who self-identified as another race (2\%), including American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, or another self-described race. A total of 393 individuals (10\%; 95\% CI, 9-11) were classified as having dementia and 804 (22\%; 95\% CI, 20-24) as having MCI. Every 5-year increase in age was associated with higher risk of dementia (weighted odds ratio [OR], 1.95 per 5-year age difference; 95\%, CI, 1.77-2.14) and MCI (OR, 1.17 per 5-year age difference, 95\% CI, 1.09-1.26). Each additional year of education was associated with a decrease in risk of dementia (OR, 0.93 per year of school, 95\% CI, 0.89-0.97) and MCI (OR, 0.94, 95\% CI, 0.91-0.97). Dementia was more common among non-Hispanic Black individuals (OR, 1.81; 95\% CI, 1.20-2.75) and MCI in Hispanic individuals (OR, 1.42; 95\% CI, 1.03-1.96) compared with non-Hispanic White individuals. Other group comparisons by race and ethnicity were not possible owing to small numbers. No differences in prevalence were found between female individuals and male individuals.Using a comprehensive neuropsychological test battery and large sample, the national prevalence of dementia and MCI in 2016 found in this cross-sectional study was similar to that of other US-based studies, indicating a disproportionate burden of dementia and MCI among older Black and Hispanic adults and those with lower education. VL - 79 IS - 12 ER - TY - JOUR T1 - Estimating transition probabilities between health states using US longitudinal survey data JF - Empirical Economics Y1 - 2022 A1 - Jung, Juergen KW - Conditional health transition probabilities KW - Health transition matrices KW - Lifecycle profiles of health transition probabilities KW - Markov property KW - Medical expenditure panel survey (MEPS) AB - We use data from two representative US household surveys, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (RAND-HRS) to estimate transition probability matrices between health states over the lifecycle from age 20–95. We compare nonparametric counting methods and parametric methods where we control for individual characteristics as well as time and cohort effects. We align two year transition probabilities from HRS with one-year transition probabilities in MEPS using a stochastic root method assuming a Markov structure. We find that the nonparametric counting method and the regression specifications based on ordered logit models produce similar results over the lifecycle. However, the counting method overestimates the probabilities of transitioning into bad health states. In addition, we find that young women have worse health prospects than their male counterparts but once individuals get older, being female is associated with transitioning into better health states with higher probabilities than men. We do not find significant differences of the conditional health transition probabilities between African Americans and the rest of the population. We also find that the lifecycle patterns are stable over time. Finally, we discuss issues with controlling for time effects, sample attrition, the Markov assumption, and other modeling issues that can arise with categorical outcome variables. VL - 63 ER - TY - JOUR T1 - Financial Hardship and Psychological Resilience during COVID-19: Differences by Race/Ethnicity. JF - The Journals of Gerontology, Series B Y1 - 2022 A1 - Taylor, Miles G A1 - Carr, Dawn C A1 - Jason, Kendra KW - COVID-19 KW - Health Disparities KW - Income KW - Race/ethnicity KW - Successful aging KW - Wellbeing AB -

OBJECTIVES: Research on the impact of COVID-19 among older adults has primarily focused on relatively acute virus outcomes, but it is likely financial hardships during this time have eroded the adaptive capacity of older adults. It is also possible these impacts vary by race and ethnicity. We examine changes in psychological resilience (PR) among older adults before and during the pandemic to determine whether financial hardships and other stressors have altered this resource for White, Black, and Hispanic older adults.

METHOD: Using the COVID module released by the HRS (n=735), we examined changes in PR between 2016 and 2020 related to financial hardships during COVID. We tested interactions to determine whether the effects were patterned by race and ethnicity.

RESULTS: Consistent with previous literature, resilience was relatively stable during this time on average. Financial hardship during COVID-19 diminished resilience, but this effect was concentrated primarily among White Americans.

DISCUSSION: The results suggest that PR is a relatively stable resource in later life, even during the pandemic. However, this resource may be impacted in the face of specific challenges in later life. Policies related to financial hardship during the pandemic should be seen as supporting the capacity for older adults to adapt to current as well as future challenges.

VL - 77 IS - 7 ER - TY - JOUR T1 - Genome-wide meta-analyses reveal novel loci for verbal short-term memory and learning. JF - Molecular Psychiatry Y1 - 2022 A1 - Lahti, Jari A1 - Tuominen, Samuli A1 - Yang, Qiong A1 - Pergola, Giulio A1 - Ahmad, Shahzad A1 - Amin, Najaf A1 - Armstrong, Nicola J A1 - Beiser, Alexa A1 - Bey, Katharina A1 - Bis, Joshua C A1 - Boerwinkle, Eric A1 - Bressler, Jan A1 - Campbell, Archie A1 - Campbell, Harry A1 - Chen, Qiang A1 - Corley, Janie A1 - Cox, Simon R A1 - Davies, Gail A1 - De Jager, Philip L A1 - Derks, Eske M A1 - Jessica Faul A1 - Fitzpatrick, Annette L A1 - Fohner, Alison E A1 - Ford, Ian A1 - Fornage, Myriam A1 - Gerring, Zachary A1 - Grabe, Hans J A1 - Grodstein, Francine A1 - Gudnason, Vilmundur A1 - Simonsick, Eleanor A1 - Holliday, Elizabeth G A1 - Joshi, Peter K A1 - Kajantie, Eero A1 - Kaprio, Jaakko A1 - Karell, Pauliina A1 - Kleineidam, Luca A1 - Knol, Maria J A1 - Kochan, Nicole A A1 - Kwok, John B A1 - Leber, Markus A1 - Lam, Max A1 - Lee, Teresa A1 - Li, Shuo A1 - Loukola, Anu A1 - Luck, Tobias A1 - Marioni, Riccardo E A1 - Mather, Karen A A1 - Medland, Sarah A1 - Mirza, Saira S A1 - Nalls, Mike A A1 - Nho, Kwangsik A1 - O'Donnell, Adrienne A1 - Oldmeadow, Christopher A1 - Painter, Jodie A1 - Pattie, Alison A1 - Reppermund, Simone A1 - Risacher, Shannon L A1 - Rose, Richard J A1 - Sadashivaiah, Vijay A1 - Scholz, Markus A1 - Satizabal, Claudia L A1 - Schofield, Peter W A1 - Schraut, Katharina E A1 - Scott, Rodney J A1 - Simino, Jeannette A1 - Smith, Albert V A1 - Smith, Jennifer A A1 - Stott, David J A1 - Surakka, Ida A1 - Teumer, Alexander A1 - Thalamuthu, Anbupalam A1 - Trompet, Stella A1 - Turner, Stephen T A1 - van der Lee, Sven J A1 - Villringer, Arno A1 - Völker, Uwe A1 - Wilson, Robert S A1 - Wittfeld, Katharina A1 - Vuoksimaa, Eero A1 - Xia, Rui A1 - Yaffe, Kristine A1 - Yu, Lei A1 - Zare, Habil A1 - Zhao, Wei A1 - Ames, David A1 - Attia, John A1 - Bennett, David A A1 - Brodaty, Henry A1 - Chasman, Daniel I A1 - Goldman, Aaron L A1 - Hayward, Caroline A1 - Ikram, M Arfan A1 - Jukema, J Wouter A1 - Sharon L R Kardia A1 - Lencz, Todd A1 - Loeffler, Markus A1 - Mattay, Venkata S A1 - Palotie, Aarno A1 - Psaty, Bruce M A1 - Ramirez, Alfredo A1 - Ridker, Paul M A1 - Riedel-Heller, Steffi G A1 - Sachdev, Perminder S A1 - Saykin, Andrew J A1 - Scherer, Martin A1 - Schofield, Peter R A1 - Sidney, Stephen A1 - Starr, John M A1 - Trollor, Julian A1 - Ulrich, William A1 - Wagner, Michael A1 - David R Weir A1 - Wilson, James F A1 - Wright, Margaret J A1 - Weinberger, Daniel R A1 - Debette, Stéphanie A1 - Eriksson, Johan G A1 - Mosley, Thomas H A1 - Launer, Lenore J A1 - van Duijn, Cornelia M A1 - Deary, Ian J A1 - Seshadri, Sudha A1 - Räikkönen, Katri KW - Genome KW - health outcomes KW - Memory KW - neurocognitive outcomes KW - polygenic score KW - Verbal Learning AB -

Understanding the genomic basis of memory processes may help in combating neurodegenerative disorders. Hence, we examined the associations of common genetic variants with verbal short-term memory and verbal learning in adults without dementia or stroke (N = 53,637). We identified novel loci in the intronic region of CDH18, and at 13q21 and 3p21.1, as well as an expected signal in the APOE/APOC1/TOMM40 region. These results replicated in an independent sample. Functional and bioinformatic analyses supported many of these loci and further implicated POC1. We showed that polygenic score for verbal learning associated with brain activation in right parieto-occipital region during working memory task. Finally, we showed genetic correlations of these memory traits with several neurocognitive and health outcomes. Our findings suggest a role of several genomic loci in verbal memory processes.

ER - TY - JOUR T1 - Grandparenting, Social Relations, and Mortality in Old Age. JF - Research on Aging Y1 - 2022 A1 - Heejung Jang A1 - Tang, Fengyan A1 - Fusco, Rachel A A1 - Engel, Rafael J A1 - Steven M. Albert KW - Grandparenting KW - Mortality KW - Social networks KW - Social Support AB -

Guided by a convoy model of social relations, this study investigates the relationships between grandparenting status, social relations, and mortality among community-dwelling grandparents age 65 and older who are caring for their grandchildren. The data were drawn from the 2008 and 2016 waves of the Health and Retirement Study ( = 564). Latent class analysis was used to identify the social network structure based on six indicators of interpersonal relationships and activities. A series of hierarchical Weibull hazard models estimated the associations between grandparent caregiving, social relations, and mortality risk. Results of survival analyses indicate that co-parenting and custodial grandparents had higher all-cause mortality risk than grandparents who babysat occasionally; however, for custodial grandparents, the association was not significant once social relation variables were added to the model. This study suggests that community-based support may be beneficial to older grandparents and improved relationship quality is integral to the well-being of older adults.

VL - 44 IS - 3-4 ER - TY - JOUR T1 - Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans JF - The Journal of Strength and Conditioning Research Y1 - 2022 A1 - Klawitter, Lukus A1 - Brenda Vincent A1 - Choi, Bong-Jin A1 - Smith, Joseph A1 - Hammer, Kimberly D. A1 - Donald A Jurivich A1 - Lindsey J Dahl A1 - Ryan P McGrath KW - Chronic disease KW - Exercise KW - Mass Screening KW - Risk Factors KW - sarcopenia AB - Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006–2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength >10% between hands had HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered as weak. Subjects reported the presence of healthcare provider–diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04–1.14) and 1.27 (CI: 1.11–1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29–1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk. VL - 36 IS - 1 ER - TY - JOUR T1 - Handgrip Strength Asymmetry Is Associated With Limitations in Individual Basic Self-Care Tasks. JF - Journal of Applied Gerontology Y1 - 2022 A1 - Mahoney, Sean J A1 - Kyle J Hackney A1 - Donald A Jurivich A1 - Lindsey J Dahl A1 - Johnson, Carol A1 - Ryan P McGrath KW - Activities of Daily Living KW - Disability KW - Frailty KW - self-care AB -

This investigation sought to determine the associations between handgrip strength (HGS) asymmetries and limitations in individual activities of daily living (ADL). The analytic sample included 18,468 participants from the 2006 to 2016 waves of the Health and Retirement Study. Those with HGS >10% stronger on either hand had any HGS asymmetry. Individuals with HGS >10% stronger on their dominant or non-dominant hand had dominant or non-dominant HGS asymmetry, respectively. ADL abilities were self-reported. Those with any HGS asymmetry had 1.21 (95% confidence interval [CI] = [1.01-1.46]) greater odds for a toileting limitation and 1.25 (CI = [1.03-1.52]) greater odds for a transferring limitation. Individuals with dominant HGS asymmetry had 1.24 (CI = [1.01-1.53]) greater odds for a transferring limitation. Those with non-dominant HGS asymmetry had 1.39 (CI = [1.01-1.93]) and 1.44 (CI = [1.05-1.96]) greater odds for a bathing and toileting limitation, respectively. HGS asymmetries could help to identify future limitations in specific ADLs.

VL - 41 IS - 2 ER - TY - JOUR T1 - Health Disparities in Cholesterol Screening Among Older Americans: Longitudinal Analysis of the Health and Retirement Study (2008-2018) JF - Circulation Y1 - 2022 A1 - Wan-Chin Kuo A1 - Serena L Sorensen A1 - Heather M Johnson KW - cholesterol screening KW - Health Disparities KW - race and ethnicity AB - Introduction: Hypercholesterolemia is often asymptomatic and requires cholesterol screening to be identified. Current guidelines recommend adults at low risk for cardiovascular disease (CVD) to receive cholesterol screening at least every 5 years with more frequent screenings in older adults and/or at higher CVD risk. Yet, currently, about 25% of Americans do not meet the every-5-year screening recommendations. While disparities in the prevention and treatment of hypercholesterolemia continue to rise, little is known regarding factors influencing cholesterol screening among older Americans in the past 10 years. Methods: This longitudinal analysis used data from the Health and Retirement Study (HRS). HRS is a nationally representative survey of older adults in the U.S. The current study focused on data collected from 2008 (Wave 9) to 2018 (Wave 14). Participants who passed away by 2019, ever had CVD or stroke, were under age 55 at baseline, had more than 3 waves of missing data in self-reported cholesterol screening, or any missing data in covariates were excluded from the current analysis. In total, 7643 participants were included. Meeting cholesterol screening recommendations was defined as those reporting more than two cholesterol screenings between waves 9-14. Poisson regression and logistic regression were used for data analysis. Results: Compared to Black, Indigenous, and People of Color (BIPOC), White older Americans were more likely to meet cholesterol screening recommendations (odds ratio= 1.60; p<0.001) and reported a higher frequency of cholesterol screening (incidence rate ratio=1.06; p<0.001). The racial differences remained significant after the adjustment of covariates. Non-smokers (p<0.001), females (p=0.022), having private insurance (p<0.001), higher education (p<0.001), higher BMI (p=0.003), having diabetes (p<0.001), and having hypertension (p<0.001) were associated with a higher likelihood of meeting cholesterol screening recommendations. Conclusions: Important disparities in cholesterol screening were identified among racial minorities, smokers, individuals without private insurance, or with lower educational attainment, highlighting important barriers to address in cardiovascular preventive care. VL - 146 IS - Suppl_1 ER - TY - RPRT T1 - How Redistributive Are Public Health Care Schemes? Evidence from Medicare and Medicaid in Old Age Y1 - 2022 A1 - Arapakis, Karolos A1 - Eric French A1 - John Bailey Jones A1 - McCauley, Jeremy KW - Medicaid KW - Medicare KW - public health care KW - Social Security earnings records AB - Most health care for the U.S. population 65 and older is publicly provided through Medicare and Medicaid. Despite the massive expenditures of these systems, little is known about how redistributive they are. Using data from the Health and Retirement Study matched to administrative Medicare, Medicaid, and Social Security earnings records, we estimate the distribution of lifetime Medicare and Medicaid benefits received and the distribution of lifetime taxes paid to finance these benefits. For the cohort who turned 65 between 1999 and 2004, we find that benefits are greater among those with high income, in large part because they live longer. Nonetheless, high-income people pay more in the way of taxes. Middle-income households gain the most from these programs as these people live long yet pay modest taxes. All income groups gain from these programs: This cohort’s lifetime tax contribution did not cover the medical benefits it received. This deficit is paid by younger cohorts. JF - MRDRC Working Paper PB - Michigan Retirement and Disability Research Center, University of Michigan CY - Ann Arbor, MI UR - https://mrdrc.isr.umich.edu/pubs/how-redistributive-are-public-health-care-schemes-evidence-from-medicare-and-medicaid-in-old-age/ ER - TY - JOUR T1 - The importance of chronic conditions for potentially avoidable hospitalizations among non-Hispanic Black and non-Hispanic White older adults in the US: a cross-sectional observational study. JF - BMC Health Services Research Y1 - 2022 A1 - Jørgensen, Terese Sara Høj A1 - Allore, Heather A1 - Elman, Miriam R A1 - Nagel, Corey A1 - Quiñones, Ana R KW - Aged KW - Asthma KW - chronic KW - Chronic Obstructive KW - Heart Failure KW - Hospitalization KW - Humans KW - Medicare KW - Pulmonary Disease KW - Renal Insufficiency AB -

BACKGROUND: Non-Hispanic (NH) Black older adults experience substantially higher rates of potentially avoidable hospitalization compared to NH White older adults. This study explores the top three chronic conditions preceding hospitalization and potentially avoidable hospitalization among NH White and NH Black Medicare beneficiaries in the United States.

METHODS: Data on 4993 individuals (4,420 NH White and 573 NH Black individuals) aged ≥ 65 years from 2014 Medicare claims were linked with sociodemographic data from previous rounds of the Health and Retirement Study. Conditional inference random forests were used to rank the importance of chronic conditions in predicting hospitalization and potentially avoidable hospitalization separately for NH White and NH Black beneficiaries. Multivariable logistic regression with the top three chronic diseases for each outcome adjusted for sociodemographic characteristics were conducted to quantify the associations.

RESULTS: In total, 22.1% of NH White and 24.9% of NH Black beneficiaries had at least one hospitalization during 2014. Among those with hospitalization, 21.3% of NH White and 29.6% of NH Black beneficiaries experienced at least one potentially avoidable hospitalization. For hospitalizations, chronic kidney disease, heart failure, and atrial fibrillation were the top three contributors among NH White beneficiaries and acute myocardial infarction, chronic obstructive pulmonary disease (COPD), and chronic kidney disease were the top three contributors among NH Black beneficiaries. These chronic conditions were associated with increased odds of hospitalization for both groups. For potentially avoidable hospitalizations, asthma, COPD, and heart failure were the top three contributors among NH White beneficiaries and fibromyalgia/chronic pain/fatigue, COPD, and asthma were the top three contributors among NH Black beneficiaries. COPD and heart failure were associated with increased odds of potentially avoidable hospitalization among NH White beneficiaries, whereas only COPD was associated with increased odds of potentially avoidable hospitalizations among NH Black beneficiaries.

CONCLUSION: Having at least one hospitalization and at least one potentially avoidable hospitalization was more prevalent among NH Black than NH White Medicare beneficiaries. This suggests greater opportunity for increasing prevention efforts among NH Black beneficiaries. The importance of COPD for potentially avoidable hospitalizations further highlights the need to focus on prevention of exacerbations for patients with COPD, possibly through greater access to primary care and continuity of care.

VL - 22 IS - 1 ER - TY - JOUR T1 - Insomnia symptoms are associated with an increased risk of type 2 diabetes mellitus among adults aged 50 and older. JF - Sleep and Breathing Y1 - 2022 A1 - Yao, Wenqin A1 - Luo, Jia A1 - Yu, Xiaohui A1 - Jiang, Wenjie A1 - Zhang, Dongfeng KW - Competing risk model KW - Cox proportional hazard model KW - insomnia symptoms KW - type 2 diabetes mellitus AB -

PURPOSE: To evaluate the association of the different degrees of insomnia symptoms with subsequent incidence of type 2 diabetes mellitus (T2DM).

METHODS: The data were extracted from Health and Retirement Study 2006-2014 waves. The association of insomnia symptoms with T2DM incidence was evaluated by the competing risk model with cumulative incidence function (death was considered a competing event) and Cox proportional hazard model with the Kaplan-Meier method. Population attributable fraction (PAF) was calculated. All analyses related to our study were conducted between November 2020 and January 2021.

RESULTS: A total of 14,112 patients were included in this study, with an average follow-up of 6.4 years, and the incidence density was 17.9 per 1000 person-years. Insomnia symptoms were positively associated with T2DM incidence compared with those with no insomnia symptoms, regardless of competing risk model (≥ 1 symptoms: sub-distribution hazard ratio (SHR) 1.13; 95% confidence interval (CI) 1.02-1.26; P-trend = 0.012) and Cox proportional hazard model (≥ 1 symptoms: hazard ratio (HR) 1.13; 95% CI 1.02-1.26; P-trend = 0.013). The cumulative incidence function (Gray's test, p < 0.001) and Kaplan-Meier estimate (log-rank test, p < 0.001) also presented this positive relationship. This positive association was more apparent in women and participants with ages from 50 to 65 years. The PAF was 4.1% with 95% CI (0.7-7.9%).

CONCLUSIONS: Insomnia symptoms may be an important risk factor for the development of T2DM, which is unbiased by the death competing risk. These findings suggest that management of sleep problems may be an important part of strategies to prevent T2DM.

VL - 26 IS - 3 ER - TY - JOUR T1 - The Intersecting Consequences of Race-Gender Health Disparities on Workforce Engagement for Older Workers: An Examination of Physical and Mental Health JF - Social Currents Y1 - 2022 A1 - Kendra Jason A1 - Christy L Erving KW - Aging and the life course KW - gender KW - Health Disparities KW - Labor KW - Occupations KW - organizations KW - race AB - The dramatic growth of older adults’ labor participation over the past 25 years, including women and people of color, is reshaping the American labor force. The current study contributes new knowledge concerning why individuals over age 50 years may be working longer despite negative impacts of deteriorating physical and mental health associated with aging. Inquiries regarding who continues to work and why can be answered, in part, by addressing how workforce engagement and health are shaped by notable social inequities along the dimensions of age, race, and gender. Guided by cumulative advantage/disadvantage and intersectionality frameworks, we examine whether having multiple chronic conditions (MCC)—two or more physical conditions—and depression affect workforce participation. Using multinomial logistic regression models, we analyze the 2014–2016 waves of the Health and Retirement Study (N = 4250). Findings reveal that having multiple chronic illnesses increase the likelihood of labor force exit, especially among workers who also have depression. We also discover intersectional nuances which illuminate complex race-gender dynamics related to health and work processes in later life. We conclude with recommendations for workplace policy that promote the retention of older workers with chronic illness and depression and aim to decrease disparities in older workers’ work engagement. VL - 9 IS - 1 ER - TY - JOUR T1 - Linear linking for related traits (LLRT): A novel method for the harmonization of cognitive domains with no or few common items. JF - Methods Y1 - 2022 A1 - Nichols, Emma L A1 - Cadar, Dorina A1 - Lee, Jinkook A1 - Richard N Jones A1 - Gross, Alden L KW - Cognition KW - HCAP KW - Research Design AB -

Harmonization means to make data comparable. Recent efforts to generate comparable data on cognitive performance of older adults from many different countries around the world have presented challenges for direct comparison. Neuropsychological instruments vary in many respects, including language, administration techniques and cultural differences, which all present important obstacles to assumptions regarding the presence of linking items. Item response theory (IRT) methods have been previously used to harmonize cross-national data on cognition, but these methods rely on linking items to establish the shared metric. We introduce an alternative approach for linking cognitive performance across two (or more) groups when the fielded assessments contain no items that can be reasonably considered linking items: Linear Linking for Related Traits (LLRT). We demonstrate this methodological approach in a sample from a single United States study split by educational attainment, and in two sets of cross-national comparisons (United States to England, and United States to India). All data were collected as part of the Harmonized Cognitive Assessment Protocol (HCAP) and are publicly available. Our method relies upon strong assumptions, and we offer suggestions for how the method can be extended to relax those assumptions in future work.

VL - 204 ER - TY - JOUR T1 - Loneliness, age at immigration, family relationships, and depression among older immigrants: A moderated relationship JF - Journal of Social and Personal Relationships Y1 - 2022 A1 - Heejung Jang A1 - Tang, Fengyan KW - age at immigration KW - depression KW - family relationships KW - Loneliness KW - Migration AB - Guided by a convoy model of social relations, this study explores the complex relationships between loneliness, age at immigration, familial relationships, and depressive symptoms among older immigrants. This study used 2010 Health and Retirement Study data from a sample of 575 immigrants (52% female, age range 65-99 years). Ordinary least squares regression models were estimated. The findings indicate that for older immigrants who came to the United States at age 45 or older, loneliness was significantly positively associated with depressive symptoms. Further, perceived negative strain and hours spent helping family moderated this relationship such that the effect of loneliness on depressive symptoms was stronger among respondents who perceived more negative family strain and spent fewer hours helping family. Familial relationships are crucial for the psychological well-being of older immigrants because they can be a source of either stress or support. The results have implications for how research and practices can support the immigrant families. VL - 39 SN - 0265-4075 IS - 6 ER - TY - JOUR T1 - Long-Term Evolution of Functional Limitations in Stroke Survivors Compared With Stroke-Free Controls: Findings From 15 Years of Follow-Up Across 3 International Surveys of Aging. JF - Stroke Y1 - 2022 A1 - Gil-Salcedo, Andres A1 - Aline Dugravot A1 - Fayosse, Aurore A1 - Jacob, Louis A1 - Mikaela Bloomberg A1 - Séverine Sabia A1 - Schnitzler, Alexis KW - Body Mass Index KW - Comorbidity KW - Health Behavior KW - Prognosis KW - Survivors AB -

BACKGROUND AND PURPOSE: In the chronic phase 2 to 5 years poststroke, limitations in activities of daily living (ADL) and instrumental ADL (IADL) initially plateau before steady increasing. However, the impact of age and differences in initial levels of disability on the evolution of these limitations remains unclear. As such, this study aims to evaluate differences in long-term evolution of ADL/IADL limitations between stroke survivors and stroke-free population, and how limitations differ by initial level of disability for stroke survivors.

METHODS: Thirty-three thousand six hundred sixty participants (5610 first-ever stroke cases with no recurrence during follow-up and 28 050 stroke-free controls) aged ≥50 from the Health and Retirement Study, Survey of Health, Ageing and Retirement in Europe, and English Longitudinal Study of Ageing were assessed for number of ADL/IADL limitations during the poststroke chronic phase (for cases) and over follow-up years 1996 to 2018 (for controls). Three thousand seven hundred eighteen stroke cases were additionally categorized by disability level using the modified Rankin Scale score of 1 to 2 years poststroke. Evolution of ADL/IADL limitations was assessed in stroke cases and controls and by modified Rankin Scale score (0-1, 2-3, 4-5) using linear mixed models. Models were stratified by age group (50-74 and ≥75 years) and adjusted for baseline characteristics, health behaviors, BMI, and comorbidities.

RESULTS: Findings showed relative stability of ADL/IADL limitations during 3 to 6 years poststroke followed by an increase for both populations, which was faster for younger stroke cases, suggesting a differential age-effect (<0.001). Disability level at 1 to 2 years poststroke influenced the evolution of limitations over time, especially for severe disability (modified Rankin Scale score, 4-5) associated with a reduction in limitations at 5 to 6 years poststroke.

CONCLUSIONS: Our findings showed that during the poststroke chronic phase functional limitations first plateau and then increase and the evolution differs by disability severity. These results highlight the importance of adaptive long-term health and social care measures for stroke survivors.

VL - 53 IS - 1 ER - TY - JOUR T1 - Long-term functional outcomes and mortality after hospitalization for extracranial hemorrhage JF - Journal of Hospital Medicine Y1 - 2022 A1 - Parks, Anna L. A1 - Jeon, Sun Y. A1 - Boscardin, W. John A1 - Steinman, Michael A. A1 - Smith, Alexander K. A1 - Covinsky, Kenneth E. A1 - Fang, Margaret C. A1 - Shah, Sachin J. KW - extracranial hemorrhage KW - functional independence KW - Hospitalization KW - Mortality KW - Survival AB - Background The effects of extracranial hemorrhage (ECH), or bleeding outside the brain, are often considered transient. Yet, there are few data on the long-term and functional consequences of ECH. Objective Define the association of ECH hospitalization with functional independence and survival in a nationally representative cohort of older adults. Design Longitudinal cohort study. Settings and Participants Data from the Health and Retirement Study from 1995 to 2016, a nationally representative, biennial survey of older adults. Adults aged 66 and above with Medicare linkage and at least 12 months of continuous Medicare Part A and B enrollment. Intervention Hospitalization for ECH. Main Outcomes and Measures Adjusted odds ratios and predicted likelihood of independence in all activities of daily living (ADLs), independence in all instrumental activities of daily living (IADLs) and extended nursing home stay. Adjusted hazard ratio and predicted likelihood for survival. Results In a cohort of 6719 subjects (mean age 77, 59% women) with average follow-up time of 8.3 years (55,767 person-years), 736 (11%) were hospitalized for ECH. ECH was associated with a 15% increase in ADL disability, 15% increase in IADL disability, 8% increase in nursing home stays, and 4% increase in mortality. After ECH, subjects became disabled and died at the same annual rate as pre-ECH but never recovered to pre-ECH levels of function. In conclusion, hospitalization for ECH was associated with significant and durable declines in independence and survival. Clinical and research efforts should incorporate the long-term harms of ECH into decision-making and strategies to mitigate these effects. VL - 17 IS - 4 ER - TY - JOUR T1 - A Matched Cohort Analysis for Examining the Association Between Slow Gait Speed and Shortened Longevity in Older Americans JF - Journal of Applied Gerontology Y1 - 2022 A1 - McGrath, Brenda M A1 - Johnson, Pamela Jo A1 - McGrath, Ryan A1 - Cawthon, Peggy M A1 - Klawitter, Lukus A1 - Choi, Bong-Jin KW - Aging KW - Epidemiology KW - Geriatric Assessment KW - Physical Functional Performance KW - walk test AB -

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.

VL - 41 IS - 8 ER - TY - JOUR T1 - Music Engagement and Episodic Memory among Middle-Aged and Older Adults: A National Cross-Sectional Analysis. JF - The Journals of Gerontology: Series B Y1 - 2022 A1 - Rouse, Hillary J A1 - Jin, Ying A1 - Hueluer, Gizem A1 - Huo, Meng A1 - Bugos, Jennifer A A1 - Veal, Britney A1 - Torres, Mia A1 - Peterson, Lindsay A1 - Dobbs, Debra A1 - Meng, Hongdao KW - age norms KW - healthcare policy KW - lifestyle KW - Memory KW - Music KW - regression methods AB -

OBJECTIVES: To determine whether music engagement influences middle-aged and older adults' 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.

VL - 77 IS - 3 ER - TY - JOUR T1 - Out-of-pocket health expenditures and healthcare services use among older Americans with cognitive impairment: Results from the 2008-2016 Health and Retirement Study. JF - The Gerontologist Y1 - 2022 A1 - Jenkins, Derek A1 - Stickel, Ariana A1 - Hector M González A1 - Wassim Tarraf KW - cognitive aging KW - Dementia KW - Health services use KW - Out-of-pocket spending AB -

BACKGROUND AND OBJECTIVES: The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how change in cognitive impairment status influences nursing-home use, hospitalizations, and out-of-pocket expenditures (OOP).

RESEARCH DESIGN AND METHODS: We use prospective data from the Health and Retirement Study (2007/08-2015/16) on adults 70-years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (Unweighted N=1,692) to fit two-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing-home use, hospitalizations, and OOP.

RESULTS: Over 8-years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use that were particularly pronounced among those that transitioned or died during follow-up, and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval=832;1,479]), maintainers ($1,145 [993;1,296]), and transitioners ($1,385 [1,041;1,730]). Individuals that died during follow-up spent $2,529 [2,101;2,957]. By the 8th year of follow-up, spending among reverters increased to $1,402 [869;1,934], and $2,188 [1,402;2,974], and $8,988 [5,820;12,157] for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 [4,345;11,094]. Estimates were only partly attenuated through adjustment to covariables.

DISCUSSION AND IMPLICATIONS: A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.

VL - 62 IS - 6 ER - TY - JOUR T1 - Patterns of Limitation in Physical Function in Late Midlife Associated with Late-Onset Alzheimer's Disease and Related Dementias: A Cluster Analysis. JF - Journal Of Alzheimers Disease Y1 - 2022 A1 - Bardenheier, Barbara Helen A1 - Resnik, Linda J A1 - Jutkowitz, Eric A1 - Gravenstein, Stefan KW - Alzheimer disease KW - Cluster Analysis KW - Dementia KW - Risk Factors AB -

BACKGROUND: To reduce the increasing societal and financial burden of Alzheimer's disease and related dementias (ADRD), prevention is critical. Even small improvements of the modifiable dementia risk factors on the individual level have the potential to lead to a substantial reduction of dementia cases at the population level.

OBJECTIVE: To determine if pattern(s) of functional decline in midlife associate with late-onset ADRD years later.

METHODS: Using a longitudinal study of adults aged 51-59 years in 1998 without symptoms of ADRD by 2002 and followed them from 2002 to 2016 (n = 5404). The outcome was incident ADRD identified by the Lange-Weir algorithm, death, or alive with no ADRD. We used cluster analysis to identify patterns of functional impairment at baseline and multinomial regression to assess their association with future ADRD.

RESULTS: Three groups of adults with differing patterns of functional impairment were at greater risk of future ADRD. Difficulty with climbing one flight of stairs was observed in all adults in two of these groups. In the third group, 100% had difficulty with lifting 10 pounds and pushing or pulling a large object, but only one-fourth had difficulty in climbing stairs.

CONCLUSION: Results imply that improved large muscle strength could decrease future risk of ADRD. If confirmed in other studies, screening for four self-reported measures of function among adults in midlife may be used for targeted interventions.

VL - 89 IS - 4 ER - TY - JOUR T1 - Persistent Depressive Symptoms and the Changes in Serum Cystatin C Levels in the Elderly: A Longitudinal Cohort Study. JF - Frontiers in Psychiatry Y1 - 2022 A1 - Han, Tiandong A1 - Zhang, Li A1 - Jiang, Weixing A1 - Wang, Lei KW - persistent depressive symptoms KW - renal function KW - serum cystatin C AB -

Background: The burden of depression in the elderly is increasing worldwide with global aging. However, there is still a lack of research on the relationship between depressive symptoms and the progression of renal function. Our aim is to evaluate the longitudinal association between baseline depressive symptoms and the changes in serum cystatin C levels over 10 years' follow-up period.

Methods: We used longitudinal data from the Health and Retirement Study (HRS), an existing community based nationally representative aging cohort study which enrolled individuals over age 50 in the USA. Depressive symptoms were determined using an eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD) at wave 7 (2004) and wave 8 (2006). Persistent depressive symptoms were defined as both CESD scores measured at waves 7 and 8 were ≥3; episodic depressive symptoms were defined as CESD scores ≥3 at wave 7 or wave 8. A linear mixed model was used to evaluate the correlation between baseline depressive symptoms and future changes in cystatin C levels.

Results: The mean age of the 7,642 participants was 63.8 ± 10.8 years, and 60.9% were women. Among the participants, 1,240 (16.2%) had episodic depressive symptoms and 778 (10.2%) had persistent depressive symptoms. Compared with participants with no depressive symptoms at both waves, a significant increase in serum cystatin C levels was found among those with persistent depressive symptoms.

Conclusions: Our results showed that baseline persistent depressive symptoms were significantly associated with an increased rate of serum cystatin C levels. The level of serum cystatin C should be monitored in the elderly with persistent depressive symptoms.

VL - 13 ER - TY - JOUR T1 - PLACE OF DEATH AND CARE SATISFACTION AMONG THE HEALTH AND RETIREMENT STUDY DECEDENTS JF - Innovation in Aging Y1 - 2022 A1 - Malatyali, Ayse A1 - Rahemi, Zahra A1 - Cidav, Tom A1 - Dye, Cheryl A1 - Jarrin, Olga A1 - McMahan, Christopher KW - cognitive impairment KW - End of life care KW - place of death AB - The place of care at the time of death can influence the satisfaction, type, and cost of end-of-life care. This study investigated factors associated with place of death among older adults in the Health and Retirement Study (Exit files 2002-2018) with cognitive impairment (n=3,102). Black and Hispanic participants were more likely to die in the hospital (OR=1.80, 1.47) and less likely to die in a nursing home (OR=0.54, 0.37) than white and non-Hispanic participants. Hispanic participants were also 50% more likely to die at home than non-Hispanics. Compared to other places, participants who died at home were 43% more satisfied, and participants who died at nursing homes were 32% less satisfied with the care they received. There was no significant effect of ethnicity on the relationship between place of death and satisfaction with care. Investigating the moderating role of other demographic factors can shed more light on this relationship. VL - 6 IS - Suppl 1 ER - TY - JOUR T1 - Postoperative Functional Health Status in Older Adults Undergoing Minor Surgery: An Observational Study JF - Journal of the American College of Surgeons Y1 - 2022 A1 - Dharmasukrit, Charlie A1 - Shinall, Myrick Clements A1 - Jeon, Sun Young A1 - John Boscardin A1 - Tang, Victoria KW - minor surgery KW - postoperative function AB - Introduction: Postoperative function is an important patient-centered outcome in older adults. While functional decline is likely in older adults undergoing major surgery, less is known about the functional outcomes of older adults undergoing minor surgery. We aimed to describe the long-term functional outcomes after minor surgery and to examine geriatric-specific risk factors associated with these outcomes. Methods: We identified subjects who underwent minor surgery while enrolled in the nationally representative Health and Retirement Study (HRS) between 1995-2017 using linked Medicare claims. Using preoperative and postoperative (≥ 6 months) interviews, logistic regression was used to determine risk factors of decline in activities in daily living (ADL) and walking. Results: Of the 9640 subjects who met inclusion criteria, 45.5% were age 75+ years at the time of surgery and 55.6% female. 2056 subjects (21.3%) experienced a decline in ADL ability, including death. Decline in ADL was more likely for those who were of advanced age (>75 years), non-married, had impaired cognition or dementia, income less than the median, high comorbidity burden, a history of falls, and impaired cognitive strength (P < 0.01 for all comparisons). These factors were also significant for decline in walking ability. Conclusion: Over 21% of the cohort experienced a decline in functional status (in ADL or walking) or death before their postoperative interview. Preoperative counseling, including anticipatory guidance for postoperative functional decline, should occur with older adult patients undergoing minor surgery. VL - 235 IS - 5 ER - TY - JOUR T1 - The quality of relationships with adult children and depressive symptoms among grandparents. JF - Aging and Mental Health Y1 - 2022 A1 - Heejung Jang A1 - Rauktis, Mary E A1 - Tang, Fengyan KW - Depressive symptoms KW - Grandparenting KW - intergenerational relationships AB -

The present study aims to identify distinct types of relationships between grandparents and their adult children, measure the associations between these relationship types and depressive symptoms among grandparents, and determine whether these associations vary by grandparent status.This study uses data from a sample of 1,196 grandparents age 51 and older from the 2014 Health and Retirement Study. Latent class analysis (LCA) is applied and identifies types of grandparent-adult children relationships. Ordinary Least Squares (OLS) regression models are used to estimate the association between relationship types and depressive symptoms by grandparent status. LCA identified four grandparent-adult children relationship types: amicable, ambivalent, detached, and disharmonious. Custodial and co-parenting grandparents were most likely to report having an ambivalent relationship with their adult children. Among co-parenting and custodial grandparents, disharmonious relationships were associated with more depressive symptoms. Interventions are suggested to improve emotional relationships with adult children and dyadic family relationships among grandparent families.

ER - TY - JOUR T1 - Quality of survey responses at older ages predicts cognitive decline and mortality risk JF - Innovation in Aging Y1 - 2022 A1 - Stefan Schneider A1 - Junghaenel, Doerte U. A1 - Erik Meijer A1 - Elizabeth Zelinski A1 - Jin, Haomiao A1 - Lee, Pey-Jiuan A1 - Arthur A. Stone KW - Aging KW - Careless responding KW - Cognitive Ability KW - self-report KW - Survey satisficing AB - Background and Objectives It is widely recognized that survey satisficing, inattentive, or careless responding in questionnaires reduces the quality of self-report data. In this study, we propose that such low-quality responding (LQR) can carry substantive meaning at older ages. Completing questionnaires is a cognitively demanding task and LQR among older adults may reflect early signals of cognitive deficits and pathological aging. We hypothesized that older people displaying greater LQR would show faster cognitive decline and greater mortality risk. Research Design and Methods We analyzed data from 9,288 adults 65 years or older in the Health and Retirement Study. Indicators of LQR were derived from participants’ response patterns in 102 psychosocial questionnaire items administered in 2006-2008. Latent growth models examined whether LQR predicted initial status and change in cognitive functioning, assessed with the modified Telephone Interview for Cognitive Status, over the subsequent 10 years. Discrete-time survival models examined whether LQR was associated with mortality risk over the 10 years. We also examined evidence for indirect (mediated) effects in which LQR predicts mortality via cognitive trajectories. Results After adjusting for age, gender, race, marital status, education, health conditions, smoking status, physical activity, and depressive symptoms, greater LQR was cross-sectionally associated with poorer cognitive functioning, and prospectively associated with faster cognitive decline over the follow-up period. Furthermore, greater LQR was associated with increased mortality risk during follow-up, and this effect was partially accounted for by the associations between LQR and cognitive functioning. Discussion and Implications Self-report questionnaires are not formally designed as cognitive tasks but this study shows that LQR indicators derived from self-report measures provide objective, performance-based information about individuals’ cognitive functioning and survival. Self-report surveys are ubiquitous in social science, and indicators of LQR may be of broad relevance as predictors of cognitive and health trajectories in older people. VL - 6 IS - 3 ER - TY - JOUR T1 - Racial and ethnic differences in cognitive health appraisals: a comparison of non-Hispanic White, non-Hispanic Black, and Hispanic older adults. JF - Aging & Mental Health Y1 - 2022 A1 - Yuri Jang A1 - Choi, E Y A1 - Franco, Y A1 - Park, N S A1 - Chiriboga, D A A1 - Kim, M T KW - cognitive aging KW - HCAP KW - Hispanics; depressive symptoms KW - non-Hispanic Blacks KW - older racial/ethnic minorities KW - self-rated cognitive health AB -

OBJECTIVES: To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables.

METHOD: The sample ( = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016-2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE).

RESULTS: The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed.

CONCLUSION: Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.

VL - 26 IS - 3 ER - TY - JOUR T1 - RACIAL AND ETHNIC VARIATIONS IN DEMENTIA DIAGNOSIS, SURVIVAL, AND END-OF-LIFE CARE QUALITY JF - Innovation in Aging Y1 - 2022 A1 - Jarrin, Olga A1 - Rahemi, Zahra A1 - Gusmano, Michael KW - dementia diagnosis KW - End of life care KW - Race/ethnicity AB - In the United States most adults have a preference to die at home and is an indicator of good end-of-life care. In the context of dementia, family members and caregivers are decision makers and part of good and equitable care involves understanding cultural variation in attitudes and social norms related to dementia, death and dying, and the meaning of a good death. This symposium explores racial and ethnic variation in lifetime dementia diagnosis and end-of-life care quality indicators. The first presentation examines racial, ethnic, and geographic variation in the rarely discussed lifetime prevalence of dementia and survival time from dementia diagnosis to death using national Medicare data. The second presentation describes the relationship between end-of-life care planning and satisfaction with end-of-life care using data from the Health and Retirement Study. The third presentation describes variation in place of death, a key indicator of end-of-life care quality, by dementia diagnosis and race/ethnicity using national Medicare data. The fourth presentation examines variation in hospice use, another indicator of end-of-life-care quality, and place of death by dementia diagnosis, race, and ethnicity using national Medicare data. The symposium concludes with a presentation examining the relationship between place of death and satisfaction with care received using data from the Health and Retirement Study. The Institute for Healthcare Improvement’s Triple Aim (improving the experience of care, improving the health of populations, and reducing per capita costs of health care) serves as a lens for discussing policy and practice implications of the major findings from each presentation. VL - 6 IS - Suppl 1 ER - TY - JOUR T1 - Racial/Ethnic Differences in Correspondence between Subjective Cognitive Ratings and Cognitive Impairment JF - The American Journal of Geriatric Psychiatry Y1 - 2022 A1 - Yuri Jang A1 - William E. Haley A1 - Eun-Young Choi A1 - Yujin Franco KW - cognitive impairment KW - Dementia KW - Racial and ethnic minorities KW - Self-rated cognition AB - Objectives : Responding to racial/ethnic disparities in dementia diagnosis and care, we examined the role of race/ethnicity in the correspondence between subjective and objective ratings of cognitive impairment. Our examination focused on the two types of discordance: (1) positive ratings in the presence of cognitive impairment and (2) negative ratings in the absence of cognitive impairment. Design and Participants : A cross-sectional assessment was conducted using the data from the Harmonized Cognitive Assessment Protocol (HCAP) project, a sub-study of the Health and Retirement Study (HRS). Our analytic sample included 3,096 participants: 2,257 non-Hispanic Whites, 498 Blacks, and 341 Hispanics. Measurements : Discordant groups were identified based on self-ratings of cognition (positive vs. negative) and the Langa–Weir classification of cognitive impairment (normal vs. impaired). Results : Blacks and Hispanics were more prone to falsely positive perceptions of their cognitive function in the presence of cognitive impairment than non-Hispanic Whites. On the other hand, non-Hispanic Whites were more likely to manifest negative ratings even in the absence of cognitive impairment. Conclusions : Our findings demonstrate the critical role of race/ethnicity in determining discordance between subjective and objective measures of cognition and highlight the importance of a tailored effort to promote dementia diagnosis and care. VL - 30 IS - 5 ER - TY - JOUR T1 - Revisiting the Effect of Retirement on Cognition: Heterogeneity and Endowment JF - The Journal of the Economics of Ageing Y1 - 2022 A1 - Dawoon Jung A1 - Jinkook Lee A1 - Erik Meijer KW - Cognition KW - genetic risk score KW - O*NET KW - Occupation KW - Retirement AB - Since the seminal paper of Rohwedder and Willis (2010), the effect of retirement on cognition has drawn significant research interest from economists. Especially with ongoing policy discussions about public pension reforms and the increasing burden of dementia, it is indisputably an important research question with significant policy implications. Building on this growing literature, our paper makes two important contributions. First, we explicitly consider cognitive demands of jobs in studying hetereogeneity of the retirement effect. As the primary explanation for the potential adverse effect of retirement is that cognition is better maintained through mental exercise (Salthouse, 2006), by investigating the cognitive demands of the job one retires from we can directly test the hypothesized relationship. Second, we avoid biases associated with omitted variables, particularly by controlling for endowed cognitive ability. While endowed, genetic differences in cognitive ability is an important omitted variable that can explain individual differences in cognitive performance as well as selection into a particular type of job, this inherited characteristic has not been controlled for in the prior literature. Taking advantage of the polygenic risk score of cognition (Davies et al., 2015), we control for individual differences in genetic endowments in estimating the effect of retirement on cognition. We find supporting evidence for differential effects of retirement by cognitive demands of jobs after controlling for innate differences in cognition and educational attainment. VL - 21 ER - TY - JOUR T1 - The role of smoking history in longitudinal changes in C-reactive protein between Black and White older adults in the US JF - Preventive Medicine Reports Y1 - 2022 A1 - Nancy C. Jao A1 - Aresha Martinez-Cardoso A1 - Moin Vahora A1 - Marcia M. Tan KW - African Americans KW - C-reactive protein KW - Smoking AB - Smoking cessation is associated with decreases in C-reactive protein (CRP), a biomarker of systemic inflammation and cancer risk; yet CRP levels remain higher long-term in individuals who quit vs. those who never smoked. While non-Hispanic, Black/African American (NHB) have higher levels of CRP vs. non-Hispanic, White/Caucasian (NHW) adults, the association between CRP and race has not been examined in individuals with smoking history. Utilizing longitudinal data from the Health and Retirement Study (HRS), the current study examined the effects of race and smoking history on CRP in older adults. NHB (n = 242) and NHW (n = 1529) participants completed HRS assessments in 2006, 2010, and 2014. Dried blood spots collected at each wave were assayed for CRP. Linear mixed models were used to examine the effect of race and smoking history on CRP across waves – controlling for sociodemographics, physical activity, body mass index (BMI), and current smoking. Overall, results showed no significant effects of race or current smoking on CRP; rather age, sex, education, BMI, physical activity, smoking history, and time × race predicted CRP (ps<.04). However, while age, sex, education, BMI, physical activity, and smoking history were also predictive of CRP in NHWs (ps<.04) in race-stratified models, only BMI was a significant predictor of CRP in NHBs (p=.012). BMI may be important in explaining inflammation-related disease risk in NHBs with a history of smoking. NHBs may not experience the same reductions in CRP with smoking cessation as NHWs – potentially contributing to tobacco-related health disparities. VL - 28 ER - TY - JOUR T1 - Self-reported measures of limitation in physical function in late midlife are associated with incident Alzheimer's disease and related dementias. JF - Aging Clinical and Experimental Research Y1 - 2022 A1 - Bardenheier, Barbara H A1 - Resnik, Linda A1 - Jutkowitz, Eric A1 - Gravenstein, Stefan KW - ADRD KW - Late midlife KW - Physical function limitation AB -

BACKGROUND: Even small improvements in modifiable Alzheimer's disease and related dementias (ADRD) risk factors could lead to a substantial reduction of dementia cases.

AIMS: To determine if self-reported functional limitation associates with ADRD symptoms 4-18 years later.

METHODS: We conducted a prospective longitudinal study using the Health and Retirement Study of adults aged 51-59 years in 1998 without symptoms of ADRD by 2002 and followed them to 2016. Main exposure variables were difficulty with activities of daily living, mobility, large muscle strength, gross motor and upper limb activities. The outcome was incident ADRD identified by the Lange-Weir algorithm, death, or alive without ADRD. We fit two GEE multinomial models for each measure: (1) baseline measure of function and (2) change in function over time.

RESULTS: In the model with baseline only and outcome, only difficulty with mobility associated with future ADRD across levels of difficulty with near dose-response effect (risk ratios (RR) difficulty with 1-5 functions respectively, compared with no difficulty: 1.82; 2.70; 1.73 2.81; 4.03). Mobility also significantly associated with ADRD when allowing for change over time among those with 3, 4 or 5 versus no mobility limitations (RR 1.76; 2.36; 2.37).

DISCUSSION: The results infer that an adult in midlife reporting difficulty with mobility as well as those with no mobility limitations in midlife but who later report severe limitations may be at increased risk of incident ADRD.

CONCLUSIONS: Self-reported measures of mobility limitation may be early indicators of ADRD and may be useful for public health planning.

VL - 34 IS - 8 ER - TY - JOUR T1 - Sex differences in post-stroke cognitive decline: A population-based longitudinal study of nationally representative data. JF - PLoS One Y1 - 2022 A1 - Bako, Abdulaziz T A1 - Potter, Thomas A1 - Tannous, Jonika A1 - Pan, Alan P A1 - Johnson, Carnayla A1 - Baig, Eman A1 - Downer, Brian A1 - Vahidy, Farhaan S KW - Cognition KW - Cognitive Dysfunction KW - Female KW - Male KW - Sex Characteristics KW - Stroke AB -

BACKGROUND: Sex differences in post-stroke cognitive decline have not been systematically evaluated in a nationally representative cohort. We use a quasi-experimental design to investigate sex differences in rate of post-stroke cognitive decline.

METHODS: Utilizing the event study design, we use the Health and Retirement Study (HRS) data (1996-2016) to evaluate the differences (percentage points [95% Confidence interval]) in the rate of change in cognitive function, measured using the modified version of the Telephone Interview for Cognitive Status (TICS-m) score, before and after incident stroke, and among patients with and without incident stroke. We estimated this event study model for the overall study population and separately fit the same model for male and female participants.

RESULTS: Of 25,872 HRS participants included in our study, 14,459 (55.9%) were females with an overall mean age (SD) of 61.2 (9.3) years. Overall, 2,911 (11.3%) participants reported experiencing incident stroke. Participants with incident stroke (vs. no stroke) had lower baseline TICS-m score (15.6 vs. 16.1). Among participants with incident stroke, the mean pre-stroke TICS-m score was higher than the mean post-stroke TICS-m score (14.9 vs. 12.7). Event study revealed a significant short-term acceleration of cognitive decline for the overall population (4.2 [1.7-6.6] percentage points, p value = 0.001) and among female participants (5.0 [1.7-8.3] percentage points, p value = 0.003). We, however, found no evidence of long-term acceleration of cognitive decline after stroke. Moreover, among males, incident stroke was not associated with significant changes in rate of post-stroke cognitive decline.

CONCLUSION: Females, in contrast to males, experience post-stroke cognitive deficits, particularly during early post-stroke period. Identifying the sex-specific stroke characteristics contributing to differences in post stroke cognitive decline may inform future strategies for reducing the burden of post-stroke cognitive impairment and dementia.

VL - 17 IS - 5 ER - TY - JOUR T1 - Sleep Disorders as a Potential Risk Factor for Dementia in Elderly Adults JF - Sleep Y1 - 2022 A1 - Kuhler, Cassandra A1 - Wills, Chloe A1 - Tubbs, Andrew A1 - Seixas, Azizi A1 - Turner, Arlener A1 - Jean-Louis, Girardin A1 - Killgore, William A1 - Grandner, Michael KW - Alzheimer disease KW - Comorbidity KW - Dementia KW - depressive disorders KW - Early Diagnosis KW - ethnic group KW - Health Personnel KW - insomnia KW - memory impairment KW - sleep disorders AB - Introduction Sleep disorders such as insomnia are seen in the early onset of Alzheimer’s disease, the most common form of dementia. Simultaneously, sleep disorders may indicate increased risk for the development of dementia. Due to the rate of comorbidity of these two conditions seen in the elderly population, the relationship between dementia and sleep disorders is a topic of interest for researchers. A bidirectional correlation between the two could have important implications in the clinical field exploring factors that lead to dementia Methods Data was assessed from 17,146 older adults from the 2018 Health and Retirement Survey. Participants were surveyed using questionnaires regarding both incident dementia or serious memory impairment in the past 2 years and the presence of a sleep disorder, as diagnosed by a doctor or health professional. Those who reported no dementia in the previous wave (N=16,547) were asked if they had been diagnosed since they were last asked. N=185 individuals reported incident dementia in the 2-years between assessments. Responses were coded to either “Yes” or “No”. A Poisson regression analysis was conducted to explore the relationship between incident dementia and sleep disorders. Results In a sample of older adults, unadjusted results indicate that having a sleep disorder was associated with a 0.6% increased risk of new onset dementia (PRR=1.006; 95%CI[1.001,1.012]; p=0.026). These results were sustained when adjusted for sex, age, race, ethnicity, and depression (PRR=1.006; 95%CI[1.001,1.012]; p=0.013). Conclusion Chronic sleep disturbances may be a factor used to indicate increased risk for dementia and help with early detection of the disease. These results demonstrate the value of sleep disorders screening among those at risk for dementia. Further research is needed to clarify these findings (e.g., explore specific sleep disorders) and expand the follow-up window (i.e., beyond 2 years). VL - 45 IS - Suppl _1 ER - TY - JOUR T1 - State-level metabolic comorbidity prevalence and control among adults age 50-plus with diabetes: estimates from electronic health records and survey data in five states. JF - Population Health Metrics Y1 - 2022 A1 - Mardon, Russell A1 - Campione, Joanne A1 - Nooney, Jennifer A1 - Merrill, Lori A1 - Johnson, Maurice A1 - Marker, David A1 - Jenkins, Frank A1 - Saydah, Sharon A1 - Rolka, Deborah A1 - Zhang, Xuanping A1 - Shrestha, Sundar A1 - Gregg, Edward KW - Comorbidity KW - Diabetes Mellitus KW - Electronic Health Records KW - Prevalence KW - Self Report AB -

BACKGROUND: Although treatment and control of diabetes can prevent complications and reduce morbidity, few data sources exist at the state level for surveillance of diabetes comorbidities and control. Surveys and electronic health records (EHRs) offer different strengths and weaknesses for surveillance of diabetes and major metabolic comorbidities. Data from self-report surveys suffer from cognitive and recall biases, and generally cannot be used for surveillance of undiagnosed cases. EHR data are becoming more readily available, but pose particular challenges for population estimation since patients are not randomly selected, not everyone has the relevant biomarker measurements, and those included tend to cluster geographically.

METHODS: We analyzed data from the National Health and Nutritional Examination Survey, the Health and Retirement Study, and EHR data from the DARTNet Institute to create state-level adjusted estimates of the prevalence and control of diabetes, and the prevalence and control of hypertension and high cholesterol in the diabetes population, age 50 and over for five states: Alabama, California, Florida, Louisiana, and Massachusetts.

RESULTS: The estimates from the two surveys generally aligned well. The EHR data were consistent with the surveys for many measures, but yielded consistently lower estimates of undiagnosed diabetes prevalence, and identified somewhat fewer comorbidities in most states.

CONCLUSIONS: Despite these limitations, EHRs may be a promising source for diabetes surveillance and assessment of control as the datasets are large and created during the routine delivery of health care.

TRIAL REGISTRATION: Not applicable.

VL - 20 IS - 1 ER - TY - ICOMM T1 - Study Shows Need for Geriatric Principles in Critical Care Medicine Y1 - 2022 A1 - Jacobs, Sheila KW - Critical Care KW - Dementia KW - Disability KW - Frailty KW - multimorbidity JF - Critical Care PB - Pulmonology Advisor UR - https://www.pulmonologyadvisor.com/home/topics/critical-care/study-shows-need-for-geriatric-principles-in-critical-care-medicine/ ER - TY - JOUR T1 - Temporary and permanent effects of withdrawal penalties on retirement savings accounts JF - Journal of Public Economics Y1 - 2022 A1 - Gopi Shah Goda A1 - Damon Jones A1 - Shanthi Ramnath KW - Distributions KW - Penalty KW - Retirement savings accounts KW - Withdrawals AB - We investigate the impact of the early withdrawal penalty on Individual Retirement Account (IRA) withdrawals by examining behavior in a short window before and after the age when the penalty is lifted. We find a large, sudden increase in withdrawals after the penalty’s expiration of 3–3.5 times the baseline level, with no evidence of anticipatory behavior. After one month, average withdrawals decline to and persist at approximately double the baseline. We find that the short-run increase is more pronounced when liquidity constraints are more likely to have been binding. Finally, we explore the implications of our results for policies that adjust the age at which early penalties expire or policies that temporarily remove such penalties. VL - 215 ER - TY - JOUR T1 - Trajectories of Frailty With Aging: Coordinated Analysis of Five Longitudinal Studies. JF - Innovation In Aging Y1 - 2022 A1 - Jenkins, Natalie D A1 - Hoogendijk, Emiel O A1 - Armstrong, Joshua J A1 - Lewis, Nathan A A1 - Ranson, Janice M A1 - Rijnhart, Judith J M A1 - Ahmed, Tamer A1 - Ghachem, Ahmed A1 - Mullin, Donncha S A1 - Ntanasi, Eva A1 - Welstead, Miles A1 - Auais, Mohammad A1 - Bennett, David A A1 - Bandinelli, Stefania A1 - Cesari, Matteo A1 - Ferrucci, Luigi A1 - French, Simon D A1 - Huisman, Martijn A1 - Llewellyn, David J A1 - Scarmeas, Nikolaos A1 - Piccinin, Andrea M A1 - Hofer, Scott M A1 - Muniz-Terrera, Graciela KW - Age-related changes KW - Frailty KW - Latent growth curve AB -

Background and Objectives: There is an urgent need to better understand frailty and its predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results. Here, we use a coordinated analytical approach in 5 independent cohorts to evaluate longitudinal trajectories of frailty and the effect of 3 previously identified critical risk factors: sex, age, and education.

Research Design and Methods: We derived a frailty index (FI) for 5 cohorts based on the accumulation of deficits approach. Four linear and quadratic growth curve models were fit in each cohort independently. Models were adjusted for sex/gender, age, years of education, and a sex/gender-by-age interaction term.

Results: Models describing linear progression of frailty best fit the data. Annual increases in FI ranged from 0.002 in the Invecchiare in Chianti cohort to 0.009 in the Longitudinal Aging Study Amsterdam (LASA). Women had consistently higher levels of frailty than men in all cohorts, ranging from an increase in the mean FI in women from 0.014 in the Health and Retirement Study cohort to 0.046 in the LASA cohort. However, the associations between sex/gender and rate of frailty progression were mixed. There was significant heterogeneity in within-person trajectories of frailty about the mean curves.

Discussion and Implications: Our findings of linear longitudinal increases in frailty highlight important avenues for future research. Specifically, we encourage further research to identify potential effect modifiers or groups that would benefit from targeted or personalized interventions.

VL - 6 IS - 2 ER - TY - JOUR T1 - UNNECESSARY AND HARMFUL MEDICATION USE IN COMMUNITY DWELLING PERSONS WITH DEMENTIA JF - Innovation in Aging Y1 - 2022 A1 - Deardorff, W James A1 - Jing, Bocheng A1 - Growdon, Matthew A1 - Yaffe, Kristine A1 - Boockvar, Kenneth S A1 - Steinman, Michael A. KW - community dwelling KW - Medication AB - Persons with dementia (PWD) often have multiple comorbidities which results in extensive medication use despite potentially limited benefit and increased risk of adverse events. Compared to the nursing home, little is known about medication overuse and misuse among the ~70% of PWD in the community. Therefore, we examined medication use from Medicare Part D prescriptions among 1,289 community-dwelling PWD aged ≥66 from the Health and Retirement Study. We classified medication overuse as over-aggressive treatment of chronic conditions (e.g., insulin/sulfonylurea use with hemoglobin A1c<7.5%) and medications inappropriate near the end of life. We classified medication misuse as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics) and problematic medications (using Beers and STOPP criteria). We describe the prevalence and patterns of different types of medication overuse/misuse. Frequently problematic medications included antipsychotics (9%), benzodiazepines (12%), and gabapentinoids (13%). Our findings highlight the burden of unnecessary/harmful medications among PWD and inform future deprescribing interventions. VL - 6 IS - Suppl 1 ER - TY - JOUR T1 - Work expectations, depressive symptoms, and passive suicidal ideation among older adults: Evidence from the Health and Retirement Study. JF - The Gerontologist Y1 - 2022 A1 - Mezuk, Briana A1 - Dang, Linh A1 - Jurgens, David A1 - Jacqui Smith KW - depression KW - Employment AB -

BACKGROUND AND OBJECTIVES: Employment and work transitions (e.g., retirement) influence mental health. However, how psychosocial contexts such as anticipation and uncertainty about work transitions, irrespective of the transitions themselves, relate to mental health is unclear. This study examined the relationships of work expectations with depressive symptoms, major depression episodes (MDE), and passive suicidal ideation over a 10-year period among the "Baby Boom" cohort of the Health and Retirement Study.

RESEARCH DESIGN AND METHODS: Analysis was limited to 13,247 respondents aged 53 - 70 observed from 2008 to 2018. Past-year depressive symptoms, MDE, and passive suicidal ideation were indexed using the Composite International Diagnostic Interview-Short Form. Expectations regarding working full-time after age 62 were assessed using a probability scale (zero to 100%). Mixed effect logistic regressions with time-varying covariates were used to assess the relationship of work expectations with mental health, accounting for demographics, health status, and functioning, and stratified by baseline employment status.

RESULTS: At baseline, higher work expectations were inversely associated with depressive symptoms. Longitudinally, higher expectations were associated with lower odds of depressive symptoms (Odds Ratio (OR) = 0.93, 95% CI: 0.91, 0.94). This association was more pronounced among respondents not working at baseline (ORNot working=0.93 vs. ORWorking=0.96). Greater uncertainty (i.e., expectations near 50%) was also inversely associated with depressive symptoms. Results were similar for past-year MDE and passive suicidal ideation.

DISCUSSION AND IMPLICATIONS: Expectations (overall likelihood and uncertainty), as indicators of psychosocial context, provide insight into the processes that link work transitions with depression risk.

VL - 62 IS - 10 ER - TY - JOUR T1 - The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. JF - Lancet Y1 - 2021 A1 - Watts, Nick A1 - Amann, Markus A1 - Arnell, Nigel A1 - Ayeb-Karlsson, Sonja A1 - Beagley, Jessica A1 - Belesova, Kristine A1 - Boykoff, Maxwell A1 - Byass, Peter A1 - Cai, Wenjia A1 - Campbell-Lendrum, Diarmid A1 - Capstick, Stuart A1 - Chambers, Jonathan A1 - Coleman, Samantha A1 - Dalin, Carole A1 - Daly, Meaghan A1 - Dasandi, Niheer A1 - Dasgupta, Shouro A1 - Davies, Michael A1 - Di Napoli, Claudia A1 - Dominguez-Salas, Paula A1 - Drummond, Paul A1 - Dubrow, Robert A1 - Ebi, Kristie L A1 - Eckelman, Matthew A1 - Ekins, Paul A1 - Escobar, Luis E A1 - Georgeson, Lucien A1 - Golder, Su A1 - Grace, Delia A1 - Graham, Hilary A1 - Haggar, Paul A1 - Hamilton, Ian A1 - Hartinger, Stella A1 - Hess, Jeremy A1 - Hsu, Shih-Che A1 - Hughes, Nick A1 - Jankin Mikhaylov, Slava A1 - Marcia P Jimenez A1 - Kelman, Ilan A1 - Kennard, Harry A1 - Kiesewetter, Gregor A1 - Kinney, Patrick L A1 - Kjellstrom, Tord A1 - Kniveton, Dominic A1 - Lampard, Pete A1 - Lemke, Bruno A1 - Liu, Yang A1 - Liu, Zhao A1 - Lott, Melissa A1 - Lowe, Rachel A1 - Martinez-Urtaza, Jaime A1 - Maslin, Mark A1 - McAllister, Lucy A1 - McGushin, Alice A1 - McMichael, Celia A1 - Milner, James A1 - Moradi-Lakeh, Maziar A1 - Morrissey, Karyn A1 - Munzert, Simon A1 - Murray, Kris A A1 - Neville, Tara A1 - Nilsson, Maria A1 - Sewe, Maquins Odhiambo A1 - Oreszczyn, Tadj A1 - Otto, Matthias A1 - Owfi, Fereidoon A1 - Pearman, Olivia A1 - Pencheon, David A1 - Quinn, Ruth A1 - Rabbaniha, Mahnaz A1 - Robinson, Elizabeth A1 - Rocklöv, Joacim A1 - Romanello, Marina A1 - Semenza, Jan C A1 - Sherman, Jodi A1 - Shi, Liuhua A1 - Springmann, Marco A1 - Tabatabaei, Meisam A1 - Taylor, Jonathon A1 - Triñanes, Joaquin A1 - Shumake-Guillemot, Joy A1 - Vu, Bryan A1 - Wilkinson, Paul A1 - Winning, Matthew A1 - Gong, Peng A1 - Montgomery, Hugh A1 - Costello, Anthony KW - Climate Change KW - Conservation of Natural Resources KW - COVID-19 KW - Extreme Weather KW - Global Health KW - health policy KW - Humans KW - International Cooperation KW - Pandemics KW - SARS-CoV-2 VL - 397 IS - 10269 ER - TY - JOUR T1 - A 2-Year Longitudinal Relationship Between Work-Family Conflict and Health Among Older Workers: Can Gardening Help? JF - Journal of Applied Gerontology Y1 - 2021 A1 - Eunae Cho A1 - Tuo-Yu Chen A1 - Megan C Janke KW - Chronic conditions KW - depression KW - Disability KW - Leisure activities KW - Self-rated health KW - Senior workers KW - work-family interference AB - With the graying workforce worldwide, identifying factors that facilitate older workers' health is critically important. We examined whether gardening mitigates the relationship of work-family conflict with disability, chronic conditions, depressive symptoms, and self-rated health among older workers. We drew a subsample of older workers aged 55 years and above from the Health and Retirement Study (N= 1,598). Our results indicate that the relationships of work-to-family conflict at baseline with disability and with poorer self-rated health at a 2-year follow-up were stronger for those who gardened less than those who gardened more. No significant interaction was found between family-to-work conflict and gardening in predicting the health outcomes. This study is the first to show that gardening may have a protective effect against the adverse impact of work-to-family conflict on older workers' health. VL - 40 IS - 10 ER - TY - JOUR T1 - Associations between education and dementia in the Caribbean and the United States: An international comparison. JF - Alzheimer's & Dementia Y1 - 2021 A1 - Li, Jing A1 - Llibre-Guerra, Jorge J A1 - Harrati, Amal A1 - Weiss, Jordan A1 - Jiménez-Velázquez, Ivonne Z A1 - Acosta, Daisy A1 - Llibre-Rodriguez, Juan de Jesús A1 - Liu, Mao-Mei A1 - William H Dow KW - Caribbean KW - Dementia KW - Education KW - Hispanics KW - Sister studies AB -

Introduction: Despite high dementia prevalence in Hispanic populations globally, especially Caribbean Hispanics, no study has comparatively examined the association between education and dementia among Hispanics living in the Caribbean Islands and older adults in the United States.

Methods: We used data on 6107 respondents aged 65 and older in the baseline wave of the population-based and harmonized 10/66 survey from Cuba, the Dominican Republic, and Puerto Rico, collected between 2003 and 2008, and 11,032 respondents aged 65 and older from the U.S.-based Health and Retirement Study data in 2014, a total of 17,139 individuals. We estimated multivariable logistic regression models examining the association between education and dementia, adjusted for age, income, assets, and occupation. The models were estimated separately for the Caribbean population (pooled and by setting) and the U.S. population by race/ethnicity (Hispanic, Black, and White), followed by pooled models across all populations.

Results: In the Caribbean population, the relative risk of dementia among low versus high educated adults was 1.45 for women (95% confidence interval [CI] 1.17, 1.74) and 1.92 (95% CI 1.35, 2.49) for men, smaller compared to those in the United States, especially among non-Hispanic Whites (women: 2.78, 95% CI 1.94, 3.61; men: 5.98, 95% CI 4.02, 7.95).

Discussion: The differential associations between education and dementia across the Caribbean and US settings may be explained by greater disparities in social conditions in the United States compared to the Caribbean, such as access to health care, healthy behaviors, and social stressors, which serve as potentially important mediators.

VL - 7 IS - 1 ER - TY - RPRT T1 - CHANGES IN NEW DISABILITY AWARDS: UNDERSTANDING TRENDS AND LOOKING AHEAD Y1 - 2021 A1 - Lindsay Jacobs KW - disabled workers KW - health measures KW - Occupation KW - Social Security Administration KW - Social Security Disability Insurance AB - After peaking at nearly nine million beneficiaries in 2014, the number of disabled workers receiving Social Security Disability Insurance (SSDI) benefits has been steadily declining. What are some of the possible changes in population characteristics that have contributed to this trend and, with potentially major revisions to the current SSDI award eligibility requirements on the horizon, should we expect this trend to continue? The aim of this research will be to determine the extent to which current trends in new SSDI awards can be attributed to (1) changes in cohort characteristics over time—including objective and subjective health measures and occupations held—and (2) differences over time in the relationship between these characteristics and reported work disability, SSDI application, and SSDI award. I will employ data from the Health and Retirement Study (HRS) to determine the relative importance of each of these channels through a decomposition analysis and perform counterfactual exercises to predict what specific changes to eligibility requirements—such as increasing the age for which education and prior work experience are considered—would have. JF - Working Paper PB - Center for Retirement Research at Boston College CY - Chestnut Hill, MA UR - https://crr.bc.edu/wp-content/uploads/2021/12/wp_2021-25.pdf ER - TY - JOUR T1 - Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry. JF - The American Journal of Human Genetics Y1 - 2021 A1 - Graff, Mariaelisa A1 - Justice, Anne E A1 - Young, Kristin L A1 - Marouli, Eirini A1 - Zhang, Xinruo A1 - Fine, Rebecca S A1 - Lim, Elise A1 - Buchanan, Victoria A1 - Rand, Kristin A1 - Feitosa, Mary F A1 - Wojczynski, Mary K A1 - Yanek, Lisa R A1 - Shao, Yaming A1 - Rohde, Rebecca A1 - Adeyemo, Adebowale A A1 - Aldrich, Melinda C A1 - Matthew A. Allison A1 - Ambrosone, Christine B A1 - Ambs, Stefan A1 - Amos, Christopher A1 - Donna K Arnett A1 - Atwood, Larry A1 - Bandera, Elisa V A1 - Traci M Bartz A1 - Becker, Diane M A1 - Berndt, Sonja I A1 - Bernstein, Leslie A1 - Bielak, Lawrence F A1 - Blot, William J A1 - Erwin P Bottinger A1 - Bowden, Donald W A1 - Bradfield, Jonathan P A1 - Brody, Jennifer A A1 - Broeckel, Ulrich A1 - Burke, Gregory A1 - Brian E Cade A1 - Cai, Qiuyin A1 - Caporaso, Neil A1 - Carlson, Chris A1 - John Carpten A1 - Casey, Graham A1 - Chanock, Stephen J A1 - Chen, Guanjie A1 - Chen, Minhui A1 - Chen, Yii-Der I A1 - Chen, Wei-Min A1 - Chesi, Alessandra A1 - Chiang, Charleston W K A1 - Chu, Lisa A1 - Coetzee, Gerry A A1 - Conti, David V A1 - Cooper, Richard S A1 - Cushman, Mary A1 - Ellen W Demerath A1 - Deming, Sandra L A1 - Dimitrov, Latchezar A1 - Ding, Jingzhong A1 - Diver, W Ryan A1 - Duan, Qing A1 - Michele K Evans A1 - Falusi, Adeyinka G A1 - Jessica Faul A1 - Myriam Fornage A1 - Caroline S Fox A1 - Freedman, Barry I A1 - Garcia, Melissa A1 - Gillanders, Elizabeth M A1 - Phyllis J Goodman A1 - Gottesman, Omri A1 - Grant, Struan F A A1 - Guo, Xiuqing A1 - Hakonarson, Hakon A1 - Haritunians, Talin A1 - Tamara B Harris A1 - Harris, Curtis C A1 - Henderson, Brian E A1 - Hennis, Anselm A1 - Dena G Hernandez A1 - Hirschhorn, Joel N A1 - McNeill, Lorna Haughton A1 - Howard, Timothy D A1 - Howard, Barbara A1 - Hsing, Ann W A1 - Hsu, Yu-Han H A1 - Hu, Jennifer J A1 - Huff, Chad D A1 - Huo, Dezheng A1 - Ingles, Sue A A1 - Irvin, Marguerite R A1 - John, Esther M A1 - Johnson, Karen C A1 - Jordan, Joanne M A1 - Kabagambe, Edmond K A1 - Kang, Sun J A1 - Sharon L R Kardia A1 - Keating, Brendan J A1 - Rick A Kittles A1 - Eric A Klein A1 - Kolb, Suzanne A1 - Kolonel, Laurence N A1 - Charles Kooperberg A1 - Kuller, Lewis A1 - Kutlar, Abdullah A1 - Leslie A Lange A1 - Langefeld, Carl D A1 - Loic Le Marchand A1 - Leonard, Hampton A1 - Lettre, Guillaume A1 - Levin, Albert M A1 - Li, Yun A1 - Li, Jin A1 - Liu, Yongmei A1 - Liu, Youfang A1 - Liu, Simin A1 - Kurt Lohman A1 - Lotay, Vaneet A1 - Lu, Yingchang A1 - Maixner, William A1 - JoAnn E Manson A1 - McKnight, Barbara A1 - Meng, Yan A1 - Monda, Keri L A1 - Monroe, Kris A1 - Moore, Jason H A1 - Thomas H Mosley A1 - Mudgal, Poorva A1 - Murphy, Adam B A1 - Nadukuru, Rajiv A1 - Michael A Nalls A1 - Nathanson, Katherine L A1 - Nayak, Uma A1 - N'Diaye, Amidou A1 - Nemesure, Barbara A1 - Neslund-Dudas, Christine A1 - Neuhouser, Marian L A1 - Nyante, Sarah A1 - Ochs-Balcom, Heather A1 - Ogundiran, Temidayo O A1 - Ogunniyi, Adesola A1 - Ojengbede, Oladosu A1 - Okut, Hayrettin A1 - Olopade, Olufunmilayo I A1 - Olshan, Andrew A1 - Padhukasahasram, Badri A1 - Palmer, Julie A1 - Palmer, Cameron D A1 - Palmer, Nicholette D A1 - George J Papanicolaou A1 - Patel, Sanjay R A1 - Pettaway, Curtis A A1 - Peyser, Patricia A A1 - Press, Michael F A1 - Rao, D C A1 - Rasmussen-Torvik, Laura J A1 - Redline, Susan A1 - Reiner, Alex P A1 - Rhie, Suhn K A1 - Rodriguez-Gil, Jorge L A1 - Charles N Rotimi A1 - Rotter, Jerome I A1 - Ruiz-Narvaez, Edward A A1 - Rybicki, Benjamin A A1 - Babatunde Salako A1 - Sale, Michele M A1 - Sanderson, Maureen A1 - Eric E Schadt A1 - Schreiner, Pamela J A1 - Schurmann, Claudia A1 - Schwartz, Ann G A1 - Daniel Shriner A1 - Signorello, Lisa B A1 - Andrew B Singleton A1 - David S Siscovick A1 - Smith, Jennifer A A1 - Smith, Shad A1 - Elizabeth K Speliotes A1 - Spitz, Margaret A1 - Stanford, Janet L A1 - Stevens, Victoria L A1 - Stram, Alex A1 - Strom, Sara S A1 - Sucheston, Lara A1 - Yan V Sun A1 - Tajuddin, Salman M A1 - Taylor, Herman A1 - Taylor, Kira A1 - Bamidele O Tayo A1 - Michael J Thun A1 - Tucker, Margaret A A1 - Vaidya, Dhananjay A1 - Van Den Berg, David J A1 - Vedantam, Sailaja A1 - Vitolins, Mara A1 - Wang, Zhaoming A1 - Erin B Ware A1 - Wassertheil-Smoller, Sylvia A1 - David R Weir A1 - Wiencke, John K A1 - Williams, Scott M A1 - L Keoki Williams A1 - Wilson, James G A1 - Witte, John S A1 - Wrensch, Margaret A1 - Wu, Xifeng A1 - Yao, Jie A1 - Zakai, Neil A1 - Zanetti, Krista A1 - Zemel, Babette S A1 - Zhao, Wei A1 - Jing Hua Zhao A1 - Zheng, Wei A1 - Zhi, Degui A1 - Zhou, Jie A1 - Zhu, Xiaofeng A1 - Ziegler, Regina G A1 - Zmuda, Joe A1 - Alan B Zonderman A1 - Psaty, Bruce M A1 - Ingrid B Borecki A1 - Cupples, L Adrienne A1 - Liu, Ching-Ti A1 - Christopher A Haiman A1 - Ruth J F Loos A1 - Ng, Maggie C Y A1 - Kari E North KW - Africa KW - African Americans KW - Blacks KW - Body Height KW - Europe KW - Female KW - Genome-Wide Association Study KW - Humans KW - Male KW - Polymorphism, Single Nucleotide AB -

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

VL - 108 IS - 4 ER - TY - CONF T1 - On the Distribution and Dynamics of Medical Expenditure among the Elderly T2 - Retirement and Disability Research Consortium 23rd Annual Meeting Y1 - 2021 A1 - Arapakis, Karolos A1 - Eric French A1 - John Bailey Jones A1 - McCauley, Jeremy KW - dynamics KW - Medicaid KW - Medical spending KW - Medicare AB - Using data from the Health and Retirement Study (HRS), we estimate the stochastic process for total medical spending and its components. By focussing on dynamics, we consider not only the risk of catastrophic expenses in a single year, but also the risk of moderate but persistent expenses that accumulate into a catastrophic lifetime cost. We also assess the reduction in out-of-pocket medical spending risk provided by public insurance schemes such as Medicare or Medicaid. JF - Retirement and Disability Research Consortium 23rd Annual Meeting PB - Center for Financial Security, University of Wisconsin-Madison CY - Virtual Event UR - https://cfsrdrc.wisc.edu/files/2021-RDRC-Meeting-Booklet.pdf#page=7 ER - TY - JOUR T1 - Do Big Five Personality Traits Moderate the Effects of Stressful Life Events on Health Trajectories? Evidence From the Health and Retirement Study. JF - The Journals of Gerontology, Series B Y1 - 2021 A1 - Lauren L Mitchell A1 - Zmora, Rachel A1 - Finlay, Jessica M A1 - Jutkowitz, Eric A1 - Joseph E Gaugler KW - Mental Health KW - Personality KW - Physical Health KW - Stress reactivity KW - Stressful Life Events AB -

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

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

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

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

VL - 76 IS - 1 ER - TY - JOUR T1 - Early Life Experiences Moderate the Relationship Between Genetic Risk of Autism and Current and Lifetime Mental Health. JF - Frontiers in Psychiatry Y1 - 2021 A1 - Su Hyun Shin A1 - Wright, Cheryl A1 - Johnston, Susan KW - autism genetics KW - early life experience KW - mother relationship KW - police encounters KW - psychiatric problem AB -

Although individuals with autism are at greater risk of mental health challenges than others, we know little about the relationship between the mental health of older adults (50+) and autism because they are less likely to be diagnosed. Identifying the risk and protective factors that are associated with mental health can increase educational awareness, inform clinical practice, and provide information to help diagnose and treat older adults with autism. This study used longitudinal panel data of the 2008-2016 waves of the Health and Retirement Study. It estimated individual random-effect models by interacting a genetic propensity toward autism and early life experiences to test whether the latter has a moderating effect on the relationships between genetics and the Center for Epidemiologic Studies Depression (CES-D) score, self-reported depression, and history of psychiatric problems. Results suggest that individuals with a higher genetic propensity for autism are less likely to develop psychiatric problems if they report a positive maternal relationship early in life. Further, a combined effect of police encounters early in life and genetic risk for autism is associated with higher CES-D scores, increased odds of self-reported depression, and a history of psychiatric problems. Clinical applications of these findings include the need to establish and support high-quality relationships by addressing both child and caregiver needs. Further, these findings support the need to design and implement proactive interventions to teach police and autistic individuals how to successfully navigate these encounters.

VL - 12 ER - TY - CONF T1 - Economic Security in Retirement: Does Borrowing from Home Equity Moderate the Impact of a Health Shock on Health Outcomes? T2 - Retirement and Disability Research Consortium 23rd Annual Meeting Y1 - 2021 A1 - Stephanie Moulton A1 - Joseph, Joshua A1 - Cäzilia Loibl A1 - Donald Haurin KW - health shock KW - Home equity KW - Retirement AB - Health shocks pose a significant risk to economic security in retirement. About 35 percent of older adults are diagnosed with a major disease by age 65, rising to 65 percent by age 90 (Poterba et al. 2018). These health shocks are costly. While the majority of older adults receive Medicare, nearly 20 percent of health expenditures are paid out of pocket (DeNardi et al. 2016). Older adults often self-insure against these risks by accumulating wealth, including home equity. In this study, we ask: To what extent does home equity mitigate the economic burden created by a health shock, ultimately leading to better health outcomes? In contrast to a life cycle model, older adults tend to only spend down home equity following an expense shock (Davidoff, 2010; Nakajima & Telyukova, 2019; Poterba & Venti, 2017a). Several recent studies document a decline in home equity after a health shock (Gilligan et al. 2018; Gupta et al. 2018; Poterba et al. 2018), with home equity being second only to formal health insurance for financing health related consumption after a health shock in older age (Dalton and LaFave 2017). These studies do not identify the extent to which liquidating home equity improves the older household’s health following a shock. An existing body of literature estimates the causal relationship between housing wealth and health outcomes generally, not limited to individuals with a health shock (Angrisani and Lee 2016; Costa-Font et al. 2019; Fichera & Gathergood 2016; Hamoudi and Dowd 2013; 2014). Similar to our approach, these studies rely on geographic and intertemporal variations in house prices to isolate the exogenous component of housing wealth, either through reduced form specifications that directly model the relationship between changes in house values or house prices on health outcomes (Angrisani and Lee 2016; Fichera & Gathergood 2016; Hamoudi and Dowd 2013; 2014) or by using geographic changes in house prices as an instrument for housing wealth (Costa-Font et al. 2019). While these papers tend to find a positive relationship between increases in housing wealth and health outcomes, they do not model the mechanisms through which this occurs—which is critical to inform policy. We expect that it is not simply the stock of home equity held by older adults that leads to better health outcomes, but the liquidation of home equity through borrowing following a health shock that leads to improved health outcomes. JF - Retirement and Disability Research Consortium 23rd Annual Meeting PB - Center for Financial Security, University of Wisconsin-Madison CY - Virtual Event UR - https://cfsrdrc.wisc.edu/files/2021-RDRC-Meeting-Booklet.pdf#page=7 ER - TY - JOUR T1 - The effect of diabetes on the cognitive trajectory of older adults in Mexico and the U.S JF - The Journals of Gerontology: Series B Y1 - 2021 A1 - Jaqueline C Avila A1 - Mejia Arango, Silvia A1 - Jupiter, Daniel A1 - Brian Downer A1 - Rebeca Wong KW - cognitive aging KW - Cross-cultural study KW - Longitudinal methods KW - MHAS AB - To study the impact of diabetes on the long-term cognitive trajectories of older adults in two countries with different socioeconomic and health settings, and to determine if this relationship differs by cognitive domains. This study uses Mexico and the United States to confirm if patterns hold in both populations, as these countries have similar diabetes prevalence but different socioeconomic conditions and diabetes-related mortality.Two nationally representative cohorts of adults aged 50 years or older are used: the Mexican Health and Aging Study for Mexico, and the Health and Retirement Study for the U.S., with sample sizes of 18, 810 and 26, 244 individuals, respectively, followed over 14 years. The outcome is cognition measured as a total composite score, and by domain (memory and non-memory). Mixed-effect linear models are used to test the effect of diabetes on cognition at 65 years old and over time in each country.Diabetes is associated with lower cognition and non-memory scores at baseline and over time in both countries. In Mexico, diabetes only predicts lower memory scores over time, while in the U.S. it only predicts lower memory scores at baseline. Women have higher total cognition and memory scores than men in both studies. The magnitude of the effect of diabetes on cognition is similar in both countries.Despite the overall lower cognition in Mexico and different socioeconomic characteristics, the impact of diabetes on cognitive decline and the main risk and protective factors for poor cognition are similar in both countries. VL - 76 SN - 1079-5014 IS - 4 ER - TY - JOUR T1 - The Effect of Receiving a Diagnosis of Alzheimer's Disease and Related Dementias on Social Relationships of Older Adults. JF - Dementia and Geriatric Cognitive Disorders Y1 - 2021 A1 - Amano, Takashi A1 - Reynolds, Addam A1 - Scher, Clara A1 - Jia, Yuane KW - Diagnosis of dementia KW - Propensity score analysis KW - Social Relationships AB -

INTRODUCTION: Although early diagnosis has been recognized as a key strategy to improve outcomes of Alzheimer's disease and related dementias (ADRD), the effect of receiving a diagnosis on patients' well-being is not well understood. This study addresses this gap by examining if receiving a dementia diagnosis influences social relationships.

METHODS: Data from the 3 waves (2012, 2014, and 2016) of the Health and Retirement Study were utilized as part of this study. This study examined whether receiving a new diagnosis of ADRD changed subsequent social relationships (social networks, social engagement, and social support). Regression analyses with inverse probability weighting were performed to estimate the impact of receiving a dementia diagnosis on changes in social relationships.

RESULTS: Receiving a new diagnosis of ADRD reduced both informal and formal social engagement. We found no statistically significant impacts of receiving a diagnosis of ADRD on social networks and social support.

CONCLUSIONS: Results suggest that receiving a new diagnosis of ADRD may have unintended impacts on social relationships. Practitioners and policymakers should be aware of these consequences and should identify strategies to alleviate the negative impact of receiving a diagnosis of ADRD and methods to mobilize support networks after receiving a diagnosis.

VL - 50 IS - 4 ER - TY - JOUR T1 - Estimating the effects of Mexico to U.S. migration on elevated depressive symptoms: evidence from pooled cross-national cohorts. JF - Annals of Epidemiology Y1 - 2021 A1 - Audrey R Murchland A1 - Adina Zeki Al Hazzouri A1 - Zhang, Lanyu A1 - Elfassy, Tali A1 - Grasset, Leslie A1 - Riley, Alicia A1 - Wong, Rebecca A1 - Mary Haan A1 - Richard N Jones A1 - Jacqueline M Torres A1 - M. Maria Glymour KW - depression KW - Immigration KW - Mental Health KW - MHAS KW - Selection AB -

BACKGROUND: Migrating from Mexico to the U.S. is a major, stressful life event with potentially profound influences on mental health. However, estimating the health effects of migration is challenging because of differential selection into migration and time-varying confounder mediators of migration effects on health.

METHODS: We pooled data from the Mexican Health and Aging Study (N=17,771) and Mexican-born U.S. Health and Retirement Study (N=898) participants to evaluate the effects of migration to the U.S. (at any age and in models for migration in childhood or adulthood) on depressive symptom-count, measured with a modified Centers for Epidemiologic Studies-Depression scale. We modeled probability of migrating in each year of life from birth to either age at initial migration to the U.S. or enrollment and used these models to calculate inverse probability of migration weights. We applied the weights to covariate-adjusted negative binomial GEE models, estimating the ratio of average symptom-count associated with migration.

RESULTS: Mexico to U.S. migration was unrelated to depressive symptoms among men (ratio of average symptom-count= 0.98 [95% CI: 0.89, 1.08]) and women (ratio of average symptom-count=1.00 [95% CI: 0.92, 1.09]). Results were similar for migration in childhood, early adulthood, or later adulthood.

CONCLUSIONS: In this sample of older Mexican-born adults, migration to the U.S. was unrelated to depressive symptoms.

VL - 64 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 - Gene-educational attainment interactions in a multi-ancestry genome-wide meta-analysis identify novel blood pressure loci. JF - Mol Psychiatry Y1 - 2021 A1 - de Las Fuentes, Lisa A1 - Yun Ju Sung A1 - Noordam, Raymond A1 - Thomas W Winkler A1 - Feitosa, Mary F A1 - Schwander, Karen A1 - Bentley, Amy R A1 - Brown, Michael R A1 - Guo, Xiuqing A1 - Alisa Manning A1 - Daniel I Chasman A1 - Aschard, Hugues A1 - Traci M Bartz A1 - Bielak, Lawrence F A1 - Campbell, Archie A1 - Cheng, Ching-Yu A1 - Dorajoo, Rajkumar A1 - Hartwig, Fernando P A1 - Horimoto, A R V R A1 - Li, Changwei A1 - Li-Gao, Ruifang A1 - Liu, Yongmei A1 - Marten, Jonathan A1 - Musani, Solomon K A1 - Ntalla, Ioanna A1 - Rankinen, Tuomo A1 - Melissa Richard A1 - Sim, Xueling A1 - Smith, Albert V A1 - Tajuddin, Salman M A1 - Bamidele O Tayo A1 - Vojinovic, Dina A1 - Warren, Helen R A1 - Xuan, Deng A1 - Alver, Maris A1 - Boissel, Mathilde A1 - Jin-Fang Chai A1 - Chen, Xu A1 - Christensen, Kaare A1 - Divers, Jasmin A1 - Evangelou, Evangelos A1 - Gao, Chuan A1 - Giorgia G Girotto A1 - Sarah E Harris A1 - He, Meian A1 - Hsu, Fang-Chi A1 - Kühnel, Brigitte A1 - Laguzzi, Federica A1 - Li, Xiaoyin A1 - Lyytikäinen, Leo-Pekka A1 - Ilja M Nolte A1 - Poveda, Alaitz A1 - Rauramaa, Rainer A1 - Riaz, Muhammad A1 - Rueedi, Rico A1 - Shu, Xiao-Ou A1 - Snieder, Harold A1 - Sofer, Tamar A1 - Takeuchi, Fumihiko A1 - Verweij, Niek A1 - Erin B Ware A1 - Weiss, Stefan A1 - Yanek, Lisa R A1 - Amin, Najaf A1 - Dan E Arking A1 - Donna K Arnett A1 - Bergmann, Sven A1 - Boerwinkle, Eric A1 - Brody, Jennifer A A1 - Broeckel, Ulrich A1 - Brumat, Marco A1 - Burke, Gregory A1 - Cabrera, Claudia P A1 - Canouil, Mickaël A1 - Chee, Miao Li A1 - Chen, Yii-Der Ida A1 - Cocca, Massimiliano A1 - Connell, John A1 - de Silva, H Janaka A1 - de Vries, Paul S A1 - Eiriksdottir, Gudny A1 - Jessica Faul A1 - Fisher, Virginia A1 - Forrester, Terrence A1 - Fox, Ervin F A1 - Friedlander, Yechiel A1 - Gao, He A1 - Gigante, Bruna A1 - Giulianini, Franco A1 - Gu, Chi Charles A1 - Gu, Dongfeng A1 - Tamara B Harris A1 - He, Jiang A1 - Heikkinen, Sami A1 - Heng, Chew-Kiat A1 - Hunt, Steven A1 - Ikram, M Arfan A1 - Irvin, Marguerite R A1 - Kähönen, Mika A1 - Kavousi, Maryam A1 - Khor, Chiea Chuen A1 - Kilpeläinen, Tuomas O A1 - Koh, Woon-Puay A1 - Komulainen, Pirjo A1 - Kraja, Aldi T A1 - Krieger, J E A1 - Langefeld, Carl D A1 - Li, Yize A1 - Liang, Jingjing A1 - David C Liewald A1 - Liu, Ching-Ti A1 - Liu, Jianjun A1 - Kurt Lohman A1 - Mägi, Reedik A1 - McKenzie, Colin A A1 - Meitinger, Thomas A1 - Andres Metspalu A1 - Milaneschi, Yuri A1 - Lili Milani A1 - Dennis O Mook-Kanamori A1 - Michael A Nalls A1 - Nelson, Christopher P A1 - Norris, Jill M A1 - Jeff O'Connell A1 - Ogunniyi, Adesola A1 - Padmanabhan, Sandosh A1 - Palmer, Nicholette D A1 - Nancy L Pedersen A1 - Thomas T Perls A1 - Peters, Annette A1 - Petersmann, Astrid A1 - Peyser, Patricia A A1 - Polasek, Ozren A1 - David J Porteous A1 - Raffel, Leslie J A1 - Rice, Treva K A1 - Rotter, Jerome I A1 - Rudan, Igor A1 - Rueda-Ochoa, Oscar-Leonel A1 - Sabanayagam, Charumathi A1 - Babatunde Salako A1 - Schreiner, Pamela J A1 - Shikany, James M A1 - Stephen Sidney A1 - Sims, Mario A1 - Sitlani, Colleen M A1 - Smith, Jennifer A A1 - John M Starr A1 - Strauch, Konstantin A1 - Swertz, Morris A A1 - Teumer, Alexander A1 - Tham, Yih Chung A1 - André G Uitterlinden A1 - Vaidya, Dhananjay A1 - van der Ende, M Yldau A1 - Waldenberger, Melanie A1 - Wang, Lihua A1 - Wang, Ya-Xing A1 - Wei, Wen-Bin A1 - David R Weir A1 - Wen, Wanqing A1 - Yao, Jie A1 - Yu, Bing A1 - Yu, Caizheng A1 - Yuan, Jian-Min A1 - Zhao, Wei A1 - Alan B Zonderman A1 - Becker, Diane M A1 - Bowden, Donald W A1 - Ian J Deary A1 - Dörr, Marcus A1 - Tõnu Esko A1 - Freedman, Barry I A1 - Froguel, Philippe A1 - Paolo P. Gasparini A1 - Gieger, Christian A1 - Jost Bruno Jonas A1 - Kammerer, Candace M A1 - Kato, Norihiro A1 - Lakka, Timo A A1 - Leander, Karin A1 - Lehtimäki, Terho A1 - Patrik K E Magnusson A1 - Marques-Vidal, Pedro A1 - Brenda W J H Penninx A1 - Nilesh J Samani A1 - van der Harst, Pim A1 - Wagenknecht, Lynne E A1 - Wu, Tangchun A1 - Zheng, Wei A1 - Zhu, Xiaofeng A1 - Bouchard, Claude A1 - Cooper, Richard S A1 - Correa, Adolfo A1 - Michele K Evans A1 - Gudnason, Vilmundur A1 - Caroline Hayward A1 - Horta, Bernardo L A1 - Tanika N Kelly A1 - Stephen B Kritchevsky A1 - Levy, Daniel A1 - Walter R Palmas A1 - Pereira, A C A1 - Province, Michael M A1 - Psaty, Bruce M A1 - Ridker, Paul M A1 - Charles N Rotimi A1 - Tai, E Shyong A1 - van Dam, Rob M A1 - Cornelia M van Duijn A1 - Wong, Tien Yin A1 - Kenneth Rice A1 - Gauderman, W James A1 - Alanna C Morrison A1 - Kari E North A1 - Sharon L R Kardia A1 - Caulfield, Mark J A1 - Elliott, Paul A1 - Munroe, Patricia B A1 - Franks, Paul W A1 - Rao, Dabeeru C A1 - Myriam Fornage KW - Blood pressure KW - Epistasis, Genetic KW - Genetic Loci KW - Genome-Wide Association Study KW - Humans KW - Hypertension KW - Polymorphism, Single Nucleotide AB -

Educational attainment is widely used as a surrogate for socioeconomic status (SES). Low SES is a risk factor for hypertension and high blood pressure (BP). To identify novel BP loci, we performed multi-ancestry meta-analyses accounting for gene-educational attainment interactions using two variables, "Some College" (yes/no) and "Graduated College" (yes/no). Interactions were evaluated using both a 1 degree of freedom (DF) interaction term and a 2DF joint test of genetic and interaction effects. Analyses were performed for systolic BP, diastolic BP, mean arterial pressure, and pulse pressure. We pursued genome-wide interrogation in Stage 1 studies (N = 117 438) and follow-up on promising variants in Stage 2 studies (N = 293 787) in five ancestry groups. Through combined meta-analyses of Stages 1 and 2, we identified 84 known and 18 novel BP loci at genome-wide significance level (P < 5 × 10). Two novel loci were identified based on the 1DF test of interaction with educational attainment, while the remaining 16 loci were identified through the 2DF joint test of genetic and interaction effects. Ten novel loci were identified in individuals of African ancestry. Several novel loci show strong biological plausibility since they involve physiologic systems implicated in BP regulation. They include genes involved in the central nervous system-adrenal signaling axis (ZDHHC17, CADPS, PIK3C2G), vascular structure and function (GNB3, CDON), and renal function (HAS2 and HAS2-AS1, SLIT3). Collectively, these findings suggest a role of educational attainment or SES in further dissection of the genetic architecture of BP.

VL - 26 IS - 6 ER - TY - JOUR T1 - Genome-wide association study of suicidal behaviour severity in mood disorders. JF - World Journal of Biological Psychiatry Y1 - 2021 A1 - Zai, Clement C A1 - Fabbri, Chiara A1 - Hosang, Georgina M A1 - Zhang, Ruo Su A1 - Koyama, Emiko A1 - de Luca, Vincenzo A1 - Tiwari, Arun K A1 - King, Nicole A1 - Strauss, John A1 - Jones, Ian A1 - Jones, Lisa A1 - Breen, Gerome A1 - Farmer, Anne E A1 - McGuffin, Peter A1 - Vincent, John B A1 - Kennedy, James L A1 - Lewis, Cathryn M KW - Bipolar Disorder KW - Genome-Wide Association Study KW - major depressive disorder KW - Mood Disorders KW - Suicidal Ideation KW - suicidality KW - suicide attempt AB -

OBJECTIVE: Suicide is a major public health problem and it has a prominent genetic component. We performed a genome-wide association study (GWAS) of suicidal behaviour severity.

METHODS: Suicide behaviour severity was assessed within the Schedules for Clinical Assessment in Neuropsychiatry in our mood disorder sample (N = 3506) for the GWAS. We also performed polygenic risk score analyses to explore genetic sharing between suicidal behaviour severity and a number of phenotypes, including bipolar disorder, major depressive disorder, alcoholism, post-traumatic stress disorder, impulsivity, insomnia, educational attainment, loneliness, maltreatment, and amygdala volume.

RESULTS: We did not detect genome-wide significant findings at the single-marker or gene level. We report a number of suggestive single-marker and gene-based findings. Our polygenic risk score analyses did not yield significant findings with these phenotypes.

CONCLUSIONS: Larger sample sizes are required to detect moderate effects.

VL - 22 IS - 9 ER - TY - JOUR T1 - Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant Use in a National Cohort of Older Americans. JF - Journal of the American Geriatrics Society Y1 - 2021 A1 - Sachin J Shah A1 - Margaret C Fang A1 - Sun Y Jeon A1 - Gregorich, Steven E A1 - Kenneth E Covinsky KW - anticoagulants KW - Atrial Fibrillation KW - Epidemiology KW - geriatric syndromes AB -

BACKGROUND: Although guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls and disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.

METHODS: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants 65 years and older with 2 years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last 2 years, receiving help with activities of daily living (ADLs) or instrumental ADLs (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use, adjusting for ischemic stroke risk (i.e., CHA DS -VASc score [congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, and sex]).

RESULTS: In this study of 779 participants with AF (median age = 80 years; median CHA DS -VASc score = 4), 82% had one or more geriatric syndromes. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairments, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect = -3.7%; 95% confidence interval = -1.4% to -5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia.

CONCLUSION: Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.

VL - 69 IS - 2 ER - TY - JOUR T1 - Handgrip Strength Asymmetry and Weakness Together are Associated with Functional Disability in Aging Americans JF - The Journals of Gerontology: Series A Y1 - 2021 A1 - Ryan P McGrath A1 - Brenda Vincent A1 - Donald A Jurivich A1 - Kyle J Hackney A1 - Grant R Tomkinson A1 - Lindsey J Dahl A1 - Brian C Clark KW - Biomarkers KW - Disablement Process KW - Epidemiology KW - Functional Performance AB - Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans.The analytic sample included 18,468 Americans aged ≥50-years from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS \>10\% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS \>10\% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS \>10\% stronger on their non-dominant hand were classified as having non-dominant HGS asymmetry. Men with HGS \<26-kilograms and women with HGS \<16-kilograms were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses.Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95\% confidence interval (CI): 1.02-1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, and 1.81 (CI: 1.52-2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13-1.50) for non-dominant HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, 1.72 (CI: 1.29-2.29) for both weakness and non-dominant HGS asymmetry, and 1.86 (CI: 1.52-2.28) for both weakness and dominant HGS asymmetry.HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers. VL - 76 IS - 2 ER - TY - JOUR T1 - Handgrip strength asymmetry is associated with future falls in older Americans. JF - Aging Clinical and Experimental Research Y1 - 2021 A1 - Ryan P McGrath A1 - Brian C Clark A1 - Cesari, Matteo A1 - Johnson, Carol A1 - Donald A Jurivich KW - Asymmetric HGS KW - Falls KW - impaired neuromuscular function AB -

BACKGROUND: Examining handgrip strength (HGS) asymmetry could extend the utility of handgrip dynamometers for screening future falls.

AIMS: We sought to determine the associations of HGS asymmetry on future falls in older Americans.

METHODS: The analytic sample included 10,446 adults aged at least 65 years from the 2006-2016 waves of the Health and Retirement Study. Falls were self-reported. A handgrip dynamometer measured HGS. The highest HGS on each hand was used for determining HGS asymmetry ratio: (non-dominant HGS/dominant HGS). Those with HGS asymmetry ratio < 1.0 had their ratio inverted to make all HGS asymmetry ratios ≥ 1.0. Participants were categorized into asymmetry groups based on their inverted HGS asymmetry ratio: (1) 0.0-10.0%, (2) 10.1-20.0%, (3) 20.1-30.0%, and (4) > 30.0%. Generalized estimating equations were used for the analyses.

RESULTS: Every 0.10 increase in HGS asymmetry ratio was associated with 1.26 (95% confidence interval (CI) 1.07-1.48) greater odds for future falls. Relative to those with HGS asymmetry 0.0-10.0%, participants with HGS asymmetry > 30.0% had 1.15 (CI 1.01-1.33) greater odds for future falls; however, the associations were not significant for those with HGS asymmetry 10.1-20.0% (odds ratio: 1.06; CI 0.98-1.14) and 20.1-30.0% (odds ratio: 1.10; CI 0.99-1.22). Compared to those with HGS asymmetry 0.0-10.0%, participants with HGS asymmetry > 10.0% and > 20.0% had 1.07 (CI 1.01-1.16) and 1.12 (CI 1.02-1.22) greater odds for future falls, respectively.

DISCUSSION: Asymmetric HGS, as a possible biomarker of impaired neuromuscular function, may help predict falls.

CONCLUSIONS: We recommend that HGS asymmetry be considered in HGS protocols and fall risk assessments.

VL - 33 IS - 9 ER - TY - JOUR T1 - Health risks of natural hazards and resilience resources: Evidence from a U.S. nationwide longitudinal study JF - Social Science & Medicine Y1 - 2021 A1 - Su Hyun Shin A1 - Ji, Hyunjung KW - Conservation of resource theory KW - Coping behavior KW - Health condition KW - Natural hazards KW - Resilience resources AB - BackgroundAlthough natural disasters can threaten health and well-being, some people show greater resilience to their effects than others. Identifying the characteristics related to resilience has important implications for reducing the health risks in the aftermath of a disaster.ObjectiveUsing the Conservation of Resources Theory as a framework, we study the role of resources in moderating the adverse effects of natural disasters on people's health and coping behaviors.MethodWe match 20,658 unique individuals aged 50 or older from the 2012–2016 waves of the Health and Retirement Study to the county-level annual natural hazard data provided by the Federal Emergency Management Agency. Using individual-fixed effect models, we first model whether the experience of natural disasters can predict people's health and coping behaviors. We then explore heterogeneity in such effects by interacting individual- and county-level resilience resources with the number of natural disasters.ResultsThe results show that with increased exposure to natural disasters, older adults are more likely to experience difficulties performing instrumental daily activities. They also tend to have fewer overnight hospital stays, higher out-of-pocket medical expenses, and increased alcohol dependency. However, older adults with certain socio-economic characteristics ‒ white, higher education, higher income, and homeownership ‒ are better able than others to mitigate any adverse health effects of natural disasters. One significant community-level resource is a robust healthcare capacity in a county with a high ratio of healthcare practitioners, where older adults are more likely to seek hospital care and have lower alcohol dependency.ConclusionsHealth resilience can be improved by strengthening community-level healthcare capacity, with a particular focus on residents with lower socio-economic resources. Failing to address healthcare provision inequalities may exacerbate health disparities. VL - 281 SN - 0277-9536 ER - TY - JOUR T1 - The incidence of the healthcare costs of chronic conditions. JF - International Journal of Health Economics and Management Y1 - 2021 A1 - Lee, Kyung Min A1 - Jeung, Chanup KW - Chronic disease KW - Compensating wage differential KW - Employer-sponsored health insurance KW - Wage AB -

Who pays for the costs of chronic conditions? In this paper, we examine whether 50-64-year old workers covered by employer-sponsored insurance bear healthcare costs of chronic conditions in the form of lower wages. Using a difference-in-differences approach with data from the Health and Retirement Study, we find that workers with chronic diseases receive significantly lower wages than healthy workers when they are covered by employer-sponsored insurance. Our findings suggest that higher healthcare costs of chronic conditions can explain the substantial part of the wage gap between workers with and without chronic diseases.

VL - 21 IS - 4 ER - TY - JOUR T1 - Loneliness mediates the relationships between perceived neighborhood characteristics and cognition in middle-aged and older adults. JF - International Journal of Geriatric Psychiatry Y1 - 2021 A1 - Yu, Xiaohui A1 - Yang, Jiulong A1 - Yin, Zhenhua A1 - Jiang, Wenjie A1 - Zhang, Dongfeng KW - Cognition KW - Loneliness KW - mediating effect KW - Perceived neighborhood characteristics AB -

OBJECTIVES: We aimed to examine whether loneliness mediates these associations between perceived neighborhood characteristics and cognition among middle-aged and older adults.

METHODS: Data from wave 10 (2010-2012) to wave 13 (2016-2017) of the Health and Retirement Study were analyzed. Perceived neighborhood characteristics were self-reported. Loneliness was measured by Revised University of California Los Angeles (R-UCLA) Loneliness Scale. Cognition was evaluated by the modified version of Telephone Interview for Cognitive Status. Baron and Kenny's causal steps and multiple linear regression models based on Karlson/Holm/Breen (KHB) method were used to examine the mediating effect.

RESULTS: At baseline, 15,142 participants had no cognitive impairment, and 11,413 individuals were finally included in our analysis after 6-year follow-up. Multiple linear regression models suggested that lower perceived neighborhood physical disorder (β = 0.073, p = 0.033) and greater perceived neighborhood safety (β = 0.350, p = 0.009) were associated with better cognition. KHB test identified the significant mediating effect of loneliness on the relationships between perceived neighborhood physical disorder (β = 0.011, p = 0.016) and perceived neighborhood safety (β = 0.023, p = 0.026) and cognition.

CONCLUSIONS: Perceived neighborhood characteristics are associated with cognition among middle-aged and older American adults. Loneliness mediated associations between perceived neighborhood physical disorder and perceived neighborhood safety and cognition.

VL - 36 IS - 12 ER - TY - JOUR T1 - Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness. JF - Journal of the American Medical Directors Association Y1 - 2021 A1 - Yu, Kexin A1 - Wu, Shinyi A1 - Yuri Jang A1 - Chou, Chih-Ping A1 - Kathleen H. Wilber A1 - Aranda, María P A1 - Iris Chi KW - fall KW - geriatric syndrome KW - Longitudinal analysis KW - random intercept cross-lagged panel model KW - Reciprocal relationships AB -

OBJECTIVES: In response to the lack of longitudinal evidence, this study aims to disentangle time sequence and directionality between the severity of geriatric conditions (GCs) and loneliness.

DESIGN: Longitudinal panel study.

SETTING AND PARTICIPANTS: The working sample had 4680 participants of 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS). All participants were at least 65 years old at baseline. Proxy responded cases and individuals who suffered from moderate to severe cognitive impairment were excluded from the analysis.

METHODS: Loneliness was measured with the 3-item UCLA loneliness scale. Five GCs were included: falls, incontinence, vision impairment, hearing impairment, and pain. Severity indicators were the number of times fallen in the past 2 years, number of days experiencing loss of bladder control in the past month, self-rated eyesight, self-rated hearing, and participants' perceived level of pain.

RESULTS: Random-intercept cross-lagged panel models were run to analyze the relationship between the severity of each individual GC and loneliness. All models were controlled for baseline demographics, social isolation, self-rated health, physical function, comorbidities, and hospitalization. The longitudinal association between loneliness and fall was bidirectional: a higher loneliness score predicted an increased number of falls and vice versa. Incontinence, vision impairment, hearing impairment, and pain were not significantly associated with loneliness longitudinally. The association between the random intercept of loneliness and some GCs (vision and pain) were significant, indicating the severity of these GCs were related to loneliness at the between-person level at baseline.

CONCLUSION AND IMPLICATIONS: Findings of the longitudinal analysis suggest a reciprocal relationship between fall and loneliness. Fall prevention programs could be integrated with social service for addressing loneliness, and alleviating loneliness might be beneficial for preventing falls. Results of this study highlight the importance of integrating clinical management of falls with social services addressing loneliness in long term care.

VL - 22 IS - 5 ER - TY - JOUR T1 - Long-term care service mix in the Veterans Health Administration after home care expansion JF - Health Services Research Y1 - 2021 A1 - Jacobs, Josephine C. A1 - Wagner, Todd H. A1 - Trivedi, Ranak A1 - Karl A Lorenz A1 - Courtney Harold Van Houtven KW - home- and community-based services KW - institutional care KW - Long-term Care KW - unpaid caregiving KW - Veterans Health Administration AB - Objective To determine whether the Veterans Health Administration's (VHA) efforts to expand access to home- and community-based services (HCBS) after the 2001 Millennium Act significantly changed Veterans' utilization of institutional, paid home, and unpaid home care relative to a non-VHA user Medicare population that was not exposed to HCBS expansion efforts. Data Sources We used linkages between the Health and Retirement Study and VHA administrative data from 1998 until 2012. Study Design We conducted a retrospective-matched cohort study using coarsened exact matching to ensure balance on observable characteristics for VHA users (n =?943) and nonusers (n =?6106). We used a difference-in-differences approach with a person fixed-effects estimator. Data Collection/Extraction Methods Individuals were eligible for inclusion in the analysis if they were age 65 or older and indicated that they were covered by Medicare insurance in 1998. Individuals were excluded if they were covered by Medicaid insurance at baseline. Individuals were considered exposed to VHA HCBS expansion efforts if they were enrolled in the VHA and used VHA services. Principal Findings Theory predicts that an increase in the public allocation of HCBS will decrease the utilization of its substitutes (e.g., institutional care and unpaid caregiving). We found that after the Millennium Act was passed, there were no observed differences between VHA users and nonusers in the probability of using institutional long-term care (0.7% points, 95% CI: ?0.009, 0.022) or in receiving paid help with activities of daily living (0.06% points, 95% CI: ?0.011, 0.0125). VHA users received more hours of unpaid care post-Millennium Act (1.48, 95% CI: ?0.232, 3.187), though this effect was not significant once we introduced controls for mental health. Conclusions Our findings indicate that mandating access to HCBS services does not necessarily imply that access to these services will follow suit. VL - 56 SN - 0017-9124 IS - 6 ER - TY - JOUR T1 - Long-Term Functional Outcomes in Older Adults After Hospitalization for Extracranial Hemorrhage JF - Circulation Y1 - 2021 A1 - Anna L Parks A1 - Sun Y Jeon A1 - John J Boscardin A1 - Michael A Steinman A1 - Alexander K Smith A1 - Margaret C Fang A1 - Kenneth E Covinsky A1 - Sachin J Shah KW - anticoagulation KW - antiplatelet drugs KW - hemorrhage AB - Introduction: Antiplatelet and anticoagulant medications often used to manage cardiovascular disease increase the risk of extracranial hemorrhage (ECH), such as gastrointestinal bleeding. There are few long-term data on the loss of function following ECH. This study’s goal was to measure the acute and persistent loss of independence in activities of daily living (ADLs) after ECH hospitalization. Methods: We used data from 1995-2015 from the Health and Retirement Study, a longitudinal, nationally representative survey of older Americans. We included subjects over age 65 who consented to Medicare linkage. We examined the association of ECH hospitalization with ability to perform all ADLs independently (walk across a room, dress, bathe, eat, toilet, get out of bed). To compare rates of ADL independence over time between those with ECH and a control group without ECH, we fit a logistic regression model that included an interaction term between ECH hospitalization and time and adjusted for comorbidities and sociodemographics. Results: In a cohort of 8950 with an average follow-up time of 7.3 years (65,335 person-years), 882 (10%) participants were hospitalized for ECH. Mean age was 78, and 59% were women. In the control group without ECH, the baseline rate of ADL independence declined by an average of 3.1% per year (average marginal effect [AME], 95% CI -3.1% to -3.3%). Assuming hospitalization for ECH at 5.2 years, the median time to ECH in this cohort, ECH was associated with an immediate decrease in ADL independence from 68% to 53% (AME -15%, 95% CI -11% to -18%). Following ECH, the average annual baseline rate of function loss did not change. Conclusions: In this nationally representative cohort, ECH hospitalization was associated with an immediate and pronounced decline in function that was equivalent to accelerating ADL disability by 5 years. After ECH, ADL independence continued to decline and did not recover to pre-ECH levels of independence over time. VL - 144 IS - Suppl _1 ER - TY - JOUR T1 - Long-term individual and population functional outcomes in older adults with atrial fibrillation. JF - Journal of the American Geriatrics Society Y1 - 2021 A1 - Anna L Parks A1 - Sun Y Jeon A1 - W John Boscardin A1 - Michael A Steinman A1 - Alexander K Smith A1 - Margaret C Fang A1 - Sachin J Shah KW - ADL disability KW - Atrial Fibrillation KW - community living KW - IADLS AB -

Background: Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability has not been previously characterized.

Methods: We performed a longitudinal, observational study in the nationally representative Health and Retirement Study (1992-2014). We included participants ≥65 years with Medicare claims who met incident AF diagnosis claims criteria. We examined the association of incident stroke with three functional outcomes: independence with activities of daily living (ADL) and instrumental activities of daily living (IADL) and community-dwelling. We fit separate logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimate the contribution of strokes to the overall population burden of functional impairment using the method of recycled predictions.

Results: Among 3530 participants (median age 79 years, 53% women, median CHA DS -VASc 5), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for population comorbidities, annually, ADL dependence increased by 4.4%, IADL dependence increased by 3.9%, and nursing home residence increased by 1.2% (p<0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p<0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4years.

Conclusion: Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant decline in function and an increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of functional loss, stroke was not the dominant determinant of population-level disability in older adults with AF.

Impact statement: We certify that this work is novel. Little is known about long-term function (ADL, IADL, community-dwelling) among older adults with AF and the association with stroke. This nationally representative study finds a high rate of function loss independent of stroke, and among those who suffer a stroke, a dramatic and immediate decline in function. Because of the high rate of function loss independent of stroke and the relatively low rate of stroke, on a population level, stroke is not the dominant determinant of disability in older adults with AF.

VL - 69 IS - 6 ER - TY - JOUR T1 - Maintaining Sense of Purpose Following Health Adversity in Older Adulthood: A Propensity Score Matching Examination. JF - The Journals of Gerontology: Series B Y1 - 2021 A1 - Patrick L Hill A1 - Beck, Emorie D A1 - Joshua J Jackson KW - health events KW - older adulthood KW - propensity score matching KW - Sense of purpose AB -

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' 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' 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.

VL - 76 IS - 8 ER - TY - JOUR T1 - MEDICAID AND MORTALITY: NEW EVIDENCE FROM LINKED SURVEY AND ADMINISTRATIVE DATA JF - Quarterly Journal of Economics Y1 - 2021 A1 - Miller, Sarah A1 - Johnson, Norman A1 - Wherry, Laura R. KW - administrative data KW - Medicaid KW - Mortality AB - 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. VL - 136 IS - 3 ER - TY - JOUR T1 - Multi-Ancestry Genome-wide Association Study Accounting for Gene-Psychosocial Factor Interactions Identifies Novel Loci for Blood Pressure Traits. JF - Human Genetics and Genomics Advances Y1 - 2021 A1 - Sun, Daokun A1 - Melissa Richard A1 - Musani, Solomon K A1 - Yun Ju Sung A1 - Thomas W Winkler A1 - Schwander, Karen A1 - Jin-Fang Chai A1 - Guo, Xiuqing A1 - Kilpeläinen, Tuomas O A1 - Vojinovic, Dina A1 - Aschard, Hugues A1 - Traci M Bartz A1 - Bielak, Lawrence F A1 - Brown, Michael R A1 - Chitrala, Kumaraswamy A1 - Hartwig, Fernando P A1 - Horimoto, Andrea R V R A1 - Liu, Yongmei A1 - Alisa Manning A1 - Noordam, Raymond A1 - Smith, Albert V A1 - Sarah E Harris A1 - Kühnel, Brigitte A1 - Lyytikäinen, Leo-Pekka A1 - Ilja M Nolte A1 - Rauramaa, Rainer A1 - van der Most, Peter J A1 - Wang, Rujia A1 - Erin B Ware A1 - Weiss, Stefan A1 - Wen, Wanqing A1 - Yanek, Lisa R A1 - Dan E Arking A1 - Donna K Arnett A1 - Barac, Ana A1 - Boerwinkle, Eric A1 - Broeckel, Ulrich A1 - Chakravarti, Aravinda A1 - Chen, Yii-Der Ida A1 - Cupples, L Adrienne A1 - Davigulus, Martha L A1 - de Las Fuentes, Lisa A1 - de Mutsert, Renée A1 - de Vries, Paul S A1 - Delaney, Joseph A C A1 - Ana V Diez Roux A1 - Dörr, Marcus A1 - Jessica Faul A1 - Fretts, Amanda M A1 - Gallo, Linda C A1 - Hans-Jörgen Grabe A1 - Gu, C Charles A1 - Tamara B Harris A1 - Hartman, Catharina C A A1 - Heikkinen, Sami A1 - Ikram, M Arfan A1 - Isasi, Carmen A1 - Johnson, W Craig A1 - Jost Bruno Jonas A1 - Kaplan, Robert C A1 - Komulainen, Pirjo A1 - Krieger, Jose E A1 - Levy, Daniel A1 - Liu, Jianjun A1 - Kurt Lohman A1 - Luik, Annemarie I A1 - Martin, Lisa W A1 - Meitinger, Thomas A1 - Milaneschi, Yuri A1 - Jeff O'Connell A1 - Walter R Palmas A1 - Peters, Annette A1 - Peyser, Patricia A A1 - Pulkki-Raback, Laura A1 - Raffel, Leslie J A1 - Reiner, Alex P A1 - Kenneth Rice A1 - Robinson, Jennifer G A1 - Rosendaal, Frits R A1 - Schmidt, Carsten Oliver A1 - Schreiner, Pamela J A1 - Schwettmann, Lars A1 - Shikany, James M A1 - Shu, Xiao-Ou A1 - Stephen Sidney A1 - Sims, Mario A1 - Smith, Jennifer A A1 - Sotoodehnia, Nona A1 - Strauch, Konstantin A1 - Tai, E Shyong A1 - Taylor, Kent A1 - André G Uitterlinden A1 - Cornelia M van Duijn A1 - Waldenberger, Melanie A1 - Wee, Hwee-Lin A1 - Wei, Wen-Bin A1 - Wilson, Gregory A1 - Xuan, Deng A1 - Yao, Jie A1 - Zeng, Donglin A1 - Zhao, Wei A1 - Zhu, Xiaofeng A1 - Alan B Zonderman A1 - Becker, Diane M A1 - Ian J Deary A1 - Gieger, Christian A1 - Lakka, Timo A A1 - Lehtimäki, Terho A1 - Kari E North A1 - Oldehinkel, Albertine J A1 - Brenda W J H Penninx A1 - Snieder, Harold A1 - Wang, Ya-Xing A1 - David R Weir A1 - Zheng, Wei A1 - Michele K Evans A1 - Gauderman, W James A1 - Gudnason, Vilmundur A1 - Horta, Bernardo L A1 - Liu, Ching-Ti A1 - Dennis O Mook-Kanamori A1 - Alanna C Morrison A1 - Pereira, Alexandre C A1 - Psaty, Bruce M A1 - Amin, Najaf A1 - Fox, Ervin R A1 - Charles Kooperberg A1 - Sim, Xueling A1 - Laura Bierut A1 - Rotter, Jerome I A1 - Sharon L R Kardia A1 - Franceschini, Nora A1 - Rao, Dabeeru C A1 - Myriam Fornage KW - blood pressure traits AB -

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.

VL - 2 IS - 1 ER - TY - JOUR T1 - No association between rheumatoid arthritis and cognitive impairment in a cross-sectional national sample of older U.S. adults. JF - BMC Rheumatology Y1 - 2021 A1 - Booth, Michael J A1 - Mary R Janevic A1 - Lindsay C Kobayashi A1 - Daniel Clauw A1 - John D Piette KW - cognitive impairment KW - Epidemiology KW - National health survey KW - rheumatoid arthritis AB -

BACKGROUND: Studies suggest an increased prevalence of cognitive impairment (CI) among people with rheumatoid arthritis (RA). However, most prior studies have used convenience samples which are subject to selection biases or have failed to adjust for key confounding variables. We thus examined the association between CI and RA in a large national probability sample of older US adults.

METHODS: Data were from interviews with 4462 participants in the 2016 wave of the nationally representative U.S. Health and Retirement Study with linked Medicare claims. RA diagnoses were identified via a minimum of two ICD-9CM or ICD-10 codes in Medicare billing records during the prior 2 years. The Langa-Weir Classification was used to classify cognitive status as normal, cognitively impaired non-dementia (CIND), or dementia based on a brief neuropsychological battery for self-respondents and informant reports for proxy respondents. We compared the odds of CI between older adults with and without RA using logistic regression, adjusted for age, education, gender, and race.

RESULTS: Medicare records identified a 3.36% prevalence of RA (150/4462). While age, gender, education, and race independently predicted CI status, controlling for these covariates we found no difference in CI prevalence according to RA status (prevalent CI in 36.7% of older adults with RA vs. 34.0% without RA; adjusted OR = 1.08, 95% CI 0.74-1.59, p = .69).

CONCLUSION: There was no association between RA and CI in this national sample of older U.S. adults.

VL - 5 IS - 1 ER - TY - JOUR T1 - No increased risk of Alzheimer's disease among people with immune-mediated inflammatory diseases: findings from a longitudinal cohort study of U.S. older adults. JF - BMC Rheumatology Y1 - 2021 A1 - Booth, Michael J A1 - Lindsay C Kobayashi A1 - Mary R Janevic A1 - Daniel Clauw A1 - John D Piette KW - Alzheimer KW - immune-mediated inflammatory disease KW - Medicare claims data AB -

OBJECTIVE: Immune-mediated inflammatory diseases (IMID) are characterized by systemic inflammation affecting the joints and bodily organs. Studies examining the association between individual IMIDs and the risk of Alzheimer's disease (AD) have yielded inconsistent findings. This study examines AD risk across a group of IMIDs in a large population-based sample of older adults.

METHODS: Data on a national sample of US adults over age 50 was drawn from the Health and Retirement Study (HRS) and linked Medicare claims from 2006 to 2014. IMIDs include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and related conditions. We identified IMIDs from 2006 to 2009 Medicare claims using International Classification of Diseases (ICD9-CM) codes. The date of incident AD was derived from Chronic Conditions Warehouse (CCW) identifiers. We examined the risk of AD from 2009 to 2014 using Cox proportional hazards models, both unadjusted and adjusted for age, gender, education, race, and the genetic risk factor APOE-e4.

RESULTS: One hundred seventy-one (6.02%) of the 2842 total HRS respondents with Medicare coverage and genetic data were classified with IMIDs. Over the subsequent 6 years, 9.36% of IMID patients developed AD compared to 8.57% of controls (unadjusted hazard ratio (HR): 1.09, 95% CI .66-1.81, p = 0.74). Adjusted HR 1.27 (95% CI 0.76-2.12, p = 0.35). Age (HR for 10-year increment 3.56, p < .001), less than high school education (HR 1.70, p = .007), and APOE-e4 (HR 2.61, p < .001 for one or two copies), were also statistically significant predictors of AD.

CONCLUSION: HRS respondents with common IMIDs do not have increased risk of Alzheimer's disease over a 6-year period.

VL - 5 IS - 1 ER - TY - RPRT T1 - Occupations, Retirement, and the Value of Disability Insurance Y1 - 2021 A1 - Lindsay Jacobs KW - disability insurance KW - life-cycle modeling KW - Occupational choice KW - Retirement AB - Occupations vary greatly in physical intensity, and there are, correspondingly, many differences in later-life work disability risk, retirement patterns, and applications for Social Security Disability Insurance (SSDI)—a national program that insures shocks to work productivity due to disability, with about 10 million current beneficiaries in the U.S. In light of its widespread coverage and large differences in utilization across occupations, this paper aims to measure the value of the SSDI program across a broad population and the extent to which it influences the major choice of occupation. Using data from the Health and Retirement Study and O*NET, I estimate a life-cycle equilibrium model of occupational choice, work, savings, and disability at older ages, and find that incorporating occupations and preference heterogeneity is an integral part of understanding work and SSDI application behavior. While SSDI coverage is nearly universal and the premiums from workers are uniform, estimates suggest that the value of the program varies greatly, from being worth 2.1 to 14.5 percent of earned income—depending on preferences and choice of occupation—though for all groups it is welfare improving. I also find that SSDI plays an important role in the choice of occupation for older workers, providing an insurance value that results in over ten percent more people choosing physically intense, blue-collar occupations at older ages. This overall effect, however, masks the underlying selection of less risk-averse individuals into blue-collar jobs, which proves to be necessary for accurately evaluating the impacts of policy on behavior. UR - https://lindsayjacobs.github.io/papers/Occupations-Retirement-DI_Jacobs.pdf ER - TY - JOUR T1 - Oral Conditions, Oral Health Related Quality of Life and Cognitive Function: Preliminary Results from the Health and Retirement Study JF - Advances in Geriatric Medicine and Research Y1 - 2021 A1 - Joshi, Prajakta A1 - Kaufman, Laura B. A1 - Cabral, Howard KW - Cognition KW - Dementia KW - Oral Health KW - oral health related quality of life AB - Background: Growing evidence suggests that cognitive functioning is influenced by oral health status. This study examines the association between the status or condition of the mouth as measured by self-report (OH), oral health related quality of life (OHRQoL) and dental care utilization on cognitive function. Design: Population‐based cross‐sectional study. Setting: United States Health and Retirement Study (2018). Participants: Community‐dwelling adults above 50 years of age (N = 1268; Mean age (SD) 67.14 ± 10.54 years). Measurements: Self-reported condition of mouth and teeth, number of teeth and denture use were used to determine the OH. OHRQoL was assessed as a composite score using self-reported pain or distress due to gums or teeth, difficulty to relax, avoiding eating certain foods, or socializing due to oral health issues. Validated cognitive score cut-offs were used: (i) (≥12) representing normal cognition (ii) (6–11) “cognitive impairment, not demented” (CIND), and (iii) (<6) dementia. Results: We found that participants with worse OHRQoL had 0.15 units lower global cognitive scores (β = −0.15, SE = 0.03, p = < 0.0001). Compared to those with dementia, participants in normal and CIND categories had greater odds of better OH (ORNormal = 1.76, (95%CI: 1.09–2.84); ORCIND = 2.86, (95%CI: 1.60–5.09)). Furthermore, participants in the CIND category had greater odds of using dentures compared to participants with dementia (ORCIND = 2.71, (95%CI: 1.49–4.93)). We did not find any statistically significant association between tooth loss or dental utilization and dementia. Conclusions: This study provides valuable preliminary insights into the potential association between OH and OHRQoL and cognitive function. If further validated, this method may allow dental and cognitive triage for follow-up assessments in community dwelling adults who may have limited access to care. VL - 3 IS - 4 ER - TY - JOUR T1 - Prevalence and predictors of depressive symptoms in older adults with cancer. JF - Journal of Geriatric Oncology Y1 - 2021 A1 - Parajuli, Jyotsana A1 - Berish, Diane A1 - Valenti, Korijna G A1 - Jao, Ying-Ling KW - Cancer KW - Chronic conditions KW - depression KW - Depressive symptoms KW - Functional limitations KW - Older Adults AB -

INTRODUCTION: Older adults with cancer are at risk of developing depressive symptoms. However, little is known about the prevalence and predictors of depressive symptoms in older adults with cancer.

MATERIALS AND METHODS: This study examined the prevalence and predictors of depressive symptoms among older adults with cancer in the United States using the data from the 2012 and 2014 wave of the Health and Retirement Study. This analysis included 1799 older adults aged 65 and over with a self-reported diagnosis of cancer. Multivariate regression analysis was used to examine the predictors of depressive symptoms. The main predictors included age, gender, race, education, marital status, chronic conditions, and functional limitations.

RESULTS: Results revealed that the prevalence of depressive symptoms in older adults with cancer was 14.9%. Results of Poisson regression revealed that greater age, belonging to a race other than White or African American, not being married, presence of more chronic conditions, and higher levels of functional limitations were associated with higher levels of depressive symptoms.

DISCUSSION: The prevalence of depressive symptoms is high in older adults with cancer and several factors predict depressive symptoms in this population. Individuals who are at high risk of developing depressive symptoms should be identified and appropriate timely interventions should be initiated to reduce the rates of depressive symptoms in older adults with cancer.

VL - 12 IS - 4 ER - TY - JOUR T1 - Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity JF - International Journal of Environmental Research and Public Health Y1 - 2021 A1 - Jun, Hankyung A1 - Emma Aguila KW - Cognitive health KW - Health Insurance KW - Mental Health KW - Multiple Chronic Conditions KW - race disparity AB - Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions. VL - 18 IS - 5 ER - TY - JOUR T1 - Quantifying Lifecourse Drivers of International Migration: A Cross-national Analysis of Mexico and the United States. JF - Epidemiology Y1 - 2021 A1 - Adina Zeki Al Hazzouri A1 - Zhang, Lanyu A1 - Audrey R Murchland A1 - Grasset, Leslie A1 - Jacqueline M Torres A1 - Richard N Jones A1 - Rebeca Wong A1 - M. Maria Glymour KW - long-term health consequences KW - MHAS KW - migrants AB -

BACKGROUND: Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health.

METHODS: We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.

RESULTS: Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.

CONCLUSIONS: Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.

VL - 32 IS - 1 ER - TY - JOUR T1 - Racial/Ethnic Differences in Mortality in Late Midlife: Have They Narrowed in Recent Years? JF - The Journals of Gerontology: Series B Y1 - 2021 A1 - Doza, Adit A1 - Gail A Jensen A1 - Wassim Tarraf KW - Death Rates KW - Disparities KW - minorities AB -

OBJECTIVES: Examine whether racial/ethnic differences in mortality rates have changed in recent years among adults in late midlife, and if so, how.

METHODS: We analyze Health and Retirement Study data on non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), and English- and Spanish-speaking Hispanics (Hispanic-English and Hispanic-Spanish), ages 50-64 from two periods: 1998-2004 (P1, n=8920) and 2004-2010 (P2, n=7224). Using survey-generalized linear regression techniques we model death-by-end-of-period as a function of race/ethnicity, and sequentially adjust for a series of period-specific baseline risk factors including demographics, health status, health insurance, health behaviors, and social networks. Regression decomposition techniques are used to assess the contribution of these factors to observed racial/ethnic differences in mortality rates.

RESULTS: The odds ratio for death (ORD) was not statistically different for Blacks (vs. Whites) in P1 but was 33% higher in P2 (OR=1.33; 95% CI=1.05-1.69). The adjusted ORD among Hispanic-English (vs. Whites) was not statistically different in both periods. The adjusted ORD among Hispanic-Spanish (vs. Whites) was lower (ORD=0.36; 95% CI= 0.22-0.59) in P1 but indistinguishable in P2. In P1, 50.1% of the disparity in mortality rates among Blacks was explained by baseline health status, 53.1% was explained by financial factors. In P2, 55.8% of the disparity in mortality rates was explained by health status, 40.0% by financial factors and 16.2% by health insurance status.

DISCUSSION: Mortality rates among Blacks and Hispanic-Spanish have risen since the mid-1990s. Hispanic-Spanish, may be losing their advantageous lower risk of mortality, long known as the "Hispanic Paradox."

VL - 76 IS - 7 ER - TY - JOUR T1 - The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Olde JF - Nutrients Y1 - 2021 A1 - Patrick Brady A1 - Askelson, Natoshia M A1 - Ashida, Sato A1 - Nothwehr, F. A1 - Janssen, Brandi A1 - Frisvold, David KW - Food insecurity KW - social exclusion AB - Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults’ health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities VL - 13 IS - 11 ER - TY - JOUR T1 - Research on Family Relationship and Cognitive Function among Older Hispanic Americans: Empirical Evidence from the Health and Retirement Study JF - Hispanic Journal of Behavioral Sciences Y1 - 2021 A1 - Xiao, Chunhui A1 - Mao, Shan A1 - Jia, Siming A1 - Lu, Nan KW - cognitive function KW - family relationship KW - gender KW - Hispanics AB - The current study aimed to investigate the associations between family relationship and cognitive function among Hispanic older population. A cross-sectional analysis was conducted with a sample size of 1,580 individuals from the Health and Retirement Study in the United States (mean age?=?65.65 (SD?=?9.33)). Family relationship was measured in three dimensions: structural, functional, and appraisal support. The results of linear regression analysis indicated that diverse composition of family network (??=?.070, p?=?.009) and receiving financial support from family members (??=?.060, p?=?.018) were associated with better cognitive function. Moderation analyses demonstrated that these associations were greater for Hispanic women than men. Current findings highlight the importance of family relationship on cognitive function among Hispanic older population and suggest that researchers and policymakers should put emphasis on the structural and functional aspects of family relationship to improve their cognitive health. VL - 43 SN - 0739-9863 IS - 1-2 ER - TY - JOUR T1 - Subtle mistakes in self-report surveys predict future transition to dementia JF - Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring Y1 - 2021 A1 - Stefan Schneider A1 - Junghaenel, Doerte U. A1 - Elizabeth Zelinski A1 - Erik Meijer A1 - Arthur A. Stone A1 - Kenneth M. Langa A1 - Arie Kapteyn KW - cognitive impairment KW - Dementia KW - early detection KW - Epidemiology KW - functional abilities KW - self-report surveys AB - Introduction We investigate whether indices of subtle reporting mistakes derived from responses in self-report surveys are associated with dementia risk. Methods We examined 13,831 participants without dementia from the prospective, population-based Health and Retirement Study (mean age 69 ± 10 years, 59% women). Participants’ response patterns in 21 questionnaires were analyzed to identify implausible responses (multivariate outliers), incompatible responses (Guttman errors), acquiescent responses, random errors, and the proportion of skipped questions. Subsequent incident dementia was determined over up to 10 years of follow-up. Results During follow-up, 2074 participants developed dementia and 3717 died. Each of the survey response indices was associated with future dementia risk controlling for confounders and accounting for death as a competing risk. Stronger associations were evident for participants who were younger and cognitively normal at baseline. Discussion Mistakes in the completion of self-report surveys in longitudinal studies may be early indicators of dementia among middle-aged and older adults. VL - 13 ER - TY - JOUR T1 - Validation of Self-Reported Rheumatoid Arthritis Using Medicare Claims: A Nationally Representative Longitudinal Study of Older Adults. JF - ACR Open Rheumatology Y1 - 2021 A1 - Booth, Michael J A1 - Daniel Clauw A1 - Mary R Janevic A1 - Lindsay C Kobayashi A1 - John D Piette KW - Medicare claims KW - rheumatoid arthritis KW - self reported AB -

OBJECTIVE: To determine the validity of self-reported physician diagnosis of rheumatoid arthritis (RA) using multiple gold-standard measures based on Medicare claims in a nationally representative sample of older adults and to verify whether additional questions about taking medication and having seen a physician in the past two years for arthritis can improve the positive predictive value (PPV) and other measures of the validity of self-reported RA.

METHODS: A total of 3768 Medicare-eligible respondents with and without incident self-reported RA were identified from the 2004, 2008, and 2012 waves of the United States Health and Retirement Study. Self-reported RA was validated using the following three claims-based algorithms: 1) a single International Classification of Diseases, ninth edition, Clinical Modification claim for RA, 2) two or more claims no greater than 2 years apart, and 3) two or more claims with at least one diagnosis by a rheumatologist. Additional self-report questions of medication use and having seen a doctor for arthritis in the past two years were validated against the same criteria.

RESULTS: A total of 345 respondents self-reported a physician diagnosis of RA. Across all three RA algorithms, the PPV of self-report ranged from 0.05 to 0.16., the sensitivity ranged from 0.23 to 0.55., and the κ statistic ranged from 0.07 to 0.15. Additional self-report data regarding arthritis care improved the PPV and other validity measures of self-report; however, the values remained low.

CONCLUSION: Most older adults who self-report RA do not have a Medicare claims history consistent with that diagnosis. Revisions to current self-reported RA questions may yield more valid identification of RA in national health surveys.

VL - 3 IS - 4 ER - TY - NEWS T1 - ‘We need people to know the ABC of finance’: facing up to the financial literacy crisis T2 - Financial Times Y1 - 2021 A1 - Johnson, Miles KW - Education KW - Financial literacy JF - Financial Times CY - London UR - https://www.ft.com/content/b6a8107c-99f4-4a43-8adc-9686e6bd603e ER - TY - RPRT T1 - Why do couples and singles save during retirement? Y1 - 2021 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones A1 - McGee, Rory KW - AHEAD KW - Couples KW - Retirement KW - Savings KW - Singles AB - While the savings of retired singles tend to fall with age, those of retired couples tend to rise. We estimate a rich model of retired singles and couples with bequest motives and uncertain longevity and medical expenses. Our estimates imply that while medical expenses are an important driver of the savings of middle-income singles, bequest motives matter for couples and high-income singles, and generate transfers to non-spousal heirs whenever a household member dies. The interaction of medical expenses and bequest motives is a crucial determinant of savings for all retirees. Hence, to understand savings, it is important to model household structure, medical expenses, and bequest motives. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA ER - TY - JOUR T1 - You say tomato, I say radish: can brief cognitive assessments in the US Health Retirement Study be harmonized with its International Partner Studies? JF - The Journals of Gerontology, Series B Y1 - 2021 A1 - Lindsay C Kobayashi A1 - Alden L Gross A1 - Laura E Gibbons A1 - Tommet, Doug A1 - Sanders, R Elizabeth A1 - Choi, Seo-Eun A1 - Mukherjee, Shubhabrata A1 - M. Maria Glymour A1 - Jennifer J Manly A1 - Lisa F Berkman A1 - Paul K Crane A1 - Mungas, Dan M A1 - Richard N Jones KW - cognitive function KW - health survey KW - international comparison KW - item response theory KW - statistical harmonization AB -

OBJECTIVES: To characterize the extent to which brief cognitive assessments administered in the population-representative US Health and Retirement Study (HRS) and its International Partner Studies can be considered to be measuring a single, unidimensional latent cognitive function construct.

METHOD: Cognitive function assessments were administered in face-to-face interviews in 12 studies in 26 countries (N=155,690), including the US HRS and selected International Partner Studies. We used the time point of first cognitive assessment for each study to minimize differential practice effects across studies, and documented cognitive test item coverage across studies. Using confirmatory factor analysis models, we estimated single factor general cognitive function models, and bifactor models representing memory-specific and non-memory-specific cognitive domains for each study. We evaluated model fits and factor loadings across studies.

RESULTS: Despite relatively sparse and inconsistent cognitive item coverage across studies, all studies had some cognitive test items in common with other studies. In all studies, the bifactor models with a memory-specific domain fit better than single factor general cognitive function models. The data fit the models at reasonable thresholds for single factor models in six of the 12 studies, and for the bifactor models in all 12 of the 12 studies.

DISCUSSION: The cognitive assessments in the US HRS and its International Partner Studies reflect comparable underlying cognitive constructs. We discuss the assumptions underlying our methods, present alternatives, and future directions for cross-national harmonization of cognitive aging data.

VL - 76 IS - 9 ER - TY - JOUR T1 - Annual Wellness Visits and Influenza Vaccinations among Older Adults in the US. JF - Journal of Primary Care & Community Health Y1 - 2020 A1 - Jørgensen, Terese Sara Høj A1 - Heather G. Allore A1 - Elman, Miriam R A1 - Corey L Nagel A1 - Zhang, Mengran A1 - Markwardt, Sheila A1 - Ana R Quiñones KW - annual wellness visits KW - influenza vaccinations KW - machine learning methods KW - preventive healthcare utilization AB -

OBJECTIVES: Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

METHODS: Data on 4999 individuals aged ≥65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

RESULTS: Two-year uptake was 22.8% for AWVs and 65.9% for influenza vaccinations. For AWVs, geographical region and wealth emerged as the most important predictors. For influenza vaccinations, number of somatic conditions, race/ethnicity, education, and wealth were the most important predictors.

CONCLUSIONS: The importance of geographic region for AWV utilization suggests that this service was unequally adopted. Non-Hispanic black participants and/or those with functional limitations were less likely to receive influenza vaccination.

VL - 11 ER - TY - JOUR T1 - The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study. JF - Innovation in Aging Y1 - 2020 A1 - Roland J. Thorpe Jr. A1 - Ryon J. Cobb A1 - King, Keyonna A1 - Bruce, Marino A A1 - Archibald, Paul A1 - Jones, Harlan P A1 - Norris, Keith C A1 - Keith E Whitfield A1 - Hudson, Darrell KW - Allostatic load KW - Black men KW - Depressive symptoms KW - health KW - Inequities KW - Men KW - Stress AB -

Background and Objectives: Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men.

Research Design and Methods: This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies-Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs).

Results: There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20-2.17]) than black men in the low AL group.

Discussion and Implications: Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.

VL - 4 IS - 5 ER - TY - JOUR T1 - Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery JF - JAMA Surgery Y1 - 2020 A1 - Victoria L. Tang A1 - Jing, Bocheng A1 - W John Boscardin A1 - Ngo, Sarah A1 - Silvestrini, Molly A1 - Finlayson, Emily A1 - Kenneth E Covinsky KW - Cognition KW - Mortality KW - Surgery AB - More older adults are undergoing major surgery despite the greater risk of postoperative mortality. Although measures, such as functional, cognitive, and psychological status, are known to be crucial components of health in older persons, they are not often used in assessing the risk of adverse postoperative outcomes in older adults.To determine the association between measures of physical, cognitive, and psychological function and 1-year mortality in older adults after major surgery.Retrospective analysis of a prospective cohort study of participants 66 years or older who were enrolled in the nationally representative Health and Retirement Study and underwent 1 of 3 types of major surgery.Major surgery, including abdominal aortic aneurysm repair, coronary artery bypass graft, and colectomy.Our outcome was mortality within 1 year of major surgery. Our primary associated factors included functional, cognitive, and psychological factors: dependence in activities of daily living (ADL), dependence in instrumental ADL, inability to walk several blocks, cognitive status, and presence of depression. We adjusted for other demographic and clinical predictors.Of 1341 participants, the mean (SD) participant age was 76 (6) years, 737 (55\%) were women, 99 (7\%) underwent abdominal aortic aneurysm repair, 686 (51\%) coronary artery bypass graft, and 556 (42\%) colectomy; 223 (17\%) died within 1 year of their operation. After adjusting for age, comorbidity burden, surgical type, sex, race/ethnicity, wealth, income, and education, the following measures were significantly associated with 1-year mortality: more than 1 ADL dependence (29\% vs 13\%; adjusted hazard ratio [aHR], 2.76; P = .001), more than 1 instrumental ADL dependence (21\% vs 14\%; aHR, 1.32; P = .05), the inability to walk several blocks (17\% vs 11\%; aHR, 1.64; P = .01), dementia (21\% vs 12\%; aHR, 1.91; P = .03), and depression (19\% vs 12\%; aHR, 1.72; P = .01). The risk of 1-year mortality increased within the increasing risk factors present (0 factors: 10.0\%; 1 factor: 16.2\%; 2 factors: 27.8\%).In this older adult cohort, 223 participants (17\%) who underwent major surgery died within 1 year and poor function, cognition, and psychological well-being were significantly associated with mortality. Measures in function, cognition, and psychological well-being need to be incorporated into the preoperative assessment to enhance surgical decision-making and patient counseling. UR - https://jamanetwork.com/journals/jamasurgery/article-abstract/2762522 ER - TY - JOUR T1 - Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care JF - JAMA Network Open Y1 - 2020 A1 - Courtney Harold Van Houtven A1 - Brian E McGarry A1 - Jutkowitz, Eric A1 - David C Grabowski KW - Affordable Care Act KW - Long-term Care KW - Medicaid KW - Patient Protection and Affordable Care Act AB - Medicaid expansion is associated with increased access to health services, increased quality of medical care delivered, and reduced mortality, but little is known about its association with use of long-term care.To examine the association of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) with long-term care use among newly eligible low-income adults and among older adults whose eligibility did not change.This difference-in-difference cohort study used data from the Health and Retirement Study, a nationally representative longitudinal survey of persons 50 years or older. Long-term care use from 2008 to 2012 was compared with use from 2014 to 2016 among low-income adults aged 50 to 64 years without Medicare coverage residing in states in which Medicaid coverage expanded in 2014 and those living in states without expansion. Low-income adults who were covered by Medicare and were ineligible for expanded Medicaid were also included in the analysis. Data were analyzed from January 15, 2018, to December 31, 2019.Residence in a state with Medicaid expansion in 2014.Any home health care use or any nursing home use in 2014 or 2016. All estimates are weighted to account for the Health and Retirement Study sampling design.Among the 891 individuals likely eligible for expanded Medicaid, the mean (SD) age was 55.2 (3.1) years; 534 (53.4%) were women, 482 (49.5%) were married, and 661 (45.9%) were White non-Hispanic. Before the ACA-funded Medicaid expansion, 0.4% (95% CI, −0.3% to 1.1%) in expansion states and 1.0% (95% CI, −0.1% to 2.2%) in nonexpansion states used nursing homes, and 1.9% (95% CI, 0.4%-3.4%) in expansion states and 7.1% (95% CI, 4.7%-9.5%) in nonexpansion states used any formal home care. The ACA-funded Medicaid expansion was associated with an increase of 4.4 percentage points (95% CI, 2.8-6.1 percentage points) in the probability of any long-term care use among low-income, middle-aged adults, with increases in home health use (3.8 percentage points; 95% CI, 2.0-5.6 percentage points) and in any nursing home use (2.1 percentage points; 95% CI, 0.9-3.3 percentage points).In this study, ACA-funded Medicaid expansion was associated with an increase in any long-term care use among newly eligible low-income, middle-aged adults, suggesting that the population covered by the Medicaid expansion may have had unmet long-term care needs before expansion. VL - 3 SN - 2574-3805 IS - 10 ER - TY - JOUR T1 - Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States JF - Innovation in Aging Y1 - 2020 A1 - Emily J Nicklett A1 - Chen, Jieling A1 - Xiang, Xiaoling A1 - Leah R. Abrams A1 - Amanda Sonnega A1 - Kimson E Johnson A1 - Cheng, Jianjia A1 - Shervin Assari KW - Age at diagnosis KW - Chronic disease self-management KW - Event-oriented model KW - Life-course perspective KW - Piecewise regression KW - Race/ethnicity AB - BACKGROUND AND OBJECTIVES: Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes. RESEARCH DESIGN AND METHODS: We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004-2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis. RESULTS: Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (β: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D. DISCUSSION AND IMPLICATIONS: Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed. VL - 4 SN - 2399-5300 IS - 1 U4 - igz048[PII] ER - TY - JOUR T1 - Bayesian variable selection in linear quantile mixed models for longitudinal data with application to macular degeneration. JF - PLoS One Y1 - 2020 A1 - Ji, Yonggang A1 - Shi, Haifang KW - Bayes Theorem KW - Computer Simulation KW - Datasets as Topic KW - Linear Models KW - Longitudinal Studies KW - Macular Degeneration AB -

This paper presents a Bayesian analysis of linear mixed models for quantile regression based on a Cholesky decomposition for the covariance matrix of random effects. We develop a Bayesian shrinkage approach to quantile mixed regression models using a Bayesian adaptive lasso and an extended Bayesian adaptive group lasso. We also consider variable selection procedures for both fixed and random effects in a linear quantile mixed model via the Bayesian adaptive lasso and extended Bayesian adaptive group lasso with spike and slab priors. To improve mixing of the Markov chains, a simple and efficient partially collapsed Gibbs sampling algorithm is developed for posterior inference. Simulation experiments and an application to the Age-Related Macular Degeneration Trial data to demonstrate the proposed methods.

VL - 15 IS - 10 ER - TY - JOUR T1 - The bidirectional relationship between physical health and memory. JF - Psychology and Aging Y1 - 2020 A1 - Nelson, Niccole A A1 - Jacobucci, Ross A1 - Kevin J. Grimm A1 - Elizabeth Zelinski KW - Cognition KW - Physical Health AB -

Individuals typically experience changes in physical health and cognitive ability across the life span. Although these constructs dynamically relate to one another, the temporal ordering of dynamic changes in physical health and cognitive ability is not well-established. Therefore, we examined the temporal ordering of the dynamic, bidirectional relationship between physical health and memory across ages 50-87 with Bivariate Dual Change Score Models (BDCSM). Employing a model-comparison approach, we tested whether inclusion of specific directional coupling parameters resulted in a meaningful improvement in model fit, controlling for education, gender, and race. The current sample included 9,103 individuals who participated in Waves 4-11 (1998-2012) of the Health and Retirement Study. Results indicated that both memory and physical health declined across ages 50-87. Furthermore, level of memory at a given time point was positively associated with subsequent change in physical health, meaning higher memory was linked to less decline in physical health by the subsequent time point. The opposite effect, namely physical health predicting memory, was much weaker. Age differences were also evident in the bidirectional coupling model, indicating that old-old individuals (i.e., ages 75-87) exhibited a much stronger coupling effect from memory to change in physical health than younger individuals (i.e., ages 50-74). In conclusion, memory buffers decline in physical health across mid-to-later life, and this effect is especially strong at older ages. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

ER - TY - JOUR T1 - Characteristics of Repeated Influenza Vaccination Among Older U.S. Adults. JF - American Journal of Preventive Medicine Y1 - 2020 A1 - Barbara H. Bardenheier A1 - Zullo, Andrew R A1 - Jutkowitz, Eric A1 - Gravenstein, Stefan KW - characteristics KW - Influenza Vaccines AB -

INTRODUCTION: Annual influenza vaccination is associated with reduced mortality among older adults and lower overall public health burden of influenza. This study seeks to identify the characteristics associated with repeat influenza vaccination and determine whether age-group (51-59, 60-69, ≥70 years) differences exist.

METHODS: Using the nationally representative, longitudinal Health and Retirement Study waves 2004, 2008, 2012, and 2016, adults aged >50 years were followed from 2004 to 2016. In 2020, age-stratified, multinomial regression models were estimated to identify the factors associated with respondents receiving the vaccine repeatedly (every time point), occasionally (some years), or never, with censoring for death.

RESULTS: The overall proportion of adults repeatedly receiving influenza vaccine monotonically increased across age groups from 25.9% among adults aged 51-59 years to 62.4% among those aged ≥70 years. Black, non-Hispanics and smokers were less likely to repeatedly receive an influenza vaccine than white, non-Hispanics and nonsmokers (RR=0.40-0.61 and RR=0.60-0.75, respectively, p<0.05 for all). Those who had 1‒4 medical doctor visits in the past 2 years (RR=1.60-2.99) or cholesterol screening (RR=2.67-3.48) in the past 2 years were significantly more likely to repeatedly receive influenza vaccine than those who had none.

CONCLUSIONS: Although adults aged 60-69 years and ≥70 years are more likely to receive influenza vaccine repeatedly than adults aged 51-59 years, age-specific interventions for repeat influenza vaccination may not be as effective as interventions targeted to certain subgroups among adults aged ≥51 years.

ER - TY - JOUR T1 - Comparison of Health Outcomes Among High- and Low-Income Adults Aged 55 to 64 Years in the US vs England JF - JAMA Intern Med Y1 - 2020 A1 - Choi, Hwajung A1 - Andrew Steptoe A1 - Michele M Heisler A1 - Philippa J Clarke A1 - Robert F. Schoeni A1 - Jivraj, Stephen A1 - Cho, Tsai-Chin A1 - Kenneth M. Langa KW - Demographics KW - ELSA KW - Income KW - socioeconomic status AB - Socioeconomic differences in life expectancy, health, and disability have been found in European countries as well as in the US. Identifying the extent and pattern of health disparities, both within and across the US and England, may be important for informing public health and public policy aimed at reducing these disparities.To compare the health of US adults aged 55 to 64 years with the health of their peers in England across the high and low ranges of income in each country.Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for 2008-2016, a pooled cross-sectional analysis of comparably measured health outcomes, with adjustment for demographic characteristics and socioeconomic status, was conducted. The analysis sample included community-dwelling adults aged 55 to 64 years from the HRS and ELSA, resulting in 46 887 person-years of observations. Data analysis was conducted from September 17, 2019, to May 12, 2020.Residence in the US or England and yearly income.Sixteen health outcomes were compared, including 5 self-assessed outcomes, 3 directly measured outcomes, and 8 self-reported physician-diagnosed health conditions.This cross-sectional study included 12 879 individuals and 31 928 person-years from HRS (mean [SD] age, 59.2 [2.8] years; 51.9% women) and 5693 individuals and 14 959 person-years from ELSA (mean [SD] age, 59.3 [2.9] years; 51.0% women). After adjusting for individual-level demographic characteristics and socioeconomic status, a substantial health gap between lower-income and higher-income adults was found in both countries, but the health gap between the bottom 20% and the top 20% of the income distribution was significantly greater in the US than England on 13 of 16 measures. The adjusted US-England difference in the prevalence gap between the bottom 20% and the top 20% ranged from 3.6 percentage points (95% CI, 2.0-5.2 percentage points) in stroke to 9.7 percentage points (95% CI, 5.4-13.9 percentage points) for functional limitation. Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6% (95% CI, 6.0%-9.3%) vs 3.8% (95% CI, 2.6%-4.9%) for stroke to 75.7% (95% CI, 72.7%-78.8%) vs 59.5% (95% CI, 56.3%-62.7%) for functional limitation. Among individuals in the highest income group, those in the US group vs England group had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9% (95% CI, 33.4%-40.4%) vs 30.0% (95% CI, 27.2%-32.7%) for hypertension to 35.4% (95% CI, 32.0%-38.7%) vs 22.5% (95% CI, 19.9%-25.1%) for arthritis.For most health outcomes examined in this cross-sectional study, the health gap between adults with low vs high income appeared to be larger in the US than in England, and the health disadvantages in the US compared with England are apparently more pronounced among individuals with low income. Public policy and public health interventions aimed at improving the health of adults with lower income should be a priority in the US. SN - 2168-6106 ER - TY - JOUR T1 - Connectivity of depression symptoms before and after diagnosis of a chronic disease: A network analysis in the U.S. Health and Retirement Study JF - Journal of Affective Disorders Y1 - 2020 A1 - Jaakko Airaksinen A1 - Kia Gluschkoff A1 - Mika Kivimäki A1 - Markus Jokela KW - Chronic disease KW - depression KW - Network analysis AB - Background Many chronic diseases increase the risk of depressive symptoms, but few studies have examined whether these diseases also affect the composition of symptoms a person is likely to experience. As the risk and progression of depression may vary between chronic diseases, we used network analysis to examine how depression symptoms are connected before and after the diagnosis of diabetes, heart disease, stroke, and cancer. Methods Participants (N = 7779) were from the longitudinal survey of the Health and Retirement Study. Participants were eligible if they had information on depression symptoms two and/or four years before and after the diagnosis of either diabetes, heart disease, cancer or stroke. We formed a control group with no chronic disease that was matched on age, sex and ethnic background to those with a disease. We constructed depression symptom networks and compared the overall connectivity of those networks, and depression symptom sum scores, for before and after the diagnosis of each disease. Results Depression symptom sum scores increased with the diagnosis of each disease. The connectivity of depression symptoms remained unchanged for all the diseases, except for stroke, for which the connectivity decreased with the diagnosis. Limitations Comorbidity with other chronic diseases was not controlled for as we focused on the onset of specific diseases. Conclusions Our results suggest that although the mean level of depression symptoms increases after the diagnosis of chronic disease, with most chronic diseases, these changes are not reflected in the network structure of depression symptoms. VL - 266 UR - http://www.sciencedirect.com/science/article/pii/S0165032719313539 ER - TY - JOUR T1 - Depression and memory function – evidence from cross-lagged panel models with unit fixed effects in ELSA and HRS JF - Psychological Medicine Y1 - 2020 A1 - Jindra, Christoph A1 - Li, Chenlu A1 - Tsang, Ruby S. M. A1 - Bauermeister, Sarah A1 - Gallacher, John KW - Cognition KW - cross-lagged panel models KW - depression KW - ELSA KW - fixed effects AB - Background Individuals with depression are often found to perform worse on cognitive tests and to have an increased risk of dementia. The causes and the direction of these associations are however not well understood. We looked at two specific hypotheses, the aetiological risk factor hypothesis and the reverse causality hypothesis. Method We analysed observational data from two cohorts, English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS), using cross-lagged panel models with unit fixed effects. Each model was run once with depression and repeated with cognition as the dependent variable and the other variable as the main explanatory variable. All models were estimated separately for contemporaneous effects and lagged effects up to 8 years in the past. We contrasted the results with models making the random effects assumption. Results Evidence from the fixed effects models is mixed. We find no evidence for the reverse causality hypothesis in ELSA and HRS. While there is no evidence for the aetiological risk factors hypothesis in ELSA, results from HRS indicate some effects. Conclusion Our findings suggest that current levels of cognitive function do not influence future levels of depression. Results in HRS provide some evidence that current levels of depressive symptoms influence future cognition. ER - TY - JOUR T1 - Effect of Discrimination on Presenteeism among Aging Workers in the United States: Moderated Mediation Effect of Positive and Negative Affect JF - International Journal of Environmental Research and Public Health Y1 - 2020 A1 - Deng, Jianwei A1 - Guo, Yuangeng A1 - Shi, Hubin A1 - Gao, Yongchuang A1 - Jin, Xuan A1 - Liu, Yexin A1 - Tianan Yang KW - Discrimination AB - This study aimed to examine how perceived everyday discrimination influences presenteeism and how conscientiousness moderates the relationship between discrimination and positive affect among older workers. Structural equation modeling (SEM) was used to examine the mediating effect. The moderated mediation model was examined by PROCESS. The results of the final SEM model showed that discrimination was directly positively associated with presenteeism. Furthermore, positive affect was significantly inversely correlated with discrimination and presenteeism. In addition, negative affect was significantly positively correlated with discrimination and presenteeism. The significant indirect effect between perceived everyday discrimination and positive affect was significantly mediated by positive and negative affect. In addition, the results of the moderated mediation model indicate that positive affect was more likely to be influenced by perceived everyday discrimination among older workers with less conscientiousness, as compared with those with greater conscientiousness. To enhance work outcomes of aging workers in the United States, managers should foster highly conscientious aging workers, award those who are hardworking and goal-oriented, and combine personal goals and organizational goals through bonuses, holidays, and benefits. Policymakers should be mindful of the negative impact of discrimination on presenteeism and should target lowly conscientious older workers. VL - 17 UR - https://www.mdpi.com/1660-4601/17/4/1425 ER - TY - JOUR T1 - The Effect of Physical and Cognitive Impairments on Caregiving JF - Medical Care Y1 - 2020 A1 - Jutkowitz, Eric A1 - Gozalo, Pedro A1 - Amal Trivedi A1 - Lauren L Mitchell A1 - Joseph E Gaugler KW - Alzheimer disease KW - cognitive impairment KW - Dementia AB - BACKGROUND: Many older adults receive caregiving; however, less is known about how a change in a care recipient's functional activity limitations [instrumental activities of daily living (IADL) and basic activities of daily living (ADL)] as well as their cognitive impairment influence the amount of caregiving received. METHODS: Using the Health and Retirement Study (2002-2014) we identified community-dwelling respondents with Alzheimer disease and related dementias (ADRD; n=674), cognitive impairment no dementia (CIND; n=530), and no cognitive impairment (n=6126). We estimated a series of two-part regression models to identify the association between care recipients' level of cognitive impairment, change in total number of IADL/ADL limitations and amount of caregiving received. RESULTS: Persons with ADRD received 235.8 (SD=265.6) monthly hours of care compared with 26.0 (SD=92.6) and 6.0 (SD=40.7) for persons with CIND and no cognitive impairment, respectively. An increase in one IADL/ADL limitation resulted in persons with ADRD and CIND receiving 4.90 (95% confidence interval: 3.40-6.39) and 1.43 (95% confidence interval: 0.17-2.69) more hours of caregiving than persons with no cognitive impairment. Increases in total IADL/ADL limitations were associated with persons with ADRD, but not CIND, receiving more days of caregiving and having more caregivers than persons with no cognitive impairment. CONCLUSIONS: Compared with persons with no cognitive impairment, increases in IADL/ADL limitations disproportionally increases the caregiving received for persons with ADRD. Policies and programs must pay attention to functional impairments among those living with ADRD. VL - 58 SN - 0025-7079 IS - 7 ER - TY - JOUR T1 - The Emerging Potential of Longitudinal Empirical Research in Estate Planning: Examples from Charitable Bequests JF - UC David Law Review Y1 - 2020 A1 - Russell N. James III KW - estate planning KW - estate transfers AB - Traditionally, empirical analysis of estate planning has been limited to data from probate or estate tax records along with occasional one-time surveys of current plans or opinions. Additionally, the internet now allows easy access to online convenience samples of survey-takers. However, each of these sources has problematic features. Estate tax returns include only the wealthiest estates, and individual-level data is confidential. Probate data is time-consuming to access and includes information only for one specific location. Popular internet panels, although potentially useful for experiments, are not nationally representative. Today, an important additional source of data, The Health and Retirement Study (“HRS”) is available. It provides high-quality, nationally representative, longitudinal information on participants’ estate planning. It not only tracks changes throughout the participants’ lives but also includes details of subsequent post-mortem transfers. Critically, this study, originating in 1992, has now accumulated a sufficient number of deceased participants (over 14,000) to permit sophisticated analyses of post-mortem wealth transfers. This Article reviews the advantages of HRS data for empirical research in estate planning and demonstrates the new types of analyses that are now possible. It does so by comprehensively outlining current knowledge regarding charitable bequests gleaned from both new and previous analyses of this data. By illustrating how much this data can illuminate one particular estate planning decision (charitable bequests), this Article is intended to spur those interested in the empirical analysis of estate planning to make further use of it. VL - 53 UR - https://lawreview.law.ucdavis.edu/issues/53/5/symposium/files/53-5_James.pdf ER - TY - RPRT T1 - Estimating Markov Transition Probabilities Between Health States Using U.S. Longitudinal Survey Data Y1 - 2020 A1 - Jung, Juergen KW - age-time-cohort effects KW - Markov health transition matrices AB - We use data from two representative U.S. household surveys, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (Rand-HRS) to estimate Markov transition probability matrices between health states over the lifecycle from age 20–95. We use non-parametric and parametric methods and control for individual characteristics such as age, gender, race, education, income as well as cohort effects. We align two year transition probabilities from HRS with one year transition probabilities in MEPS using a stochastic root method. We find that the non-parametric counting method and the regression specifications based on ordered logit models produce similar results over the lifecycle. However, the counting method overestimates the probabilities of transitioning into bad health states. In addition, we find that young women have worse health prospects than their male counterparts but once individuals get older, being female is associated with transitioning into better health states with higher probabilities than men. We do not find significant differences of the conditional health transition probabilities between African Americans and the rest of the population. We also find that the lifecycle patterns are stable over time. Finally, we discuss issues with controlling for time effects, sample attrition, and other modeling issues that can arise with categorical outcome variables. JF - Department of Economics Working Paper Series PB - Towson University CY - Towson, MD UR - http://webapps.towson.edu/cbe/economics/workingpapers/2020-06.pdf ER - TY - JOUR T1 - Family caregiving in the community up to 8-years after onset of dementia JF - BMC Geriatrics Y1 - 2020 A1 - Jutkowitz, Eric A1 - Joseph E Gaugler A1 - Amal Trivedi A1 - Lauren L Mitchell A1 - Gozalo, Pedro KW - Alzheimer’s disease and related dementias KW - Community based long-term care KW - Health Services KW - Public Health AB - Background Persons with Alzheimer’s disease and related dementias (ADRD) receive care from family/friends, but how care changes from the onset of dementia remains less understood. Methods We used the Health and Retirement Study (2002–2012) to identify community-dwelling individuals predicted to have incident ADRD. We investigated the amount of caregiving received for activities of daily living in the 8-years after disease onset. Results At incidence (n = 1158), persons with ADRD received 151 h (SD = 231) of caregiving a month, 25 (SD = 26) caregiving days a month and had 1.3 (SD = 1.4) caregivers a month. By 8-years post incidence, 187 (16%) individuals transitioned to a nursing home and 662 (57%) died in the community. Community-dwelling persons with ADRD at 8-years post incidence (n = 30) received 283 h (SD = 257) of caregiving, 38 (SD = 24) caregiving days, and had 2.2 (SD = 1.3) caregivers. Conclusions Community-dwelling persons with ADRD receive a substantial amount of caregiving over the first 8-years after disease onset. VL - 20 SN - 1471-2318 IS - 1 ER - TY - JOUR T1 - Gender differences in health in Havana versus in Mexico City and in the US Hispanic population JF - European Journal of Ageing Y1 - 2020 A1 - Kühn, Mine A1 - Díaz-Venegas, Carlos A1 - Jasilionis, Domantas A1 - Oksuzyan, Anna KW - Cuba KW - depression KW - Female disadvantage KW - Physical disability KW - Self-reported health AB - Health progress in the 1960s and 1970s placed Cuba at the vanguard of longevity in Latin America and the Caribbean. This success has often been attributed to equity of access to the health care system and its cost-effectiveness in the country. Cuba also has a small gender gap in life expectancy. In this study, we examined how this pattern is reflected in the gender differences in health among the population aged 60+ in Havana. We compared gender differences in health in samples drawn from Havana, Mexico City, and the US Hispanic population: three geographic settings with very different political, health care, and social systems. The data come from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean and the 2000 Health and Retirement Study. Age-adjusted prevalence and logistic regressions were estimated for poor self-rated health, limitations on activities of daily living, depression, and mobility limitations. While an absolute female disadvantage in health was apparent in all three populations, the relative gender differences were inconsistent across all four health domains. Gender differences were most pronounced in Havana, even after adjusting for age, socio-economic status, family characteristics, and smoking behaviour. Despite having higher overall life expectancy and more equitable and universal access to primary care and preventive medicine, women in Havana appear to have a larger burden of ill health than women in less equitable societies. The study provides indirect evidence that Cuba faces challenges in combating the health threats posed by chronic diseases and other diseases and conditions common among the population aged 60+. SN - 1613-9380 UR - https://link.springer.com/article/10.1007/s10433-020-00563-w#Abs1 JO - European Journal of Ageing ER - TY - JOUR T1 - Genome-wide association study of cognitive function in diverse Hispanics/Latinos: results from the Hispanic Community Health Study/Study of Latinos. JF - Translational Psychiatry Y1 - 2020 A1 - Jian, Xueqiu A1 - Sofer, Tamar A1 - Wassim Tarraf A1 - Bressler, Jan A1 - Jessica Faul A1 - Zhao, Wei A1 - Scott M Ratliff A1 - Lamar, Melissa A1 - Lenore J Launer A1 - Laurie, Cathy C A1 - Schneiderman, Neil A1 - David R Weir A1 - Wright, Clinton B A1 - Kristine Yaffe A1 - Zeng, Donglin A1 - DeCarli, Charles A1 - Thomas H Mosley A1 - Smith, Jennifer A A1 - Hector M González A1 - Myriam Fornage KW - Aged KW - Cognition KW - Genome-Wide Association Study KW - Hispanic or Latino KW - Humans KW - Middle Aged KW - Neuropsychological tests KW - Public Health KW - Ubiquitin-Conjugating Enzymes AB -

Cognitive function such as reasoning, attention, memory, and language is strongly correlated with brain aging. Compared to non-Hispanic whites, Hispanics/Latinos have a higher risk of cognitive impairment and dementia. The genetic determinants of cognitive function have not been widely explored in this diverse and admixed population. We conducted a genome-wide association analysis of cognitive function in up to 7600 middle aged and older Hispanics/Latinos (mean = 55 years) from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). Four cognitive measures were examined: the Brief Spanish English Verbal Learning Test (B-SEVLT), the Word Fluency Test (WFT), the Digit Symbol Substitution Test (DSST), the Six-Item Screener (SIS). Four novel loci were identified: one for B-SEVLT at 4p14, two for WFT at 3p14.1 and 6p21.32, and one for DSST at 10p13. These loci implicate genes highly expressed in brain and previously connected to neurological diseases (UBE2K, FRMD4B, the HLA gene complex). By applying tissue-specific gene expression prediction models to our genotype data, additional genes highly expressed in brain showed suggestive associations with cognitive measures possibly indicating novel biological mechanisms, including IFT122 in the hippocampus for SIS, SNX31 in the basal ganglia for B-SEVLT, RPS6KB2 in the frontal cortex for WFT, and CSPG5 in the hypothalamus for DSST. These findings provide new information about the genetic determinants of cognitive function in this unique population. In addition, we derived a measure of general cognitive function based on these cognitive tests and generated genome-wide association summary results, providing a resource to the research community for comparison, replication, and meta-analysis in future genetic studies in Hispanics/Latinos.

VL - 10 IS - 1 ER - TY - JOUR T1 - The Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Study Design and Methods JF - Neuroepidemiology Y1 - 2020 A1 - Kenneth M. Langa A1 - Lindsay H Ryan A1 - Ryan J McCammon A1 - Richard N Jones A1 - Jennifer J Manly A1 - Deborah A Levine A1 - Amanda Sonnega A1 - Farron, M. A1 - David R Weir KW - Cognition KW - cognitive assessment KW - study design AB - Introduction: The Harmonized Cognitive Assessment Protocol (HCAP) Project is a substudy within the Health and Retirement Study (HRS), an ongoing nationally representative panel study of about 20,000 adults aged 51 or older in the United States. The HCAP is part of an international research collaboration funded by the National Institute on Aging to better measure and identify cognitive impairment and dementia in representative population-based samples of older adults, in the context of ongoing longitudinal studies of aging in high-, middle-, and low-income countries around the world. Methods: The HCAP cognitive test battery was designed to measure a range of key cognitive domains affected by cognitive aging (including attention, memory, executive function, language, and visuospatial function) and to allow harmonization and comparisons to other studies in the United States and around the world. The HCAP included a pair of in-person interviews, one with the target HRS respondent (a randomly selected HRS sample member, aged 65+) that lasted approximately 1 h and one with an informant nominated by the respondent that lasted approximately 20 min. The final HRS HCAP sample included 3,496 study subjects, representing a 79% response rate among those invited to participate. Conclusion: Linking detailed HCAP cognitive assessments to the wealth of available longitudinal HRS data on cognition, health, biomarkers, genetics, health care utilization, informal care, and economic resources and behavior will provide unique and expanded opportunities to study cognitive impairment and dementia in a nationally representative US population-based sample. The fielding of similar HCAP projects in multiple countries around the world will provide additional opportunities to study international differences in the prevalence, incidence, and outcomes of dementia globally with comparable data. Like all HRS data, HCAP data are publicly available at no cost to researchers. SN - 0251-5350 ER - TY - JOUR T1 - Is Healthy Neuroticism Associated with Health Behaviors? A Coordinated Integrative Data Analysis JF - Collabra: Psychology Y1 - 2020 A1 - Graham, Eileen A1 - Sara J Weston A1 - Nicholas A. Turiano A1 - Damaris Aschwanden A1 - Booth, Tom A1 - Harrison, Fleur A1 - James, Byran A1 - Nathan A Lewis A1 - Makkar, Steven A1 - Mueller, Swantje A1 - Wisniewski, Kristi A1 - Yoneda, Tomiko A1 - Zhaoyang, Ruixue A1 - Avron Spiro III A1 - Willis, Sherry A1 - K. Warner Schaie A1 - Sliwinski, Martin A1 - Lipton, Richard A1 - Katz, Mindy A1 - Ian J Deary A1 - Elizabeth Zelinski A1 - David A Bennett A1 - Sachdev, P S A1 - Brodaty, H A1 - Troller, Julian A1 - Ames, David A1 - Margaret J Wright A1 - Denis Gerstorf A1 - Allemand, Mathias A1 - Drewelies, Johanna A1 - Wagner, Gert G A1 - Muniz-Terrera, Graciela A1 - Andrea M Piccinin A1 - Scott M Hofer A1 - Daniel K. Mroczek KW - Coordinated IDA KW - Health behaviors KW - Healthy Neuroticism AB - Current literature suggests that neuroticism is positively associated with maladaptive life choices, likelihood of disease, and mortality. However, recent research has identified circumstances under which neuroticism is associated with positive outcomes. The current project examined whether “healthy neuroticism”, defined as the interaction of neuroticism and conscientiousness, was associated with the following health behaviors: smoking, alcohol consumption, and physical activity. Using a pre-registered multi-study coordinated integrative data analysis (IDA) approach, we investigated whether “healthy neuroticism” predicted the odds of engaging in each of the aforementioned activities. Each study estimated identical models, using the same covariates and data transformations, enabling optimal comparability of results. These results were then meta-analyzed in order to estimate an average (N-weighted) effect and to ascertain the extent of heterogeneity in the effects. Overall, these results suggest that neuroticism alone was not related to health behaviors, while individuals higher in conscientiousness were less likely to be smokers or drinkers, and more likely to engage in physical activity. In terms of the healthy neuroticism interaction of neuroticism and conscientiousness, significant interactions for smoking and physical activity suggest that the association between neuroticism and health behaviors was smaller among those high in conscientiousness. These findings lend credence to the idea that healthy neuroticism may be linked to certain health behaviors and that these effects are generalizable across several heterogeneous samples. VL - 6 IS - 1 ER - TY - RPRT T1 - How Can Policymakers Close the Racial Gap in Retirement Security? Y1 - 2020 A1 - Richard W. Johnson KW - Aging KW - Income and wealth KW - Poverty KW - race and ethnicity AB - Financial insecurity at older ages is a growing policy concern. Retirement income largely depends on earnings received at working ages, which determine Social Security benefits, any employer pensions that retirees receive, and a person’s capacity to set aside additional funds for retirement. Although earnings have been growing for women, bolstering their future retirement income, earnings have stagnated over the past few decades for men in the bottom three-quarters of the earnings distribution (Machin 2016; Rose 2015), threatening their retirement security. JF - Urban Institute Research Report PB - Urban Institute CY - Washington, D.C. UR - https://www.urban.org/research/publication/how-can-policymakers-close-racial-gap-retirement-security ER - TY - JOUR T1 - How Children's Education Affects Caregiving: Evidence from Parent’s Last Years of Life JF - Economics & Human Biology Y1 - 2020 A1 - Nan Jiang A1 - Neeraj Kaushal KW - Aging KW - Caregiving KW - Education KW - intergenerational support AB - Using data from the Health and Retirement Study (1994–2012), we studied the association between adult children’s education and financial and caregiving support they provided to their aging parents in the last years of the parents’ life. We controlled for the circumstances of parents’ death, their functional limitations, whether they were in long-term care or home-care settings in the last year of their life, and in some models, various measures of parents’ self-reported health. Estimates suggest that having a college degree and above has a significantly positive association with monetary transfers and knowledge support children provide to their parents. Estimates remained robust in models that included parent fixed effects. Evidence of children’s education on instrumental support to parents was nonlinear in that although some college education increased instrumental support, but, a college degree did not have a statistically significant effect. Gender did not play a moderating role in the relationship between offspring education and support towards parents. ER - TY - JOUR T1 - The Impact of Region and Urbanicity on the Discrimination-Cognitive Health Link Among Older Blacks JF - Research in Human Development Y1 - 2020 A1 - Kimson E Johnson A1 - Sol, Ketlyne A1 - Sprague, Briana N. A1 - Tamara J. Cadet A1 - Muñoz, Elizabeth A1 - Noah J Webster KW - Cognitive health KW - Discrimination KW - non-urban versus urban areas AB - Little research has examined how the link between discrimination and cognitive health varies by where people live. This study investigates how living in non-urban versus urban areas in different regions in the United States moderates the discrimination-cognitive health link among older non-Hispanic Blacks. Data are from the 2012 and 2014 waves of the Health and Retirement Study (HRS; N = 2,347). Regression analyses indicate that experiencing more everyday discrimination is significantly associated with lower episodic memory when living in urban areas. Among non-Hispanic Blacks, the discrimination-episodic memory link does not significantly vary across U.S. regional contexts. Findings highlight variation in the association between everyday discrimination and cognitive health by where older non-Hispanic Blacks live. Results suggest the importance of socio-environmental factors in shaping how stressful experiences such as discrimination are linked to cognitive health in later life. VL - 17 SN - 1542-7609 IS - 1 ER - TY - JOUR T1 - Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies JF - International Journal of Obesity Y1 - 2020 A1 - Virtanen, Marianna A1 - Markus Jokela A1 - Lallukka, Tea A1 - Magnusson Hanson, Linda A1 - Pentti, Jaana A1 - Solja T. Nyberg A1 - Alfredsson, Lars A1 - G David Batty A1 - Casini, Annalisa A1 - Clays, Els A1 - DeBacquer, Dirk A1 - Ervasti, Jenni A1 - Fransson, Eleonor A1 - Halonen, Jaana I. A1 - Head, Jenny A1 - Kittel, France A1 - Knutsson, Anders A1 - Leineweber, Constanze A1 - Nordin, Maria A1 - Oksanen, Tuula A1 - Pietiläinen, Olli A1 - Rahkonen, Ossi A1 - Salo, Paula A1 - Archana Singh-Manoux A1 - Stenholm, Sari A1 - Suominen, Sakari B. A1 - Theorell, Töres A1 - Vahtera, Jussi A1 - Westerholm, Peter A1 - Westerlund, Hugo A1 - Mika Kivimäki KW - Preventive medicine KW - Risk Factors AB - Objective To examine the relation between long working hours and change in body mass index (BMI). Methods We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35–40 h, reference), 41–48 h, 49–54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25–29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. Results Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90–1.00) for part-time work, 1.07 (1.02–1.12) for 41–48 weekly working hours, 1.09 (1.03–1.16) for 49–54 h and 1.17 (1.08–1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. Conclusions This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours. VL - 44 SN - 1476-5497 JO - International Journal of Obesity ER - TY - RPRT T1 - Medical Spending, Bequests, and Asset Dynamics Around the Time of Death Y1 - 2020 A1 - John Bailey Jones A1 - Mariacristina De Nardi A1 - Eric French A1 - McGee, Rory A1 - Rodgers, Rachel KW - Asset dynamics KW - End of life expenses KW - Medical spending AB - Using data from the Health and Retirement Survey, we document the changes in assets that occur before a person'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. JF - NBER Working Paper Series PB - National Bureau of Economic Research CY - Cambridge, MA UR - http://www.nber.org/papers/w26879 ER - TY - JOUR T1 - Mendelian randomization of smoking behavior on cognitive status among older Americans JF - Alzheimer's & Dementia: The Journal of the Alzheimer's Association Y1 - 2020 A1 - Kelly M Bakulski A1 - Fu, Mingzhou A1 - Jessica Faul A1 - Jin, Yuan A1 - Erin B Ware KW - Dementia KW - Mendelian randomization KW - Smoking AB - 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. VL - 16 IS - S10 ER - TY - JOUR T1 - Meta-analysis of up to 622,409 individuals identifies 40 novel smoking behaviour associated genetic loci. JF - Molecular Psychiatry Y1 - 2020 A1 - Erzurumluoglu, A Mesut A1 - Liu, Mengzhen A1 - Jackson, Victoria E A1 - Barnes, Daniel R A1 - Datta, Gargi A1 - Melbourne, Carl A A1 - Young, Robin A1 - Batini, Chiara A1 - Surendran, Praveen A1 - Jiang, Tao A1 - Adnan, Sheikh Daud A1 - Afaq, Saima A1 - Agrawal, Arpana A1 - Altmaier, Elisabeth A1 - Antoniou, Antonis C A1 - Asselbergs, Folkert W A1 - Baumbach, Clemens A1 - Laura Bierut A1 - Bertelsen, Sarah A1 - Boehnke, Michael A1 - Bots, Michiel L A1 - Brazel, David M A1 - Chambers, John C A1 - Chang-Claude, Jenny A1 - Chen, Chu A1 - Corley, Janie A1 - Chou, Yi-Ling A1 - David, Sean P A1 - de Boer, Rudolf A A1 - Christiaan de Leeuw A1 - Joe G Dennis A1 - Dominiczak, Anna F A1 - Dunning, Alison M A1 - Easton, Douglas F A1 - Charles B Eaton A1 - Elliott, Paul A1 - Evangelou, Evangelos A1 - Jessica Faul A1 - Tatiana Foroud A1 - Goate, Alison A1 - Gong, Jian A1 - Hans-Jörgen Grabe A1 - Jeffrey Haessler A1 - Christopher A Haiman A1 - Hallmans, Göran A1 - Anke R Hammerschlag A1 - Sarah E Harris A1 - Andrew T Hattersley A1 - Andrew C Heath A1 - Hsu, Chris A1 - Iacono, William G A1 - Kanoni, Stavroula A1 - Kapoor, Manav A1 - Kaprio, Jaakko A1 - Sharon L R Kardia A1 - Karpe, Fredrik A1 - Kontto, Jukka A1 - Kooner, Jaspal S A1 - Charles Kooperberg A1 - Kuulasmaa, Kari A1 - Laakso, Markku A1 - Lai, Dongbing A1 - Langenberg, Claudia A1 - Le, Nhung A1 - Lettre, Guillaume A1 - Loukola, Anu A1 - Luan, Jian'an A1 - Pamela A F Madden A1 - Mangino, Massimo A1 - Riccardo E Marioni A1 - Marouli, Eirini A1 - Marten, Jonathan A1 - Nicholas G Martin A1 - McGue, Matt A1 - Michailidou, Kyriaki A1 - Mihailov, Evelin A1 - Moayyeri, Alireza A1 - Moitry, Marie A1 - Müller-Nurasyid, Martina A1 - Naheed, Aliya A1 - Nauck, Matthias A1 - Neville, Matthew J A1 - Sune Fallgaard Nielsen A1 - Kari E North A1 - Markus Perola A1 - Pharoah, Paul D P A1 - Pistis, Giorgio A1 - Tinca J Polderman A1 - Posthuma, Danielle A1 - Neil Poulter A1 - Qaiser, Beenish A1 - Rasheed, Asif A1 - Reiner, Alex A1 - Renstrom, Frida A1 - Rice, John A1 - Rohde, Rebecca A1 - Rolandsson, Olov A1 - Nilesh J Samani A1 - Samuel, Maria A1 - Schlessinger, David A1 - H Steven Scholte A1 - Scott, Robert A A1 - Peter Sever A1 - Shao, Yaming A1 - Shrine, Nick A1 - Smith, Jennifer A A1 - John M Starr A1 - Kathleen E Stirrups A1 - Stram, Danielle A1 - Heather M Stringham A1 - Tachmazidou, Ioanna A1 - Tardif, Jean-Claude A1 - Thompson, Deborah J A1 - Hilary A Tindle A1 - Tragante, Vinicius A1 - Trompet, Stella A1 - Turcot, Valérie A1 - Tyrrell, Jessica A1 - Vaartjes, Ilonca A1 - Van Der Leij, Andries R A1 - van der Meer, Peter A1 - Varga, Tibor V A1 - Verweij, Niek A1 - Völzke, Henry A1 - Wareham, Nicholas J A1 - Warren, Helen R A1 - David R Weir A1 - Weiss, Stefan A1 - Wetherill, Leah A1 - Yaghootkar, Hanieh A1 - Yavas, Ersin A1 - Jiang, Yu A1 - Chen, Fang A1 - Zhan, Xiaowei A1 - Zhang, Weihua A1 - Zhao, Wei A1 - Zhao, Wei A1 - Zhou, Kaixin A1 - Amouyel, Philippe A1 - Blankenberg, Stefan A1 - Caulfield, Mark J A1 - Chowdhury, Rajiv A1 - Francesco Cucca A1 - Ian J Deary A1 - Deloukas, Panos A1 - Di Angelantonio, Emanuele A1 - Marco M Ferrario A1 - Ferrières, Jean A1 - Franks, Paul W A1 - Timothy M Frayling A1 - Frossard, Philippe A1 - Hall, Ian P A1 - Caroline Hayward A1 - Jansson, Jan-Håkan A1 - Jukema, J Wouter A1 - Kee, Frank A1 - Männistö, Satu A1 - Andres Metspalu A1 - Munroe, Patricia B A1 - Børge G Nordestgaard A1 - Palmer, Colin N A A1 - Veikko Salomaa A1 - Sattar, Naveed A1 - Timothy Spector A1 - David P Strachan A1 - van der Harst, Pim A1 - Zeggini, Eleftheria A1 - Saleheen, Danish A1 - Adam S Butterworth A1 - Wain, Louise V A1 - Gonçalo R Abecasis A1 - Danesh, John A1 - Tobin, Martin D A1 - Scott Vrieze A1 - Liu, Dajiang J A1 - Howson, Joanna M M KW - Biological Specimen Banks KW - Databases, Factual KW - Europe KW - Exome KW - Female KW - Genetic Loci KW - Humans KW - Male KW - Polymorphism, Single Nucleotide KW - Smoking KW - United Kingdom AB -

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 × 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 × 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 × 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.

VL - 25 IS - 10 ER - TY - CHAP T1 - Microsimulation of Health Expectancies, Life Course Health, and Health Policy Outcomes T2 - International Handbooks of Population: International Handbook of Health Expectancies Y1 - 2020 A1 - Laditka, Sarah B. A1 - Laditka, James N. A1 - Jagger, Carol ED - Jagger, Carol ED - Eileen M. Crimmins ED - Saito, Yasuhiko ED - De Carvalho Yokota, Renata Tiene ED - Van Oyen, Herman ED - Robine, Jean-Marie KW - Active life expectancy KW - Forecasting KW - Health expectancy KW - health policy KW - Population Health AB - 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'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. JF - International Handbooks of Population: International Handbook of Health Expectancies PB - Springer International Publishing CY - Basel VL - 9 SN - 978-3-030-37668-0 ER - TY - JOUR T1 - Neighborhood Engagement, Dogs, and Life Satisfaction in Older Adulthood. JF - Journal of Applied Gerontology Y1 - 2020 A1 - Angela L Curl A1 - Bibbo, Jessica A1 - Rebecca A Johnson KW - Engagement KW - Life Satisfaction KW - neighborhood AB -

OBJECTIVES: This study examined the relationships between dog ownership, dog walking, and the emotional bond with a dog to neighborhood engagement and life satisfaction among those over age 50.

METHOD: Using data from the Health and Retirement Study ( = 476), two path analysis models were conducted to test the research hypotheses.

RESULTS: Findings indicated that dog ownership did not have a direct or indirect relationship on life satisfaction. However, time spent in dog walking was associated with frequency of social interactions, which itself had a positive association with life satisfaction. The bond with a dog was not directly associated with life satisfaction but was associated with dog walking.

DISCUSSION: Dog walking is a promising strategy for simultaneously promoting better health and social engagement, and these factors in turn can promote greater life satisfaction of older adults.

ER - TY - RPRT T1 - Occupations and Work at Older Ages: Varied Responses to Policy Y1 - 2020 A1 - Lindsay Jacobs KW - health KW - Labor Supply KW - OASDI KW - Older workers KW - Retirement AB - There are a number of differences between individuals in “blue-collar” and “white-collar” occupations in the timing of retirement, savings, Social Security OASI claiming ages, and SSDI applications. This paper presents descriptive evidence of these differences and develops and estimates the parameters of a model of later-life labor supply, savings, and Social Security OASDI behavior. The model accounts for a number of differences across blue- and white-collar workers in particular and is then used to predict behavior and measure welfare under the counterfactual policy scenarios of increases in the Early Retirement and Full Retirement Ages for claiming Social Security benefits. I find that increasing the Early Retirement Age has large labor supply and disutility effects for blue-collar workers, and results in greater SSDI application for this group. This is driven primarily by those in blue-collar occupations experiencing more steeply declining productivity with age and less margin on which to respond to policy changes. Increasing the Full Retirement Age affects the labor supply of white-collar but not blue-collar workers. It does, however, increase the savings somewhat for the latter group. JF - The Center for Financial Security's Working Papers PB - University of Wisconsin-Madison CY - Madison UR - https://cfsrdrc.wisc.edu/files/research-briefs/WI19_02_Jacobs_FinalPaper_11.22.19.pdf ER - TY - JOUR T1 - Parental Education and Self-Rated Health among Older Adults: Evidence from the U.S. and South Korea JF - Journal of Asian Sociology Y1 - 2020 A1 - SeungAh H. Lee A1 - Kimberly J. Johnson A1 - Jiyoung Lyu KW - Education KW - KLoSA KW - Self-rated health AB - The purpose of this cross-national study is to investigate the association between parental education, an important early-life socioeconomic indicator, and self-rated health (SRH) among older adults in Western (U.S.) and Eastern (Korea) countries. The study sample is drawn from nationally representative data collected by the 2016 Health and Retirement Study (HRS) and the 2016 Korean Longitudinal Study of Aging (KLoSA). The final sample consists of 9,610 HRS and 4,425 KLoSA respondents age 65 or older. Hierarchical logistic regression models are used to examine the association between paternal and maternal education and SRH. The results show that low maternal education is significantly associated with fair/poor SRH in the U.S., while low paternal education is associated with fair/poor SRH among older Korean adults, controlling for other covariates. The disparity found in parental education may be due to the cultural differences in patriarchal values and the rate of change in gender expectations and economic development. VL - 49 ER - TY - JOUR T1 - Parental Education and Self-Rated Health among Older AdultsEvidence from the U.S. and South Korea JF - Journal of Asian Sociology Y1 - 2020 A1 - Lee, Seungah H. A1 - Kimberly J. Johnson A1 - Jiyoung Lyu KW - KLoSA KW - maternal education KW - paternal education KW - Self-rated health AB - [The purpose of this cross-national study is to investigate the association between parental education, an important early-life socioeconomic indicator, and self-rated health (SRH) among older adults in Western (U.S.) and Eastern (Korea) countries. The study sample is drawn from nationally representative data collected by the 2016 Health and Retirement Study (HRS) and the 2016 Korean Longitudinal Study of Aging (KLoSA). The final sample consists of 9,610 HRS and 4,425 KLoSA respondents age 65 or older. Hierarchical logistic regression models are used to examine the association between paternal and maternal education and SRH. The results show that low maternal education is significantly associated with fair/poor SRH in the U.S., while low paternal education is associated with fair/poor SRH among older Korean adults, controlling for other covariates. The disparity found in parental education may be due to the cultural differences in patriarchal values and the rate of change in gender expectations and economic development.] VL - 49 SN - 26714574, 26718200 UR - https://www.jstor.org/stable/26979898 IS - 4 ER - TY - JOUR T1 - Perceived Usefulness and Easiness of Information and Communication Technologies and Volunteering among Older Adults JF - Journal of Gerontological Social Work Y1 - 2020 A1 - Joonyoung Cho A1 - BoRin Kim A1 - Jehoon Jeon A1 - Sojung Park KW - Poverty KW - productive aging KW - Technology KW - Volunteerism AB - ABSTRACTThis study investigates the association between older adults’ perception of usefulness and easiness (PUE) of Internet Communication and Technologies (ICTs) and volunteering, and if this association differs across their income status. Data were obtained from the 2012 wave of the Health and Retirement Study (HRS), and the sample was restricted to respondents aged between 60 and 84 (N = 901) and who completed the 2012 HRS technology module. Multinomial logistic regression was employed to examine the independent and joint influence of PUE of ICTs and of low-income status on volunteering. The results show that only people with high PUE engaged in more than 100 hours of volunteering among older adults after controlling for covariates. The positive effect of high PUE was found to be more significant in the low-income group. This is the first known research to investigate the PUE of ICTs and volunteering among older adults. This study expands the knowledge of volunteering among older adults by exploring ICTs which can be considered as one of the most influential macrosocial changes in the current society. Moreover, our findings provide some insights and an empirical foundation in volunteering programs for older adults of different PUE levels. VL - 63 IS - 3 N1 - PMID: 32401174 ER - TY - JOUR T1 - Population structure and pharmacogenomic risk stratification in the United States. JF - BMC Biology Y1 - 2020 A1 - Nagar, Shashwat Deepali A1 - Conley, Andrew B A1 - Jordan, I King KW - Ethnic Groups KW - Genetics, Population KW - Genome, Human KW - Genotype KW - Humans KW - Pharmacogenetics KW - Risk Assessment KW - United States AB -

BACKGROUND: Pharmacogenomic (PGx) variants mediate how individuals respond to medication, and response differences among racial/ethnic groups have been attributed to patterns of PGx diversity. We hypothesized that genetic ancestry (GA) would provide higher resolution for stratifying PGx risk, since it serves as a more reliable surrogate for genetic diversity than self-identified race/ethnicity (SIRE), which includes a substantial social component. We analyzed a cohort of 8628 individuals from the United States (US), for whom we had both SIRE information and whole genome genotypes, with a focus on the three largest SIRE groups in the US: White, Black (African-American), and Hispanic (Latino). Our approach to the question of PGx risk stratification entailed the integration of two distinct methodologies: population genetics and evidence-based medicine. This integrated approach allowed us to consider the clinical implications for the observed patterns of PGx variation found within and between population groups.

RESULTS: Whole genome genotypes were used to characterize individuals' continental ancestry fractions-European, African, and Native American-and individuals were grouped according to their GA profiles. SIRE and GA groups were found to be highly concordant. Continental ancestry predicts individuals' SIRE with > 96% accuracy, and accordingly, GA provides only a marginal increase in resolution for PGx risk stratification. In light of the concordance between SIRE and GA, taken together with the fact that information on SIRE is readily available to clinicians, we evaluated PGx variation between SIRE groups to explore the potential clinical utility of race and ethnicity. PGx variants are highly diverged compared to the genomic background; 82 variants show significant frequency differences among SIRE groups, and genome-wide patterns of PGx variation are almost entirely concordant with SIRE. The vast majority of PGx variation is found within rather than between groups, a well-established fact for almost all genetic variants, which is often taken to argue against the clinical utility of population stratification. Nevertheless, analysis of highly differentiated PGx variants illustrates how SIRE partitions PGx variation based on groups' characteristic ancestry patterns. These cases underscore the extent to which SIRE carries clinically valuable information for stratifying PGx risk among populations, albeit with less utility for predicting individual-level PGx alleles (genotypes), supporting the concept of population pharmacogenomics.

CONCLUSIONS: Perhaps most interestingly, we show that individuals who identify as Black or Hispanic stand to gain far more from the consideration of race/ethnicity in treatment decisions than individuals from the majority White population.

VL - 18 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/33050895?dopt=Abstract ER - TY - JOUR T1 - Postretirement life satisfaction and financial vulnerability: The moderating role of control JF - Journals of Gerontology - Series B Psychological Sciences and Social Sciences Y1 - 2020 A1 - Dawn C Carr A1 - Moen, P. A1 - Perry Jenkins, M. A1 - Smyer, M. KW - Personal control KW - Retirement KW - Successful aging AB - Objectives: This article examines changes in life satisfaction around retirement exits for those with varying preretirement incomes, testing whether constraints on personal control and control over finances moderate the relationship between retiring and preretirement income. Method: This longitudinal study draws data from the 2004-2014 waves of the Health and Retirement Study to examine changes in life satisfaction pre- versus postretirement for three groups (the poor/near poor, financially vulnerable, and financially stable) of full-time workers aged 51-87 years (N = 970), and a subset (N = 334) who fully retire over a 4-year period. Results: Controlling for baseline life satisfaction, health, job/demographic characteristics, and social engagement, ordinary least squares regression results show financially stable retirees report higher levels of postretirement life satisfaction relative to their full-time working counterparts, whereas the poor/near poor and the financially vulnerable report similar life satisfaction to those who continue working full time. Constraints on personal control and control over finances moderate postretirement life satisfaction for the financially vulnerable. Discussion: Results suggest full retirement predicts improved life satisfaction only for those most advantaged financially. Financially vulnerable older workers may adjust more effectively to retirement if they have access to resources that facilitate greater control over their lives. © 2018 The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. VL - 75 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081528537&doi=10.1093%2fgeronb%2fgby105&partnerID=40&md5=6dbfe386a5b903c47e3a8926acb571fd IS - 4 N1 - cited By 0 ER - TY - RPRT T1 - Retirement Security: Older Women Report Facing a Financially Uncertain Future Y1 - 2020 A1 - Charles Jeszeck KW - gender KW - Gender Differences KW - gender issues KW - Retirement KW - retirement security KW - women AB - In all 14 focus groups GAO held with older women, women described some level of anxiety about financial security in retirement. Many expressed concerns about the future of Social Security and Medicare benefits, and the costs of health care and housing. Women in the groups also cited a range of experiences that hindered their retirement security, such as divorce or leaving the workforce before they planned to (see fig.). Women in all 14 focus groups said their lack of personal finance education negatively affected their ability to plan for retirement. Many shared ideas about personal finance education including the view that it should be incorporated into school curriculum starting in kindergarten and continuing through college, and should be available through all phases of life. PB - U.S. Government Accountability Office UR - https://www.gao.gov/products/gao-20-435 ER - TY - JOUR T1 - The role of Hope in subsequent health and well-being for older adults: An outcome-wide longitudinal approach JF - Global Epidemiology Y1 - 2020 A1 - Long, Katelyn N.G. A1 - Eric S Kim A1 - Chen, Ying A1 - Wilson, Matthew F. A1 - Worthington Jr., Everett L. A1 - Tyler J VanderWeele KW - Hope KW - hopelessness KW - Older Adults KW - outcome-wide analysis KW - Physical Health KW - Well-being AB - Hope is a topic widely discussed in the humanities and researched in the field of psychology. To explore the potential public health implications of hope for subsequent health and well-being outcomes, we prospectively examined the relation between baseline hope and a wide range of outcomes that included indicators of: physical health, health behaviors, and psychosocial well-being in older adults using an outcome-wide approach. Data from the Health and Retirement Study (N = 12,998, mean age = 66 years) were analyzed. Bonferroni correction was used to account for multiple testing. All models controlled for a wide array of factors including: sociodemographic characteristics, personality factors, and prior values of the exposure (hope) and all outcomes. A greater sense of hope was associated with: better physical health and health behavior outcomes on some indicators (e.g., reduced risk of all cause-mortality, fewer number of chronic conditions, lower risk of cancer, and fewer sleep problems), higher psychological well-being (e.g., increased positive affect, life satisfaction, and purpose in life), lower psychological distress, and better social well-being. A secondary analysis explored antecedents of hope. We identified several potentially modifiable factors that may lead to increased hope. These results may have important population-level implications for increasing hope and improving the physical, psychological, and social well-being of our growing older adult population. VL - 2 ER - TY - JOUR T1 - Sleep Difficulties and Cognition over a 10-Year Period in a National Sample of U.S. Older Adults JF - Innovation in Aging Y1 - 2020 A1 - Robbins, Rebecca A1 - Amanda Sonnega A1 - Robert W. Turner A1 - Jean-Louis, Girardin A1 - Butler, Mark A1 - Osorio, Ricardo M A1 - Kenneth M. Langa KW - cognitive function KW - Gerontology KW - healthy aging KW - Sleep KW - Translational medicine AB - Sleep difficulties are common among older adults and are associated with cognitive decline. We used data from a large, nationally representative longitudinal survey of adults over the age of 50 in the U.S. to examine the relationship between specific sleep difficulties and cognitive function over time.Longitudinal data from the 2004-2014 waves of the Health and Retirement Study were used in the current study. We examined sleep difficulties and cognitive function within participants and across time (n=16,201). Sleep difficulty measures included difficulty initiating sleep, nocturnal awakenings, early morning awakenings, and waking feeling rested from rarely/never (1) to most nights (3). The modified Telephone Interview for Cognitive Status (TICS-m) was used to measure cognitive function. Generalized Linear Mixed Models (GLMM) were used with time varying covariates to examine the relationship between sleep difficulties and cognitive function over time.In covariate-adjusted models, compared to “never” reporting sleep difficulty, difficulty initiating sleep “most nights” was associated with worse cognitive function over time (Year 2014: b=-0.40, 95%CI: -0.63 to -0.16, p<.01) as was difficulty waking up too early “most nights” (Year 2014: b=-0.31, 95%CI: -0.56 to -0.07, p<.05). In covariate-adjusted analyses, compared to “never” reporting waking up feeling rested, cognitive function was higher among those who reported waking up feeling rested “some nights” (Year 2010: b=0.21, 95%CI: 0.02 to 0.40, p<.05).Our findings highlight an association between early morning awakenings and worse cognitive function, but also an association between waking feeling rested and better cognitive function over time.Sleep difficulties are common among older adults yet reduce quality of life and also contribute to the development of and potentially accelerate cognitive decline. This study examines specific sleep difficulties (e.g., difficulty falling asleep) and their unique relationship to cognition over time among older adults in the U.S. The primary aim of this work is to illuminate the specific sleep difficulties that are most concerning from the standpoint of cognitive impairment so as to inform the design of future tailored sleep improvement programs for older adults. SN - 2399-5300 ER - TY - RPRT T1 - Social Security Reform with Heterogeneous Mortality Y1 - 2020 A1 - John Bailey Jones A1 - Li, Yue KW - Labor Supply KW - Mortality KW - Social Security KW - Welfare AB - Using a heterogeneous-agent, life-cycle model of Social Security claiming, labor supply and saving, we consider the implications of lifespan inequality for Social Security reform. Quantitative experiments show that welfare is maximized when baseline benefits are independent of lifetime earnings, the payroll tax cap is kept roughly unchanged, and claiming adjustments are reduced. Eliminating the earnings test and the income taxation of Social Security benefits provides additional gains. The Social Security system that would maximize welfare in a “2050 demographics” scenario, characterized by longer lifespans and an increased education-mortality gradient, is similar to the one that would maximize welfare today. JF - Richmond Federal Working Paper Series PB - Federal Reserve Bank of Richmond CY - Richmond, VA UR - https://www.richmondfed.org/-/media/richmondfedorg/publications/research/working_papers/2020/wp20-09.pdf ER - TY - RPRT T1 - Three fast facts: Self-employment trends among older Americans Y1 - 2020 A1 - Cal J. Halvorsen A1 - Jacquelyn Boone James KW - self employment AB - How important is self-employment as a form of work among older Americans? There are several ways you can answer this question, and this research brief will cover three general trends in self-employment rates. JF - Self-employment brief PB - Center on Aging & Work at Boston College CY - Newton, MA UR - https://dlib.bc.edu/islandora/object/bc-ir%3A108936 ER - TY - JOUR T1 - Trajectories of Aging among US Older Adults: Mixed Evidence for a Hispanic Paradox. JF - The Journals of Gerontology Series B: Psychological Sciences & Social Sciences Y1 - 2020 A1 - Wassim Tarraf A1 - Gail A Jensen A1 - Heather E Dillaway A1 - Priscilla M Vásquez A1 - Hector M González KW - Aging trajectories KW - cognitive aging KW - healthy aging KW - Hispanic paradox KW - Immigrant health AB -

Objectives: A well-documented paradox is that Hispanics tend to live longer than non-Hispanic Whites (NHW), despite structural disadvantages. We evaluate whether the "Hispanic paradox" extends to more comprehensive longitudinal aging classifications and examine how lifecourse factors relate to these groupings.

Methods: We used biennial data (1998-2014) on adults 65-years and older at baseline from the Health and Retirement Study. We use joint latent class discrete time and growth curve modeling to identify trajectories of aging, and multinomial logit models to determine whether US-born (USB-H) and Foreign-born (FB-H) Hispanics experience healthier styles of aging than non-Hispanic Whites (NHW), and test how lifecycle factors influence this relationship.

Results: We identify four trajectory classes including, "cognitive unhealthy," "high morbidity," "non-accelerated", and "healthy." Compared to NHWs, both USB-H and FB-H have higher relative risk ratios (RRR) of "cognitive unhealthy" and "high morbidity" classifications, relative to "non-accelerated." These patterns persist upon controlling for lifecourse factors. Both Hispanic groups, however, also have higher RRRs for "healthy" classification (vs. "non-accelerated") upon adjusting for adult achievements and health behaviors.

Discussion: Controlling for lifefcourse factors USB-H and FB-H have equal or higher likelihood for "high morbidity" and "cognitive unhealthy" classifications, respectively, relative to NHWs. Yet, both groups are equally likely of being in the "healthy" group compared to NHWs. These segregations into healthy and unhealthy groups require more research and could contribute to explaining the paradoxical patterns produced when population heterogeneity is not taken into account.

VL - 75 UR - https://apps.webofknowledge.com/InboundService.do?product=WOS&Func=Frame&DestFail=https%3A%2F%2Fwww.webofknowledge.com&SrcApp=search&SrcAuth=Alerting&SID=8BR9UbZLRdbYq1kUVAS&customersID=Alerting&mode=FullRecord&IsProductCode=Yes&AlertId=2547ce2d-b446-4503 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29788310?dopt=Abstract ER - TY - JOUR T1 - Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. JF - Nature Genetics Y1 - 2019 A1 - Liu, Mengzhen A1 - Jiang, Yu A1 - Wedow, Robbee A1 - Li, Yue A1 - Brazel, David M A1 - Chen, Fang A1 - Datta, Gargi A1 - Davila-Velderrain, Jose A1 - McGuire, Daniel A1 - Tian, Chao A1 - Zhan, Xiaowei A1 - Choquet, Hélène A1 - Docherty, Anna R A1 - Jessica Faul A1 - Foerster, Johanna R A1 - Fritsche, Lars G A1 - Gabrielsen, Maiken Elvestad A1 - Gordon, Scott D A1 - Jeffrey Haessler A1 - Jouke-Jan Hottenga A1 - Huang, Hongyan A1 - Jang, Seon-Kyeong A1 - Philip R Jansen A1 - Ling, Yueh A1 - Mägi, Reedik A1 - Matoba, Nana A1 - McMahon, George A1 - Mulas, Antonella A1 - Orrù, Valeria A1 - Palviainen, Teemu A1 - Anita Pandit A1 - Reginsson, Gunnar W A1 - Skogholt, Anne Heidi A1 - Smith, Jennifer A A1 - Taylor, Amy E A1 - Turman, Constance A1 - Gonneke Willemsen A1 - Young, Hannah A1 - Young, Kendra A A1 - Zajac, Gregory J M A1 - Zhao, Wei A1 - Zhou, Wei A1 - Bjornsdottir, Gyda A1 - Boardman, Jason D A1 - Boehnke, Michael A1 - Dorret I Boomsma A1 - Chen, Chu A1 - Francesco Cucca A1 - Davies, Gareth E A1 - Charles B Eaton A1 - Ehringer, Marissa A A1 - Tõnu Esko A1 - Fiorillo, Edoardo A1 - Gillespie, Nathan A A1 - Gudbjartsson, Daniel F A1 - Haller, Toomas A1 - Kathleen Mullan Harris A1 - Andrew C Heath A1 - Hewitt, John K A1 - Hickie, Ian B A1 - Hokanson, John E A1 - Hopfer, Christian J A1 - Hunter, David J A1 - Iacono, William G A1 - Johnson, Eric O A1 - Kamatani, Yoichiro A1 - Sharon L R Kardia A1 - Matthew C Keller A1 - Kellis, Manolis A1 - Charles Kooperberg A1 - Kraft, Peter A1 - Krauter, Kenneth S A1 - Laakso, Markku A1 - Penelope A Lind A1 - Loukola, Anu A1 - Lutz, Sharon M A1 - Pamela A F Madden A1 - Nicholas G Martin A1 - McGue, Matt A1 - Matthew B McQueen A1 - Sarah E Medland A1 - Andres Metspalu A1 - Mohlke, Karen L A1 - Nielsen, Jonas B A1 - Okada, Yukinori A1 - Peters, Ulrike A1 - Tinca J Polderman A1 - Posthuma, Danielle A1 - Reiner, Alexander P A1 - Rice, John P A1 - Rimm, Eric A1 - Rose, Richard J A1 - Runarsdottir, Valgerdur A1 - Stallings, Michael C A1 - Stančáková, Alena A1 - Stefansson, Hreinn A1 - Thai, Khanh K A1 - Hilary A Tindle A1 - Tyrfingsson, Thorarinn A1 - Wall, Tamara L A1 - David R Weir A1 - Weisner, Constance A1 - Whitfield, John B A1 - Winsvold, Bendik Slagsvold A1 - Yin, Jie A1 - Zuccolo, Luisa A1 - Laura Bierut A1 - Hveem, Kristian A1 - Lee, James J A1 - Munafò, Marcus R A1 - Saccone, Nancy L A1 - Willer, Cristen J A1 - Marilyn C Cornelis A1 - David, Sean P A1 - Hinds, David A A1 - Jorgenson, Eric A1 - Kaprio, Jaakko A1 - Stitzel, Jerry A A1 - Stefansson, Kari A1 - Thorgeirsson, Thorgeir E A1 - Gonçalo R Abecasis A1 - Liu, Dajiang J A1 - Scott Vrieze KW - Alcohol Drinking KW - Female KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Phenotype KW - Risk KW - Smoking KW - Tobacco KW - Tobacco Use Disorder AB -

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders. They are heritable and etiologically related behaviors that have been resistant to gene discovery efforts. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures.

VL - 51 IS - 2 ER - TY - JOUR T1 - Change in leisure participation among older adults after falling JF - Leisure Sciences Y1 - 2019 A1 - Tuo-Yu Chen A1 - Megan C Janke KW - Disabilities KW - Falls KW - Older Adults KW - Participation AB - Falls among older adults can lead to severe physical and psychological consequences. However, whether leisure participation changes after falling is not clear. We investigated whether falls resulted in reduced leisure participation in terms of duration, number, and intensity among older adults. Secondary data from the Health and Retirement Study and the Consumption and Activities Mail Survey (n = 1163) were analyzed. The results showed falls did not predict future leisure participation. Female, white, higher education, fewer functional limitations, and good balance were significant predictors of leisure participation at follow-up. Being white also predicted a significant decline in total number of leisure activities from baseline to follow-up, whereas higher education protected older adults from a significant reduction in total intensity of leisure activity. Our findings suggest falls may not directly affect leisure participation, but its risk factors, such as demographics, functional limitations, and balance, have a direct impact on leisure participation. UR - https://www.tandfonline.com/doi/full/10.1080/01490400.2018.1536568?scroll=top&needAccess=true JO - Leisure Sciences ER - TY - JOUR T1 - Chronic conditions and depressive symptoms in older adults: the mediating role of functional limitations JF - Aging and Mental Health Y1 - 2019 A1 - Parajuli, J. A1 - Berish, D. A1 - Jao, Y.-L. KW - Chronic conditions KW - Chronic Diseases KW - depression KW - Depressive symptoms KW - Functional limitations AB - Background: Depressive symptoms, chronic conditions, and functional limitations are common in older adults. Several studies have examined the relationship between chronic conditions or functional limitations and depressive symptoms separately. However, little is known about how much of the effect of chronic conditions on depressive symptoms is due to the functional limitations resulting from such conditions. Methods: This paper examined the longitudinal association of chronic conditions and functional limitations with depressive symptoms in older adults aged 65 and over in the USA using the data from the 2012 wave and 2014 wave of the Health and Retirement Study (HRS). Mediation analysis was used to examine the mediation effects of 2012 functional limitations on the relationship between 2012 chronic conditions and 2014 depressive symptoms controlling for other measures including gender, age, race, education, marital status, and BMI. Results: Results revealed that chronic conditions and functional limitations were significantly associated with depressive symptoms. There was a 13.7% mediation effect when 2012 functional limitations were added as a mediator on the relationship between 2012 chronic conditions and 2014 depressive symptoms. Conclusion: Functional limitations mediate the relationship between chronic conditions and depressive symptoms. Preventing or managing functional limitations may help reduce depressive symptoms in older adults with chronic conditions. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. VL - 25 IS - 2 ER - TY - Generic T1 - COGNITIVE IMPAIRMENT AND SLEEP DIFFICULTIES OVER 10 YEARS IN A NATIONAL SAMPLE OF OLDER ADULTS T2 - Innovation in Aging Y1 - 2019 A1 - Robbins, Rebecca A1 - Amanda Sonnega A1 - Turner II, Robert W A1 - Jean-Louis, Girardin A1 - Kenneth M. Langa KW - Cognition KW - cognitive impairment KW - Sleep AB - Prior studies suggest that sleep difficulties (e.g., trouble falling asleep) may be associated with cognitive impairment. We used a large, nationally representative longitudinal survey of adults over the age of 50 in the US to examine the relationship between sleep difficulties and cognitive functioning. Generalized estimation equation (GEE) linear regression models were used to analyze data from the 2004-2014 waves of the Health and Retirement Study. We examined sleep difficulties and cognitive functioning within participants and across time (n=17,642). Sleep difficulty was measured as trouble falling asleep, nocturnal awakenings, and waking too early scored as 1= rarely/never, 2=sometimes, and 3=most of the time. A summary score indicated cognitive functioning (range 0-27). Models controlled for age, gender, race/ethnicity, marital status, education, chronic medical conditions, depressive symptoms, and body mass index (BMI). Compared to those with no sleep difficulties, those who reported difficulty falling asleep [“sometimes” OR=0.83,95%CI:0.71-0.96 and “most of the time” OR=0.79,95%CI: 0.64-0.98] and waking too early [“most of the time” OR=0.79,95%CI: 0.63-0.98] had worse cognitive functioning. Compared to those with no sleep difficulties, those who reported nocturnal awakenings [“most of the time” OR=1.29,95%CI:1.08-1.54] had higher cognitive functioning. Over time, lower cognitive function was more likely among those reporting difficulty falling asleep (OR=0.73,95%CI:0.54-0.97), nocturnal awakenings (OR=0.77,95%CI:0.61-0.97) and waking too early (OR=0.65,95%CI: 0.47-0.88). In this nationally representative, longitudinal sample of older US adults, we found that over time lower cognitive function was more likely among those who reported difficulty falling asleep, nocturnal awakenings, and waking too early. JF - Innovation in Aging VL - 3 SN - 2399-5300 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840199/ IS - Suppl 1 JO - Innov Aging ER - TY - JOUR T1 - Comparing the utility of mitochondrial and nuclear DNA to adjust for genetic ancestry in association studies. JF - Cells Y1 - 2019 A1 - Miller, Brendan A1 - Thalida E. Arpawong A1 - Jiao, Henry A1 - Kim, Su-Jeong A1 - Yen, Kelvin A1 - Hemal H Mehta A1 - Wan, Junxiang A1 - John Carpten A1 - Cohen, Pinchas KW - Genetics KW - GWAS KW - Survey Methodology AB - Mitochondrial genome-wide association studies identify mitochondrial single nucleotide polymorphisms (mtSNPs) that associate with disease or disease-related phenotypes. Most mitochondrial and nuclear genome-wide association studies adjust for genetic ancestry by including principal components derived from nuclear DNA, but not from mitochondrial DNA, as covariates in statistical regression analyses. Furthermore, there is no standard when controlling for genetic ancestry during mitochondrial and nuclear genetic interaction association scans, especially across ethnicities with substantial mitochondrial genetic heterogeneity. The purpose of this study is to (1) compare the degree of ethnic variation captured by principal components calculated from microarray-defined nuclear and mitochondrial DNA and (2) assess the utility of mitochondrial principal components for association studies. Analytic techniques used in this study include a principal component analysis for genetic ancestry, decision-tree classification for self-reported ethnicity, and linear regression for association tests. Data from the Health and Retirement Study, which includes self-reported White, Black, and Hispanic Americans, was used for all analyses. We report that (1) mitochondrial principal component analysis (PCA) captures ethnic variation to a similar or slightly greater degree than nuclear PCA in Blacks and Hispanics, (2) nuclear and mitochondrial DNA classify self-reported ethnicity to a high degree but with a similar level of error, and 3) mitochondrial principal components can be used as covariates to adjust for population stratification in association studies with complex traits, as demonstrated by our analysis of height-a phenotype with a high heritability. Overall, genetic association studies might reveal true and robust mtSNP associations when including mitochondrial principal components as regression covariates. VL - 8 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30987182?dopt=Abstract ER - TY - JOUR T1 - Do family caregivers offset healthcare costs for older adults? A mapping review on the costs of care for older adults with versus without caregivers JF - The Gerontologist Y1 - 2019 A1 - Esther M Friedman A1 - Rodakowski, Juleen A1 - Schulz, Richard A1 - Scott Beach A1 - Martsolf, Grant R A1 - James, A Everette KW - Adult children KW - Caregiving KW - Health care utilization AB - Background and Objectives Older adults face significant long-term care and health care costs. But some of these costs can potentially be offset through family caregivers who may serve as substitutes for formal care or directly improve the care recipient’s health and reduce health care utilization and expenditures. This article reviews the current literature to determine whether it is possible through existing work to compare the costs of care for individuals with versus without family caregivers and, if not, where the data, measurement, and other methodological challenges lie. Research Design and Methods A mapping review of published works containing information on health care utilization and expenditures and caregiving was conducted. A narrative approach was used to review and identify methodological challenges in the literature. Results Our review identified 47 articles that met our criteria and had information on caregiving and health care costs or utilization. Although findings were mixed, for the most part, having a family caregiver was associated with reduced health care utilization and a decreased risk of institutionalization however, the precise difference in health care expenditures for individuals with caregivers compared to those without was rarely examined, and findings were inconsistent across articles reviewed. Discussion and Implications The number of family caregivers providing care to loved ones is expected to grow with the aging of the Baby Boomers. Various programs and policies have been proposed to support these caregivers, but they could be costly. These costs can potentially be offset if family caregivers reduce health care spending. More research is needed, however, to quantify the savings stemming from family caregiving. VL - 59 UR - https://academic.oup.com/gerontologist/article/59/5/e535/5427472 IS - 5 ER - TY - JOUR T1 - DOES A PERCEIVED CONNECTION TO A NEIGHBORHOOD REDUCE LONELINESS? JF - Innovation in Aging Y1 - 2019 A1 - Kimberly J. Johnson A1 - Adeniji, Dolapo O KW - Loneliness KW - neighborhood AB - This study investigated whether perceived neighborhood quality was associated with chronic loneliness for adults 60 and older in the United States. Although loneliness can be episodic and overcome, chronic loneliness has been identified as a social determinant of health. Utilizing ecological systems theory we hypothesized that higher levels of neighborhood social cohesiveness would be associated with lower odds of chronic loneliness. We postulated that the networks available to people in the proximal area where they live could provide social opportunities for reducing loneliness. This idea was consistent with prior findings indicating the salience of neighborhoods for retirees, but inconsistent with research indicating the importance of a confidant in reducing loneliness. Data from the 2008 and 2012 Health and Retirement Study Psychosocial Surveys were used (n = 3530). Loneliness was measured using the 3-item scale developed by Hughes and colleagues in 2004. Findings from unadjusted logistic regression indicated that loneliness was inversely related to neighborhood cohesion as measured by an index of the trustworthiness, friendliness and helpfulness of neighbors and cleanliness, occupancy, lack of graffiti, and sense of belonging in the area (OR = .73, p < .001). When demographic and health-related factors were entered into the model the odds of being lonely were significantly lower for those with higher ratings of social cohesion (OR = .83, p < .001). These findings were consistent with the idea that neighborhoods are an important social place for older persons and interventions at the neighborhood level may be more effective than individualized treatment plans. VL - 3 SN - 2399-5300 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841328/ IS - Suppl 1 JO - Innov Aging ER - TY - THES T1 - Effects of Social Relations on Mortality in the Context of Grandparenting T2 - Social Work Y1 - 2019 A1 - Heejung Jang KW - Caregiving KW - Grandparenting KW - Mortality KW - Social relations AB - Issues of health and well-being have received considerable attention as a way to help grandparent caregivers. There is growing evidence that grandparenting is beneficial to grandparent caregivers? health, yet acting as grandparent caregiver also is detrimental to health and social relations when a grandparent provides an extensive level of care to grandchildren. The extent to which grandparent caregiving benefits or harms the health of a grandparent is still unknown; mortality specifically has not been systematically studied. Moreover, although altruistic behaviors towards others have been shown to have beneficial effects on caregivers? health in general, there is little information regarding social relations of grandparent caregivers and their impact on mortality. This study aims to investigate the roles of different aspects of social relations among community-dwelling older adults, examining whether aspects of social relations, including social networks, received functional support aid, and perceived support quality mediate the association between grandparent caregiving and mortality. The data were drawn from the 2008 and 2014 Health and Retirement Study (N=1,196). Results of survival analyses indicate that custodial and co-parenting grandparents had higher all-cause mortality risks relative to occasional babysitting grandparents over the subsequent 6-year observation period; however, for the custodial grandparents, the associations were not significant after health, health behaviors, and depressive symptoms were added into the model. Latent class analyses were conducted to identify the social network typology with seven indicators of interpersonal relationships and activities. Results from the latent class analysis identified four clusters: diverse, friend-focused, family-focused, and restricted/ non-friends. Specifically, family-focused network was significantly associated with increased mortality risks among grandparents. Custodial grandparents received more functional support but perceived less positive support, which further enhanced the negative associations between custodial grandparenting status and increased mortality risk. This study suggests that community-based support to strengthen social networks may be beneficial to older grandparents and that improved positive relationship quality matters for older adults? well-being. JF - Social Work PB - University of Pittsburgh CY - Pittsburgh, PA VL - PhD UR - http://d-scholarship.pitt.edu/37018/ ER - TY - JOUR T1 - Exome Chip Meta-analysis Fine Maps Causal Variants and Elucidates the Genetic Architecture of Rare Coding Variants in Smoking and Alcohol Use. JF - Biological Psychiatry Y1 - 2019 A1 - Brazel, David M A1 - Jiang, Yu A1 - Hughey, Jordan M A1 - Turcot, Valérie A1 - Zhan, Xiaowei A1 - Gong, Jian A1 - Batini, Chiara A1 - Weissenkampen, J Dylan A1 - Liu, Mengzhen A1 - Barnes, Daniel R A1 - Bertelsen, Sarah A1 - Chou, Yi-Ling A1 - Erzurumluoglu, A Mesut A1 - Jessica Faul A1 - Jeffrey Haessler A1 - Anke R Hammerschlag A1 - Hsu, Chris A1 - Kapoor, Manav A1 - Lai, Dongbing A1 - Le, Nhung A1 - Christiaan de Leeuw A1 - Loukola, Anu A1 - Mangino, Massimo A1 - Melbourne, Carl A A1 - Pistis, Giorgio A1 - Qaiser, Beenish A1 - Rohde, Rebecca A1 - Shao, Yaming A1 - Heather M Stringham A1 - Wetherill, Leah A1 - Zhao, Wei A1 - Agrawal, Arpana A1 - Laura Bierut A1 - Chen, Chu A1 - Charles B Eaton A1 - Goate, Alison A1 - Christopher A Haiman A1 - Andrew C Heath A1 - Iacono, William G A1 - Nicholas G Martin A1 - Tinca J Polderman A1 - Reiner, Alex A1 - Rice, John A1 - Schlessinger, David A1 - H Steven Scholte A1 - Smith, Jennifer A A1 - Tardif, Jean-Claude A1 - Hilary A Tindle A1 - Van Der Leij, Andries R A1 - Boehnke, Michael A1 - Chang-Claude, Jenny A1 - Francesco Cucca A1 - David, Sean P A1 - Tatiana Foroud A1 - Howson, Joanna M M A1 - Sharon L R Kardia A1 - Charles Kooperberg A1 - Laakso, Markku A1 - Lettre, Guillaume A1 - Pamela A F Madden A1 - McGue, Matt A1 - Kari E North A1 - Posthuma, Danielle A1 - Timothy Spector A1 - Stram, Daniel A1 - Tobin, Martin D A1 - David R Weir A1 - Kaprio, Jaakko A1 - Gonçalo R Abecasis A1 - Liu, Dajiang J A1 - Scott Vrieze KW - Alcohol Drinking KW - Databases, Genetic KW - Exome KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Oligonucleotide Array Sequence Analysis KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Smoking AB -

BACKGROUND: Smoking and alcohol use have been associated with common genetic variants in multiple loci. Rare variants within these loci hold promise in the identification of biological mechanisms in substance use. Exome arrays and genotype imputation can now efficiently genotype rare nonsynonymous and loss of function variants. Such variants are expected to have deleterious functional consequences and to contribute to disease risk.

METHODS: We analyzed ∼250,000 rare variants from 16 independent studies genotyped with exome arrays and augmented this dataset with imputed data from the UK Biobank. Associations were tested for five phenotypes: cigarettes per day, pack-years, smoking initiation, age of smoking initiation, and alcoholic drinks per week. We conducted stratified heritability analyses, single-variant tests, and gene-based burden tests of nonsynonymous/loss-of-function coding variants. We performed a novel fine-mapping analysis to winnow the number of putative causal variants within associated loci.

RESULTS: Meta-analytic sample sizes ranged from 152,348 to 433,216, depending on the phenotype. Rare coding variation explained 1.1% to 2.2% of phenotypic variance, reflecting 11% to 18% of the total single nucleotide polymorphism heritability of these phenotypes. We identified 171 genome-wide associated loci across all phenotypes. Fine mapping identified putative causal variants with double base-pair resolution at 24 of these loci, and between three and 10 variants for 65 loci. Twenty loci contained rare coding variants in the 95% credible intervals.

CONCLUSIONS: Rare coding variation significantly contributes to the heritability of smoking and alcohol use. Fine-mapping genome-wide association study loci identifies specific variants contributing to the biological etiology of substance use behavior.

VL - 85 IS - 11 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 - Factors that impact family perception of goal-concordant care at the end of life. JF - Journal of Palliative Medicine Y1 - 2019 A1 - Haines, Lindsay A1 - Rahman, Omari-Khalid A1 - Justin J Sanders A1 - Kimberly J. Johnson A1 - Amy Kelley KW - Advance care planning KW - Racial/ethnic differences AB -

BACKGROUND: Goal-concordant care (GCC)-care aligned with a patient's known goals and values-is a measure of the quality of end-of-life (EOL) care that can be assessed by surveying family members after a patient's death. It is unknown whether patient characteristics affect this measure.

OBJECTIVE: The objective of the article was to examine family report of GCC and its associations with patient characteristics.

METHODS: Using the Health and Retirement Study, which is a nationally representative, longitudinal cohort of adults over age 50, we sampled decedents whose family completed the 2014 postdeath interview. Families reported frequency of GCC at the EOL. A multivariable regression model assessed the associations between family report of GCC and decedent characteristics.

RESULTS: Of 1175 respondents, 76% reported that the decedent "usually" or "always" received GCC. Proxy report of GCC was independently associated with age (adjusted odds ratio [AOR] 1.02, 95% confidence interval [CI] 1.01-1.03), having three or more chronic medical conditions (AOR 1.34, CI 1.02-1.77), the presence of written or verbal advance care planning (ACP) (AOR 1.38, CI 1.02-1.88), and an interaction term of race and ability to participate in EOL decision making (AOR 3.83, CI 1.02-14.40). African American race was not independently associated with GCC (AOR 0.73, CI 0.5-1.06).

CONCLUSION: Family's report of GCC is associated with ACP, age, and multimorbidity. Being African American and perceived as able to participate in EOL decision making was significantly associated with report of GCC. Bringing the patient's voice into EOL care discussions through upstream ACP with likely surrogates may be particularly important to improving GCC for African Americans.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/30758243?dopt=Abstract ER - TY - JOUR T1 - The financial burden of paid home care on older adults: Oldest and sickest are least likely to have enough income JF - Health Affairs Y1 - 2019 A1 - Richard W. Johnson A1 - Wang, Claire Xiaozhi KW - Community-dwelling KW - Financial burden KW - Long-term Care AB - Paid home care can significantly improve the lives of older adults with disabilities and their families, but recipients often incur substantial out-of-pocket spending. We simulated the financial burden of paid home care for a nationally representative sample of non-Medicaid community-dwelling adults ages sixty-five and older. We found that 74 percent could fund at least two years of a moderate amount of paid home care if they liquidated all of their assets, and 58 percent could fund at least two years of an extensive amount of paid home care. Among older adults with significant disabilities, however, only 57 percent could fund at least two years of moderate paid home care by liquidating all of their assets, and 40 percent could fund at least two years of extensive paid home care. Paid home care could become less affordable if growing labor shortages raise future costs. VL - 38 UR - http://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00025 IS - 6 JO - Health Affairs ER - TY - JOUR T1 - Genomics of 1 million parent lifespans implicates novel pathways and common diseases and distinguishes survival chances. JF - Elife Y1 - 2019 A1 - Paul Rhj Timmers A1 - Mounier, Ninon A1 - Lall, Kristi A1 - Fischer, Krista A1 - Ning, Zheng A1 - Feng, Xiao A1 - Bretherick, Andrew D A1 - Clark, David W A1 - Shen, Xia A1 - Tõnu Esko A1 - Kutalik, Zoltán A1 - James F Wilson A1 - Joshi, Peter K KW - Age Factors KW - Aged KW - Bayes Theorem KW - Disease KW - DNA Methylation KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Genomics KW - Humans KW - Longevity KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Parents KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - Sex Characteristics KW - Signal Transduction KW - Survival Analysis AB -

We use a genome-wide association of 1 million parental lifespans of genotyped subjects and data on mortality risk factors to validate previously unreplicated findings near , , , , , and 13q21.31, and identify and replicate novel findings near , , and . We also validate previous findings near 5q33.3/ and , whilst finding contradictory evidence at other loci. Gene set and cell-specific analyses show that expression in foetal brain cells and adult dorsolateral prefrontal cortex is enriched for lifespan variation, as are gene pathways involving lipid proteins and homeostasis, vesicle-mediated transport, and synaptic function. Individual genetic variants that increase dementia, cardiovascular disease, and lung cancer - but not other cancers - explain the most variance. Resulting polygenic scores show a mean lifespan difference of around five years of life across the deciles.

Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).

VL - 8 ER - TY - JOUR T1 - Going It Alone: Advance Directive Discordance in Older Married Couples JF - Journal of Applied Gerontology Y1 - 2019 A1 - Catheryn S Koss A1 - Jensen, Donna KW - Advance directives KW - Couples AB - Contrary to expectations of joint decision-making, a substantial minority of older married couples report only one spouse possessing an advance directive. Using Health and Retirement Study data, the authors examined advance directive discordance among heterosexual married couples in which at least one spouse had completed an advance directive. It was predicted that spouses who differed in age, self-rated health, or race/ethnicity would be more apt to adopt individualistic as opposed to relational motivational stances, resulting in higher odds of nonmatching advance directive status. Heterogamy did not account for discordance, but couples in which one or both spouses attended some college were more likely to report advance directive concordance. In contrast, couples in which one or both spouses were non-White were more likely to display advance directive discordance. Study results raise concerns about the effectiveness and reach of advance care planning promotion efforts among low-education and non-White older married adults. SN - 0733-4648 UR - https://doi.org/10.1177/0733464819884439 N1 - doi: 10.1177/0733464819884439 JO - J Appl Gerontol ER - TY - JOUR T1 - Gradual Change, Homeostasis, and Punctuated Equilibrium: Reconsidering Patterns of Health in Later Life JF - Demography Y1 - 2019 A1 - Michal Engelman A1 - Heide Jackson KW - Aging KW - Demography KW - Equilibrium KW - health KW - Health problems KW - Homeostasis KW - Inequality KW - Life stage transitions KW - Life Tables KW - Longitudinal analysis KW - Multistate KW - Older people KW - Psychology KW - Sequence analysis KW - Statistical models KW - trajectory AB - Longitudinal methods aggregate individual health histories to produce inferences about aging populations, but to what extent do these summaries reflect the experiences of older adults? We describe the assumption of gradual change built into several influential statistical models and draw on widely used, nationally representative survey data to empirically compare the conclusions drawn from mixed-regression methods (growth curve models and latent class growth analysis) designed to capture trajectories with key descriptive statistics and methods (multistate life tables and sequence analysis) that depict discrete states and transitions. We show that individual-level data record stasis irregularly punctuated by relatively sudden change in health status or mortality. Although change is prevalent in the sample, for individuals it occurs rarely, at irregular times and intervals, and in a nonlinear and multidirectional fashion. We conclude by discussing the implications of this punctuated equilibrium pattern for understanding health changes in individuals and the dynamics of inequality in aging populations. VL - 56 SN - 00703370 UR - https://www.ncbi.nlm.nih.gov/pubmed/31713126 N1 - Copyright - Demography is a copyright of Springer, (2019). All Rights Reserved; Last updated - 2020-01-02 ER - TY - THES T1 - The Impact of Adult Children's Education on Elderly Parents' Health and Old-Age Support: Evidence from the United States and China T2 - Social Work Y1 - 2019 A1 - Nan Jiang KW - 0351:Gerontology KW - 0452:Social work KW - Aging KW - Education KW - Gerontology KW - Human capital KW - Inter-generational relationship KW - Social Sciences KW - Social work AB - The aim of this dissertation is to study the effect of adult children's education on the health and economic wellbeing of their parents in old age. This dissertation contributes to the field of human capital theory through enhancing the understanding of the connections between adult children and parents in old age. It studies large nationally representative data sets in the US and China. The findings highlight the potential importance of pathways through which children’s human capital affects parents in later life and suggest that offspring’s human capital (education) is important for parental health and old-age support. This research has important implications for the amelioration of health disparities related to intergenerational inequality in both the U.S and China. JF - Social Work PB - Columbia University VL - PhD SN - 9781392078761 UR - https://academiccommons.columbia.edu/doi/10.7916/d8-hfpz-rr25 N1 - Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-05-03 ER - TY - JOUR T1 - A meta-analysis of genome-wide association studies identifies multiple longevity genes. JF - Nature Communications Y1 - 2019 A1 - Deelen, Joris A1 - Daniel S Evans A1 - Dan E Arking A1 - Tesi, Niccolò A1 - Nygaard, Marianne A1 - Liu, Xiaomin A1 - Wojczynski, Mary K A1 - Biggs, Mary L A1 - van der Spek, Ashley A1 - Atzmon, Gil A1 - Erin B Ware A1 - Sarnowski, Chloé A1 - Albert Vernon Smith A1 - Seppälä, Ilkka A1 - Cordell, Heather J A1 - Dose, Janina A1 - Amin, Najaf A1 - Alice M. Arnold A1 - Kristin L. Ayers A1 - Barzilai, Nir A1 - Becker, Elizabeth J A1 - Beekman, Marian A1 - Blanché, Hélène A1 - Christensen, Kaare A1 - Christiansen, Lene A1 - Collerton, Joanna C A1 - Cubaynes, Sarah A1 - Steven R Cummings A1 - Davies, Karen A1 - Debrabant, Birgit A1 - Deleuze, Jean-François A1 - Duncan, Rachel A1 - Jessica Faul A1 - Franceschi, Claudio A1 - Galan, Pilar A1 - Gudnason, Vilmundur A1 - Tamara B Harris A1 - Huisman, Martijn A1 - Hurme, Mikko A A1 - Jagger, Carol A1 - Jansen, Iris A1 - Jylhä, Marja A1 - Kähönen, Mika A1 - Karasik, David A1 - Sharon L R Kardia A1 - Kingston, Andrew A1 - Kirkwood, Thomas B L A1 - Lenore J Launer A1 - Lehtimäki, Terho A1 - Lieb, Wolfgang A1 - Lyytikäinen, Leo-Pekka A1 - Martin-Ruiz, Carmen A1 - Min, Junxia A1 - Nebel, Almut A1 - Anne B Newman A1 - Nie, Chao A1 - Nohr, Ellen A A1 - Orwoll, Eric S A1 - Thomas T Perls A1 - Province, Michael A A1 - Psaty, Bruce M A1 - Olli T Raitakari A1 - Reinders, Marcel J T A1 - Robine, Jean-Marie A1 - Rotter, Jerome I A1 - Sebastiani, Paola A1 - Jennifer A Smith A1 - Sørensen, Thorkild I A A1 - Kent D Taylor A1 - André G Uitterlinden A1 - van der Flier, Wiesje A1 - Sven J van der Lee A1 - Cornelia M van Duijn A1 - van Heemst, Diana A1 - James W Vaupel A1 - David R Weir A1 - Ye, Kenny A1 - Zeng, Yi A1 - Zheng, Wanlin A1 - Holstege, Henne A1 - Douglas P Kiel A1 - Kathryn L Lunetta A1 - Eline P Slagboom A1 - Joanne M Murabito KW - genes KW - Genome-Wide Association Study KW - GWA KW - longevity genes KW - meta-analysis AB -

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.

VL - 10 UR - https://www.ncbi.nlm.nih.gov/pubmed/31413261 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31413261?dopt=Abstract ER - TY - JOUR T1 - Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity. JF - Nature Communications Y1 - 2019 A1 - Kilpeläinen, Tuomas O A1 - Bentley, Amy R A1 - Noordam, Raymond A1 - Yun Ju Sung A1 - Schwander, Karen A1 - Thomas W Winkler A1 - Jakupović, Hermina A1 - Daniel I Chasman A1 - Alisa Manning A1 - Ntalla, Ioanna A1 - Aschard, Hugues A1 - Brown, Michael R A1 - de Las Fuentes, Lisa A1 - Franceschini, Nora A1 - Guo, Xiuqing A1 - Vojinovic, Dina A1 - Aslibekyan, Stella A1 - Feitosa, Mary F A1 - Kho, Minjung A1 - Musani, Solomon K A1 - Melissa Richard A1 - Wang, Heming A1 - Wang, Zhe A1 - Traci M Bartz A1 - Bielak, Lawrence F A1 - Campbell, Archie A1 - Dorajoo, Rajkumar A1 - Fisher, Virginia A1 - Hartwig, Fernando P A1 - Horimoto, Andrea R V R A1 - Li, Changwei A1 - Kurt Lohman A1 - Marten, Jonathan A1 - Sim, Xueling A1 - Smith, Albert V A1 - Tajuddin, Salman M A1 - Alver, Maris A1 - Amini, Marzyeh A1 - Boissel, Mathilde A1 - Jin-Fang Chai A1 - Chen, Xu A1 - Divers, Jasmin A1 - Evangelou, Evangelos A1 - Gao, Chuan A1 - Graff, Mariaelisa A1 - Sarah E Harris A1 - He, Meian A1 - Hsu, Fang-Chi A1 - Jackson, Anne U A1 - Jing Hua Zhao A1 - Kraja, Aldi T A1 - Kühnel, Brigitte A1 - Laguzzi, Federica A1 - Lyytikäinen, Leo-Pekka A1 - Ilja M Nolte A1 - Rauramaa, Rainer A1 - Riaz, Muhammad A1 - Robino, Antonietta A1 - Rueedi, Rico A1 - Heather M Stringham A1 - Takeuchi, Fumihiko A1 - van der Most, Peter J A1 - Varga, Tibor V A1 - Verweij, Niek A1 - Erin B Ware A1 - Wen, Wanqing A1 - Li, Xiaoyin A1 - Yanek, Lisa R A1 - Amin, Najaf A1 - Donna K Arnett A1 - Boerwinkle, Eric A1 - Brumat, Marco A1 - Brian E Cade A1 - Canouil, Mickaël A1 - Chen, Yii-Der Ida A1 - Concas, Maria Pina A1 - Connell, John A1 - de Mutsert, Renée A1 - de Silva, H Janaka A1 - de Vries, Paul S A1 - Demirkan, Ayse A1 - Ding, Jingzhong A1 - Charles B Eaton A1 - Jessica Faul A1 - Friedlander, Yechiel A1 - Gabriel, Kelley P A1 - Ghanbari, Mohsen A1 - Giulianini, Franco A1 - Gu, Chi Charles A1 - Gu, Dongfeng A1 - Tamara B Harris A1 - He, Jiang A1 - Heikkinen, Sami A1 - Heng, Chew-Kiat A1 - Hunt, Steven C A1 - Ikram, M Arfan A1 - Jost Bruno Jonas A1 - Koh, Woon-Puay A1 - Komulainen, Pirjo A1 - Krieger, Jose E A1 - Stephen B Kritchevsky A1 - Kutalik, Zoltán A1 - Kuusisto, Johanna A1 - Langefeld, Carl D A1 - Langenberg, Claudia A1 - Lenore J Launer A1 - Leander, Karin A1 - Lemaitre, Rozenn N A1 - Lewis, Cora E A1 - Liang, Jingjing A1 - Liu, Jianjun A1 - Mägi, Reedik A1 - Manichaikul, Ani A1 - Meitinger, Thomas A1 - Andres Metspalu A1 - Milaneschi, Yuri A1 - Mohlke, Karen L A1 - Thomas H Mosley A1 - Murray, Alison D A1 - Michael A Nalls A1 - Nang, Ei-Ei Khaing A1 - Nelson, Christopher P A1 - Nona, Sotoodehnia A1 - Norris, Jill M A1 - Nwuba, Chiamaka Vivian A1 - Jeff O'Connell A1 - Palmer, Nicholette D A1 - Papanicolau, George J A1 - Pazoki, Raha A1 - Nancy L Pedersen A1 - Peters, Annette A1 - Peyser, Patricia A A1 - Polasek, Ozren A1 - David J Porteous A1 - Poveda, Alaitz A1 - Olli T Raitakari A1 - Rich, Stephen S A1 - Neil Risch A1 - Robinson, Jennifer G A1 - Rose, Lynda M A1 - Rudan, Igor A1 - Schreiner, Pamela J A1 - Scott, Robert A A1 - Stephen Sidney A1 - Sims, Mario A1 - Smith, Jennifer A A1 - Snieder, Harold A1 - Sofer, Tamar A1 - John M Starr A1 - Sternfeld, Barbara A1 - Strauch, Konstantin A1 - Tang, Hua A1 - Kent D Taylor A1 - Tsai, Michael Y A1 - Tuomilehto, Jaakko A1 - André G Uitterlinden A1 - van der Ende, M Yldau A1 - van Heemst, Diana A1 - Voortman, Trudy A1 - Waldenberger, Melanie A1 - Wennberg, Patrik A1 - Wilson, Gregory A1 - Xiang, Yong-Bing A1 - Yao, Jie A1 - Yu, Caizheng A1 - Yuan, Jian-Min A1 - Zhao, Wei A1 - Alan B Zonderman A1 - Becker, Diane M A1 - Boehnke, Michael A1 - Bowden, Donald W A1 - de Faire, Ulf A1 - Ian J Deary A1 - Elliott, Paul A1 - Tõnu Esko A1 - Freedman, Barry I A1 - Froguel, Philippe A1 - Paolo P. Gasparini A1 - Gieger, Christian A1 - Kato, Norihiro A1 - Laakso, Markku A1 - Lakka, Timo A A1 - Lehtimäki, Terho A1 - Patrik K E Magnusson A1 - Oldehinkel, Albertine J A1 - Brenda W J H Penninx A1 - Nilesh J Samani A1 - Shu, Xiao-Ou A1 - van der Harst, Pim A1 - Jana V. van Vliet-Ostaptchouk A1 - Vollenweider, Peter A1 - Wagenknecht, Lynne E A1 - Wang, Ya X A1 - Wareham, Nicholas J A1 - David R Weir A1 - Wu, Tangchun A1 - Zheng, Wei A1 - Zhu, Xiaofeng A1 - Michele K Evans A1 - Franks, Paul W A1 - Gudnason, Vilmundur A1 - Caroline Hayward A1 - Horta, Bernardo L A1 - Tanika N Kelly A1 - Liu, Yongmei A1 - Kari E North A1 - Pereira, Alexandre C A1 - Ridker, Paul M A1 - Tai, E Shyong A1 - van Dam, Rob M A1 - Fox, Ervin R A1 - Sharon L R Kardia A1 - Liu, Ching-Ti A1 - Dennis O Mook-Kanamori A1 - Province, Michael A A1 - Redline, Susan A1 - Cornelia M van Duijn A1 - Rotter, Jerome I A1 - Charles Kooperberg A1 - Gauderman, W James A1 - Psaty, Bruce M A1 - Kenneth Rice A1 - Munroe, Patricia B A1 - Myriam Fornage A1 - Cupples, L Adrienne A1 - Charles N Rotimi A1 - Alanna C Morrison A1 - Rao, Dabeeru C A1 - Ruth J F Loos KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Asians KW - Blacks KW - Brazil KW - Calcium-Binding Proteins KW - Cholesterol KW - Cholesterol, HDL KW - Cholesterol, LDL KW - Exercise KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Genotype KW - Hispanic or Latino KW - Humans KW - LIM-Homeodomain Proteins KW - Lipid Metabolism KW - Lipids KW - Male KW - Membrane Proteins KW - Microtubule-Associated Proteins KW - Middle Aged KW - Muscle Proteins KW - Nerve Tissue Proteins KW - Transcription Factors KW - Triglycerides KW - Whites KW - Young Adult AB -

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.

VL - 10 IS - 1 ER - TY - JOUR T1 - New alcohol-related genes suggest shared genetic mechanisms with neuropsychiatric disorders. JF - Nature Human Behaviour Y1 - 2019 A1 - Evangelou, Evangelos A1 - Gao, He A1 - Chu, Congying A1 - Ntritsos, Georgios A1 - Blakeley, Paul A1 - Butts, Andrew R A1 - Pazoki, Raha A1 - Suzuki, Hideaki A1 - Koskeridis, Fotios A1 - Yiorkas, Andrianos M A1 - Karaman, Ibrahim A1 - Elliott, Joshua A1 - Luo, Qiang A1 - Aeschbacher, Stefanie A1 - Traci M Bartz A1 - Baumeister, Sebastian E A1 - Braund, Peter S A1 - Brown, Michael R A1 - Brody, Jennifer A A1 - Clarke, Toni-Kim A1 - Dimou, Niki A1 - Jessica Faul A1 - Homuth, Georg A1 - Jackson, Anne U A1 - Kentistou, Katherine A A1 - Joshi, Peter K A1 - Lemaitre, Rozenn N A1 - Penelope A Lind A1 - Lyytikäinen, Leo-Pekka A1 - Mangino, Massimo A1 - Milaneschi, Yuri A1 - Nelson, Christopher P A1 - Ilja M Nolte A1 - Perälä, Mia-Maria A1 - Polasek, Ozren A1 - David J Porteous A1 - Scott M Ratliff A1 - Smith, Jennifer A A1 - Stančáková, Alena A1 - Teumer, Alexander A1 - Tuominen, Samuli A1 - Thériault, Sébastien A1 - Vangipurapu, Jagadish A1 - Whitfield, John B A1 - Wood, Alexis A1 - Yao, Jie A1 - Yu, Bing A1 - Zhao, Wei A1 - Dan E Arking A1 - Auvinen, Juha A1 - Liu, Chunyu A1 - Männikkö, Minna A1 - Risch, Lorenz A1 - Rotter, Jerome I A1 - Snieder, Harold A1 - Veijola, Juha A1 - Alexandra I Blakemore A1 - Boehnke, Michael A1 - Campbell, Harry A1 - Conen, David A1 - Johan G Eriksson A1 - Hans-Jörgen Grabe A1 - Guo, Xiuqing A1 - van der Harst, Pim A1 - Catharina A Hartman A1 - Caroline Hayward A1 - Andrew C Heath A1 - Järvelin, Marjo-Riitta A1 - Kähönen, Mika A1 - Sharon L R Kardia A1 - Kühne, Michael A1 - Kuusisto, Johanna A1 - Laakso, Markku A1 - Lahti, Jari A1 - Lehtimäki, Terho A1 - McIntosh, Andrew M A1 - Mohlke, Karen L A1 - Alanna C Morrison A1 - Nicholas G Martin A1 - Oldehinkel, Albertine J A1 - Brenda W J H Penninx A1 - Psaty, Bruce M A1 - Olli T Raitakari A1 - Rudan, Igor A1 - Nilesh J Samani A1 - Scott, Laura J A1 - Timothy Spector A1 - Verweij, Niek A1 - David R Weir A1 - James F Wilson A1 - Levy, Daniel A1 - Tzoulaki, Ioanna A1 - Bell, Jimmy D A1 - Matthews, Paul M A1 - Rothenfluh, Adrian A1 - Desrivières, Sylvane A1 - Schumann, Gunter A1 - Elliott, Paul KW - Adult KW - Aged KW - Alcohol Drinking KW - Alcoholism KW - Brain KW - Female KW - genes KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Magnetic Resonance Imaging KW - Male KW - Mental Disorders KW - Middle Aged KW - Neuroimaging KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Schizophrenia KW - Whites AB -

Excessive alcohol consumption is one of the main causes of death and disability worldwide. Alcohol consumption is a heritable complex trait. Here we conducted a meta-analysis of genome-wide association studies of alcohol consumption (g d) from the UK Biobank, the Alcohol Genome-Wide Consortium and the Cohorts for Heart and Aging Research in Genomic Epidemiology Plus consortia, collecting data from 480,842 people of European descent to decipher the genetic architecture of alcohol intake. We identified 46 new common loci and investigated their potential functional importance using magnetic resonance imaging data and gene expression studies. We identify genetic pathways associated with alcohol consumption and suggest genetic mechanisms that are shared with neuropsychiatric disorders such as schizophrenia.

VL - 3 IS - 9 ER - TY - JOUR T1 - Optimism and healthy aging in women and men. JF - American Journal of Epidemiology Y1 - 2019 A1 - Eric S Kim A1 - James, Peter A1 - Emily S Zevon A1 - Trudel-Fitzgerald, Claudia A1 - Laura D Kubzansky A1 - Grodstein, Francine KW - Gender Differences KW - Health Trajectories KW - Optimism KW - Personality KW - Well-being AB - Mounting evidence indicates specific associations between higher levels of optimism and healthier behaviors, reduced risk of chronic diseases, and lower mortality. Yet, for public health purposes, it is critical to consider how optimism may be related to a full scope of health conditions in aging-from cognitive to physical health. Using prospective data from the Health and Retirement Study (N=5,698), we examined if higher baseline optimism was associated with subsequent increased likelihood of maintaining healthy aging over 6-8 years of follow-up. Optimism was assessed at study baseline (2006 or 2008), and components of healthy aging were assessed every two years, defined as: 1) remaining free of major chronic diseases; 2) having no cognitive impairment; and 3) good physical functioning. Hazard ratios were obtained using Cox proportional hazards models, and a range of relevant covariates were considered (sociodemographics, depressive symptoms, health behaviors). After adjusting for sociodemographics and depression, the most (top quartile) versus least (bottom quartile) optimistic participants had a 24% increased likelihood of maintaining healthy aging (95% CI: 1.11, 1.38). Further adjustment for health behaviors did not meaningfully change the findings. Optimism, a potentially modifiable health asset, merits further research for its potential to improve likelihood of health in aging. U1 - http://www.ncbi.nlm.nih.gov/pubmed/30834429?dopt=Abstract ER - TY - JOUR T1 - Pets in the lives of older adults: A life course perspective JF - Anthrozoös Y1 - 2019 A1 - Bibbo, Jessica A1 - Angela L Curl A1 - Rebecca A Johnson KW - Decision making KW - Life trajectories KW - Pets AB - This study employed the life course perspective to investigate the convergence of two demographic shifts: the aging of the population and the increase of pet ownership. Specifically, we examined whether pet ownership, the degree of bond with a pet, and reasons for and against pet ownership differed between three age cohorts: the young-old (ages 51–64 years), older adults (ages 65–84), and the oldest-old (ages 85 and over). This study analyzed data from 1,367 respondents of the 2012 wave of the Health and Retirement Study (HRS) using bivariate statistics and multivariate regression models. We found evidence for differences in rates of pet ownership by race, ethnicity, age, number living in household, and whether someone was living with a spouse or partner, but not by gender, education, income, wealth, or health. The bond with a pet did not differ across age cohorts. Companionship was the most common reason for owning a pet across the three age groups, while concern about the resources (e.g., time and work) required of pet ownership was the most common reason for not living with a pet. Results were interpreted at the individual level using the life course perspective’s tenets of timing in lives, linked lives, and human agency, while taking the societal level tenet of historical time and place into account. While rates of pet ownership differed by age cohort, all participants reported a strong bond with their companion animal. Programs and policies can help facilitate these ongoing relationships. The life course perspective provides a useful framework to gain a deeper understanding of pet ownership and the human–animal bond throughout people’s lives. VL - 32 IS - 4 JO - Anthrozoös ER - TY - JOUR T1 - The race paradox in subjective wellbeing among older Americans JF - Ageing and Society Y1 - 2019 A1 - Tang, Fengyan A1 - Heejung Jang A1 - Mary Beth Rauktis A1 - Donald Musa A1 - Scott Beach KW - Happiness KW - Racial/ethnic differences KW - Social Support KW - Well-being AB - This study aims to assess racial differences in subjective wellbeing (SWB) and to examine whether the pathways of social support and social engagement to SWB vary by racial groups in the United States of America. Using a local sample (N = 1,035) and a nationally representative sample of the Health and Retirement Study (N = 7,718), we compared life satisfaction and happiness between non-Hispanic Whites and Blacks aged 55 and over. We evaluated the extent to which race, other socio-demographic characteristics, health, social engagement and social support explained the variances in SWB and examined the moderation effects of race on the relationships of SWB with age, social support and social engagement. Multiple regression analyses showed that non-Hispanic Blacks were at least as satisfied as, and even happier than White peers, after equalising social resources and health variables. Social support was significantly related to SWB, and it seemed that positive support was more important to Whites than to Blacks in predicting life satisfaction. In addition, the racial crossover effect existed, that is, the old-old (80+) Blacks were happier than their White peers. Findings indicate a national trend of the race paradox in SWB and underscore the importance of social support in promoting older adults’ wellbeing. Future research is recommended to investigate other potential mechanisms among Black older Americans to explain their relatively better SWB. VL - 39 UR - https://www.cambridge.org/core/product/identifier/S0144686X17001064/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X17001064 IS - 3 JO - Ageing and Society ER - TY - JOUR T1 - Religion, Life Expectancy and Disability-Free Life Expectancy Among Older Women and Men in the United States JF - The Journals of Gerontology: Series B Y1 - 2019 A1 - Mary Beth Ofstedal A1 - Chi-Tsun Chiu A1 - Jagger, Carol A1 - Saito, Yasuhiko KW - Disabilities KW - Gender Differences KW - Mortality KW - Religion AB - OBJECTIVES Existing literature shows religion is associated with health and survival separately. We extend this literature by considering health and survival together using a multi-state life table approach to estimate total, disability-free and disabled life expectancy, separately for women and men, for two disability measures, and by two indicators of religion. METHOD Data come from the Health and Retirement Study (1998-2014 waves). Predictors include importance of religion and attendance at religious services. The disability measures are defined by ADLs and IADLs. Models control for sociodemographic and health covariates. RESULTS Attendance at religious services shows a strong and consistent association with life and health expectancy. Men and women who attend services at least once a week (compared to those who attend less frequently or never) have between 1.1 and 5.1 years longer total life expectancy and between 1.0 and 4.3 years longer ADL disability-free life expectancy. Findings for IADL disability are similar. Importance of religion is related to total and disabled life expectancy (both ADL and IADL), but the differentials are smaller and less consistent. Controlling for sociodemographic and health factors does not explain these associations. DISCUSSION By estimating total, disability-free and disabled life expectancy we are able to quantify the advantage of religion for health. Results are consistent with previous studies that have focused on health and mortality separately. VL - 74 UR - https://academic.oup.com/psychsocgerontology/article-abstract/74/8/e107/5078835?redirectedFrom=fulltext IS - 8 ER - TY - JOUR T1 - Robust Respondents and Lost Limitations: The Implications of Nonrandom Missingness for the Estimation of Health Trajectories. JF - Journal of Aging and Health Y1 - 2019 A1 - Heide Jackson A1 - Michal Engelman A1 - Bandeen-Roche, Karen KW - Health Trajectories KW - Survey Methodology AB -

OBJECTIVE: We offer a strategy for quantifying the impact of mortality and attrition on inferences from later-life health trajectory models.

METHOD: Using latent class growth analysis (LCGA), we identify functional limitation trajectory classes in the Health and Retirement Study. We compare results from complete case and full information maximum likelihood (FIML) analyses, and demonstrate a method for producing upper- and lower-bound estimates of the impact of attrition on results.

RESULTS: LCGA inferences vary substantially depending on the handling of missing data. For older adults who die during the follow-up period, the widely used FIML approach may underestimate functional limitations by up to 20%.

DISCUSSION: The most commonly used approaches to handling missing data likely underestimate the extent of poor health in aging populations. Although there is no single solution for nonrandom missingness, we show that bounding estimates can help analysts to better characterize patterns of health in later life.

VL - 31 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29254422?dopt=Abstract ER - TY - JOUR T1 - Weakness May Have a Causal Association With Early Mortality in Older Americans: A Matched Cohort Analysis JF - Journal of the American Medical Directors Association Y1 - 2019 A1 - Ryan P McGrath A1 - Brenda Vincent A1 - Mark D Peterson A1 - Donald A Jurivich A1 - Lindsey J Dahl A1 - Kyle J Hackney A1 - Brian C Clark KW - Aging KW - Epidemiology KW - Geriatrics KW - Hand Strength KW - Muscle Strength KW - sarcopenia AB - Objectives Quantifying the association between muscle weakness and mortality with carefully matched cohorts will help to better establish the impact of weakness on premature death. We used a matched cohort analysis in a national sample of older Americans to determine if those who were weak had a higher risk for mortality compared with control groups with incrementally higher strength capacities. Design Longitudinal panel. Setting Detailed interviews that included physical measures were conducted in person, whereas core interviews were often performed over the telephone. Participants Data from 19,729 Americans aged at least 50 years from the 2006-2014 waves of the Health and Retirement Study were analyzed. Measures A handgrip dynamometer was used to assess handgrip strength (HGS) in each participant. Men with HGS <26 kg were considered weak, ≥26 kg were considered not weak, and ≥32 kg were considered strong. Women with HGS <16 kg were classified as weak, ≥16 kg were classified as not-weak, and ≥20 kg were classified as strong. The National Death Index and postmortem interviews determined the date of death. The greedy matching algorithm was used to match cohorts. Results Of the 1077 weak and not-weak matched pairs, 401 weak (37.2%) and 296 not-weak (27.4%) older Americans died over an average 4.4 ± 2.5-year follow-up. There were 392 weak (37.0%) and 243 strong (22.9%) persons who died over a mean 4.5 ± 2.5-year follow-up from the 1057 weak and strong matched pairs. Those in the weak cohort had a 1.40 [95% confidence interval (CI) 1.19, 1.64] and 1.54 (CI 1.30, 1.83) higher hazard for mortality relative to persons in the not-weak and strong control cohorts, respectively. Conclusions and Implications Our findings may indicate a causal association between muscle weakness and mortality in older Americans. Health care providers should include measures of HGS as part of routine health assessments and discuss the health risks of muscle weakness with their patients. UR - http://www.sciencedirect.com/science/article/pii/S152586101930756X ER - TY - JOUR T1 - Widowhood and Depression in a Cross-National Perspective: Evidence from the United States, Europe, Korea, and China. JF - The Journals of Gerontology: Series B Y1 - 2019 A1 - Jadhav, Apoorva A1 - David R Weir KW - Bereavement KW - CHARLS KW - Cross-National KW - Depressive symptoms KW - ELSA KW - KLoSA KW - SHARE AB -

Objectives: We explore marital and depression trajectories over time for men and women, and distinguish between mood and somatic depression across contexts.

Method: We use longitudinal data from 2002 to 2013 from the United States, England, Europe, Korea, and China to explore depression among individuals married at baseline and follow their trajectories into widowhood with married as the reference group. We use random effects models to estimate these trajectories using the Center for Epidemiologic Studies Depression Scale (CES-D) or EURO-D scales for men and women.

Results: Depression peaks within the first year of widowhood for men and women, but women recover to levels comparable to married counterparts in all countries. Men sustain high levels of depression even 6-10 years post-widowhood everywhere except Europe. Widowed women have higher somatic depression compared to men, who have higher mood depression. Family plays differential roles in mediating depression across countries.

Discussion: Our research shows the complex global relationship between widowhood and depression. Studies that do not compare depression trajectories over time may make incorrect inferences about the persistence of depression by gender and country. Interventions should target different components of depression: mood-related symptoms for men and somatic-related symptoms for women for most effective recovery.

VL - 73 IS - 8 ER - TY - JOUR T1 - Caregivers dying before care recipients with dementia. JF - Alzheimer's & Dementia Y1 - 2018 A1 - Joseph E Gaugler A1 - Jutkowitz, Eric A1 - Peterson, Christine A1 - Zmora, Rachel KW - Caregiving KW - Cognitive Ability KW - Dementia AB -

Introduction: Although a handful of studies have examined mortality among caregivers of persons with Alzheimer's disease or a related dementia (ADRD), the proportion of caregivers who die before their cognitively impaired care recipients remains unknown.

Methods: We conducted descriptive and survival analyses on up to 17 years of data from the nationally representative Health and Retirement Study to evaluate the proportion of spouse caregivers who died before their care recipients.

Results: Eighteen percent of spouse ADRD caregivers died before their care recipients, and spouse caregivers had a significantly lower risk of mortality than their husbands or wives with ADRD.

Discussion: Although a large majority of spouse ADRD caregivers will likely not die before their cognitively impaired husband or wife, those persons with ADRD who survive longer than their caregivers are worthy of future inquiry given their potential risk for negative health outcomes.

VL - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30581974?dopt=Abstract ER - TY - JOUR T1 - Chronic disease burden predicts food insecurity among older adults. JF - Public Health Nutrition Y1 - 2018 A1 - Jih, Jane A1 - Stijacic-Cenzer, Irena A1 - Hilary K Seligman A1 - W John Boscardin A1 - Thu T Nguyen A1 - Christine S Ritchie KW - Chronic conditions KW - Comorbidity KW - Food insecurity AB -

OBJECTIVE: Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.

DESIGN: Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS.

SETTING: USA.

SUBJECTS: Respondents of the 2013 HRS HCNS with household incomes <300 % of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0-1, 2-4, ≥5 conditions), with multiple chronic conditions (MCC) defined as ≥2 conditions.

RESULTS: The prevalence of food insecurity was 27·8 %. Compared with those having 0-1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2-4 conditions being 2·12 (95 % CI 1·45, 3·09) and for those with ≥5 conditions being 3·64 (95 % CI 2·47, 5·37).

CONCLUSIONS: A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

VL - 21 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29388533?dopt=Abstract ER - TY - JOUR T1 - A Common DIO2 Polymorphism and Alzheimer Disease Dementia in African and European Americans JF - Journal of Endocrinology & Metabolism Y1 - 2018 A1 - Elizabeth A. McAninch A1 - Rajan, Kumar B A1 - Sungro Jo A1 - Layal Chaker A1 - et al. KW - Alzheimer's disease KW - Cognitive Ability KW - Genome AB - Context A common single nucleotide polymorphism in DIO2, Thr92AlaD2, has been associated with a transcriptome typically found in neurodegenerative diseases in postmortem human brain tissue. Objective To determine whether Thr92AlaD2 is associated with incident Alzheimer disease (AD). Design Population-based study; human brain tissue microarray. Setting Community-based cohorts from Chicago and northeastern Illinois and religious clergymen from across the United States constituted the primary population. A representative sample of the U.S. population was used for secondary analyses. Participants 3054 African Americans (AAs) and 9304 European Americans (EAs). Main Outcome Measure Incident AD. Results In the primary population, AAs with Thr92AlaD2 had 1.3 times [95% confidence interval (CI), 1.02 to 1.68; P = 0.048] greater odds of developing AD. AAs from a second population with Thr92AlaD2 showed a trend toward increased odds of dementia (odds ratio, 1.33; 95% CI, 0.99 to 1.78; P = 0.06) and 1.35 times greater odds of developing cognitive impairment not demented (CIND; 95% CI, 1.09 to 1.67; P = 0.006). Meta-analysis showed that AAs with Thr92AlaD2 had 1.3 times increased odds of developing AD/dementia (95% CI, 1.07 to 1.58; P = 0.008). In EAs, no association was found between Thr92AlaD2 and AD, dementia, or CIND. Microarray of AA brain tissue identified transcriptional patterns linked to AD pathogenesis. Conclusions Thr92AlaD2 was associated with molecular markers known to underlie AD pathogenesis in AAs, translating to an observed phenotype of increased odds of developing AD/dementia in AAs in these populations. Thr92AlaD2 might represent one factor contributing to racial discrepancies in incident AD. VL - 103 UR - https://academic.oup.com/jcem/article/103/5/1818/4893706 IS - 5 ER - TY - RPRT T1 - Delayed Retirement and the Growth in Income Inequality at Older Ages Y1 - 2018 A1 - Richard W. Johnson KW - Income inequality KW - Retirement AB - As concerns about retirement savings have intensified, many older adults have begun working beyond traditional retirement age. By working longer, they can improve their retirement security by increasing their future monthly Social Security payments and shortening the time they must rely on their savings. But does delaying retirement deepen income inequality for older adults by leaving those with health problems behind? Delayed retirement can boost financial security but excludes workers with health problems Employment and income for 62-to-64-year-olds has increased substantially over the past two decades for people in good health. But employment and income have stagnated for older Americans with health problems, who face lower income than their healthier counterparts for the rest of their lives. To assess how later retirement affects income inequality at older ages, we examined how the relationship between health status, employment, and income has shifted for people eligible for early Social Security retirement benefits but too young to receive full retirement benefits. PB - The Urban Institute UR - https://www.urban.org/research/publication/delayed-retirement-and-growth-income-inequality-older-ages ER - TY - RPRT T1 - Distributional Effects of Alternative Strategies for Financing Long-Term Services and Supports and Assisting Family Caregivers Y1 - 2018 A1 - Melissa Favreault A1 - Richard W. Johnson KW - Disabilities KW - Insurance KW - Taxes AB - We use two historical data sources – the Health and Retirement Study and the Medicare Current Beneficiary Study – to consider the patterns in older Americans’ severe disability and their use of long-term services and supports (LTSS) by age and socioeconomic status. We then use a dynamic microsimulation model to project how the effects of various interventions to support those with severe disabilities and their caregivers would be distributed across the income distribution. The interventions that we examine fall into three broad classes: tax credits for caregiving expenses, respite care for people in the community with family caregivers, and new social insurance programs. Within each broad class of policies, we examine how sensitive outcomes are to changes in policy details (such as, in the case of tax credits, deductible levels, refundability, and income phase-outs). This paper found that: Older adults with less education and less wealth are more likely to report disabilities and service use than their more educated and wealthier counterparts.This pattern persists when we look at people at a point in time but also, more robustly, when we look at their disabilities prospectively. In a sample of older adults who do not report disabilities at baseline, we find that those with fewer economic resources earlier in life are generally more likely to develop disabilities and use paid LTSS over the next two decades, but the differences narrow when we restrict the sample to people who do not develop disabilities until their late 70s. The policy implications of this paper are: The uneven distribution of disability risks across the population poses challenges for developing effective LTSS policies. Those most likely to need LTSS often lack enough resources to contribute to LTSS programs, and programs that try to contain costs by using underwriting or imposing work requirements often disqualify those who most need coverage.Certain classes of policies, such as respite care benefits, tend to direct much of their benefits to those in lower income quintiles, according to our projections. Caregiver tax credits and social insurance programs generally distribute benefits more proportionally, although impacts vary depending on how the policies are specified.Policy design details can significantly affect distributional outcomes. Provisions’ effects can be sensitive to the stacking order in which they are implemented.It can be useful to examine trends and proposals not only cross-sectionally but also over longer time periods. For example, the distributional effects of social insurance programs depend on the relatively high early-life mortality of those with less education and lower earnings and wealth. JF - Working Papers PB - Center for Retirement Research at Boston College CY - Boston, MA UR - http://crr.bc.edu/wp-content/uploads/2018/03/wp_2018-1.pdf ER - TY - RPRT T1 - Exploring the Consequences of Discrimination and Health for Retirement by Race and Ethnicity: Results from the Health and Retirement Study Y1 - 2018 A1 - Guillermo Ernest Gonzales A1 - Lee, Yeonjung A1 - Padula, William V. A1 - Jung, Lindsey Subin KW - Discrimination KW - Racial/ethnic differences KW - Retirement Planning and Satisfaction AB - This paper examines the association of structural discriminatory risk factors and health with retirement age. It uses data from the Health and Retirement Study (HRS). Critical components of the analysis include ordinary least squares regressions to evaluate associations of discrimination (major lifetime discrimination, neighborhood disadvantage, work discrimination and everyday discrimination) and health with retirement age, while controlling for time, cohort, race, ethnicity, gender, marital status, education, health insurance, income and wealth. Interaction effects explore differences by discrimination and health. Individuals’ ages 51+, employed full-time, part-time, or unemployed were drawn from the HRS Leave-Behind Questionnaire in 2006. Approximately half of the sample retired during the observation period 2008-2014. Key limitations are that valid and reliable measures of discrimination were queried only twice during an 8-year period, limiting our understanding of the timing of events as they relate to health and economic outcomes. JF - Center for Retirement Research at Boston College Working Paper Series PB - Center for Retirement Research at Boston College CY - Chestnut Hill, MA UR - http://crr.bc.edu/working-papers/exploring-the-consequences-of-discrimination-and-health-for-retirement-by-race-and-ethnicity-results-from-the-health-and-retirement-study/ ER - TY - JOUR T1 - Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals. JF - Nature Genetics Y1 - 2018 A1 - Lee, James J A1 - Wedow, Robbee A1 - Okbay, Aysu A1 - Kong, Edward A1 - Maghzian, Omeed A1 - Zacher, Meghan A1 - Nguyen-Viet, Tuan Anh A1 - Bowers, Peter A1 - Sidorenko, Julia A1 - Richard Karlsson Linnér A1 - Mark Alan Fontana A1 - Kundu, Tushar A1 - Lee, Chanwook A1 - Hui Liu A1 - Li, Ruoxi A1 - Royer, Rebecca A1 - Pascal N Timshel A1 - Walters, Raymond K A1 - Willoughby, Emily A A1 - Yengo, Loic A1 - Alver, Maris A1 - Bao, Yanchun A1 - Clark, David W A1 - Day, Felix R A1 - Furlotte, Nicholas A A1 - Joshi, Peter K A1 - Kathryn E Kemper A1 - Kleinman, Aaron A1 - Langenberg, Claudia A1 - Mägi, Reedik A1 - Joey W Trampush A1 - Verma, Shefali Setia A1 - Wu, Yang A1 - Lam, Max A1 - Jing Hua Zhao A1 - Zheng, Zhili A1 - Jason D Boardman A1 - Campbell, Harry A1 - Freese, Jeremy A1 - Kathleen Mullan Harris A1 - Caroline Hayward A1 - Herd, Pamela A1 - Kumari, Meena A1 - Lencz, Todd A1 - Luan, Jian'an A1 - Anil K. Malhotra A1 - Andres Metspalu A1 - Lili Milani A1 - Ong, Ken K A1 - Perry, John R B A1 - David J Porteous A1 - Ritchie, Marylyn D A1 - Smart, Melissa C A1 - Smith, Blair H A1 - Tung, Joyce Y A1 - Wareham, Nicholas J A1 - James F Wilson A1 - Jonathan P. Beauchamp A1 - Dalton C Conley A1 - Tõnu Esko A1 - Lehrer, Steven F A1 - Patrik K E Magnusson A1 - Oskarsson, Sven A1 - Pers, Tune H A1 - Matthew R Robinson A1 - Thom, Kevin A1 - Watson, Chelsea A1 - Chabris, Christopher F A1 - Meyer, Michelle N A1 - David I Laibson A1 - Yang, Jian A1 - Johannesson, Magnus A1 - Philipp D Koellinger A1 - Turley, Patrick A1 - Peter M Visscher A1 - Daniel J. Benjamin A1 - Cesarini, David KW - Adult KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Educational Status KW - Female KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Phenotype KW - Polymorphism, Single Nucleotide AB -

Here we conducted a large-scale genetic association analysis of educational attainment in a sample of approximately 1.1 million individuals and identify 1,271 independent genome-wide-significant SNPs. For the SNPs taken together, we found evidence of heterogeneous effects across environments. The SNPs implicate genes involved in brain-development processes and neuron-to-neuron communication. In a separate analysis of the X chromosome, we identify 10 independent genome-wide-significant SNPs and estimate a SNP heritability of around 0.3% in both men and women, consistent with partial dosage compensation. A joint (multi-phenotype) analysis of educational attainment and three related cognitive phenotypes generates polygenic scores that explain 11-13% of the variance in educational attainment and 7-10% of the variance in cognitive performance. This prediction accuracy substantially increases the utility of polygenic scores as tools in research.

VL - 50 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30038396?dopt=Abstract ER - TY - JOUR T1 - Genome-wide association meta-analysis in 269,867 individuals identifies new genetic and functional links to intelligence JF - Nature Genetics Y1 - 2018 A1 - Savage, Jeanne E. A1 - Philip R Jansen A1 - Stringer, Sven A1 - Watanabe, Kyoko A1 - Bryois, Julien A1 - Christiaan de Leeuw A1 - Nagel, Mats A1 - Awasthi, Swapnil A1 - Barr, Peter B. A1 - Coleman, Jonathan R. I. A1 - Grasby, Katrina L. A1 - Anke R Hammerschlag A1 - Kaminski, Jakob A. A1 - Karlsson, Robert A1 - Krapohl, Eva A1 - Lam, Max A1 - Nygaard, Marianne A1 - Chandra A Reynolds A1 - Joey W Trampush A1 - Young, Hannah A1 - Zabaneh, Delilah A1 - Hägg, Sara A1 - Narelle K Hansell A1 - Ida Karlsson A1 - Linnarsson, Sten A1 - Grant W Montgomery A1 - Muñoz-Manchado, Ana B. A1 - Quinlan, Erin B. A1 - Schumann, Gunter A1 - Skene, Nathan G. A1 - Webb, Bradley T. A1 - White, Tonya A1 - Dan E Arking A1 - Avramopoulos, Dimitrios A1 - Robert M Bilder A1 - Bitsios, Panos A1 - Katherine E Burdick A1 - Tyrone D. Cannon A1 - Chiba-Falek, Ornit A1 - Christoforou, Andrea A1 - Elizabeth T. Cirulli A1 - Congdon, Eliza A1 - Corvin, Aiden A1 - Gail Davies A1 - Ian J Deary A1 - DeRosse, Pamela A1 - Dickinson, Dwight A1 - Djurovic, Srdjan A1 - Donohoe, Gary A1 - Conley, Emily Drabant A1 - Johan G Eriksson A1 - Espeseth, Thomas A1 - Nelson A. Freimer A1 - Giakoumaki, Stella A1 - Giegling, Ina A1 - Gill, Michael A1 - David C. Glahn A1 - Ahmad R Hariri A1 - Hatzimanolis, Alex A1 - Matthew C Keller A1 - Knowles, Emma A1 - Koltai, Deborah A1 - Konte, Bettina A1 - Lahti, Jari A1 - Stephanie Le Hellard A1 - Lencz, Todd A1 - David C Liewald A1 - London, Edythe A1 - Astri J Lundervold A1 - Anil K. Malhotra A1 - Melle, Ingrid A1 - Morris, Derek A1 - Anna C Need A1 - William E R Ollier A1 - Aarno Palotie A1 - Payton, Antony A1 - Pendleton, Neil A1 - Russell A Poldrack A1 - Katri Räikkönen A1 - Reinvang, Ivar A1 - Roussos, Panos A1 - Rujescu, Dan A1 - Fred W Sabb A1 - Matthew A Scult A1 - Smeland, Olav B. A1 - Smyrnis, Nikolaos A1 - John M Starr A1 - Vidar M Steen A1 - Nikos C Stefanis A1 - Richard E Straub A1 - Sundet, Kjetil A1 - Henning Tiemeier A1 - Aristotle N Voineskos A1 - Daniel R Weinberger A1 - Elisabeth Widen A1 - Yu, Jin A1 - Gonçalo R Abecasis A1 - Andreassen, Ole A. A1 - Breen, Gerome A1 - Christiansen, Lene A1 - Debrabant, Birgit A1 - Danielle M. Dick A1 - Heinz, Andreas A1 - Hjerling-Leffler, Jens A1 - Mohammed Arfan Ikram A1 - Kendler, Kenneth S. A1 - Nicholas G Martin A1 - Sarah E Medland A1 - Nancy L Pedersen A1 - Plomin, Robert A1 - Tinca J Polderman A1 - Ripke, Stephan A1 - van der Sluis, Sophie A1 - Patrick F. Sullivan A1 - Scott Vrieze A1 - Margaret J Wright A1 - Posthuma, Danielle KW - Genome-Wide Association Study KW - Intelligence KW - Meta-analyses AB - Intelligence is highly heritable1 and a major determinant of human health and well-being2. Recent genome-wide meta-analyses have identified 24 genomic loci linked to variation in intelligence3-7, but much about its genetic underpinnings remains to be discovered. Here, we present a large-scale genetic association study of intelligence (n = 269,867), identifying 205 associated genomic loci (190 new) and 1,016 genes (939 new) via positional mapping, expression quantitative trait locus (eQTL) mapping, chromatin interaction mapping, and gene-based association analysis. We find enrichment of genetic effects in conserved and coding regions and associations with 146 nonsynonymous exonic variants. Associated genes are strongly expressed in the brain, specifically in striatal medium spiny neurons and hippocampal pyramidal neurons. Gene set analyses implicate pathways related to nervous system development and synaptic structure. We confirm previous strong genetic correlations with multiple health-related outcomes, and Mendelian randomization analysis results suggest protective effects of intelligence for Alzheimer's disease and ADHD and bidirectional causation with pleiotropic effects for schizophrenia. These results are a major step forward in understanding the neurobiology of cognitive function as well as genetically related neurological and psychiatric disorders. VL - 50 UR - http://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdfhttp://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdf IS - 7 JO - Nat Genet ER - TY - NEWS T1 - The grave health consequences of a personal financial catastrophe T2 - The Washington Post Y1 - 2018 A1 - Johnson, Carolyn Y. KW - Mortality KW - News KW - Wealth Shocks JF - The Washington Post CY - Washington, D.C. UR - https://www.washingtonpost.com/news/wonk/wp/2018/04/03/the-grave-health-consequences-of-a-personal-financial-catastrophe/?utm_term=.fe9c79aec4c6 ER - TY - JOUR T1 - Health Shocks and Initiation of Use of Preventive Services Among Older Adults. JF - J Appl Gerontol Y1 - 2018 A1 - Ng, Boon Peng A1 - Gail A Jensen KW - Aged KW - Cholesterol KW - Early Detection of Cancer KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Influenza, Human KW - Male KW - Mammography KW - Middle Aged KW - Papanicolaou Test KW - Prostatic Neoplasms KW - Vaccination KW - Vaginal Smears AB -

This article examines whether adverse changes to health or functioning serve as an impetus to begin using preventive services among older individuals with a history of non-use. Using data from the 1998-2008 Health and Retirement Study, the use of mammograms, pap smears, prostate cancer screenings, cholesterol checks, and flu shots is examined among 2,975 self-reported non-users of such services. Older women who experience a health shock are 1.86, 1.50, 1.79, and 1.46 times more likely to begin getting mammograms, pap smears, cholesterol checks, and flu shots, respectively. Older men who experience a health shock are 2.24, 2.72, and 1.64 times more likely to begin getting prostate cancer screenings, cholesterol checks, and flu shots, respectively. All of these results are statistically significant. Thus, older adults often improve their health behaviors after experiencing an adverse health event.

VL - 37 UR - http://jag.sagepub.com/cgi/doi/10.1177/0733464816657474 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27449258?dopt=Abstract JO - Journal of Applied Gerontology ER - TY - JOUR T1 - Healthy aging after age 65: A life-span health production function approach. JF - Research on Aging Y1 - 2018 A1 - Nasim B Ferdows A1 - Gail A Jensen A1 - Wassim Tarraf KW - Health Behavior KW - Lifecycles AB - This article examines the determinants of healthy aging using Grossman's framework of a health production function. Healthy aging, sometimes described as successful aging, is produced using a variety of inputs, determined in early life, young adulthood, midlife, and later life. A healthy aging production function is estimated using nationally representative data from the 2010 and 2012 Health and Retirement Study on 7,355 noninstitutionalized seniors. Using a simultaneous equation mediation model, we quantify how childhood factors contribute to healthy aging, both directly and indirectly through their effects on mediating adult outcomes. We find that favorable childhood conditions significantly improve healthy aging scores, both directly and indirectly, mediated through education, income, and wealth. We also find that good health habits have positive effects on healthy aging that are larger in magnitude than the effects of childhood factors. Our findings suggest that exercising, maintaining proper weight, and not smoking are likely to translate into healthier aging. VL - 40 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28610549?dopt=Abstract ER - TY - RPRT T1 - How Secure Is Employment at Older Ages? Y1 - 2018 A1 - Richard W. Johnson A1 - Gosselin, Peter KW - Ageism KW - Discrimination KW - Employment and Labor Force KW - Retirement Planning and Satisfaction AB - Tracking older adults in the Health and Retirement Study from 1992 to 2016, we find that about one-half of full-time, full-year workers ages 51 to 54 experience an employer-related involuntary job separation after age 50 that substantially reduces earnings for years or leads to long-term unemployment. The steady earnings that many people count on in their 50s and 60s to build their retirement savings and ensure some financial security in later life often vanishes, upending retirement expectations and creating economic hardship. This problem will likely intensify as more people realize they must work longer to enjoy a comfortable retirement. JF - Research Report PB - Urban Institute CY - Washington, DC UR - https://www.urban.org/research/publication/how-secure-employment-older-ages ER - TY - RPRT T1 - Is It Time to Raise the Social Security Retirement Age? Y1 - 2018 A1 - Richard W. Johnson AB - Social Security faces a long-term financing problem. The program now spends more than it collects each year, and Social Security’s trustees project that it will be unable to pay full benefits beginning in 2034. Reducing the payment period by raising the age at which beneficiaries can begin collecting benefits would improve Social Security’s finances. But some older people, especially those with limited education and incomes, could suffer financially if they had to wait longer to collect retirement benefits. This report examines how raising Social Security’s early entitlement age (EEA), currently 62, might affect beneficiaries and discusses ways to protect adults who might not be able to work until qualifying for Social Security benefits. PB - The Urban Institute UR - https://www.urban.org/research/publication/it-time-raise-social-security-retirement-age ER - TY - JOUR T1 - The Life Skills of Older Americans: Association with Economic, Psychological, Social, and Health Outcomes JF - Scientific Reports Y1 - 2018 A1 - Andrew Steptoe A1 - Sarah E Jackson KW - Mortality KW - Optimism KW - Personality KW - Socioeconomic factors AB - Studies of children and adolescents indicate that success in life is determined in part by attributes such as conscientiousness, emotional stability and sense of control, independently of childhood socioeconomic status and cognitive ability. Less is known about the role of these characteristics at older ages. This study investigated the relationship of five life skills - conscientiousness, emotional stability, persistence, optimism and sense of control - with a range of outcomes in 8,843 participants (mean age 72.57 years) in the Health and Retirement Study, a representative study of older Americans. More life skills were associated with greater wealth and income, better emotional wellbeing, stronger social relationships, less loneliness, better health, fewer chronic illnesses and impaired activities of daily living, better mobility and less obesity, after controlling for childhood socioeconomic status and current cognitive ability. Longitudinally, more life skills predicted emotional wellbeing, less loneliness and more prosocial behavior, better health and mobility over a 4 year period. Associations were independent of gender, ethnicity, family background, education and cognitive ability. The number of attributes was important rather than any single life skill. Life skills continue to matter at advanced ages, and fostering these characteristics in older adults may pay dividends in terms of later life health and wellbeing. VL - 8 UR - http://www.nature.com/articles/s41598-018-27909-whttp://www.nature.com/articles/s41598-018-27909-w.pdfhttp://www.nature.com/articles/s41598-018-27909-w.pdfhttp://www.nature.com/articles/s41598-018-27909-w IS - 1 JO - Sci Rep ER - TY - RPRT T1 - The Lifetime Medical Spending of Retirees Y1 - 2018 A1 - John Bailey Jones A1 - Mariacristina De Nardi A1 - Eric French A1 - McGee, Rory A1 - Kirschner, Justin KW - Medicaid KW - Medical Expenses KW - Mortality KW - Out-of-pocket payments AB - Using dynamic models of health, mortality, and out-of-pocket medical spending (both inclusive and net of Medicaid payments), we estimate the distribution of lifetime medical spending that retired U.S. households face over the remainder of their lives. We find that at age 70, households will on average incur $122,000 in medical spending, including Medicaid payments, over their remaining lives. At the top tail, 5 percent of households will incur more than $300,000, and 1 percent of households will incur over $600,000 in medical spending inclusive of Medicaid. The level and the dispersion of this spending diminish only slowly with age. Although permanent income, initial health, and initial marital status have large effects on this spending, much of the dispersion in lifetime spending is due to events realized later in life. Medicaid covers the majority of the lifetime costs of the poorest households and significantly reduces their risk JF - NBER Working Paper Series PB - National Bureau of Economic Research CY - Cambridge, MA UR - http://www.nber.org/papers/w24599.pdf ER - TY - JOUR T1 - Measuring Sarcopenia Severity in Older Adults and the Value of Effective Interventions JF - The journal of nutrition, health & aging Y1 - 2018 A1 - MacEwan, Joanna P. A1 - Thomas M Gill A1 - Johnson, K. A1 - Doctor, J. A1 - Jeffrey Sullivan A1 - Shim, J. A1 - Dana P Goldman KW - Economics KW - health KW - Physical activity KW - Sacropenia AB - 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 2010–2040 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— almost $800B in the most optimistic scenarios. © 2018, The Author(s). UR - http://link.springer.com/10.1007/s12603-018-1104-7http://link.springer.com/content/pdf/10.1007/s12603-018-1104-7.pdf JO - J Nutr Health Aging ER - TY - JOUR T1 - Pain as a risk factor for loneliness among older adults. JF - Journal of Aging and Health Y1 - 2018 A1 - Emerson, Kerstin A1 - Boggero, Ian A1 - Ostir, Glenn A1 - Jayawardhana, Jayani KW - Chronic pain KW - Depressive symptoms KW - Loneliness AB -

OBJECTIVE: The objective of this is to examine whether pain is associated with the onset of loneliness in a sample of community-dwelling older adults.

METHODS: We used data from the 2008 and 2012 Health and Retirement Study. We limited the sample to community-dwelling persons aged 60 years and over who were not lonely in 2008 in order to predict the risk of onset of loneliness (incidence) in 2012. Our analytic sample included 1,563 observations.

RESULTS: Approximately 31.7% of participants reported loneliness at follow-up (2012). Logistic regression models showed that the odds of loneliness onset was 1.58 higher for those with pain at both time points, compared with those who had pain at neither time point, even after controlling for other covariates.

DISCUSSION: The results indicate that pain may increase the risk of loneliness in older adults. This suggests that appropriate pain interventions could prevent future loneliness, which in turn could prevent functional decline, disability, and premature mortality.

VL - 30 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28728466?dopt=Abstract ER - TY - JOUR T1 - Postretirement work and volunteering by poverty groups informed by role theory. JF - Journal of Gerontological Social Work Y1 - 2018 A1 - Joonyoung Cho A1 - BoRin Kim A1 - So Jung Park A1 - Jang, Jakyung KW - Volunteerism AB - This study uses role theory to examine the association between postretirement work and volunteering among retirees and to determine whether this association varies across poverty status. Data came from the 2012 wave of the Health and Retirement Study (HRS). The sample was restricted to respondents of older retirees (N = 6,619). We found that postretirement work positively influenced volunteering. However, poverty can be a risk factor of volunteering among older retirees. The positive effect of post-retirement work was found to be more significant in the near-poverty group. We provide an empirical foundation to help inform volunteer programs for retirees. VL - 61 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29236613?dopt=Abstract ER - TY - JOUR T1 - Productive aging via volunteering: Does social cohesion influence level of engagement? JF - Journal of Gerontological Social Work Y1 - 2018 A1 - Kimberly J. Johnson A1 - Kenzie Latham-Mintus A1 - Judith L Poey KW - Neighborhoods KW - Social Support KW - Volunteerism AB - This study investigated whether neighborhood social cohesion influenced volunteer intensity over two years. The sample was drawn from Health and Retirement Study respondents who completed the 2010 or 2012 Psychosocial and Lifestyle Questionnaire (n = 12,929). Results showed that compared to nonvolunteers, a one-unit increase in neighborhood social cohesion increased the odds of moderate (OR: 1.07, p < .05) and high volunteering (OR: 1.10, p < .001). However, other productive roles, social contact, and education were significant in distinguishing high intensity from moderate volunteering while neighborhood social cohesion was not. Social workers should consider the neighborhood environment when recruiting volunteers. VL - 61 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29697314?dopt=Abstract ER - TY - JOUR T1 - Protein-altering variants associated with body mass index implicate pathways that control energy intake and expenditure in obesity. JF - Nat Genet Y1 - 2018 A1 - Turcot, Valérie A1 - Lu, Yingchang A1 - Highland, Heather M A1 - Schurmann, Claudia A1 - Justice, Anne E A1 - Fine, Rebecca S A1 - Bradfield, Jonathan P A1 - Tõnu Esko A1 - Giri, Ayush A1 - Graff, Mariaelisa A1 - Guo, Xiuqing A1 - Hendricks, Audrey E A1 - Karaderi, Tugce A1 - Lempradl, Adelheid A1 - Locke, Adam E A1 - Mahajan, Anubha A1 - Marouli, Eirini A1 - Sivapalaratnam, Suthesh A1 - Young, Kristin L A1 - Alfred, Tamuno A1 - Feitosa, Mary F A1 - Masca, Nicholas G D A1 - Alisa Manning A1 - Medina-Gomez, Carolina A1 - Mudgal, Poorva A1 - Ng, Maggie C Y A1 - Reiner, Alex P A1 - Vedantam, Sailaja A1 - Willems, Sara M A1 - Thomas W Winkler A1 - Gonçalo R Abecasis A1 - Aben, Katja K A1 - Alam, Dewan S A1 - Alharthi, Sameer E A1 - Matthew A. Allison A1 - Amouyel, Philippe A1 - Asselbergs, Folkert W A1 - Auer, Paul L A1 - Balkau, Beverley A1 - Bang, Lia E A1 - Barroso, Inês A1 - Bastarache, Lisa A1 - Benn, Marianne A1 - Bergmann, Sven A1 - Bielak, Lawrence F A1 - Blüher, Matthias A1 - Boehnke, Michael A1 - Boeing, Heiner A1 - Boerwinkle, Eric A1 - Böger, Carsten A A1 - Bork-Jensen, Jette A1 - Bots, Michiel L A1 - Erwin P Bottinger A1 - Bowden, Donald W A1 - Brandslund, Ivan A1 - Breen, Gerome A1 - Brilliant, Murray H A1 - Broer, Linda A1 - Brumat, Marco A1 - Burt, Amber A A1 - Adam S Butterworth A1 - Campbell, Peter T A1 - Cappellani, Stefania A1 - Carey, David J A1 - Catamo, Eulalia A1 - Caulfield, Mark J A1 - Chambers, John C A1 - Daniel I Chasman A1 - Yii-Der I Chen A1 - Chowdhury, Rajiv A1 - Cramer Christensen A1 - Chu, Audrey Y A1 - Cocca, Massimiliano A1 - Collins, Francis S A1 - Cook, James P A1 - Corley, Janie A1 - Jordi Corominas Galbany A1 - Cox, Amanda J A1 - Crosslin, David S A1 - Cuellar-Partida, Gabriel A1 - D'Eustacchio, Angela A1 - Danesh, John A1 - Gail Davies A1 - Bakker, Paul I W A1 - Groot, Mark C H A1 - Mutsert, Renée A1 - Ian J Deary A1 - George Dedoussis A1 - Ellen W Demerath A1 - Heijer, Martin A1 - Anneke I den Hollander A1 - Hester M den Ruijter A1 - Joe G Dennis A1 - Denny, Josh C A1 - Angelantonio, Emanuele A1 - Drenos, Fotios A1 - Du, Mengmeng A1 - Dubé, Marie-Pierre A1 - Dunning, Alison M A1 - Easton, Douglas F A1 - Edwards, Todd L A1 - Ellinghaus, David A1 - Ellinor, Patrick T A1 - Elliott, Paul A1 - Evangelou, Evangelos A1 - Farmaki, Aliki-Eleni A1 - Farooqi, I Sadaf A1 - Jessica Faul A1 - Fauser, Sascha A1 - Feng, Shuang A1 - Ferrannini, Ele A1 - Ferrières, Jean A1 - Florez, Jose C A1 - Ford, Ian A1 - Myriam Fornage A1 - Franco, Oscar H A1 - Franke, Andre A1 - Franks, Paul W A1 - Friedrich, Nele A1 - Frikke-Schmidt, Ruth A1 - Galesloot, Tessel E A1 - Gan, Wei A1 - Gandin, Ilaria A1 - Paolo P. Gasparini A1 - Gibson, Jane A1 - Giedraitis, Vilmantas A1 - Gjesing, Anette P A1 - Gordon-Larsen, Penny A1 - Gorski, Mathias A1 - Hans-Jörgen Grabe A1 - Grant, Struan F A A1 - Grarup, Niels A1 - Griffiths, Helen L A1 - Grove, Megan L A1 - Gudnason, Vilmundur A1 - Gustafsson, Stefan A1 - Jeffrey Haessler A1 - Hakonarson, Hakon A1 - Anke R Hammerschlag A1 - Hansen, Torben A1 - Tamara B Harris A1 - Andrew T Hattersley A1 - Have, Christian T A1 - Caroline Hayward A1 - He, Liang A1 - Heard-Costa, Nancy L A1 - Andrew C Heath A1 - Iris M Heid A1 - Helgeland, Øyvind A1 - Hernesniemi, Jussi A1 - Hewitt, Alex W A1 - Oddgeir L Holmen A1 - Hovingh, G Kees A1 - Howson, Joanna M M A1 - Hu, Yao A1 - Huang, Paul L A1 - Huffman, Jennifer E A1 - Mohammed Arfan Ikram A1 - Ingelsson, Erik A1 - Jackson, Anne U A1 - Jansson, Jan-Håkan A1 - Jarvik, Gail P A1 - Jensen, Gorm B A1 - Jia, Yucheng A1 - Johansson, Stefan A1 - Jørgensen, Marit E A1 - Jørgensen, Torben A1 - Jukema, J Wouter A1 - Kahali, Bratati A1 - Kahn, René S A1 - Kähönen, Mika A1 - Kamstrup, Pia R A1 - Kanoni, Stavroula A1 - Kaprio, Jaakko A1 - Karaleftheri, Maria A1 - Sharon L R Kardia A1 - Karpe, Fredrik A1 - Kathiresan, Sekar A1 - Kee, Frank A1 - Lambertus A Kiemeney A1 - Eric S Kim A1 - Kitajima, Hidetoshi A1 - Komulainen, Pirjo A1 - Kooner, Jaspal S A1 - Charles Kooperberg A1 - Korhonen, Tellervo A1 - Kovacs, Peter A1 - Kuivaniemi, Helena A1 - Kutalik, Zoltán A1 - Kuulasmaa, Kari A1 - Kuusisto, Johanna A1 - Laakso, Markku A1 - Lakka, Timo A A1 - Lamparter, David A1 - Lange, Ethan M A1 - Leslie A Lange A1 - Langenberg, Claudia A1 - Eric B Larson A1 - Lee, Nanette R A1 - Lehtimäki, Terho A1 - Lewis, Cora E A1 - Li, Huaixing A1 - Li, Jin A1 - Li-Gao, Ruifang A1 - Lin, Honghuang A1 - Lin, Keng-Hung A1 - Lin, Li-An A1 - Lin, Xu A1 - Lars Lind A1 - Lindström, Jaana A1 - Linneberg, Allan A1 - Liu, Ching-Ti A1 - Liu, Dajiang J A1 - Yongmei Liu A1 - Ken Sin Lo A1 - Lophatananon, Artitaya A1 - Lotery, Andrew J A1 - Loukola, Anu A1 - Luan, Jian'an A1 - Lubitz, Steven A A1 - Lyytikäinen, Leo-Pekka A1 - Männistö, Satu A1 - Marenne, Gaëlle A1 - Mazul, Angela L A1 - McCarthy, Mark I A1 - McKean-Cowdin, Roberta A1 - Sarah E Medland A1 - Meidtner, Karina A1 - Lili Milani A1 - Mistry, Vanisha A1 - Mitchell, Paul A1 - Mohlke, Karen L A1 - Moilanen, Leena A1 - Moitry, Marie A1 - Grant W Montgomery A1 - Dennis O Mook-Kanamori A1 - Moore, Carmel A1 - Mori, Trevor A A1 - Morris, Andrew D A1 - Morris, Andrew P A1 - Müller-Nurasyid, Martina A1 - Munroe, Patricia B A1 - Michael A Nalls A1 - Narisu, Narisu A1 - Nelson, Christopher P A1 - Neville, Matt A1 - Sune Fallgaard Nielsen A1 - Nikus, Kjell A1 - Njølstad, Pål R A1 - Børge G Nordestgaard A1 - Nyholt, Dale R A1 - Jeff O'Connell A1 - O'Donoghue, Michelle L A1 - Ophoff, Roel A A1 - Owen, Katharine R A1 - Packard, Chris J A1 - Padmanabhan, Sandosh A1 - Palmer, Colin N A A1 - Palmer, Nicholette D A1 - Pasterkamp, Gerard A1 - Patel, Aniruddh P A1 - Pattie, Alison A1 - Pedersen, Oluf A1 - Peissig, Peggy L A1 - Peloso, Gina M A1 - Pennell, Craig E A1 - Markus Perola A1 - Perry, James A A1 - Perry, John R B A1 - Pers, Tune H A1 - Person, Thomas N A1 - Peters, Annette A1 - Petersen, Eva R B A1 - Peyser, Patricia A A1 - Pirie, Ailith A1 - Polasek, Ozren A1 - Tinca J Polderman A1 - Puolijoki, Hannu A1 - Olli T Raitakari A1 - Rasheed, Asif A1 - Rauramaa, Rainer A1 - Reilly, Dermot F A1 - Renstrom, Frida A1 - Rheinberger, Myriam A1 - Ridker, Paul M A1 - Rioux, John D A1 - Rivas, Manuel A A1 - Roberts, David J A1 - Neil R Robertson A1 - Robino, Antonietta A1 - Rolandsson, Olov A1 - Rudan, Igor A1 - Ruth, Katherine S A1 - Saleheen, Danish A1 - Veikko Salomaa A1 - Nilesh J Samani A1 - Sapkota, Yadav A1 - Sattar, Naveed A1 - Schoen, Robert E A1 - Schreiner, Pamela J A1 - Schulze, Matthias B A1 - Scott, Robert A A1 - Segura-Lepe, Marcelo P A1 - Svati H Shah A1 - Sheu, Wayne H-H A1 - Sim, Xueling A1 - Slater, Andrew J A1 - Small, Kerrin S A1 - Albert Vernon Smith A1 - Southam, Lorraine A1 - Timothy Spector A1 - Elizabeth K Speliotes A1 - John M Starr A1 - Stefansson, Kari A1 - Steinthorsdottir, Valgerdur A1 - Kathleen E Stirrups A1 - Strauch, Konstantin A1 - Heather M Stringham A1 - Stumvoll, Michael A1 - Sun, Liang A1 - Surendran, Praveen A1 - Swift, Amy J A1 - Tada, Hayato A1 - Tansey, Katherine E A1 - Tardif, Jean-Claude A1 - Kent D Taylor A1 - Teumer, Alexander A1 - Thompson, Deborah J A1 - Thorleifsson, Gudmar A1 - Thorsteinsdottir, Unnur A1 - Thuesen, Betina H A1 - Tönjes, Anke A1 - Tromp, Gerard A1 - Trompet, Stella A1 - Tsafantakis, Emmanouil A1 - Tuomilehto, Jaakko A1 - Tybjaerg-Hansen, Anne A1 - Tyrer, Jonathan P A1 - Uher, Rudolf A1 - André G Uitterlinden A1 - Uusitupa, Matti A1 - Laan, Sander W A1 - Duijn, Cornelia M A1 - Leeuwen, Nienke A1 - van Setten, Jessica A1 - Vanhala, Mauno A1 - Varbo, Anette A1 - Varga, Tibor V A1 - Varma, Rohit A1 - Digna R Velez Edwards A1 - Vermeulen, Sita H A1 - Veronesi, Giovanni A1 - Vestergaard, Henrik A1 - Vitart, Veronique A1 - Vogt, Thomas F A1 - Völker, Uwe A1 - Vuckovic, Dragana A1 - Wagenknecht, Lynne E A1 - Walker, Mark A1 - Wallentin, Lars A1 - Wang, Feijie A1 - Wang, Carol A A1 - Wang, Shuai A1 - Wang, Yiqin A1 - Erin B Ware A1 - Wareham, Nicholas J A1 - Warren, Helen R A1 - Dawn M Waterworth A1 - Wessel, Jennifer A1 - White, Harvey D A1 - Willer, Cristen J A1 - Wilson, James G A1 - Daniel Witte A1 - Andrew R Wood A1 - Wu, Ying A1 - Yaghootkar, Hanieh A1 - Yao, Jie A1 - Yao, Pang A1 - Laura M Yerges-Armstrong A1 - Young, Robin A1 - Zeggini, Eleftheria A1 - Zhan, Xiaowei A1 - Zhang, Weihua A1 - Wei Zhao A1 - Zhou, Wei A1 - Krina T Zondervan A1 - Rotter, Jerome I A1 - Pospisilik, John A A1 - Fernando Rivadeneira A1 - Ingrid B Borecki A1 - Deloukas, Panos A1 - Timothy M Frayling A1 - Lettre, Guillaume A1 - Kari E North A1 - Lindgren, Cecilia M A1 - Joel N Hirschhron A1 - Ruth J F Loos AB -

Genome-wide association studies (GWAS) have identified >250 loci for body mass index (BMI), implicating pathways related to neuronal biology. Most GWAS loci represent clusters of common, noncoding variants from which pinpointing causal genes remains challenging. Here we combined data from 718,734 individuals to discover rare and low-frequency (minor allele frequency (MAF) < 5%) coding variants associated with BMI. We identified 14 coding variants in 13 genes, of which 8 variants were in genes (ZBTB7B, ACHE, RAPGEF3, RAB21, ZFHX3, ENTPD6, ZFR2 and ZNF169) newly implicated in human obesity, 2 variants were in genes (MC4R and KSR2) previously observed to be mutated in extreme obesity and 2 variants were in GIPR. The effect sizes of rare variants are ~10 times larger than those of common variants, with the largest effect observed in carriers of an MC4R mutation introducing a stop codon (p.Tyr35Ter, MAF = 0.01%), who weighed ~7 kg more than non-carriers. Pathway analyses based on the variants associated with BMI confirm enrichment of neuronal genes and provide new evidence for adipocyte and energy expenditure biology, widening the potential of genetically supported therapeutic targets in obesity.

VL - 50 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29273807?dopt=Abstract ER - TY - JOUR T1 - Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study JF - BMJ Y1 - 2018 A1 - Stringhini, Silvia A1 - Carmeli, Cristian A1 - Markus Jokela A1 - Mauricio Avendano A1 - McCrory, Cathal A1 - d’Errico, Angelo A1 - Bochud, Murielle A1 - Barros, Henrique A1 - Costa, Giuseppe A1 - Chadeau-Hyam, Marc A1 - Delpierre, Cyrille A1 - Gandini, Martina A1 - Fraga, Silvia A1 - Goldberg, Marcel A1 - Giles, Graham G A1 - Lassale, Camille A1 - Kenny, Rose Anne A1 - Kelly-Irving, Michelle A1 - Paccaud, Fred A1 - Layte, Richard A1 - Muennig, Peter A1 - Michael Marmot A1 - Ribeiro, Ana Isabel A1 - Severi, Gianluca A1 - Andrew Steptoe A1 - Shipley, Martin J A1 - Zins, Marie A1 - Johan P Mackenbach A1 - Vineis, Paolo A1 - Mika Kivimäki KW - Cross-National KW - Gait speed KW - Risk Factors KW - Socioeconomic factors AB - Objective To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. Design Multi-cohort population based study. Setting 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017. Participants 109 107 men and women aged 45-90 years. Main outcome measure Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors. Results According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors. Conclusions The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning. VL - 360 UR - http://www.bmj.com/lookup/doi/10.1136/bmj.k1046https://syndication.highwire.org/content/doi/10.1136/bmj.k1046http://data.bmj.org/tdm/10.1136/bmj.k1046 JO - BMJ ER - TY - JOUR T1 - State-level estimation of diabetes and prediabetes prevalence: Combining national and local survey data and clinical data. JF - Statistics in Medicine Y1 - 2018 A1 - David A Marker A1 - Mardon, Russ A1 - Jenkins, Frank A1 - Campione, Joanne A1 - Nooney, Jennifer A1 - Li, Jane A1 - Saydeh, Sharon A1 - Zhang, Xuanping A1 - Shrestha, Sundar A1 - Deborah B. Rolka KW - Bias KW - California KW - Diabetes Mellitus KW - Electronic Health Records KW - Health Surveys KW - Humans KW - Insurance Claim Review KW - New York City KW - Nutrition Surveys KW - Prediabetic State KW - Prevalence KW - Statistics as Topic KW - United States AB -

Many statisticians and policy researchers are interested in using data generated through the normal delivery of health care services, rather than carefully designed and implemented population-representative surveys, to estimate disease prevalence. These larger databases allow for the estimation of smaller geographies, for example, states, at potentially lower expense. However, these health care records frequently do not cover all of the population of interest and may not collect some covariates that are important for accurate estimation. In a recent paper, the authors have described how to adjust for the incomplete coverage of administrative claims data and electronic health records at the state or local level. This article illustrates how to adjust and combine multiple data sets, namely, national surveys, state-level surveys, claims data, and electronic health record data, to improve estimates of diabetes and prediabetes prevalence, along with the estimates of the method's accuracy. We demonstrate and validate the method using data from three jurisdictions (Alabama, California, and New York City). This method can be applied more generally to other areas and other data sources.

VL - 37 IS - 27 ER - TY - JOUR T1 - Study of 300,486 individuals identifies 148 independent genetic loci influencing general cognitive function. JF - Nature Communications Y1 - 2018 A1 - Gail Davies A1 - Lam, Max A1 - Sarah E Harris A1 - Joey W Trampush A1 - Luciano, Michelle A1 - W David Hill A1 - Hagenaars, Saskia P A1 - Ritchie, Stuart J A1 - Riccardo E Marioni A1 - Fawns-Ritchie, Chloe A1 - David C Liewald A1 - Okely, Judith A A1 - Ahola-Olli, Ari V A1 - Barnes, Catriona L K A1 - Bertram, Lars A1 - Joshua C. Bis A1 - Katherine E Burdick A1 - Christoforou, Andrea A1 - DeRosse, Pamela A1 - Djurovic, Srdjan A1 - Espeseth, Thomas A1 - Giakoumaki, Stella A1 - Giddaluru, Sudheer A1 - Gustavson, Daniel E A1 - Caroline Hayward A1 - Edith Hofer A1 - Ikram, M Arfan A1 - Karlsson, Robert A1 - Knowles, Emma A1 - Lahti, Jari A1 - Leber, Markus A1 - Li, Shuo A1 - Mather, Karen A A1 - Melle, Ingrid A1 - Morris, Derek A1 - Christopher J Oldmeadow A1 - Palviainen, Teemu A1 - Payton, Antony A1 - Pazoki, Raha A1 - Katja E Petrovic A1 - Chandra A Reynolds A1 - Sargurupremraj, Muralidharan A1 - Scholz, Markus A1 - Smith, Jennifer A A1 - Smith, Albert V A1 - Terzikhan, Natalie A1 - Thalamuthu, Anbupalam A1 - Trompet, Stella A1 - Sven J van der Lee A1 - Erin B Ware A1 - Windham, B Gwen A1 - Margaret J Wright A1 - Yang, Jingyun A1 - Yu, Jin A1 - Ames, David A1 - Amin, Najaf A1 - Amouyel, Philippe A1 - Andreassen, Ole A A1 - Armstrong, Nicola J A1 - Assareh, Amelia A A1 - John R. Attia A1 - Attix, Deborah A1 - Avramopoulos, Dimitrios A1 - David A Bennett A1 - Böhmer, Anne C A1 - Patricia A. Boyle A1 - Brodaty, Henry A1 - Campbell, Harry A1 - Tyrone D. Cannon A1 - Elizabeth T. Cirulli A1 - Congdon, Eliza A1 - Conley, Emily Drabant A1 - Corley, Janie A1 - Cox, Simon R A1 - Dale, Anders M A1 - Dehghan, Abbas A1 - Danielle M. Dick A1 - Dickinson, Dwight A1 - Johan G Eriksson A1 - Evangelou, Evangelos A1 - Jessica Faul A1 - Ford, Ian A1 - Nelson A. Freimer A1 - Gao, He A1 - Giegling, Ina A1 - Gillespie, Nathan A A1 - Gordon, Scott D A1 - Gottesman, Rebecca F A1 - Michael E Griswold A1 - Gudnason, Vilmundur A1 - Tamara B Harris A1 - Hartmann, Annette M A1 - Hatzimanolis, Alex A1 - Gerardo Heiss A1 - Holliday, Elizabeth G A1 - Joshi, Peter K A1 - Kähönen, Mika A1 - Sharon L R Kardia A1 - Ida Karlsson A1 - Kleineidam, Luca A1 - David S Knopman A1 - Kochan, Nicole A A1 - Konte, Bettina A1 - Kwok, John B A1 - Stephanie Le Hellard A1 - Lee, Teresa A1 - Lehtimäki, Terho A1 - Li, Shu-Chen A1 - Lill, Christina M A1 - Liu, Tian A1 - Koini, Marisa A1 - London, Edythe A1 - Longstreth, Will T A1 - Lopez, Oscar L A1 - Loukola, Anu A1 - Luck, Tobias A1 - Astri J Lundervold A1 - Lundquist, Anders A1 - Lyytikäinen, Leo-Pekka A1 - Nicholas G Martin A1 - Grant W Montgomery A1 - Murray, Alison D A1 - Anna C Need A1 - Noordam, Raymond A1 - Nyberg, Lars A1 - William E R Ollier A1 - Papenberg, Goran A1 - Pattie, Alison A1 - Polasek, Ozren A1 - Russell A Poldrack A1 - Psaty, Bruce M A1 - Reppermund, Simone A1 - Steffi G Riedel-Heller A1 - Rose, Richard J A1 - Rotter, Jerome I A1 - Roussos, Panos A1 - Rovio, Suvi P A1 - Saba, Yasaman A1 - Fred W Sabb A1 - Sachdev, Perminder S A1 - Satizabal, Claudia L A1 - Schmid, Matthias A1 - Rodney J Scott A1 - Matthew A Scult A1 - Simino, Jeannette A1 - Slagboom, P Eline A1 - Smyrnis, Nikolaos A1 - Soumaré, Aïcha A1 - Nikos C Stefanis A1 - Stott, David J A1 - Richard E Straub A1 - Sundet, Kjetil A1 - Taylor, Adele M A1 - Kent D Taylor A1 - Tzoulaki, Ioanna A1 - Tzourio, Christophe A1 - André G Uitterlinden A1 - Vitart, Veronique A1 - Aristotle N Voineskos A1 - Kaprio, Jaakko A1 - Wagner, Michael A1 - Wagner, Holger A1 - Weinhold, Leonie A1 - Wen, K Hoyan A1 - Elisabeth Widen A1 - Yang, Qiong A1 - Zhao, Wei A1 - Hieab H Adams A1 - Dan E Arking A1 - Robert M Bilder A1 - Bitsios, Panos A1 - Boerwinkle, Eric A1 - Chiba-Falek, Ornit A1 - Corvin, Aiden A1 - Philip L de Jager A1 - Debette, Stéphanie A1 - Donohoe, Gary A1 - Elliott, Paul A1 - Fitzpatrick, Annette L A1 - Gill, Michael A1 - David C. Glahn A1 - Hägg, Sara A1 - Narelle K Hansell A1 - Ahmad R Hariri A1 - Ikram, M Kamran A1 - Jukema, J Wouter A1 - Vuoksimaa, Eero A1 - Matthew C Keller A1 - Kremen, William S A1 - Lenore J Launer A1 - Lindenberger, Ulman A1 - Aarno Palotie A1 - Nancy L Pedersen A1 - Pendleton, Neil A1 - David J Porteous A1 - Katri Räikkönen A1 - Olli T Raitakari A1 - Ramirez, Alfredo A1 - Reinvang, Ivar A1 - Rudan, Igor A1 - Schmidt, Reinhold A1 - Schmidt, Helena A1 - Peter W Schofield A1 - Peter R Schofield A1 - John M Starr A1 - Vidar M Steen A1 - Trollor, Julian N A1 - Turner, Steven T A1 - Cornelia M van Duijn A1 - Villringer, Arno A1 - Daniel R Weinberger A1 - David R Weir A1 - James F Wilson A1 - Anil K. Malhotra A1 - McIntosh, Andrew M A1 - Gale, Catharine R A1 - Seshadri, Sudha A1 - Thomas H Mosley A1 - Bressler, Jan A1 - Lencz, Todd A1 - Ian J Deary KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Cognition KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Humans KW - Mental Disorders KW - Middle Aged KW - Multifactorial Inheritance KW - Neurodegenerative Diseases KW - Neurodevelopmental Disorders KW - Polymorphism, Single Nucleotide KW - Reaction Time KW - Young Adult AB -

General cognitive function is a prominent and relatively stable human trait that is associated with many important life outcomes. We combine cognitive and genetic data from the CHARGE and COGENT consortia, and UK Biobank (total N = 300,486; age 16-102) and find 148 genome-wide significant independent loci (P < 5 × 10) associated with general cognitive function. Within the novel genetic loci are variants associated with neurodegenerative and neurodevelopmental disorders, physical and psychiatric illnesses, and brain structure. Gene-based analyses find 709 genes associated with general cognitive function. Expression levels across the cortex are associated with general cognitive function. Using polygenic scores, up to 4.3% of variance in general cognitive function is predicted in independent samples. We detect significant genetic overlap between general cognitive function, reaction time, and many health variables including eyesight, hypertension, and longevity. In conclusion we identify novel genetic loci and pathways contributing to the heritability of general cognitive function.

VL - 9 IS - 1 ER - TY - JOUR T1 - Trends in informal care for disabled older Americans, 1982-2012. JF - Gerontologist Y1 - 2018 A1 - Alexander L Janus A1 - Doty, Pamela KW - Disabilities AB -

Background and Objectives: We examine trends in informal care from the perspective of both community-dwelling disabled older Americans and their caregivers from 1982 to 2012. We decompose hours of care received from spouses and children according to changes in: (a) the number of potential spousal and child caregivers ("family structure"), (b) the likelihood that existing spouses and children are caregivers ("caregiving propensity"), and (c) the amount of care provided by individual caregivers ("time burden").

Research Design and Methods: We examine two sets of time trends based on distinct samples of community-dwelling disabled older Americans from the 1982-2004 waves of the National Long-Term Care Survey (NLTCS) and the 2000-2012 waves of the Health and Retirement Study (HRS).

Results: Existing spouses' and children's decreasing likelihood of being caregivers led to fewer spousal and child caregivers per disabled older person in the 2004 NLTCS than the 1982 NLTCS. However, the NLTCS and HRS time trends suggest that the amount of care provided by individual caregivers was similar from 1989 to 2012.

Discussion and Implications: Because individual caregivers' time burden has remained fairly constant since at least 1989, advocacy on behalf of policies that promote more and better support for caregivers is appropriate.

VL - 58 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28591784?dopt=Abstract ER - TY - JOUR T1 - Biopsychosocial Predictors of Fall Events Among Older African Americans. JF - Research on Aging Y1 - 2017 A1 - Emily J Nicklett A1 - Taylor, Robert Joseph A1 - Rostant, Ola A1 - Kimson E Johnson A1 - Evans, Linnea KW - Falls KW - Health Shocks KW - Older Adults KW - Racial/ethnic differences KW - Women and Minorities AB - This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective, we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010-2012 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed. VL - 39 IS - 4 ER - TY - JOUR T1 - Bringing functional status into a big data world: Validation of national Veterans Affairs functional status data JF - PLoS One Y1 - 2017 A1 - Rebecca T Brown A1 - Kiya D Komaiko A1 - Shi, Ying A1 - Kathy Z Fung A1 - W John Boscardin A1 - Au-Yeung, Alvin A1 - Tarasovsky, Gary A1 - Jacob, Riya A1 - Michael A Steinman ED - Hernandez-Boussard, Tina KW - Daily activities KW - Functional status KW - Veterans AB - Background The ability to perform basic daily activities (“functional status”) is key to older adults’ quality of life and strongly predicts health outcomes. However, data on functional status are seldom collected during routine clinical care in a way that makes them available for clinical use and research. Objectives To validate functional status data that Veterans Affairs (VA) medical centers recently started collecting during routine clinical care, compared to the same data collected in a structured research setting. Design Prospective validation study. Setting Seven VA medical centers that collected complete data on 5 activities of daily living (ADLs) and 8 instrumental activities of daily living (IADLs) from older patients attending primary care appointments. Participants Randomly selected patients aged 75 and older who had new ADL and IADL data collected during a primary care appointment (N = 252). We oversampled patients with ADL dependence and applied these sampling weights to our analyses. Measurements Telephone-based interviews using a validated measure to assess the same 5 ADLs and 8 IADLs. Results Mean age was 83 years, 96% were male, and 75% were white. Of 85 participants whom VA data identified as dependent in 1 or more ADLs, 74 (87%) reported being dependent by interview; of 167 whom VA data identified as independent in ADLs, 149 (89%) reported being independent. The sample-weighted sensitivity of the VA data for identifying ADL dependence was 45% (95% CI, 29%, 62%) compared to the reference standard, the specificity was 99% (95% CI, 99%, >99%), and the positive predictive value was 87% (95% CI, 79%, 93%). The weighted kappa statistic was 0.55 (95% CI, 0.41, 0.68) for the agreement between VA data and research-collected data in identifying ADL dependence. Conclusion Overall agreement of VA functional status data with a reference standard was moderate, with fair sensitivity but high specificity and positive predictive value. VL - 12 UR - http://dx.plos.org/10.1371/journal.pone.0178726 IS - 6 JO - PLoS ONE ER - TY - JOUR T1 - Diabetes and labor market exits: Evidence from the Health & Retirement Study (HRS) JF - The Journal of the Economics of Ageing Y1 - 2017 A1 - Chatterji, Pinka A1 - Heesoo Joo A1 - Kajal Chatterji Lahiri KW - Chronic disease KW - Diabetes KW - Employment and Labor Force KW - Retirement Planning and Satisfaction AB - The objective of this paper is to estimate the effect of diabetes on labor market exit using longitudinal data from the 1992-2010 Health and Retirement Study (HRS). We estimate a discrete time hazard model to test whether diabetes affects the hazard of leaving employment among individuals who were working for pay at the age of 55-56. Using a probit model, we also estimate the effect of having undiagnosed or poorly controlled diabetes on the probability of labor market exit two years later. Our results indicate that diabetes is associated with an increased hazard of exiting the labor market for males, but not for females. This effect for males persists when we include controls for onset of other health conditions, two of which are documented complications of diabetes (stroke and heart conditions). We also find that diagnosed diabetes with medication use, regardless of whether or not it is under control, is associated with large negative effects on the likelihood of employment two years later. (C) 2016 Elsevier B.V. All rights reserved. VL - 9 UR - http://linkinghub.elsevier.com/retrieve/pii/S2212828X16300639http://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/plain JO - The Journal of the Economics of Ageing ER - TY - JOUR T1 - Discovery and fine-mapping of adiposity loci using high density imputation of genome-wide association studies in individuals of African ancestry: African Ancestry Anthropometry Genetics Consortium. JF - PLoS Genetics Y1 - 2017 A1 - Ng, Maggie C Y A1 - Graff, Mariaelisa A1 - Lu, Yingchang A1 - Justice, Anne E A1 - Mudgal, Poorva A1 - Liu, Ching-Ti A1 - Young, Kristin A1 - Yanek, Lisa R A1 - Feitosa, Mary F A1 - Wojczynski, Mary K A1 - Rand, Kristin A1 - Brody, Jennifer A A1 - Brian E Cade A1 - Dimitrov, Latchezar A1 - Duan, Qing A1 - Guo, Xiuqing A1 - Leslie A Lange A1 - Michael A Nalls A1 - Okut, Hayrettin A1 - Tajuddin, Salman M A1 - Bamidele O Tayo A1 - Vedantam, Sailaja A1 - Bradfield, Jonathan P A1 - Chen, Guanjie A1 - Chen, Wei-Min A1 - Chesi, Alessandra A1 - Irvin, Marguerite R A1 - Padhukasahasram, Badri A1 - Smith, Jennifer A A1 - Zheng, Wei A1 - Matthew A. Allison A1 - Ambrosone, Christine B A1 - Bandera, Elisa V A1 - Traci M Bartz A1 - Berndt, Sonja I A1 - Bernstein, Leslie A1 - Blot, William J A1 - Erwin P Bottinger A1 - John Carpten A1 - Chanock, Stephen J A1 - Chen, Yii-Der Ida A1 - Conti, David V A1 - Cooper, Richard S A1 - Myriam Fornage A1 - Freedman, Barry I A1 - Garcia, Melissa A1 - Phyllis J Goodman A1 - Hsu, Yu-Han H A1 - Hu, Jennifer A1 - Huff, Chad D A1 - Ingles, Sue A A1 - John, Esther M A1 - Rick A Kittles A1 - Eric A Klein A1 - Li, Jin A1 - McKnight, Barbara A1 - Nayak, Uma A1 - Nemesure, Barbara A1 - Ogunniyi, Adesola A1 - Olshan, Andrew A1 - Press, Michael F A1 - Rohde, Rebecca A1 - Rybicki, Benjamin A A1 - Babatunde Salako A1 - Sanderson, Maureen A1 - Shao, Yaming A1 - David S Siscovick A1 - Stanford, Janet L A1 - Stevens, Victoria L A1 - Stram, Alex A1 - Strom, Sara S A1 - Vaidya, Dhananjay A1 - Witte, John S A1 - Yao, Jie A1 - Zhu, Xiaofeng A1 - Ziegler, Regina G A1 - Alan B Zonderman A1 - Adeyemo, Adebowale A1 - Ambs, Stefan A1 - Cushman, Mary A1 - Jessica Faul A1 - Hakonarson, Hakon A1 - Levin, Albert M A1 - Nathanson, Katherine L A1 - Erin B Ware A1 - David R Weir A1 - Zhao, Wei A1 - Zhi, Degui A1 - Donna K Arnett A1 - Grant, Struan F A A1 - Sharon L R Kardia A1 - Oloapde, Olufunmilayo I A1 - Rao, D C A1 - Charles N Rotimi A1 - Sale, Michele M A1 - L Keoki Williams A1 - Zemel, Babette S A1 - Becker, Diane M A1 - Ingrid B Borecki A1 - Michele K Evans A1 - Tamara B Harris A1 - Hirschhorn, Joel N A1 - Li, Yun A1 - Patel, Sanjay R A1 - Psaty, Bruce M A1 - Rotter, Jerome I A1 - Wilson, James G A1 - Bowden, Donald W A1 - Cupples, L Adrienne A1 - Christopher A Haiman A1 - Ruth J F Loos A1 - Kari E North KW - Adiposity KW - Anthropometry KW - Blacks KW - Body Mass Index KW - Chromosome Mapping KW - Female KW - Gene Frequency KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Linkage Disequilibrium KW - Male KW - Obesity KW - Polymorphism, Single Nucleotide KW - Serine Endopeptidases KW - Transcription Factor 7-Like 2 Protein KW - Waist-Hip Ratio KW - Whites AB -

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

VL - 13 IS - 4 ER - TY - JOUR T1 - Dog Walking, the Human-Animal Bond and Older Adults' Physical Health. JF - Gerontologist Y1 - 2017 A1 - Angela L Curl A1 - Bibbo, Jessica A1 - Rebecca A Johnson KW - Aged KW - Animals KW - Dogs KW - Female KW - Health Status KW - Human-Animal Bond KW - Humans KW - Least-Squares Analysis KW - Linear Models KW - Logistic Models KW - Male KW - Middle Aged KW - Ownership KW - Walking AB -

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

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

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

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

VL - 57 UR - http://gerontologist.oxfordjournals.org/content/early/2016/03/18/geront.gnw051.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27002004?dopt=Abstract U4 - Exercise/physical activity/Recreational therapy/activities/Preventative medicine/care/services/Function/mobility/Dog walking ER - TY - JOUR T1 - Economic Burden of Informal Caregiving Associated With History of Stroke and Falls Among Older Adults in the U.S. JF - American Journal of Preventive Medicine Y1 - 2017 A1 - Heesoo Joo A1 - Wang, Guijing A1 - Yee, Sue Lin A1 - Zhang, Ping A1 - Sleet, David KW - Caregiving KW - Economics KW - Falls KW - Health Shocks KW - Stroke AB - Introduction Older adults are at high risk for stroke and falls, both of which require a large amount of informal caregiving. However, the economic burden of informal caregiving associated with stroke and fall history is not well known. Methods Using the 2010 Health and Retirement Study, data on non-institutionalized adults aged ≥65 years (N=10,129) in 2015–2017 were analyzed. Two-part models were used to estimate informal caregiving hours. Based on estimates from the models using a replacement cost approach, the authors derived informal caregiving hours and costs associated with falls in the past 2 years for stroke and non-stroke persons. Results Both the prevalence of falls overall and of falls with injuries were higher among people with stroke than those without (49.5% vs 35.1% for falls and 16.0% vs 10.3% for injurious falls, p<0.01). Stroke survivors needed more informal caregiving hours than their non-stroke counterparts, and the number of informal caregiving hours was positively associated with non-injurious falls and even more so with injurious falls. The national burden of informal caregiving (2015 U.S. dollars) associated with injurious falls amounted to $2.9 billion (95% CI=$1.1 billion, $4.7 billion) for stroke survivors (about 0.5 million people), and $6.5 billion (95% CI=$4.3 billion, $8.7 billion) for those who never had a stroke (about 3.6 million people). Conclusions In U.S. older adults, informal caregiving hours and costs associated with falls are substantial, especially for stroke survivors. Preventing falls and fall-related injuries, especially among stroke survivors, therefore has potential for reducing the burden of informal caregiving. VL - 53 UR - http://linkinghub.elsevier.com/retrieve/pii/S0749379717304270http://api.elsevier.com/content/article/PII:S0749379717304270?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0749379717304270?httpAccept=text/plain IS - 6 JO - American Journal of Preventive Medicine ER - TY - JOUR T1 - Effects of cognition, function, and behavioral and psychological symptoms on Medicare expenditures and health care utilization for persons with dementia. JF - Journals of Gerontology Series A: Biological Sciences and Medical Sciences Y1 - 2017 A1 - Jutkowitz, Eric A1 - Robert L Kane A1 - Dowd, Bryan A1 - Joseph E Gaugler A1 - Richard F MacLehose A1 - Karen M Kuntz KW - Cognitive Ability KW - Dementia KW - Medicare expenditures KW - Restricted data AB -

Background: Clinical features of dementia (cognition, function, and behavioral/psychological symptoms [BPSD]) may differentially affect Medicare expenditures/health care utilization.

Methods: We linked cross-sectional data from the Aging, Demographics, and Memory Study to Medicare data to evaluate the association between dementia clinical features among those with dementia and Medicare expenditures/health care utilization (n = 234). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Function was evaluated as the number of functional limitations (0-10). BPSD was evaluated as the number of symptoms (0-12). Expenditures were estimated with a generalized linear model (log-link and gamma distribution). Number of hospitalizations, institutional outpatient visits, and physician visits were estimated with a negative binomial regression. Medicare covered skilled nursing days were estimated with a zero-inflated negative binomial model.

Results: Cognition and BPSD were not associated with expenditures. Among individuals with less than seven functional limitations, one additional limitation was associated with $123 (95% confidence interval: $19-$227) additional monthly Medicare spending. Better cognition and poorer function were associated with more hospitalizations among those with an MMSE less than three and less than six functional limitations, respectively. BPSD had no effect on hospitalizations. Poorer function and fewer BPSD were associated with more skilled nursing among individuals with one to seven functional limitations and more than four symptoms, respectively. Cognition had no effect on skilled nursing care. No clinical feature was associated with institutional outpatient care. Of individuals with an MMSE less than 15, poorer cognition was associated with fewer physician visits. Among those with more than six functional limitations, poorer function was associated with fewer physician visits.

Conclusions: Poorer function, not cognition or BPSD, was associated with higher Medicare expenditures.

VL - 72 IS - 6 ER - TY - JOUR T1 - Effects of Medicare coverage of a "Welcome-to-Medicare" visit on use of preventive services among new Medicare enrollees. JF - Journal of Aging Research Y1 - 2017 A1 - Ng, Boon Peng A1 - Gail A Jensen A1 - Fritz, Heather KW - Medicare linkage KW - Medicare/Medicaid/Health Insurance AB - In January 2005, Medicare began covering a one-time initial preventive physical examination (IPPE), also called a "Welcome-to-Medicare" visit, during a beneficiary's first 6 months under Part B. This paper examines the effects of offering Medicare IPPE coverage on the use of mammograms, breast self-exams, Pap smears, prostate cancer screenings, cholesterol screenings, and flu vaccines among beneficiaries new to Part B. We adopt a difference-in-difference estimator and estimate a set of multivariate logit models to quantify the effects of introducing Medicare IPPE coverage on the use of preventive services. Models are estimated separately for men and women. Data for the analysis come from the 1996-2008 Health and Retirement Study. Among both men and women, having coverage for a one-time IPPE under Medicare had no effects on the utilization of any of the preventive services listed above. In this study, we find that offering coverage for a one-time IPPE under Medicare was insufficient to spur greater use of preventive services among new Medicare beneficiaries. These findings are important and suggest that policy-makers may need to consider other approaches to increase the use of recommended preventive services. U1 - http://www.ncbi.nlm.nih.gov/pubmed/28546878?dopt=Abstract ER - TY - JOUR T1 - Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity. JF - Nature Communications Y1 - 2017 A1 - Joshi, Peter K A1 - Nicola Pirastu A1 - Kentistou, Katherine A A1 - Fischer, Krista A1 - Edith Hofer A1 - Schraut, Katharina E A1 - Clark, David W A1 - Nutile, Teresa A1 - Barnes, Catriona L K A1 - Paul Rhj Timmers A1 - Shen, Xia A1 - Gandin, Ilaria A1 - McDaid, Aaron F A1 - Hansen, Thomas Folkmann A1 - Gordon, Scott D A1 - Giulianini, Franco A1 - Boutin, Thibaud S A1 - Abdellaoui, Abdel A1 - Zhao, Wei A1 - Medina-Gomez, Carolina A1 - Traci M Bartz A1 - Trompet, Stella A1 - Leslie A Lange A1 - Raffield, Laura A1 - van der Spek, Ashley A1 - Galesloot, Tessel E A1 - Proitsi, Petroula A1 - Yanek, Lisa R A1 - Bielak, Lawrence F A1 - Payton, Antony A1 - Murgia, Federico A1 - Concas, Maria Pina A1 - Biino, Ginevra A1 - Tajuddin, Salman M A1 - Seppälä, Ilkka A1 - Amin, Najaf A1 - Boerwinkle, Eric A1 - Børglum, Anders D A1 - Campbell, Archie A1 - Ellen W Demerath A1 - Demuth, Ilja A1 - Jessica Faul A1 - Ford, Ian A1 - Gialluisi, Alessandro A1 - Gögele, Martin A1 - Graff, Mariaelisa A1 - Aroon Hingorani A1 - Jouke-Jan Hottenga A1 - Hougaard, David M A1 - Hurme, Mikko A A1 - Ikram, M Arfan A1 - Jylhä, Marja A1 - Kuh, Diana A1 - Ligthart, Lannie A1 - Lill, Christina M A1 - Lindenberger, Ulman A1 - Lumley, Thomas A1 - Mägi, Reedik A1 - Marques-Vidal, Pedro A1 - Sarah E Medland A1 - Lili Milani A1 - Nagy, Reka A1 - William E R Ollier A1 - Peyser, Patricia A A1 - Pramstaller, Peter P A1 - Ridker, Paul M A1 - Fernando Rivadeneira A1 - Ruggiero, Daniela A1 - Saba, Yasaman A1 - Schmidt, Reinhold A1 - Schmidt, Helena A1 - Slagboom, P Eline A1 - Smith, Blair H A1 - Smith, Jennifer A A1 - Sotoodehnia, Nona A1 - Steinhagen-Thiessen, Elisabeth A1 - van Rooij, Frank J A A1 - Verbeek, André L A1 - Vermeulen, Sita H A1 - Vollenweider, Peter A1 - Wang, Yunpeng A1 - Werge, Thomas A1 - Whitfield, John B A1 - Alan B Zonderman A1 - Lehtimäki, Terho A1 - Michele K Evans A1 - Pirastu, Mario A1 - Fuchsberger, Christian A1 - Bertram, Lars A1 - Pendleton, Neil A1 - Sharon L R Kardia A1 - Ciullo, Marina A1 - Becker, Diane M A1 - Wong, Andrew A1 - Psaty, Bruce M A1 - Cornelia M van Duijn A1 - Wilson, James G A1 - Jukema, J Wouter A1 - Lambertus A Kiemeney A1 - André G Uitterlinden A1 - Franceschini, Nora A1 - Kari E North A1 - David R Weir A1 - Andres Metspalu A1 - Dorret I Boomsma A1 - Caroline Hayward A1 - Daniel I Chasman A1 - Nicholas G Martin A1 - Sattar, Naveed A1 - Campbell, Harry A1 - Tõnu Esko A1 - Kutalik, Zoltán A1 - James F Wilson KW - Alleles KW - Body Mass Index KW - Coronary Disease KW - Education KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - HLA-DQ alpha-Chains KW - HLA-DRB1 Chains KW - Humans KW - Insulin Resistance KW - Life Style KW - Lipoprotein(a) KW - Lipoproteins, HDL KW - Longevity KW - Lung Neoplasms KW - Obesity KW - Polymorphism, Single Nucleotide KW - Smoking KW - Socioeconomic factors AB -

Genomic analysis of longevity offers the potential to illuminate the biology of human aging. Here, using genome-wide association meta-analysis of 606,059 parents' survival, we discover two regions associated with longevity (HLA-DQA1/DRB1 and LPA). We also validate previous suggestions that APOE, CHRNA3/5, CDKN2A/B, SH2B3 and FOXO3A influence longevity. Next we show that giving up smoking, educational attainment, openness to new experience and high-density lipoprotein (HDL) cholesterol levels are most positively genetically correlated with lifespan while susceptibility to coronary artery disease (CAD), cigarettes smoked per day, lung cancer, insulin resistance and body fat are most negatively correlated. We suggest that the effect of education on lifespan is principally mediated through smoking while the effect of obesity appears to act via CAD. Using instrumental variables, we suggest that an increase of one body mass index unit reduces lifespan by 7 months while 1 year of education adds 11 months to expected lifespan.Variability in human longevity is genetically influenced. Using genetic data of parental lifespan, the authors identify associations at HLA-DQA/DRB1 and LPA and find that genetic variants that increase educational attainment have a positive effect on lifespan whereas increasing BMI negatively affects lifespan.

VL - 8 IS - 1 ER - TY - JOUR T1 - Genotype–covariate interaction effects and the heritability of adult body mass index JF - Nature Genetics Y1 - 2017 A1 - Matthew R Robinson A1 - English, Geoffrey A1 - Moser, Gerhard A1 - Lloyd-Jones, Luke R. A1 - Triplett, Marcus A. A1 - Zhihong Zhu A1 - Ilja M Nolte A1 - Jana V. van Vliet-Ostaptchouk A1 - Snieder, Harold A1 - Tõnu Esko A1 - Lili Milani A1 - Mägi, Reedik A1 - Andres Metspalu A1 - Patrik K E Magnusson A1 - Nancy L Pedersen A1 - Ingelsson, Erik A1 - Johannesson, Magnus A1 - Yang, Jian A1 - Cesarini, David A1 - Peter M Visscher KW - BMI KW - Genetics KW - GWAS AB - Obesity is a worldwide epidemie, with major health and economic costs. Here we estimate heritability for body mass index (BMI) in 172,000 sibling pairs and 150,832 unrelated individuals and explore the contribution of genotype-covariate interaction effects at common SNP loci. We find evidence for genotype-age interaction (likelihood ratio test (LRT) = 73.58, degrees of freedom (df) = 1, P = 4.83 x 10-18), which contributed 8.1 % (1.4% s.e.) to BMI variation. Across eight self-reported lifestyle factors, including diet and exercise, we find genotype-environment interaction only for smoking behavior (LRT = 19.70, P = 5.03 x 10-5 and LRT = 30.80, P = 1.42 x 10-8), which contributed 4.0% (0.8% s.e.) to BMI variation. Bayesian association analysis suggests that BMI is highly polygenic, with 75% of the SNP heritability attributable to loci that each explain <0.01 % of the phenotypic variance. Our findings imply that substantially larger sample sizes across ages and lifestyles are required to understand the full genetic architecture of BMI. VL - 49 IS - 8 JO - Nat Genet ER - TY - RPRT T1 - Health, Health Insurance, and Retirement: A Survey Y1 - 2017 A1 - Eric French A1 - John Bailey Jones KW - Disabilities KW - Health Conditions and Status KW - Medicare/Medicaid/Health Insurance KW - Older Adults KW - Retirement Planning and Satisfaction AB - The degree to which retirement decisions are driven by health is a key concern for both academics and policymakers. In this paper we survey the economic literature on the health-retirement link in developed countries. We describe the mechanisms through which health affects labor supply and discuss how they interact with public pensions and public health insurance. The historical evidence suggests that health is not the primary source of variation in retirement across countries and over time. Furthermore, declining health with age can only explain a small share of the decline in employment near retirement age. Health considerations nonetheless play an important role, especially in explaining cross-sectional variation in employment and other outcomes within countries. We review the mechanisms through which health affects retirement and discuss recent empirical analyses. JF - Working Paper Series PB - Federal Reserve Bank of Richmond CY - Richmond, Virginia UR - https://www.richmondfed.org/-/media/richmondfedorg/publications/research/working_papers/2017/pdf/wp17-03.pdf ER - TY - JOUR T1 - His way, her way: Retirement timing among dual-earner couples JF - Advances in Life Course Research Y1 - 2017 A1 - Jonathan Jackson KW - Employment and Labor Force KW - Gender Differences KW - Marriage KW - Retirement Planning and Satisfaction AB - This article examines how the retirement timing of husbands and wives has evolved in the face of women's rising economic resources. Using 11 waves of data from the Health and Retirement Study, I trace individuals into retirement, examining how spousal employment characteristics may facilitate or hinder one's own ability to retire and if such spousal influences have changed across cohorts. Results from event history models indicate that the retirement trajectories have changed for the leading baby boom cohort, as evidence implies they are delaying retirement longer than previous cohorts. Despite women's rising labor force attachment, the findings do not generally support the notion that wives are influencing their husbands' retirement timing more or that the influence of husbands on wives' retirement timing has declined across cohorts. VL - 33 UR - http://linkinghub.elsevier.com/retrieve/pii/S104026081630051Xhttp://api.elsevier.com/content/article/PII:S104026081630051X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S104026081630051X?httpAccept=text/plain JO - Advances in Life Course Research ER - TY - JOUR T1 - Hispanics' retirement transitions and differences by nativity. JF - Journal of Aging and Health Y1 - 2017 A1 - Mudrazija, Stipica A1 - Richard W. Johnson A1 - Wang, Claire Xiaozhi KW - Hispanics KW - Racial/ethnic differences KW - Retirement Planning and Satisfaction AB -

OBJECTIVE: This study examines differences in retirement decisions between older Hispanics and non-Hispanics, with a special focus on the role of nativity.

METHODS: We use 1998-2012 waves of the Health and Retirement Study. We estimate survival models of retirement and compare retirement transitions for U.S.-born Hispanics, foreign-born Hispanics, non-Hispanic Whites, and non-Hispanic Blacks.

RESULTS: Foreign-born Hispanics retire significantly later than other racial and ethnic groups. Controlling for personal characteristics, their risk of retirement is 39% lower compared with non-Hispanic Whites. Retirement transitions do not differ significantly between U.S.-born Hispanics and non-Hispanic Whites.

DISCUSSION: Difference in retirement timing between U.S.- and foreign-born Hispanics may partly be due to lower incomes and wealth accumulation of foreign-born Hispanics. Workforce development initiatives, policy initiatives promoting retirement savings, and Social Security reforms could improve future retirement security for older Hispanics, and make retirement a viable option for more foreign-born Hispanics.

VL - 29 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28569096?dopt=Abstract ER - TY - JOUR T1 - The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: A systematic review JF - Respiratory Medicine Y1 - 2017 A1 - Baird, Chelsea A1 - Lovell, Janaka A1 - Marilyn Johnson A1 - Shiell, Kerrie A1 - Ibrahim, Joseph E. KW - Cognitive Ability KW - COPD KW - Survey Methodology AB - Objective To determine the characteristics of persons with cognitive impairment being able to self-manage in chronic obstructive pulmonary disease (COPD). Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance this systematic review examined all studies in English from 1st January 2000 to 20 February 2016, describing the relationship between cognition and COPD self-management domains in older community dwelling persons with dementia or cognitive impairment. Results Of 4474 studies identified, thirteen studies were eligible for inclusion. No studies differentiated populations into recognized dementia subtypes. Study aims were variable; most (n = 7) examined inhaler competency alone. Studies identified a link between worsening cognition and the need for assistance in activities of daily living. Only one study evaluated the impact of cognition on overall self-management and found no association between cognitive impairment and self-rated self-management. Mild degrees of cognitive impairment were associated with reduced symptom recall. Cognitive impairment in COPD was associated with high degrees of inhaler incompetency. Basic cognitive screening tests were able to predict inhaler incompetence with reduced overall cognitive function, dyspraxia, and/or executive function identified as predictors of incompetency. Conclusions Multiple measures of disability consistently demonstrated that cognitive impairment in COPD significantly increased the need for assistance in many aspects of daily living, treatment adherence, and effective self-management. Given the nature of neuropsychological deficits seen in COPD, dedicated screening tools are required. Future research should investigate the impact of cognitive dysfunction in COPD and identify how to support those that lack capacity to self-manage. VL - 129 UR - http://www.sciencedirect.com/science/article/pii/S0954611117301725?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb JO - Respiratory Medicine ER - TY - ICOMM T1 - More evidence that health insurance really does save lives Y1 - 2017 A1 - Jacobs, Tom KW - Commentary KW - Medicare/Medicaid/Health Insurance KW - News JF - PS Mag PB - Pacific Standard VL - 2017 UR - https://psmag.com/news/health-insurance-saves-lives ER - TY - JOUR T1 - Multiple Chronic Conditions, Resilience, and Workforce Transitions in Later Life: A Socio-Ecological Model. JF - The Gerontologist Y1 - 2017 A1 - Kendra Jason A1 - Dawn C Carr A1 - Tiffany R Washington A1 - Tandrea S Hilliard A1 - Chivon A Mingo KW - Comorbidity KW - Resilience KW - Retirement Planning and Satisfaction AB -

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.

VL - 57 IS - 2 ER - TY - JOUR T1 - New Blood Pressure-Associated Loci Identified in Meta-Analyses of 475 000 Individuals. JF - Circulation: Cardiovascular Genetics Y1 - 2017 A1 - Kraja, Aldi T A1 - Cook, James P A1 - Warren, Helen R A1 - Surendran, Praveen A1 - Liu, Chunyu A1 - Evangelou, Evangelos A1 - Alisa Manning A1 - Grarup, Niels A1 - Drenos, Fotios A1 - Sim, Xueling A1 - Smith, Albert Vernon A1 - Amin, Najaf A1 - Alexandra I Blakemore A1 - Bork-Jensen, Jette A1 - Brandslund, Ivan A1 - Farmaki, Aliki-Eleni A1 - Fava, Cristiano A1 - Ferreira, Teresa A1 - Herzig, Karl-Heinz A1 - Giri, Ayush A1 - Giulianini, Franco A1 - Grove, Megan L A1 - Guo, Xiuqing A1 - Sarah E Harris A1 - Have, Christian T A1 - Havulinna, Aki S A1 - Zhang, He A1 - Jørgensen, Marit E A1 - Käräjämäki, AnneMari A1 - Charles Kooperberg A1 - Linneberg, Allan A1 - Little, Louis A1 - Liu, Yongmei A1 - Bonnycastle, Lori L A1 - Lu, Yingchang A1 - Mägi, Reedik A1 - Mahajan, Anubha A1 - Malerba, Giovanni A1 - Riccardo E Marioni A1 - Mei, Hao A1 - Menni, Cristina A1 - Alanna C Morrison A1 - Padmanabhan, Sandosh A1 - Walter R Palmas A1 - Poveda, Alaitz A1 - Rauramaa, Rainer A1 - Nigel W Rayner A1 - Riaz, Muhammad A1 - Rice, Ken A1 - Melissa Richard A1 - Smith, Jennifer A A1 - Southam, Lorraine A1 - Stančáková, Alena A1 - Kathleen E Stirrups A1 - Tragante, Vinicius A1 - Tuomi, Tiinamaija A1 - Tzoulaki, Ioanna A1 - Varga, Tibor V A1 - Weiss, Stefan A1 - Yiorkas, Andrianos M A1 - Young, Robin A1 - Zhang, Weihua A1 - Barnes, Michael R A1 - Cabrera, Claudia P A1 - Gao, He A1 - Boehnke, Michael A1 - Boerwinkle, Eric A1 - Chambers, John C A1 - Connell, John M A1 - Cramer Christensen A1 - de Boer, Rudolf A A1 - Ian J Deary A1 - George Dedoussis A1 - Deloukas, Panos A1 - Dominiczak, Anna F A1 - Dörr, Marcus A1 - Joehanes, Roby A1 - Edwards, Todd L A1 - Tõnu Esko A1 - Myriam Fornage A1 - Franceschini, Nora A1 - Franks, Paul W A1 - Gambaro, Giovanni A1 - Leif C Groop A1 - Hallmans, Göran A1 - Hansen, Torben A1 - Caroline Hayward A1 - Heikki, Oksa A1 - Ingelsson, Erik A1 - Tuomilehto, Jaakko A1 - Järvelin, Marjo-Riitta A1 - Sharon L R Kardia A1 - Karpe, Fredrik A1 - Kooner, Jaspal S A1 - Lakka, Timo A A1 - Langenberg, Claudia A1 - Lars Lind A1 - Ruth J F Loos A1 - Laakso, Markku A1 - McCarthy, Mark I A1 - Melander, Olle A1 - Mohlke, Karen L A1 - Morris, Andrew P A1 - Palmer, Colin N A A1 - Pedersen, Oluf A1 - Polasek, Ozren A1 - Neil Poulter A1 - Province, Michael A A1 - Psaty, Bruce M A1 - Ridker, Paul M A1 - Rotter, Jerome I A1 - Rudan, Igor A1 - Veikko Salomaa A1 - Nilesh J Samani A1 - Peter Sever A1 - Skaaby, Tea A1 - Stafford, Jeanette M A1 - John M Starr A1 - van der Harst, Pim A1 - van der Meer, Peter A1 - Cornelia M van Duijn A1 - Vergnaud, Anne-Claire A1 - Gudnason, Vilmundur A1 - Wareham, Nicholas J A1 - Wilson, James G A1 - Willer, Cristen J A1 - Daniel Witte A1 - Zeggini, Eleftheria A1 - Saleheen, Danish A1 - Adam S Butterworth A1 - Danesh, John A1 - Asselbergs, Folkert W A1 - Wain, Louise V A1 - Georg B Ehret A1 - Daniel I Chasman A1 - Caulfield, Mark J A1 - Elliott, Paul A1 - Lindgren, Cecilia M A1 - Levy, Daniel A1 - Newton-Cheh, Christopher A1 - Munroe, Patricia B A1 - Howson, Joanna M M KW - Antiporters KW - Blood pressure KW - Cell Adhesion Molecules, Neuronal KW - Databases, Factual KW - Genetic Loci KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Microfilament Proteins KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Receptors, Lymphocyte Homing AB -

BACKGROUND: Genome-wide association studies have recently identified >400 loci that harbor DNA sequence variants that influence blood pressure (BP). Our earlier studies identified and validated 56 single nucleotide variants (SNVs) associated with BP from meta-analyses of exome chip genotype data. An additional 100 variants yielded suggestive evidence of association.

METHODS AND RESULTS: Here, we augment the sample with 140 886 European individuals from the UK Biobank, in whom 77 of the 100 suggestive SNVs were available for association analysis with systolic BP or diastolic BP or pulse pressure. We performed 2 meta-analyses, one in individuals of European, South Asian, African, and Hispanic descent (pan-ancestry, ≈475 000), and the other in the subset of individuals of European descent (≈423 000). Twenty-one SNVs were genome-wide significant (<5×10) for BP, of which 4 are new BP loci: rs9678851 (missense, ), rs7437940 (), rs13303 (missense, ), and rs1055144 (). In addition, we identified a potentially independent novel BP-associated SNV, rs3416322 (missense, ) at a known locus, uncorrelated with the previously reported SNVs. Two SNVs are associated with expression levels of nearby genes, and SNVs at 3 loci are associated with other traits. One SNV with a minor allele frequency <0.01, (rs3025380 at ) was genome-wide significant.

CONCLUSIONS: We report 4 novel loci associated with BP regulation, and 1 independent variant at an established BP locus. This analysis highlights several candidate genes with variation that alter protein function or gene expression for potential follow-up.

VL - 10 IS - 5 ER - TY - JOUR T1 - Novel Methods and Data Sources for Surveillance of State-Level Diabetes and Prediabetes Prevalence JF - Preventing Chronic Disease Y1 - 2017 A1 - Mardon, Russ A1 - David A Marker A1 - Nooney, Jennifer A1 - Campione, Joanne A1 - Jenkins, Frank A1 - Johnson, Maurice A1 - Merrill, Lori A1 - Deborah B. Rolka A1 - Saydah, Sharon A1 - Geiss, Linda S. A1 - Zhang, Xuanping A1 - Shrestha, Sundar KW - Diabetes KW - Methodology KW - prediabetes AB - States bear substantial responsibility for addressing the rising rates of diabetes and prediabetes in the United States. However, accurate state-level estimates of diabetes and prediabetes prevalence that include undiagnosed cases have been impossible to produce with traditional sources of state-level data. Various new and nontraditional sources for estimating state-level prevalence are now available. These include surveys with expanded samples that can support state-level estimation in some states and administrative and clinical data from insurance claims and electronic health records. These sources pose methodologic challenges because they typically cover partial, sometimes nonrandom subpopulations; they do not always use the same measurements for all individuals; and they use different and limited sets of variables for case finding and adjustment. We present an approach for adjusting new and nontraditional data sources for diabetes surveillance that addresses these limitations, and we present the results of our proposed approach for 2 states (Alabama and California) as a proof of concept. The method reweights surveys and other data sources with population undercoverage to make them more representative of state populations, and it adjusts for nonrandom use of laboratory testing in clinically generated data sets. These enhanced diabetes and prediabetes prevalence estimates can be used to better understand the total burden of diabetes and prediabetes at the state level and to guide policies and programs designed to prevent and control these chronic diseases. VL - 14 ER - TY - JOUR T1 - Racial and socioeconomic disparities in disabling chronic pain: Findings from the Health and Retirement Study. JF - The Journal of Pain: Official Journal of the American Pain Society Y1 - 2017 A1 - Mary R Janevic A1 - Sara J McLaughlin A1 - Alicia A Heapy A1 - Thacker, Casey A1 - John D Piette KW - Chronic pain KW - Racial/ethnic differences KW - Socioeconomic factors AB - The U.S. National Pain Strategy calls for increased population research on "high impact chronic pain," i.e., longstanding pain that substantially limits participation in daily activities. Using data from the nationally-representative Health and Retirement Study (HRS), we investigated the prevalence of high-impact chronic pain in U.S. adults over age 50 overall and within population subgroups. We also explored sociodemographic variation in pain-related disability within specific activity domains. Data are from a subsample of HRS respondents (n=1,925) who were randomly selected for a supplementary pain module in 2010. Our outcome was operationalized as pain duration of >7 months and a disability rating of >7 (0 to 10 scale) in at least one domain: family/home, leisure, social activities, work, or basic activities. Overall, 8.2% (95% C.I. = 6.7 to 10.1%) of adults over age 50 met criteria for high-impact chronic pain. This proportion rose to 17.1% (95% C.I. = 12.3 to 23.4%) among individuals in the lowest wealth quartile. Prevalence differences by education, race/ethnicity and age were not significant. Arthritis and depression were significantly associated with high-impact pain in multivariable analysis. Among adults with any chronic pain, African Americans and individuals in the lowest wealth quartile reported more pain-related disability across activity domains.

PERSPECTIVE: High-impact chronic pain is unequally distributed among midlife and older U.S. adults. Efforts to reduce the burden of disabling chronic pain should prioritize socioeconomically vulnerable groups, who may have the least access to multi-modal pain treatment to improve function. VL - 18 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28760648?dopt=Abstract ER - TY - JOUR T1 - Rare and low-frequency coding variants alter human adult height. JF - Nature Y1 - 2017 A1 - Marouli, Eirini A1 - Graff, Mariaelisa A1 - Medina-Gomez, Carolina A1 - Ken Sin Lo A1 - Andrew R Wood A1 - Kjaer, Troels R A1 - Fine, Rebecca S A1 - Lu, Yingchang A1 - Schurmann, Claudia A1 - Highland, Heather M A1 - Rüeger, Sina A1 - Thorleifsson, Gudmar A1 - Justice, Anne E A1 - Lamparter, David A1 - Kathleen E Stirrups A1 - Turcot, Valérie A1 - Young, Kristin L A1 - Thomas W Winkler A1 - Tõnu Esko A1 - Karaderi, Tugce A1 - Locke, Adam E A1 - Masca, Nicholas G D A1 - Ng, Maggie C Y A1 - Mudgal, Poorva A1 - Rivas, Manuel A A1 - Vedantam, Sailaja A1 - Mahajan, Anubha A1 - Guo, Xiuqing A1 - Gonçalo R Abecasis A1 - Aben, Katja K A1 - Adair, Linda S A1 - Alam, Dewan S A1 - Albrecht, Eva A1 - Allin, Kristine H A1 - Matthew A. Allison A1 - Amouyel, Philippe A1 - Appel, Emil V A1 - Arveiler, Dominique A1 - Asselbergs, Folkert W A1 - Auer, Paul L A1 - Balkau, Beverley A1 - Banas, Bernhard A1 - Bang, Lia E A1 - Benn, Marianne A1 - Bergmann, Sven A1 - Bielak, Lawrence F A1 - Blüher, Matthias A1 - Boeing, Heiner A1 - Boerwinkle, Eric A1 - Böger, Carsten A A1 - Bonnycastle, Lori L A1 - Bork-Jensen, Jette A1 - Bots, Michiel L A1 - Erwin P Bottinger A1 - Bowden, Donald W A1 - Brandslund, Ivan A1 - Breen, Gerome A1 - Brilliant, Murray H A1 - Broer, Linda A1 - Burt, Amber A A1 - Adam S Butterworth A1 - Carey, David J A1 - Caulfield, Mark J A1 - Chambers, John C A1 - Daniel I Chasman A1 - Yii-Der I Chen A1 - Chowdhury, Rajiv A1 - Cramer Christensen A1 - Chu, Audrey Y A1 - Cocca, Massimiliano A1 - Collins, Francis S A1 - Cook, James P A1 - Corley, Janie A1 - Jordi Corominas Galbany A1 - Cox, Amanda J A1 - Cuellar-Partida, Gabriel A1 - Danesh, John A1 - Gail Davies A1 - de Bakker, Paul I W A1 - de Borst, Gert J A1 - de Denus, Simon A1 - de Groot, Mark C H A1 - de Mutsert, Renée A1 - Ian J Deary A1 - George Dedoussis A1 - Ellen W Demerath A1 - Anneke I den Hollander A1 - Joe G Dennis A1 - Di Angelantonio, Emanuele A1 - Drenos, Fotios A1 - Du, Mengmeng A1 - Dunning, Alison M A1 - Easton, Douglas F A1 - Ebeling, Tapani A1 - Edwards, Todd L A1 - Ellinor, Patrick T A1 - Elliott, Paul A1 - Evangelou, Evangelos A1 - Farmaki, Aliki-Eleni A1 - Jessica Faul A1 - Feitosa, Mary F A1 - Feng, Shuang A1 - Ferrannini, Ele A1 - Marco M Ferrario A1 - Ferrières, Jean A1 - Florez, Jose C A1 - Ford, Ian A1 - Myriam Fornage A1 - Franks, Paul W A1 - Frikke-Schmidt, Ruth A1 - Galesloot, Tessel E A1 - Gan, Wei A1 - Gandin, Ilaria A1 - Paolo P. Gasparini A1 - Giedraitis, Vilmantas A1 - Giri, Ayush A1 - Giorgia G Girotto A1 - Gordon, Scott D A1 - Gordon-Larsen, Penny A1 - Gorski, Mathias A1 - Grarup, Niels A1 - Grove, Megan L A1 - Gudnason, Vilmundur A1 - Gustafsson, Stefan A1 - Hansen, Torben A1 - Kathleen Mullan Harris A1 - Tamara B Harris A1 - Andrew T Hattersley A1 - Caroline Hayward A1 - He, Liang A1 - Iris M Heid A1 - Heikkilä, Kauko A1 - Helgeland, Øyvind A1 - Hernesniemi, Jussi A1 - Hewitt, Alex W A1 - Lynne J Hocking A1 - Hollensted, Mette A1 - Oddgeir L Holmen A1 - Hovingh, G Kees A1 - Howson, Joanna M M A1 - Hoyng, Carel B A1 - Huang, Paul L A1 - Hveem, Kristian A1 - Mohammed Arfan Ikram A1 - Ingelsson, Erik A1 - Jackson, Anne U A1 - Jansson, Jan-Håkan A1 - Jarvik, Gail P A1 - Jensen, Gorm B A1 - Jhun, Min A A1 - Jia, Yucheng A1 - Jiang, Xuejuan A1 - Johansson, Stefan A1 - Jørgensen, Marit E A1 - Jørgensen, Torben A1 - Jousilahti, Pekka A1 - Jukema, J Wouter A1 - Kahali, Bratati A1 - Kahn, René S A1 - Kähönen, Mika A1 - Kamstrup, Pia R A1 - Kanoni, Stavroula A1 - Kaprio, Jaakko A1 - Karaleftheri, Maria A1 - Sharon L R Kardia A1 - Karpe, Fredrik A1 - Kee, Frank A1 - Keeman, Renske A1 - Lambertus A Kiemeney A1 - Kitajima, Hidetoshi A1 - Kluivers, Kirsten B A1 - Kocher, Thomas A1 - Komulainen, Pirjo A1 - Kontto, Jukka A1 - Kooner, Jaspal S A1 - Charles Kooperberg A1 - Kovacs, Peter A1 - Kriebel, Jennifer A1 - Kuivaniemi, Helena A1 - Küry, Sébastien A1 - Kuusisto, Johanna A1 - La Bianca, Martina A1 - Laakso, Markku A1 - Lakka, Timo A A1 - Lange, Ethan M A1 - Leslie A Lange A1 - Langefeld, Carl D A1 - Langenberg, Claudia A1 - Eric B Larson A1 - Lee, I-Te A1 - Lehtimäki, Terho A1 - Lewis, Cora E A1 - Li, Huaixing A1 - Li, Jin A1 - Li-Gao, Ruifang A1 - Lin, Honghuang A1 - Lin, Li-An A1 - Lin, Xu A1 - Lars Lind A1 - Lindström, Jaana A1 - Linneberg, Allan A1 - Liu, Yeheng A1 - Yongmei Liu A1 - Lophatananon, Artitaya A1 - Luan, Jian'an A1 - Lubitz, Steven A A1 - Lyytikäinen, Leo-Pekka A1 - Mackey, David A A1 - Pamela A F Madden A1 - Alisa Manning A1 - Männistö, Satu A1 - Marenne, Gaëlle A1 - Marten, Jonathan A1 - Nicholas G Martin A1 - Mazul, Angela L A1 - Meidtner, Karina A1 - Andres Metspalu A1 - Mitchell, Paul A1 - Mohlke, Karen L A1 - Dennis O Mook-Kanamori A1 - Morgan, Anna A1 - Morris, Andrew D A1 - Morris, Andrew P A1 - Müller-Nurasyid, Martina A1 - Munroe, Patricia B A1 - Michael A Nalls A1 - Nauck, Matthias A1 - Nelson, Christopher P A1 - Neville, Matt A1 - Sune Fallgaard Nielsen A1 - Nikus, Kjell A1 - Njølstad, Pål R A1 - Børge G Nordestgaard A1 - Ntalla, Ioanna A1 - Jeff O'Connell A1 - Oksa, Heikki A1 - Loes M Olde Loohuis A1 - Ophoff, Roel A A1 - Owen, Katharine R A1 - Packard, Chris J A1 - Padmanabhan, Sandosh A1 - Palmer, Colin N A A1 - Pasterkamp, Gerard A1 - Patel, Aniruddh P A1 - Pattie, Alison A1 - Pedersen, Oluf A1 - Peissig, Peggy L A1 - Peloso, Gina M A1 - Pennell, Craig E A1 - Markus Perola A1 - Perry, James A A1 - Perry, John R B A1 - Person, Thomas N A1 - Pirie, Ailith A1 - Polasek, Ozren A1 - Posthuma, Danielle A1 - Olli T Raitakari A1 - Rasheed, Asif A1 - Rauramaa, Rainer A1 - Reilly, Dermot F A1 - Reiner, Alex P A1 - Renstrom, Frida A1 - Ridker, Paul M A1 - Rioux, John D A1 - Neil R Robertson A1 - Robino, Antonietta A1 - Rolandsson, Olov A1 - Rudan, Igor A1 - Ruth, Katherine S A1 - Saleheen, Danish A1 - Veikko Salomaa A1 - Nilesh J Samani A1 - Sandow, Kevin A1 - Sapkota, Yadav A1 - Sattar, Naveed A1 - Schmidt, Marjanka K A1 - Schreiner, Pamela J A1 - Schulze, Matthias B A1 - Scott, Robert A A1 - Segura-Lepe, Marcelo P A1 - Svati H Shah A1 - Sim, Xueling A1 - Sivapalaratnam, Suthesh A1 - Small, Kerrin S A1 - Albert Vernon Smith A1 - Jennifer A Smith A1 - Southam, Lorraine A1 - Timothy Spector A1 - Elizabeth K Speliotes A1 - John M Starr A1 - Steinthorsdottir, Valgerdur A1 - Heather M Stringham A1 - Stumvoll, Michael A1 - Surendran, Praveen A1 - 't Hart, Leen M A1 - Tansey, Katherine E A1 - Tardif, Jean-Claude A1 - Kent D Taylor A1 - Teumer, Alexander A1 - Thompson, Deborah J A1 - Thorsteinsdottir, Unnur A1 - Thuesen, Betina H A1 - Tönjes, Anke A1 - Tromp, Gerard A1 - Trompet, Stella A1 - Tsafantakis, Emmanouil A1 - Tuomilehto, Jaakko A1 - Tybjaerg-Hansen, Anne A1 - Tyrer, Jonathan P A1 - Uher, Rudolf A1 - André G Uitterlinden A1 - Ulivi, Sheila A1 - van der Laan, Sander W A1 - Van Der Leij, Andries R A1 - Cornelia M van Duijn A1 - van Schoor, Natasja M A1 - van Setten, Jessica A1 - Varbo, Anette A1 - Varga, Tibor V A1 - Varma, Rohit A1 - Digna R Velez Edwards A1 - Vermeulen, Sita H A1 - Vestergaard, Henrik A1 - Vitart, Veronique A1 - Vogt, Thomas F A1 - Vozzi, Diego A1 - Walker, Mark A1 - Wang, Feijie A1 - Wang, Carol A A1 - Wang, Shuai A1 - Wang, Yiqin A1 - Wareham, Nicholas J A1 - Warren, Helen R A1 - Wessel, Jennifer A1 - Willems, Sara M A1 - Wilson, James G A1 - Daniel Witte A1 - Woods, Michael O A1 - Wu, Ying A1 - Yaghootkar, Hanieh A1 - Yao, Jie A1 - Yao, Pang A1 - Laura M Yerges-Armstrong A1 - Young, Robin A1 - Zeggini, Eleftheria A1 - Zhan, Xiaowei A1 - Zhang, Weihua A1 - Jing Hua Zhao A1 - Wei Zhao A1 - Wei Zhao A1 - Zheng, He A1 - Zhou, Wei A1 - Rotter, Jerome I A1 - Boehnke, Michael A1 - Kathiresan, Sekar A1 - McCarthy, Mark I A1 - Willer, Cristen J A1 - Stefansson, Kari A1 - Ingrid B Borecki A1 - Liu, Dajiang J A1 - Kari E North A1 - Heard-Costa, Nancy L A1 - Pers, Tune H A1 - Lindgren, Cecilia M A1 - Oxvig, Claus A1 - Kutalik, Zoltán A1 - Fernando Rivadeneira A1 - Ruth J F Loos A1 - Timothy M Frayling A1 - Joel N Hirschhron A1 - Deloukas, Panos A1 - Lettre, Guillaume AB -

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1-4.8%) and effects of up to 2 centimetres per allele (such as those in IHH, STC2, AR and CRISPLD2), greater than ten times the average effect of common variants. In functional follow-up studies, rare height-increasing alleles of STC2 (giving an increase of 1-2 centimetres per allele) compromised proteolytic inhibition of PAPP-A and increased cleavage of IGFBP-4 in vitro, resulting in higher bioavailability of insulin-like growth factors. These 83 height-associated variants overlap genes that are mutated in monogenic growth disorders and highlight new biological candidates (such as ADAMTS3, IL11RA and NOX4) and pathways (such as proteoglycan and glycosaminoglycan synthesis) involved in growth. Our results demonstrate that sufficiently large sample sizes can uncover rare and low-frequency variants of moderate-to-large effect associated with polygenic human phenotypes, and that these variants implicate relevant genes and pathways.

VL - 542 IS - 7640 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28146470?dopt=Abstract ER - TY - THES T1 - Relationships between resilience indicators and engagement in disease prevention behavior among adults in the Health and Retirement Study T2 - Epidemiology Y1 - 2017 A1 - Kelsi O. Jackson KW - Health Conditions and Status KW - Preventative Care KW - Resilience AB - BACKGROUND: Seniors are the fastest growing age demographic in the United States; by 2030, 72 million Americans are projected to be over the age of 65. These rapid demographic changes have called for better understanding of healthy, successful aging. Previous work using data on Americans of retirement age showed that resiliency is associated with lower healthcare utilization which tends to be costly to individuals and burdensome to an already strained healthcare system. The primary goal and hypothesis of this study is to test the association between resiliency and participation in disease prevention behaviors. METHODS: The study used a sample of 6,693 respondents from the 2012 wave of the Health and Retirement Study who answered the Psychosocial Leave-Behind questionnaire. Logistic regression was used to evaluate the relationship between indicators of resilience (mastery and social support) with the behavioral outcomes (receiving a flu shot, prostate screening, or mammography). The cancer screening models were restricted by gender. Relationships between the outcomes and workforce participation status, marital status, physical activity, education, history of smoking, comorbidity, body mass index, and cumulative lifetime adversity were also explored. All analyses were conducted using SAS survey procedures to account for complex survey design. RESULTS: The present findings do not provide consistent evidence that higher resilience corresponds to greater utilization of preventative health behavior. Results indicate that high mastery is associated with greater likelihood of receiving a mammogram, but show lower odds of receiving a flu shot. For social support, the results demonstrated that individuals who scored higher on the negative social support scale are more likely to get a mammogram or flu shot. There is little to suggest that resilient individuals engage in healthy disease prevention behaviors more than their less resilient counterparts. Future studies might look at comparing estimates based on different methodologies for measuring resilience in this population or exploring different variables that better characterize the health behaviors of resilient senior citizens. JF - Epidemiology PB - Emory University CY - Atlanta, GA VL - Master's UR - https://legacy-etd.library.emory.edu/view/record/pid/emory:s1d2c ER - TY - JOUR T1 - Single-trait and multi-trait genome-wide association analyses identify novel loci for blood pressure in African-ancestry populations. JF - PLoS Genetics Y1 - 2017 A1 - Liang, Jingjing A1 - Le, Thu H A1 - Digna R Velez Edwards A1 - Bamidele O Tayo A1 - Gaulton, Kyle J A1 - Smith, Jennifer A A1 - Lu, Yingchang A1 - Jensen, Richard A A1 - Chen, Guanjie A1 - Yanek, Lisa R A1 - Schwander, Karen A1 - Tajuddin, Salman M A1 - Sofer, Tamar A1 - Kim, Wonji A1 - Kayima, James A1 - McKenzie, Colin A A1 - Fox, Ervin A1 - Michael A Nalls A1 - Young, J Hunter A1 - Yan V Sun A1 - Lane, Jacqueline M A1 - Cechova, Sylvia A1 - Zhou, Jie A1 - Tang, Hua A1 - Myriam Fornage A1 - Musani, Solomon K A1 - Wang, Heming A1 - Lee, Juyoung A1 - Adeyemo, Adebowale A1 - Dreisbach, Albert W A1 - Forrester, Terrence A1 - Chu, Pei-Lun A1 - Anne Cappola A1 - Michele K Evans A1 - Alanna C Morrison A1 - Martin, Lisa W A1 - Kerri Wiggins A1 - Hui, Qin A1 - Zhao, Wei A1 - Jackson, Rebecca D A1 - Erin B Ware A1 - Jessica Faul A1 - Reiner, Alex P A1 - Bray, Michael A1 - Denny, Joshua C A1 - Thomas H Mosley A1 - Walter R Palmas A1 - Guo, Xiuqing A1 - George J Papanicolaou A1 - Alan Penman A1 - Polak, Joseph F A1 - Kenneth Rice A1 - Taylor, Ken D A1 - Boerwinkle, Eric A1 - Erwin P Bottinger A1 - Liu, Kiang A1 - Neil Risch A1 - Hunt, Steven C A1 - Charles Kooperberg A1 - Alan B Zonderman A1 - Laurie, Cathy C A1 - Becker, Diane M A1 - Cai, Jianwen A1 - Ruth J F Loos A1 - Psaty, Bruce M A1 - David R Weir A1 - Sharon L R Kardia A1 - Donna K Arnett A1 - Won, Sungho A1 - Edwards, Todd L A1 - Redline, Susan A1 - Cooper, Richard S A1 - Rao, D C A1 - Rotter, Jerome I A1 - Charles N Rotimi A1 - Levy, Daniel A1 - Chakravarti, Aravinda A1 - Zhu, Xiaofeng A1 - Franceschini, Nora KW - African Americans KW - Animals KW - Basic Helix-Loop-Helix Transcription Factors KW - Blood pressure KW - Cadherins KW - Case-Control Studies KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Humans KW - Hypertension KW - Male KW - Membrane Proteins KW - Mice KW - Multifactorial Inheritance KW - Polymorphism, Single Nucleotide AB -

Hypertension is a leading cause of global disease, mortality, and disability. While individuals of African descent suffer a disproportionate burden of hypertension and its complications, they have been underrepresented in genetic studies. To identify novel susceptibility loci for blood pressure and hypertension in people of African ancestry, we performed both single and multiple-trait genome-wide association analyses. We analyzed 21 genome-wide association studies comprised of 31,968 individuals of African ancestry, and validated our results with additional 54,395 individuals from multi-ethnic studies. These analyses identified nine loci with eleven independent variants which reached genome-wide significance (P < 1.25×10-8) for either systolic and diastolic blood pressure, hypertension, or for combined traits. Single-trait analyses identified two loci (TARID/TCF21 and LLPH/TMBIM4) and multiple-trait analyses identified one novel locus (FRMD3) for blood pressure. At these three loci, as well as at GRP20/CDH17, associated variants had alleles common only in African-ancestry populations. Functional annotation showed enrichment for genes expressed in immune and kidney cells, as well as in heart and vascular cells/tissues. Experiments driven by these findings and using angiotensin-II induced hypertension in mice showed altered kidney mRNA expression of six genes, suggesting their potential role in hypertension. Our study provides new evidence for genes related to hypertension susceptibility, and the need to study African-ancestry populations in order to identify biologic factors contributing to hypertension.

VL - 13 IS - 5 ER - TY - JOUR T1 - Social Isolation and Medicare Spending: Among Older Adults, Objective Isolation Increases Expenditures While Loneliness Does Not JF - Journal of Aging and Health Y1 - 2017 A1 - Jonathan G Shaw A1 - Farid, Monica A1 - Claire Noël-Miller A1 - Joseph, Neesha A1 - Houser, Ari A1 - Steven Asch A1 - Bhattacharya, Jay A1 - Flowers, Lynda KW - Depressive symptoms KW - Isolation KW - Loneliness KW - Medicare expenditures KW - Medicare linkage KW - Medicare/Medicaid/Health Insurance KW - Social Support AB - Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to three-item loneliness scale) as predictors of subsequent Medicare spending. In multivariable regression adjusting for health and demographics, we determined marginal differences in Medicare expenditures. Secondary outcomes included spending by setting, and mortality. Results: Objective isolation predicts greater spending, US$1,644 (p <.001) per beneficiary annually, whereas loneliness predicts reduced spending, 'US$768 (p <.001). Increased spending concentrated in inpatient and nursing home (skilled nursing facilities [SNFs]) care; despite more health care, objectively isolated beneficiaries had 31% (p <.001) greater risk of death. Loneliness did not predict SNF use or mortality, but predicted slightly less inpatient and outpatient care. Discussion: Objectively isolated seniors have higher Medicare spending, driven by increased hospitalization and institutionalization, and face greater mortality. Policies supporting social connectedness could reap significant savings. VL - 29 UR - http://journals.sagepub.com/doi/10.1177/0898264317703559http://journals.sagepub.com/doi/pdf/10.1177/0898264317703559 IS - 7 JO - J Aging Health ER - TY - JOUR T1 - SOS2 and ACP1 Loci Identified through Large-Scale Exome Chip Analysis Regulate Kidney Development and Function. JF - Journal of the American Society of Nephrology Y1 - 2017 A1 - Li, Man A1 - Li, Yong A1 - Weeks, Olivia A1 - Mijatovic, Vladan A1 - Teumer, Alexander A1 - Huffman, Jennifer E A1 - Tromp, Gerard A1 - Fuchsberger, Christian A1 - Gorski, Mathias A1 - Lyytikäinen, Leo-Pekka A1 - Nutile, Teresa A1 - Sedaghat, Sanaz A1 - Sorice, Rossella A1 - Tin, Adrienne A1 - Yang, Qiong A1 - Ahluwalia, Tarunveer S A1 - Dan E Arking A1 - Bihlmeyer, Nathan A A1 - Böger, Carsten A A1 - Carroll, Robert J A1 - Daniel I Chasman A1 - Marilyn C Cornelis A1 - Dehghan, Abbas A1 - Jessica Faul A1 - Feitosa, Mary F A1 - Gambaro, Giovanni A1 - Paolo P. Gasparini A1 - Giulianini, Franco A1 - Iris M Heid A1 - Huang, Jinyan A1 - Imboden, Medea A1 - Jackson, Anne U A1 - Janina Jeff A1 - Jhun, Min A A1 - Katz, Ronit A1 - Kifley, Annette A1 - Kilpeläinen, Tuomas O A1 - Kumar, Ashish A1 - Laakso, Markku A1 - Li-Gao, Ruifang A1 - Kurt Lohman A1 - Lu, Yingchang A1 - Mägi, Reedik A1 - Malerba, Giovanni A1 - Mihailov, Evelin A1 - Mohlke, Karen L A1 - Dennis O Mook-Kanamori A1 - Robino, Antonietta A1 - Ruderfer, Douglas A1 - Salvi, Erika A1 - Schick, Ursula M A1 - Schulz, Christina-Alexandra A1 - Smith, Albert V A1 - Smith, Jennifer A A1 - Traglia, Michela A1 - Laura M Yerges-Armstrong A1 - Zhao, Wei A1 - Goodarzi, Mark O A1 - Kraja, Aldi T A1 - Liu, Chunyu A1 - Wessel, Jennifer A1 - Boerwinkle, Eric A1 - Ingrid B Borecki A1 - Bork-Jensen, Jette A1 - Erwin P Bottinger A1 - Braga, Daniele A1 - Brandslund, Ivan A1 - Brody, Jennifer A A1 - Campbell, Archie A1 - Carey, David J A1 - Cramer Christensen A1 - Coresh, Josef A1 - Crook, Errol A1 - Curhan, Gary C A1 - Cusi, Daniele A1 - de Boer, Ian H A1 - de Vries, Aiko P J A1 - Denny, Joshua C A1 - Devuyst, Olivier A1 - Dreisbach, Albert W A1 - Endlich, Karlhans A1 - Tõnu Esko A1 - Franco, Oscar H A1 - Fulop, Tibor A1 - Gerhard, Glenn S A1 - Glümer, Charlotte A1 - Gottesman, Omri A1 - Grarup, Niels A1 - Gudnason, Vilmundur A1 - Hansen, Torben A1 - Tamara B Harris A1 - Caroline Hayward A1 - Lynne J Hocking A1 - Hofman, Albert A1 - Hu, Frank B A1 - Husemoen, Lise Lotte N A1 - Jackson, Rebecca D A1 - Jørgensen, Torben A1 - Jørgensen, Marit E A1 - Kähönen, Mika A1 - Sharon L R Kardia A1 - König, Wolfgang A1 - Charles Kooperberg A1 - Kriebel, Jennifer A1 - Lenore J Launer A1 - Lauritzen, Torsten A1 - Lehtimäki, Terho A1 - Levy, Daniel A1 - Linksted, Pamela A1 - Linneberg, Allan A1 - Liu, Yongmei A1 - Ruth J F Loos A1 - Lupo, Antonio A1 - Meisinger, Christine A1 - Melander, Olle A1 - Andres Metspalu A1 - Mitchell, Paul A1 - Nauck, Matthias A1 - Nürnberg, Peter A1 - Orho-Melander, Marju A1 - Parsa, Afshin A1 - Pedersen, Oluf A1 - Peters, Annette A1 - Peters, Ulrike A1 - Polasek, Ozren A1 - David J Porteous A1 - Nicole M Probst-Hensch A1 - Psaty, Bruce M A1 - Qi, Lu A1 - Olli T Raitakari A1 - Reiner, Alex P A1 - Rettig, Rainer A1 - Ridker, Paul M A1 - Fernando Rivadeneira A1 - Rossouw, Jacques E A1 - Schmidt, Frank A1 - David S Siscovick A1 - Soranzo, Nicole A1 - Strauch, Konstantin A1 - Toniolo, Daniela A1 - Stephen T Turner A1 - André G Uitterlinden A1 - Ulivi, Sheila A1 - Velayutham, Dinesh A1 - Völker, Uwe A1 - Völzke, Henry A1 - Waldenberger, Melanie A1 - Wang, Jie Jin A1 - David R Weir A1 - Daniel Witte A1 - Kuivaniemi, Helena A1 - Caroline S Fox A1 - Franceschini, Nora A1 - Goessling, Wolfram A1 - Köttgen, Anna A1 - Chu, Audrey Y KW - Animals KW - Exome KW - Genetic Loci KW - Genome-Wide Association Study KW - Glomerular Filtration Rate KW - Humans KW - kidney KW - Protein Tyrosine Phosphatases KW - Proto-Oncogene Proteins KW - Son of Sevenless Proteins KW - Zebrafish AB -

Genome-wide association studies have identified >50 common variants associated with kidney function, but these variants do not fully explain the variation in eGFR. We performed a two-stage meta-analysis of associations between genotypes from the Illumina exome array and eGFR on the basis of serum creatinine (eGFRcrea) among participants of European ancestry from the CKDGen Consortium (: 111,666; : 48,343). In single-variant analyses, we identified single nucleotide polymorphisms at seven new loci associated with eGFRcrea (, , and ; <3.7×10), of which most were common and annotated as nonsynonymous variants. Gene-based analysis identified associations of functional rare variants in three genes with eGFRcrea, including a novel association with the SOS Ras/Rho guanine nucleotide exchange factor 2 gene, (=5.4×10 by sequence kernel association test). Experimental follow-up in zebrafish embryos revealed changes in glomerular gene expression and renal tubule morphology in the embryonic kidney of and -knockdowns. These developmental abnormalities associated with altered blood clearance rate and heightened prevalence of edema. This study expands the number of loci associated with kidney function and identifies novel genes with potential roles in kidney formation.

VL - 28 IS - 3 ER - TY - JOUR T1 - Stress, self-regulation, and context: Evidence from the Health and Retirement Survey. JF - SSM - Population Health Y1 - 2017 A1 - Briana Mezuk A1 - Scott M Ratliff A1 - Jeannie B. Concha A1 - Cleopatra M Abdou A1 - Rafferty, Jane A1 - Lee, Hedwig A1 - James S Jackson KW - Depressive symptoms KW - Health Disparities KW - Stress AB - Health-related behaviors, such as smoking, alcohol use, exercise, and diet, are major determinants of physical health and health disparities. However, a growing body of experimental research in humans and animals also suggests these behaviors can impact the ways our bodies respond to stress, such that they modulate (that is, serve as a means to self-regulate or cope with) the deleterious impact of stressful experiences on mental health. A handful of epidemiologic studies have investigated the intersection between stress and health behaviors on health disparities (both mental and physical), with mixed results. In this study we use a novel instrument designed to explicitly measure the self-regulatory motivations and perceived effectiveness of eight health-related self-regulatory behaviors (smoking, alcohol, drug use, overeating, prayer, exercise, social support, talking with a councilor) in a subset of the Health and Retirement Study (N=1,354, Mean age=67, 54% female). We find that these behaviors are commonly endorsed as self-regulatory stress-coping strategies, with prayer, social support, exercise, and overeating used most frequently. The likelihood of using particular behaviors as self-regulatory strategies varied significantly by sex, but not by race/ethnicity, education, or wealth. We also find that greater stress exposure is associated with higher likelihood of using these behaviors to self-regulate feelings of emotional distress, particularly health-harming behaviors like smoking, alcohol, and overeating. These findings provide an important link between sociological and psychological theoretical models on stress and empirical epidemiological research on social determinants of health and health disparities. VL - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29130063?dopt=Abstract ER - TY - ICOMM T1 - Trying to keep brain sharp doesn't have to be costly Y1 - 2017 A1 - Johnson, Linda A. KW - Interviews KW - News PB - Associated Press CY - New York City, NY UR - https://m.washingtontimes.com/news/2017/jul/12/trying-to-keep-brain-sharp-doesnt-have-to-be-costl/ ER - TY - Generic T1 - The Accuracy of Economic Measurement in the Health and Retirement Study Y1 - 2016 A1 - Eric French A1 - John Bailey Jones A1 - McCauley, Jeremy KW - Health Insurance KW - Out-of-pocket medical expenses AB - We assess the quality of the HRS's measures of out-of-pocket medical spend- ing and health insurance premia, both in the \core interviews" and in the \exit interview" data. We provide detailed evidence on the quality of the HRS insur- ance premia data, and we compare the HRS exit data to exit data in the MCBS. We document how changes in survey questions, including the introduction of \unfolding brackets", a ect the HRS measures. We document what we believe are errors in the HRS imputations and provide some suggestions for improving the accuracy of some imputed variables. Overall, we nd the HRS data to be of high quality. However, we believe that many interesting variables in the HRS are under-utilized because users must perform imputations themselves. PB - National Institute on Aging CY - Bethesda, MD ER - TY - JOUR T1 - Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans. JF - PLoS One Y1 - 2016 A1 - Anusha M Vable A1 - Ichiro Kawachi A1 - Canning, David A1 - M. Maria Glymour A1 - Marcia P Jimenez A1 - S. V. Subramanian KW - Adult KW - Aged KW - depression KW - Female KW - Humans KW - Korean War KW - Male KW - Mental Disorders KW - Mental Health KW - Middle Aged KW - Odds Ratio KW - Population Surveillance KW - Social Class KW - Spouses KW - Veterans KW - Veterans Health AB -

BACKGROUND: The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated.

METHODS: Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent's educational attainment in a subset of analyses.

RESULTS: Husband's Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28).

CONCLUSIONS: We found no evidence of a relationship between husband's Korean War GI Bill eligibility and wives' mental health in these data, however there may be a true effect that our analysis was underpowered to detect.

VL - 11 UR - https://www.ncbi.nlm.nih.gov/pubmed/27186983 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27186983?dopt=Abstract ER - TY - JOUR T1 - Assessing morbidity compression in two cohorts from the Health and Retirement Study JF - Journal of Epidemiology and Community Health Y1 - 2016 A1 - Hiram Beltrán-Sánchez A1 - Marcia P Jimenez A1 - S. V. Subramanian KW - Chronic conditions KW - Disease KW - Expectations KW - Health Conditions and Status KW - Self-reported health AB - Background: Increases in life expectancy are hypothesised to be associated with shorter proportional time spent with morbidity (compression of morbidity). We assessed whether this has occurred among older adults in the USA during the 1990s and 2000s. Methods: We used data from the Health and Retirement Study to estimate a morbidity score based on eight chronic conditions and compare it (1) prospectively between two age-matched cohorts in 1992 and 2004 over a 6-year follow-up, and (2) retrospectively in the three waves prior to death among respondents who die in (1998 2004) and (2004 2010). Results: Prospective assessment shows significantly higher prevalence in 6 of eight chronic conditions in the 2000s, with 37 higher diabetes prevalence. A retrospective evaluation shows significantly higher prevalence in 7 of eight chronic conditions in the three waves prior to death for (2004 2010) versus (1998 2004), with 41 higher prevalence of arthritis. Importantly, the farther away from time of death, the higher the average number of chronic conditions in (2004 2010). Conclusions: Using the largest longitudinal ageing study in the USA, we found no clear evidence of compression of morbidity as measured by self-reported chronic disease. Older adults in the USA may be experiencing greater disease burden in recent times. UR - http://jech.bmj.com/content/early/2016/04/21/jech-2015-206722.abstract ER - TY - JOUR T1 - Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression. JF - Ann Epidemiol Y1 - 2016 A1 - Anusha M Vable A1 - Canning, David A1 - M. Maria Glymour A1 - Ichiro Kawachi A1 - Marcia P Jimenez A1 - S. V. Subramanian KW - Aged KW - Aged, 80 and over KW - depression KW - Health Status Disparities KW - Humans KW - Korean War KW - Male KW - Public Policy KW - Residence Characteristics KW - Risk Factors KW - Socioeconomic factors KW - Veterans AB -

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

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

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

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

PB - 26 VL - 26 UR - http://www.sciencedirect.com/science/article/pii/S1047279715300107 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26778285?dopt=Abstract ER - TY - JOUR T1 - Does the Relationship of the Proxy to the Target Person Affect the Concordance between Survey Reports and Medicare Claims Measures of Health Services Use? JF - Health Serv Res Y1 - 2016 A1 - George L Wehby A1 - Michael P Jones A1 - Fred A Ullrich A1 - Yiyue Lou A1 - Frederic D Wolinsky KW - Ambulatory Surgical Procedures KW - Female KW - Hospitalization KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare KW - Patient Acceptance of Health Care KW - Proxy KW - Self Report KW - Socioeconomic factors KW - Spouses KW - United States AB -

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

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

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

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

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

VL - 51 UR - https://www.ncbi.nlm.nih.gov/pubmed/26059195 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26059195?dopt=Abstract ER - TY - JOUR T1 - Gender Differences in Trajectories of Physical Activity Among Older Americans With Diabetes JF - Journal of Aging and Health Y1 - 2016 A1 - Sara J McLaughlin A1 - Cathleen M. Connell A1 - Mary R Janevic KW - Demographics KW - Health Conditions and Status KW - Methodology AB - Objective: The primary objective of this study was to examine gender differences in engagement in physical activity over time among older U.S. adults with diabetes. Method: Using data from the Health and Retirement Study, we investigated physical activity between 2004 and 2010 among 1,857 adults aged 65 years and above with diabetes. Results: Less than half of adults were physically active at baseline. The probability of physical activity declined over the 6-year period, with no significant gender variation in the effect of time. Because the odds of physical activity were lower for women at baseline and the effect of time did not vary by gender, the trajectory of physical activity was less favorable for women than men. Discussion: The women in this cohort of older Americans started and remained less active than their male counterparts. Investigations covering a larger portion of the life course and those examining the impact of life events and transitions on physical activity among adults with diabetes are needed. PB - 28 VL - 28 UR - http://jah.sagepub.com/content/early/2015/07/14/0898264315594136.abstract IS - 3 U4 - diabetes/gender/health behavior/longitudinal/physical activity/trajectories ER - TY - JOUR T1 - Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function. JF - Nat Commun Y1 - 2016 A1 - Pattaro, Cristian A1 - Teumer, Alexander A1 - Gorski, Mathias A1 - Chu, Audrey Y A1 - Li, Man A1 - Mijatovic, Vladan A1 - Garnaas, Maija A1 - Tin, Adrienne A1 - Sorice, Rossella A1 - Yong Li A1 - Taliun, Daniel A1 - Olden, Matthias A1 - Foster, Meredith A1 - Qiong Yang A1 - Chen, Ming-Huei A1 - Pers, Tune H A1 - Andrew D Johnson A1 - Ko, Yi-An A1 - Fuchsberger, Christian A1 - Bamidele O Tayo A1 - Michael A Nalls A1 - Feitosa, Mary F A1 - Isaacs, Aaron A1 - Dehghan, Abbas A1 - d'Adamo, Pio A1 - Adebawole Adeyemo A1 - Dieffenbach, Aida Karina A1 - Alan B Zonderman A1 - Ilja M Nolte A1 - van der Most, Peter J A1 - Alan F Wright A1 - Alan R Shuldiner A1 - Alanna C Morrison A1 - Hofman, Albert A1 - Albert Vernon Smith A1 - Dreisbach, Albert W A1 - Franke, Andre A1 - André G Uitterlinden A1 - Andres Metspalu A1 - Tönjes, Anke A1 - Lupo, Antonio A1 - Robino, Antonietta A1 - Johansson, Åsa A1 - Demirkan, Ayse A1 - Kollerits, Barbara A1 - Freedman, Barry I A1 - Ponte, Belen A1 - Ben A Oostra A1 - Paulweber, Bernhard A1 - Krämer, Bernhard K A1 - Mitchell, Braxton D A1 - Buckley, Brendan M A1 - Peralta, Carmen A A1 - Caroline Hayward A1 - Helmer, Catherine A1 - Charles N Rotimi A1 - Shaffer, Christian M A1 - Müller, Christian A1 - Cinzia Felicita Sala A1 - Cornelia M van Duijn A1 - Saint-Pierre, Aude A1 - Daniel Ackermann A1 - Daniel Shriner A1 - Ruggiero, Daniela A1 - Toniolo, Daniela A1 - Lu, Yingchang A1 - Cusi, Daniele A1 - Czamara, Darina A1 - Ellinghaus, David A1 - David S Siscovick A1 - Ruderfer, Douglas A1 - Gieger, Christian A1 - Grallert, Harald A1 - Rochtchina, Elena A1 - Atkinson, Elizabeth J A1 - Holliday, Elizabeth G A1 - Boerwinkle, Eric A1 - Salvi, Erika A1 - Erwin P Bottinger A1 - Murgia, Federico A1 - Fernando Rivadeneira A1 - Ernst, Florian A1 - Kronenberg, Florian A1 - Hu, Frank B A1 - Navis, Gerjan J A1 - Curhan, Gary C A1 - Georg B Ehret A1 - Homuth, Georg A1 - Coassin, Stefan A1 - Thun, Gian-Andri A1 - Pistis, Giorgio A1 - Gambaro, Giovanni A1 - Malerba, Giovanni A1 - Grant W Montgomery A1 - Guðny Eiríksdóttir A1 - Jacobs, Gunnar A1 - Guo Li A1 - Wichmann, H-Erich A1 - Campbell, Harry A1 - Schmidt, Helena A1 - Wallaschofski, Henri A1 - Völzke, Henry A1 - Brenner, Hermann A1 - Kroemer, Heyo K A1 - Kramer, Holly A1 - Lin, Honghuang A1 - Irene Mateo Leach A1 - Ford, Ian A1 - Guessous, Idris A1 - Rudan, Igor A1 - Prokopenko, Inga A1 - Ingrid B Borecki A1 - Iris M Heid A1 - Kolcic, Ivana A1 - Persico, Ivana A1 - Jukema, J Wouter A1 - James F Wilson A1 - Felix, Janine F A1 - Divers, Jasmin A1 - Lambert, Jean-Charles A1 - Stafford, Jeanette M A1 - Gaspoz, Jean-Michel A1 - Jennifer A Smith A1 - Jessica Faul A1 - Wang, Jie Jin A1 - Ding, Jingzhong A1 - Joel N Hirschhron A1 - John R. Attia A1 - Whitfield, John B A1 - Chalmers, John A1 - Viikari, Jorma A1 - Coresh, Josef A1 - Denny, Joshua C A1 - Karjalainen, Juha A1 - Fernandes, Jyotika K A1 - Endlich, Karlhans A1 - Butterbach, Katja A1 - Keene, Keith L A1 - Kurt Lohman A1 - Portas, Laura A1 - Lenore J Launer A1 - Lyytikäinen, Leo-Pekka A1 - Yengo, Loic A1 - Lude L Franke A1 - Luigi Ferrucci A1 - Rose, Lynda M A1 - Kedenko, Lyudmyla A1 - Rao, Madhumathi A1 - Struchalin, Maksim A1 - Kleber, Marcus E A1 - Cavalieri, Margherita A1 - Haun, Margot A1 - Marilyn C Cornelis A1 - Ciullo, Marina A1 - Pirastu, Mario A1 - de Andrade, Mariza A1 - McEvoy, Mark A A1 - Woodward, Mark A1 - Adam, Martin A1 - Cocca, Massimiliano A1 - Nauck, Matthias A1 - Imboden, Medea A1 - Waldenberger, Melanie A1 - Pruijm, Menno A1 - Metzger, Marie A1 - Stumvoll, Michael A1 - Michele K Evans A1 - Sale, Michele M A1 - Kähönen, Mika A1 - Boban, Mladen A1 - Bochud, Murielle A1 - Rheinberger, Myriam A1 - Verweij, Niek A1 - Bouatia-Naji, Nabila A1 - Nicholas G Martin A1 - Nicholas D Hastie A1 - Nicole M Probst-Hensch A1 - Soranzo, Nicole A1 - Devuyst, Olivier A1 - Olli T Raitakari A1 - Gottesman, Omri A1 - Franco, Oscar H A1 - Polasek, Ozren A1 - Paolo P. Gasparini A1 - Munroe, Patricia B A1 - Ridker, Paul M A1 - Mitchell, Paul A1 - Muntner, Paul A1 - Meisinger, Christa A1 - Johannes H Smit A1 - Kovacs, Peter A1 - Wild, Philipp S A1 - Froguel, Philippe A1 - Rettig, Rainer A1 - Mägi, Reedik A1 - Biffar, Reiner A1 - Schmidt, Reinhold A1 - Middelberg, Rita P S A1 - Carroll, Robert J A1 - Brenda W J H Penninx A1 - Rodney J Scott A1 - Katz, Ronit A1 - Sedaghat, Sanaz A1 - Sarah Wild A1 - Sharon L R Kardia A1 - Ulivi, Sheila A1 - Hwang, Shih-Jen A1 - Enroth, Stefan A1 - Kloiber, Stefan A1 - Trompet, Stella A1 - Stengel, Benedicte A1 - Hancock, Stephen J A1 - Stephen T Turner A1 - Rosas, Sylvia E A1 - Stracke, Sylvia A1 - Tamara B Harris A1 - Zeller, Tanja A1 - Zemunik, Tatijana A1 - Lehtimäki, Terho A1 - Illig, Thomas A1 - Aspelund, Thor A1 - Nikopensius, Tiit A1 - Tõnu Esko A1 - Toshiko Tanaka A1 - Gyllensten, Ulf A1 - Völker, Uwe A1 - Emilsson, Valur A1 - Vitart, Veronique A1 - Aalto, Ville A1 - Gudnason, Vilmundur A1 - Chouraki, Vincent A1 - Chen, Wei-Min A1 - Igl, Wilmar A1 - März, Winfried A1 - Koenig, Wolfgang A1 - Lieb, Wolfgang A1 - Ruth J F Loos A1 - Yongmei Liu A1 - Snieder, Harold A1 - Pramstaller, Peter P A1 - Parsa, Afshin A1 - Jeff O'Connell A1 - Susztak, Katalin A1 - Hamet, Pavel A1 - Tremblay, Johanne A1 - de Boer, Ian H A1 - Böger, Carsten A A1 - Goessling, Wolfram A1 - Daniel I Chasman A1 - Köttgen, Anna A1 - Kao, W H Linda A1 - Caroline S Fox KW - Chronic disease KW - Genome-Wide Association Study KW - Genotype KW - Humans AB -

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways.

VL - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26831199?dopt=Abstract ER - TY - JOUR T1 - Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. JF - Nat Genet Y1 - 2016 A1 - Okbay, Aysu A1 - Baselmans, Bart M L A1 - De Neve, Jan-Emmanuel A1 - Turley, Patrick A1 - Nivard, Michel G A1 - Mark Alan Fontana A1 - Meddens, S Fleur W A1 - Richard Karlsson Linnér A1 - Cornelius A Rietveld A1 - Derringer, Jaime A1 - Gratten, Jacob A1 - Lee, James J A1 - Liu, Jimmy Z A1 - de Vlaming, Ronald A1 - Ahluwalia, Tarunveer S A1 - Buchwald, Jadwiga A1 - Cavadino, Alana A1 - Frazier-Wood, Alexis C A1 - Furlotte, Nicholas A A1 - Garfield, Victoria A1 - Geisel, Marie Henrike A1 - Gonzalez, Juan R A1 - Haitjema, Saskia A1 - Karlsson, Robert A1 - van der Laan, Sander W A1 - Ladwig, Karl-Heinz A1 - J. Lahti A1 - Sven J van der Lee A1 - Penelope A Lind A1 - Tian Liu A1 - Lindsay K Matteson A1 - Mihailov, Evelin A1 - Michael B Miller A1 - Minica, Camelia C A1 - Ilja M Nolte A1 - Dennis O Mook-Kanamori A1 - van der Most, Peter J A1 - Christopher J Oldmeadow A1 - Qian, Yong A1 - Olli T Raitakari A1 - Rawal, Rajesh A1 - Realo, Anu A1 - Rueedi, Rico A1 - Schmidt, Börge A1 - Albert Vernon Smith A1 - Stergiakouli, Evie A1 - Toshiko Tanaka A1 - Kent D Taylor A1 - Wedenoja, Juho A1 - Jürgen Wellmann A1 - Westra, Harm-Jan A1 - Willems, Sara M A1 - Wei Zhao A1 - Amin, Najaf A1 - Bakshi, Andrew A1 - Patricia A. Boyle A1 - Cherney, Samantha A1 - Cox, Simon R A1 - Gail Davies A1 - Davis, Oliver S P A1 - Ding, Jun A1 - Nese Direk A1 - Eibich, Peter A1 - Emeny, Rebecca T A1 - Fatemifar, Ghazaleh A1 - Jessica Faul A1 - Luigi Ferrucci A1 - Andreas J Forstner A1 - Gieger, Christian A1 - Gupta, Richa A1 - Tamara B Harris A1 - Harris, Juliette M A1 - Holliday, Elizabeth G A1 - Jouke-Jan Hottenga A1 - Philip L de Jager A1 - Marika A Kaakinen A1 - Kajantie, Eero A1 - Karhunen, Ville A1 - Kolcic, Ivana A1 - Kumari, Meena A1 - Lenore J Launer A1 - Lude L Franke A1 - Li-Gao, Ruifang A1 - Koini, Marisa A1 - Loukola, Anu A1 - Marques-Vidal, Pedro A1 - Grant W Montgomery A1 - Mosing, Miriam A A1 - Paternoster, Lavinia A1 - Pattie, Alison A1 - Katja E Petrovic A1 - Pulkki-Raback, Laura A1 - Quaye, Lydia A1 - Katri Räikkönen A1 - Rudan, Igor A1 - Rodney J Scott A1 - Jennifer A Smith A1 - Angelina R Sutin A1 - Trzaskowski, Maciej A1 - Anna A E Vinkhuyzen A1 - Lei Yu A1 - Zabaneh, Delilah A1 - John R. Attia A1 - David A Bennett A1 - Klaus Berger A1 - Bertram, Lars A1 - Dorret I Boomsma A1 - Snieder, Harold A1 - Chang, Shun-Chiao A1 - Francesco Cucca A1 - Ian J Deary A1 - Cornelia M van Duijn A1 - Johan G Eriksson A1 - Bültmann, Ute A1 - Eco J. C. de Geus A1 - Groenen, Patrick J F A1 - Gudnason, Vilmundur A1 - Hansen, Torben A1 - Catharina A Hartman A1 - Haworth, Claire M A A1 - Caroline Hayward A1 - Andrew C Heath A1 - Hinds, David A A1 - Hyppönen, Elina A1 - Iacono, William G A1 - Järvelin, Marjo-Riitta A1 - Jöckel, Karl-Heinz A1 - Kaprio, Jaakko A1 - Sharon L R Kardia A1 - Keltikangas-Järvinen, Liisa A1 - Kraft, Peter A1 - Laura D Kubzansky A1 - Lehtimäki, Terho A1 - Patrik K E Magnusson A1 - Nicholas G Martin A1 - McGue, Matt A1 - Andres Metspalu A1 - Melinda C Mills A1 - de Mutsert, Renée A1 - Oldehinkel, Albertine J A1 - Pasterkamp, Gerard A1 - Nancy L Pedersen A1 - Plomin, Robert A1 - Polasek, Ozren A1 - Power, Christine A1 - Rich, Stephen S A1 - Rosendaal, Frits R A1 - Hester M. den Ruijter A1 - Schlessinger, David A1 - Schmidt, Helena A1 - Svento, Rauli A1 - Schmidt, Reinhold A1 - Alizadeh, Behrooz Z A1 - Thorkild I. A. Sørensen A1 - Timothy Spector A1 - Andrew Steptoe A1 - Antonio Terracciano A1 - A. Roy Thurik A1 - Nicholas J Timpson A1 - Henning Tiemeier A1 - André G Uitterlinden A1 - Vollenweider, Peter A1 - Wagner, Gert G A1 - David R Weir A1 - Yang, Jian A1 - Dalton C Conley A1 - Hofman, Albert A1 - Johannesson, Magnus A1 - David I Laibson A1 - Sarah E Medland A1 - Meyer, Michelle N A1 - Pickrell, Joseph K A1 - Tõnu Esko A1 - Krueger, Robert F A1 - Jonathan P. Beauchamp A1 - Philipp D Koellinger A1 - Daniel J. Benjamin A1 - Bartels, Meike A1 - Cesarini, David KW - Anxiety Disorders KW - Bayes Theorem KW - depression KW - Genome-Wide Association Study KW - Humans KW - Neuroticism KW - Phenotype KW - Polymorphism, Single Nucleotide AB -

Very few genetic variants have been associated with depression and neuroticism, likely because of limitations on sample size in previous studies. Subjective well-being, a phenotype that is genetically correlated with both of these traits, has not yet been studied with genome-wide data. We conducted genome-wide association studies of three phenotypes: subjective well-being (n = 298,420), depressive symptoms (n = 161,460), and neuroticism (n = 170,911). We identify 3 variants associated with subjective well-being, 2 variants associated with depressive symptoms, and 11 variants associated with neuroticism, including 2 inversion polymorphisms. The two loci associated with depressive symptoms replicate in an independent depression sample. Joint analyses that exploit the high genetic correlations between the phenotypes (|ρ^| ≈ 0.8) strengthen the overall credibility of the findings and allow us to identify additional variants. Across our phenotypes, loci regulating expression in central nervous system and adrenal or pancreas tissues are strongly enriched for association.

VL - 48 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27089181?dopt=Abstract ER - TY - JOUR T1 - Genome-wide analysis identifies 12 loci influencing human reproductive behavior. JF - Nat Genet Y1 - 2016 A1 - Nicola Barban A1 - Jansen, Rick A1 - de Vlaming, Ronald A1 - Vaez, Ahmad A1 - Mandemakers, Jornt J A1 - Felix C Tropf A1 - Shen, Xia A1 - James F Wilson A1 - Daniel I Chasman A1 - Ilja M Nolte A1 - Tragante, Vinicius A1 - van der Laan, Sander W A1 - Perry, John R B A1 - Kong, Augustine A1 - Ahluwalia, Tarunveer S A1 - Albrecht, Eva A1 - Laura M Yerges-Armstrong A1 - Atzmon, Gil A1 - Auro, Kirsi A1 - Kristin L. Ayers A1 - Bakshi, Andrew A1 - Ben-Avraham, Danny A1 - Klaus Berger A1 - Bergman, Aviv A1 - Bertram, Lars A1 - Bielak, Lawrence F A1 - Bjornsdottir, Gyda A1 - Bonder, Marc Jan A1 - Broer, Linda A1 - Bui, Minh A1 - Barbieri, Caterina A1 - Cavadino, Alana A1 - Chavarro, Jorge E A1 - Turman, Constance A1 - Maria Pina Concas A1 - Cordell, Heather J A1 - Gail Davies A1 - Eibich, Peter A1 - Eriksson, Nicholas A1 - Tõnu Esko A1 - Eriksson, Joel A1 - Falahi, Fahimeh A1 - Felix, Janine F A1 - Mark Alan Fontana A1 - Lude L Franke A1 - Gandin, Ilaria A1 - Gaskins, Audrey J A1 - Gieger, Christian A1 - Gunderson, Erica P A1 - Guo, Xiuqing A1 - Caroline Hayward A1 - He, Chunyan A1 - Edith Hofer A1 - Huang, Hongyan A1 - Joshi, Peter K A1 - Kanoni, Stavroula A1 - Karlsson, Robert A1 - Kiechl, Stefan A1 - Kifley, Annette A1 - Kluttig, Alexander A1 - Kraft, Peter A1 - Lagou, Vasiliki A1 - Lecoeur, Cecile A1 - Lahti, Jari A1 - Li-Gao, Ruifang A1 - Penelope A Lind A1 - Tian Liu A1 - Makalic, Enes A1 - Mamasoula, Crysovalanto A1 - Lindsay K Matteson A1 - Mbarek, Hamdi A1 - McArdle, Patrick F A1 - McMahon, George A1 - Meddens, S Fleur W A1 - Mihailov, Evelin A1 - Michael B Miller A1 - Missmer, Stacey A A1 - Monnereau, Claire A1 - van der Most, Peter J A1 - Myhre, Ronny A1 - Michael A Nalls A1 - Nutile, Teresa A1 - Ioanna Panagiota Kalafati A1 - Porcu, Eleonora A1 - Prokopenko, Inga A1 - Rajan, Kumar B A1 - Rich-Edwards, Janet A1 - Cornelius A Rietveld A1 - Robino, Antonietta A1 - Rose, Lynda M A1 - Rueedi, Rico A1 - Ryan, Kathleen A A1 - Saba, Yasaman A1 - Schmidt, Daniel A1 - Jennifer A Smith A1 - Stolk, Lisette A1 - Streeten, Elizabeth A1 - Tönjes, Anke A1 - Thorleifsson, Gudmar A1 - Ulivi, Sheila A1 - Wedenoja, Juho A1 - Jürgen Wellmann A1 - Willeit, Peter A1 - Yao, Jie A1 - Yengo, Loic A1 - Jing Hua Zhao A1 - Wei Zhao A1 - Zhernakova, Daria V A1 - Amin, Najaf A1 - Andrews, Howard A1 - Balkau, Beverley A1 - Barzilai, Nir A1 - Bergmann, Sven A1 - Biino, Ginevra A1 - Bisgaard, Hans A1 - Bønnelykke, Klaus A1 - Dorret I Boomsma A1 - Buring, Julie E A1 - Campbell, Harry A1 - Cappellani, Stefania A1 - Ciullo, Marina A1 - Cox, Simon R A1 - Francesco Cucca A1 - Toniolo, Daniela A1 - Davey-Smith, George A1 - Ian J Deary A1 - George Dedoussis A1 - Deloukas, Panos A1 - Cornelia M van Duijn A1 - Eco J. C. de Geus A1 - Johan G Eriksson A1 - Jessica Faul A1 - Cinzia Felicita Sala A1 - Froguel, Philippe A1 - Paolo P. Gasparini A1 - Giorgia G Girotto A1 - Hans-Jörgen Grabe A1 - Greiser, Karin Halina A1 - Groenen, Patrick J F A1 - de Haan, Hugoline G A1 - Haerting, Johannes A1 - Tamara B Harris A1 - Andrew C Heath A1 - Heikkilä, Kauko A1 - Hofman, Albert A1 - Homuth, Georg A1 - Holliday, Elizabeth G A1 - John L Hopper A1 - Hyppönen, Elina A1 - Jacobsson, Bo A1 - Vincent Jaddoe A1 - Johannesson, Magnus A1 - Jugessur, Astanand A1 - Kähönen, Mika A1 - Kajantie, Eero A1 - Sharon L R Kardia A1 - Keavney, Bernard A1 - Kolcic, Ivana A1 - Koponen, Päivikki A1 - Kovacs, Peter A1 - Kronenberg, Florian A1 - Kutalik, Zoltán A1 - La Bianca, Martina A1 - Lachance, Genevieve A1 - Iacono, William G A1 - Lai, Sandra A1 - Lehtimäki, Terho A1 - David C Liewald A1 - Lindgren, Cecilia M A1 - Yongmei Liu A1 - Luben, Robert A1 - Lucht, Michael A1 - Luoto, Riitta A1 - Magnus, Per A1 - Patrik K E Magnusson A1 - Nicholas G Martin A1 - McGue, Matt A1 - McQuillan, Ruth A1 - Sarah E Medland A1 - Meisinger, Christa A1 - Mellström, Dan A1 - Andres Metspalu A1 - Traglia, Michela A1 - Lili Milani A1 - Mitchell, Paul A1 - Grant W Montgomery A1 - Dennis O Mook-Kanamori A1 - de Mutsert, Renée A1 - Nohr, Ellen A A1 - Ohlsson, Claes A1 - Olsen, Jørn A1 - Ong, Ken K A1 - Paternoster, Lavinia A1 - Pattie, Alison A1 - Brenda W J H Penninx A1 - Markus Perola A1 - Peyser, Patricia A A1 - Pirastu, Mario A1 - Polasek, Ozren A1 - Power, Chris A1 - Kaprio, Jaakko A1 - Raffel, Leslie J A1 - Katri Räikkönen A1 - Olli T Raitakari A1 - Ridker, Paul M A1 - Ring, Susan M A1 - Roll, Kathryn A1 - Rudan, Igor A1 - Ruggiero, Daniela A1 - Rujescu, Dan A1 - Veikko Salomaa A1 - Schlessinger, David A1 - Schmidt, Helena A1 - Schmidt, Reinhold A1 - Schupf, Nicole A1 - Johannes H Smit A1 - Sorice, Rossella A1 - Timothy Spector A1 - John M Starr A1 - Stöckl, Doris A1 - Strauch, Konstantin A1 - Stumvoll, Michael A1 - Swertz, Morris A A1 - Thorsteinsdottir, Unnur A1 - A. Roy Thurik A1 - Nicholas J Timpson A1 - Tung, Joyce Y A1 - André G Uitterlinden A1 - Vaccargiu, Simona A1 - Viikari, Jorma A1 - Vitart, Veronique A1 - Völzke, Henry A1 - Vollenweider, Peter A1 - Vuckovic, Dragana A1 - Waage, Johannes A1 - Wagner, Gert G A1 - Wang, Jie Jin A1 - Wareham, Nicholas J A1 - David R Weir A1 - Gonneke Willemsen A1 - Willeit, Johann A1 - Alan F Wright A1 - Krina T Zondervan A1 - Stefansson, Kari A1 - Krueger, Robert F A1 - Lee, James J A1 - Daniel J. Benjamin A1 - Cesarini, David A1 - Philipp D Koellinger A1 - den Hoed, Marcel A1 - Snieder, Harold A1 - Melinda C Mills AB -

The genetic architecture of human reproductive behavior-age at first birth (AFB) and number of children ever born (NEB)-has a strong relationship with fitness, human development, infertility and risk of neuropsychiatric disorders. However, very few genetic loci have been identified, and the underlying mechanisms of AFB and NEB are poorly understood. We report a large genome-wide association study of both sexes including 251,151 individuals for AFB and 343,072 individuals for NEB. We identified 12 independent loci that are significantly associated with AFB and/or NEB in a SNP-based genome-wide association study and 4 additional loci associated in a gene-based effort. These loci harbor genes that are likely to have a role, either directly or by affecting non-local gene expression, in human reproduction and infertility, thereby increasing understanding of these complex traits.

VL - 48 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27798627?dopt=Abstract ER - TY - JOUR T1 - Genome-wide association study identifies 74 loci associated with educational attainment. JF - Nature Y1 - 2016 A1 - Okbay, Aysu A1 - Jonathan P. Beauchamp A1 - Mark Alan Fontana A1 - Lee, James J A1 - Pers, Tune H A1 - Cornelius A Rietveld A1 - Turley, Patrick A1 - Chen, Guo-Bo A1 - Emilsson, Valur A1 - Meddens, S Fleur W A1 - Oskarsson, Sven A1 - Pickrell, Joseph K A1 - Thom, Kevin A1 - Pascal N Timshel A1 - de Vlaming, Ronald A1 - Abdel Abdellaoui A1 - Ahluwalia, Tarunveer S A1 - Bacelis, Jonas A1 - Baumbach, Clemens A1 - Bjornsdottir, Gyda A1 - Brandsma, Johannes H A1 - Maria Pina Concas A1 - Derringer, Jaime A1 - Furlotte, Nicholas A A1 - Galesloot, Tessel E A1 - Giorgia G Girotto A1 - Gupta, Richa A1 - Hall, Leanne M A1 - Sarah E Harris A1 - Edith Hofer A1 - Horikoshi, Momoko A1 - Huffman, Jennifer E A1 - Kaasik, Kadri A1 - Ioanna Panagiota Kalafati A1 - Karlsson, Robert A1 - Kong, Augustine A1 - Lahti, Jari A1 - Sven J van der Lee A1 - Christiaan de Leeuw A1 - Penelope A Lind A1 - Lindgren, Karl-Oskar A1 - Tian Liu A1 - Mangino, Massimo A1 - Marten, Jonathan A1 - Mihailov, Evelin A1 - Michael B Miller A1 - van der Most, Peter J A1 - Christopher J Oldmeadow A1 - Payton, Antony A1 - Pervjakova, Natalia A1 - Wouter J Peyrot A1 - Qian, Yong A1 - Olli T Raitakari A1 - Rueedi, Rico A1 - Salvi, Erika A1 - Schmidt, Börge A1 - Schraut, Katharina E A1 - Jianxin Shi A1 - Albert Vernon Smith A1 - Poot, Raymond A A1 - St Pourcain, Beate A1 - Teumer, Alexander A1 - Thorleifsson, Gudmar A1 - Verweij, Niek A1 - Vuckovic, Dragana A1 - Jürgen Wellmann A1 - Westra, Harm-Jan A1 - Yang, Jingyun A1 - Wei Zhao A1 - Zhihong Zhu A1 - Alizadeh, Behrooz Z A1 - Amin, Najaf A1 - Bakshi, Andrew A1 - Baumeister, Sebastian E A1 - Biino, Ginevra A1 - Bønnelykke, Klaus A1 - Patricia A. Boyle A1 - Campbell, Harry A1 - Cappuccio, Francesco P A1 - Gail Davies A1 - De Neve, Jan-Emmanuel A1 - Deloukas, Panos A1 - Demuth, Ilja A1 - Ding, Jun A1 - Eibich, Peter A1 - Eisele, Lewin A1 - Eklund, Niina A1 - Jessica Faul A1 - Feitosa, Mary F A1 - Andreas J Forstner A1 - Gandin, Ilaria A1 - Gunnarsson, Bjarni A1 - Halldórsson, Bjarni V A1 - Tamara B Harris A1 - Andrew C Heath A1 - Lynne J Hocking A1 - Holliday, Elizabeth G A1 - Homuth, Georg A1 - Horan, Michael A A1 - Jouke-Jan Hottenga A1 - Philip L de Jager A1 - Joshi, Peter K A1 - Jugessur, Astanand A1 - Marika A Kaakinen A1 - Kähönen, Mika A1 - Kanoni, Stavroula A1 - Keltigangas-Järvinen, Liisa A1 - Lambertus A Kiemeney A1 - Kolcic, Ivana A1 - Koskinen, Seppo A1 - Kraja, Aldi T A1 - Kroh, Martin A1 - Kutalik, Zoltán A1 - Latvala, Antti A1 - Lenore J Launer A1 - Lebreton, Maël P A1 - Douglas F Levinson A1 - Paul Lichtenstein A1 - Lichtner, Peter A1 - David C Liewald A1 - Loukola, Anu A1 - Pamela A F Madden A1 - Mägi, Reedik A1 - Mäki-Opas, Tomi A1 - Riccardo E Marioni A1 - Marques-Vidal, Pedro A1 - Meddens, Gerardus A A1 - McMahon, George A1 - Meisinger, Christa A1 - Meitinger, Thomas A1 - Milaneschi, Yusplitri A1 - Lili Milani A1 - Grant W Montgomery A1 - Myhre, Ronny A1 - Nelson, Christopher P A1 - Nyholt, Dale R A1 - William E R Ollier A1 - Aarno Palotie A1 - Paternoster, Lavinia A1 - Nancy L Pedersen A1 - Katja E Petrovic A1 - David J Porteous A1 - Katri Räikkönen A1 - Ring, Susan M A1 - Robino, Antonietta A1 - Rostapshova, Olga A1 - Rudan, Igor A1 - Rustichini, Aldo A1 - Veikko Salomaa A1 - Sanders, Alan R A1 - Sarin, Antti-Pekka A1 - Schmidt, Helena A1 - Rodney J Scott A1 - Smith, Blair H A1 - Jennifer A Smith A1 - Staessen, Jan A A1 - Steinhagen-Thiessen, Elisabeth A1 - Strauch, Konstantin A1 - Antonio Terracciano A1 - Tobin, Martin D A1 - Ulivi, Sheila A1 - Vaccargiu, Simona A1 - Quaye, Lydia A1 - van Rooij, Frank J A A1 - Venturini, Cristina A1 - Anna A E Vinkhuyzen A1 - Völker, Uwe A1 - Völzke, Henry A1 - Vonk, Judith M A1 - Vozzi, Diego A1 - Waage, Johannes A1 - Erin B Ware A1 - Gonneke Willemsen A1 - John R. Attia A1 - David A Bennett A1 - Klaus Berger A1 - Bertram, Lars A1 - Bisgaard, Hans A1 - Dorret I Boomsma A1 - Ingrid B Borecki A1 - Bültmann, Ute A1 - Chabris, Christopher F A1 - Francesco Cucca A1 - Cusi, Daniele A1 - Ian J Deary A1 - George Dedoussis A1 - Cornelia M van Duijn A1 - Johan G Eriksson A1 - Franke, Barbara A1 - Lude L Franke A1 - Paolo P. Gasparini A1 - Gejman, Pablo V A1 - Gieger, Christian A1 - Hans-Jörgen Grabe A1 - Gratten, Jacob A1 - Groenen, Patrick J F A1 - Gudnason, Vilmundur A1 - van der Harst, Pim A1 - Caroline Hayward A1 - Hinds, David A A1 - Hoffmann, Wolfgang A1 - Hyppönen, Elina A1 - Iacono, William G A1 - Jacobsson, Bo A1 - Järvelin, Marjo-Riitta A1 - Jöckel, Karl-Heinz A1 - Kaprio, Jaakko A1 - Sharon L R Kardia A1 - Lehtimäki, Terho A1 - Lehrer, Steven F A1 - Patrik K E Magnusson A1 - Nicholas G Martin A1 - McGue, Matt A1 - Andres Metspalu A1 - Pendleton, Neil A1 - Brenda W J H Penninx A1 - Markus Perola A1 - Nicola Pirastu A1 - Pirastu, Mario A1 - Polasek, Ozren A1 - Posthuma, Danielle A1 - Power, Christine A1 - Province, Michael A A1 - Nilesh J Samani A1 - Schlessinger, David A1 - Schmidt, Reinhold A1 - Thorkild I. A. Sørensen A1 - Timothy Spector A1 - Stefansson, Kari A1 - Thorsteinsdottir, Unnur A1 - A. Roy Thurik A1 - Nicholas J Timpson A1 - Henning Tiemeier A1 - Tung, Joyce Y A1 - André G Uitterlinden A1 - Vitart, Veronique A1 - Vollenweider, Peter A1 - David R Weir A1 - James F Wilson A1 - Alan F Wright A1 - Dalton C Conley A1 - Krueger, Robert F A1 - George Davey Smith A1 - Hofman, Albert A1 - David I Laibson A1 - Sarah E Medland A1 - Meyer, Michelle N A1 - Yang, Jian A1 - Johannesson, Magnus A1 - Peter M Visscher A1 - Tõnu Esko A1 - Philipp D Koellinger A1 - Cesarini, David A1 - Daniel J. Benjamin KW - Alzheimer's disease KW - Bipolar Disorder KW - Cognitive Ability KW - Education KW - Fetus KW - Genome-Wide Association Study KW - Humans KW - Molecular Sequence Annotation KW - Polymorphism, Single Nucleotide KW - Schizophrenia KW - United Kingdom AB -

Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20% of the variation across individuals. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases.

VL - 533 IS - 7604 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27225129?dopt=Abstract ER - TY - JOUR T1 - GWAS analysis of handgrip and lower body strength in older adults in the CHARGE consortium. JF - Aging Cell Y1 - 2016 A1 - Amy M Matteini A1 - Toshiko Tanaka A1 - Karasik, David A1 - Atzmon, Gil A1 - Chou, Wen-Chi A1 - John D Eicher A1 - Andrew D Johnson A1 - Alice M. Arnold A1 - Michele L Callisaya A1 - Gail Davies A1 - Daniel S Evans A1 - Holtfreter, Birte A1 - Kurt Lohman A1 - Kathryn L Lunetta A1 - Mangino, Massimo A1 - Albert Vernon Smith A1 - Jennifer A Smith A1 - Teumer, Alexander A1 - Lei Yu A1 - Dan E Arking A1 - Aron S Buchman A1 - Chibinik, Lori B A1 - Philip L de Jager A1 - Jessica Faul A1 - Melissa E Garcia A1 - Gillham-Nasenya, Irina A1 - Gudnason, Vilmundur A1 - Hofman, Albert A1 - Hsu, Yi-Hsiang A1 - Ittermann, Till A1 - Lahousse, Lies A1 - David C Liewald A1 - Yongmei Liu A1 - Lopez, Lorna A1 - Fernando Rivadeneira A1 - Rotter, Jerome I A1 - Siggeirsdottir, Kristin A1 - John M Starr A1 - Thomson, Russell A1 - Tranah, Gregory J A1 - André G Uitterlinden A1 - Völker, Uwe A1 - Völzke, Henry A1 - David R Weir A1 - Kristine Yaffe A1 - Wei Zhao A1 - Wei Vivian Zhuang A1 - Zmuda, Joseph M A1 - David A Bennett A1 - Steven R Cummings A1 - Ian J Deary A1 - Luigi Ferrucci A1 - Tamara B Harris A1 - Sharon L R Kardia A1 - Kocher, Thomas A1 - Stephen B Kritchevsky A1 - Psaty, Bruce M A1 - Seshadri, Sudha A1 - Timothy Spector A1 - Velandai K Srikanth A1 - Beverly G Windham A1 - Zillikens, M Carola A1 - Anne B Newman A1 - Jeremy D Walston A1 - Douglas P Kiel A1 - Joanne M Murabito KW - Adult KW - Aged KW - Chromatin Immunoprecipitation KW - Cohort Studies KW - Epigenesis, Genetic KW - Genome-Wide Association Study KW - Hand Strength KW - Humans KW - Molecular Sequence Annotation KW - Muscle Strength KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Reproducibility of Results AB -

Decline in muscle strength with aging is an important predictor of health trajectory in the elderly. Several factors, including genetics, are proposed contributors to variability in muscle strength. To identify genetic contributors to muscle strength, a meta-analysis of genomewide association studies of handgrip was conducted. Grip strength was measured using a handheld dynamometer in 27 581 individuals of European descent over 65 years of age from 14 cohort studies. Genomewide association analysis was conducted on ~2.7 million imputed and genotyped variants (SNPs). Replication of the most significant findings was conducted using data from 6393 individuals from three cohorts. GWAS of lower body strength was also characterized in a subset of cohorts. Two genomewide significant (P-value< 5 × 10(-8) ) and 39 suggestive (P-value< 5 × 10(-5) ) associations were observed from meta-analysis of the discovery cohorts. After meta-analysis with replication cohorts, genomewide significant association was observed for rs752045 on chromosome 8 (β = 0.47, SE = 0.08, P-value = 5.20 × 10(-10) ). This SNP is mapped to an intergenic region and is located within an accessible chromatin region (DNase hypersensitivity site) in skeletal muscle myotubes differentiated from the human skeletal muscle myoblasts cell line. This locus alters a binding motif of the CCAAT/enhancer-binding protein-β (CEBPB) that is implicated in muscle repair mechanisms. GWAS of lower body strength did not yield significant results. A common genetic variant in a chromosomal region that regulates myotube differentiation and muscle repair may contribute to variability in grip strength in the elderly. Further studies are needed to uncover the mechanisms that link this genetic variant with muscle strength.

VL - 15 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27325353?dopt=Abstract ER - TY - JOUR T1 - Health Literacy and Access to Care. JF - Journal of Health Communication Y1 - 2016 A1 - Helen G Levy A1 - Alexander T Janke KW - Aging KW - Health Literacy KW - Healthcare KW - Older Adults AB -

Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forgo needed care or to report difficulty finding a provider, even after we controlled for other factors, including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after we controlled for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way.

VL - 21 Suppl 1 ER - TY - JOUR T1 - Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study. JF - American Journal of Preventive Medicine Y1 - 2016 A1 - Cleopatra M Abdou A1 - Adam W. Fingerhut A1 - James S Jackson A1 - Felicia V Wheaton KW - Age Factors KW - Aged KW - Ageism KW - Attitude of Health Personnel KW - depression KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Mental Health KW - Middle Aged KW - Overweight KW - Physician-Patient Relations KW - Physicians KW - Prejudice KW - Racism KW - Sex Factors KW - Socioeconomic factors KW - Stereotyping AB -

INTRODUCTION: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care.

METHODS: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use.

RESULTS: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine.

CONCLUSIONS: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups.

PB - 50 VL - 50 IS - 2 U2 - PMC4755717 U4 - HEALTH CARE/Stereotypes/PHYSICIAN TRUST/Social identity/Social identity ER - TY - THES T1 - How Might Differences in Immigration Experiences for Men and Women Lead to Gender Disparities in Functional Limitations for Older Mexican Immigrants in the U.S.? Y1 - 2016 A1 - Stepler, Renee A. KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - A number of studies have shown that across all races and ethnicities women tend to have higher levels of functional limitations than men despite lower rates of mortality (Warner and Brown 2011; Solé-Auró et al. 2014). While several studies do incorporate Mexican-Americans and include nativity as a control, it is possible that Mexican-born immigrants' experiences differ from their U.S.-born counterparts in ways that may affect health later in life. Using longitudinal data from the Health and Retirement Study, this study investigates the factors that may account for differences in the strength and mobility limitations between older men and women who are Mexican immigrants living in the United States. These data indicate that socioeconomic status, chronic disease, and depressive symptoms serve as predictors for functional limitations later in life for Mexican-born men and women, and that each of these predictors serves as an explanation for differences in the functional status of these men and women. These findings extend research of gender disparities in morbidity by examining this subpopulation and highlight the importance of focusing on preventing comorbidities and depression, especially for women. PB - The George Washington University CY - Washington, DC VL - 1606805 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1758795190?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: N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2016 Last updated - 2016-02-17 U4 - 0493:Aging JO - How Might Differences in Immigration Experiences for Men and Women Lead to Gender Disparities in Functional Limitations for Older Mexican Immigrants in the U.S.? ER - TY - JOUR T1 - Job Strain as a Risk Factor for Incident Diabetes Mellitus in Middle and Older Age U.S. Workers. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Mutambudzi, Miriam A1 - Javed, Zulqarnain KW - Aged KW - Aging KW - Diabetes Mellitus KW - Female KW - Humans KW - Kaplan-Meier Estimate KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Factors KW - Stress, Psychological KW - United States KW - Work AB -

OBJECTIVES: The current study examined the relationship between the 4 quadrants of the job strain model and incident diabetes in U.S. working adults 50 years and older.

METHODS: This study used longitudinal data from the 2006-2012 waves of the Health and Retirement Study (n = 1,396). Kaplan-Meier survival curves and Cox proportional hazard regression models were used to examine whether job strain significantly predicted diabetes incidence.

RESULTS: Participants in high strain and passive jobs had significantly higher risk of diabetes relative to those in low strain jobs. In the univariate survival curves, significantly higher risk of diabetes was observed in men working in passive jobs. After adjustment for relevant covariates, participants in high strain (hazard ratio [HR] = 1.73, 95% confidence interval [CI] = 1.09-2.75) and passive (HR = 1.66, 95% CI = 1.01-2.73) jobs had a significantly increased risk of diabetes. Among adults 65 years and older, high strain and passive jobs were associated with an approximately fourfold increased risk of incident diabetes.

DISCUSSION: High strain and passive occupations which represent low control over work are associated with increased risk of diabetes incidence among older workers. More research is required to better understand how psychosocial work factors impact health in aging workers. Further, research should continue to explore gender differences in effects of job strain on diabetes.

VL - 71 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27445405?dopt=Abstract ER - TY - JOUR T1 - Marital Quality and Health in Middle and Later Adulthood: Dyadic Associations JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2016 A1 - Choi, Heejeong A1 - Yorgason, Jeremy B. A1 - Johnson, David R. KW - Adult children KW - Health Conditions and Status KW - Methodology AB - 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. PB - 71 VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/03/16/geronb.gbu222.abstract IS - 1 U4 - Actor partner interdependence model/Functional limitations/Marital quality/Perceived support/Self-rated health/Health and Retirement Study ER - TY - JOUR T1 - Measures of aging with disability in U.S. secondary data sets: Results of a scoping review JF - Disability and Health Journal Y1 - 2016 A1 - Putnam, Michelle A1 - Molton, Ivan R. A1 - Truitt, Anjali R. A1 - Smith, Amanda E. A1 - Jensen, Mark P. KW - Disabilities KW - Health Conditions and Status KW - Methodology AB - 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. PB - 9 VL - 9 UR - http://www.sciencedirect.com/science/article/pii/S1936657415000990 IS - 1 U4 - Aging/Disability/Disability/Secondary data/Measurement/Quantitative analysis ER - TY - JOUR T1 - Meta-analysis identifies common and rare variants influencing blood pressure and overlapping with metabolic trait loci. JF - Nat Genet Y1 - 2016 A1 - Liu, Chunyu A1 - Kraja, Aldi T A1 - Jennifer A Smith A1 - Brody, Jennifer A A1 - Franceschini, Nora A1 - Joshua C. Bis A1 - Kenneth Rice A1 - Alanna C Morrison A1 - Lu, Yingchang A1 - Weiss, Stefan A1 - Guo, Xiuqing A1 - Walter R Palmas A1 - Martin, Lisa W A1 - Yii-Der I Chen A1 - Surendran, Praveen A1 - Drenos, Fotios A1 - Cook, James P A1 - Auer, Paul L A1 - Chu, Audrey Y A1 - Giri, Ayush A1 - Wei Zhao A1 - Jakobsdottir, Johanna A1 - Lin, Li-An A1 - Stafford, Jeanette M A1 - Amin, Najaf A1 - Mei, Hao A1 - Yao, Jie A1 - Voorman, Arend A1 - Larson, Martin G A1 - Grove, Megan L A1 - Albert Vernon Smith A1 - Hwang, Shih-Jen A1 - Chen, Han A1 - Huan, Tianxiao A1 - Kosova, Gulum A1 - Stitziel, Nathan O A1 - Kathiresan, Sekar A1 - Nilesh J Samani A1 - Schunkert, Heribert A1 - Deloukas, Panos A1 - Li, Man A1 - Fuchsberger, Christian A1 - Pattaro, Cristian A1 - Gorski, Mathias A1 - Charles Kooperberg A1 - George J Papanicolaou A1 - Rossouw, Jacques E A1 - Jessica Faul A1 - Sharon L R Kardia A1 - Bouchard, Claude A1 - Raffel, Leslie J A1 - André G Uitterlinden A1 - Franco, Oscar H A1 - Ramachandran S Vasan A1 - O'Donnell, Christopher J A1 - Kent D Taylor A1 - Liu, Kiang A1 - Erwin P Bottinger A1 - Gottesman, Omri A1 - Daw, E Warwick A1 - Giulianini, Franco A1 - Ganesh, Santhi A1 - Salfati, Elias A1 - Tamara B Harris A1 - Lenore J Launer A1 - Dörr, Marcus A1 - Felix, Stephan B A1 - Rettig, Rainer A1 - Völzke, Henry A1 - Eric S Kim A1 - Lee, Wen-Jane A1 - Lee, I-Te A1 - Sheu, Wayne H-H A1 - Tsosie, Krystal S A1 - Digna R Velez Edwards A1 - Yongmei Liu A1 - Correa, Adolfo A1 - David R Weir A1 - Völker, Uwe A1 - Ridker, Paul M A1 - Boerwinkle, Eric A1 - Gudnason, Vilmundur A1 - Reiner, Alexander P A1 - Cornelia M van Duijn A1 - Ingrid B Borecki A1 - Edwards, Todd L A1 - Chakravarti, Aravinda A1 - Rotter, Jerome I A1 - Psaty, Bruce M A1 - Ruth J F Loos A1 - Myriam Fornage A1 - Georg B Ehret A1 - Newton-Cheh, Christopher A1 - Levy, Daniel A1 - Daniel I Chasman AB -

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.

VL - 48 IS - 10 ER - TY - RPRT T1 - Occupational Choice, Retirement, and the Effects of Disability Insurance Y1 - 2016 A1 - Lindsay Jacobs KW - disability insurance KW - Occupational choice KW - Retirement AB - There is much variation in the physical requirements across occupations, giving rise to great differences in later-life productivity, disability risk, and the value of Social Security Disability Insurance (SSDI). In this paper, I look at how such differences across occupations affect initial career choice as well as the extent to which SSDI, which insures shocks to productivity due to disability, prompts more people to choose physically intense occupations. Using data from the Health and Retirement Study (HRS) and the Current Population Survey (CPS), I estimate a dynamic model of occupational choice and retirement with heterogeneous agents and equilibrium effects on earnings across occupations. I document the differences between blue-collar and white-collar occupations in the effects of declining health and disability on productivity, which affects labor supply in later life and, in the context of a life-cycle model, influences the occupation decision. Through counterfactual exercises, I show that the additional disability risk in blue-collar jobs relative to white-collar jobs is equivalent to an additional six percentage point reduction in lifetime consumption and that the absence of SSDI, which insures some of this risk, would be equivalent to, respectively, a twelve and seven percent reduction in consumption for those in blue- and white- collar jobs. Furthermore, I find that the presence of SSDI results in three percent more individuals choosing blue-collar occupations, which is comparable to the effect on occupation selection resulting from an eight-percent increase in blue-collar earnings. This overall effect, however, masks the importance of the selection of less risk-averse individuals into blue-collar jobs and the equilibrium effects on wages; earnings for the most risk-averse type would have to be nearly fifteen percent greater to choose blue-collar{{p}}occupations in the absence of SSDI. JF - Finance and Economics Discussion Series PB - Board of Governors of the Federal Reserve System ER - TY - JOUR T1 - Personality Polygenes, Positive Affect, and Life Satisfaction. JF - Twin Res Hum Genet Y1 - 2016 A1 - Weiss, Alexander A1 - Baselmans, Bart M L A1 - Edith Hofer A1 - Yang, Jingyun A1 - Okbay, Aysu A1 - Penelope A Lind A1 - Michael B Miller A1 - Ilja M Nolte A1 - Wei Zhao A1 - Hagenaars, Saskia P A1 - Jouke-Jan Hottenga A1 - Lindsay K Matteson A1 - Snieder, Harold A1 - Jessica Faul A1 - Catharina A Hartman A1 - Patricia A. Boyle A1 - Henning Tiemeier A1 - Mosing, Miriam A A1 - Pattie, Alison A1 - Gail Davies A1 - David C Liewald A1 - Schmidt, Reinhold A1 - Philip L de Jager A1 - Andrew C Heath A1 - Markus Jokela A1 - John M Starr A1 - Oldehinkel, Albertine J A1 - Johannesson, Magnus A1 - Cesarini, David A1 - Hofman, Albert A1 - Sarah E Harris A1 - Jennifer A Smith A1 - Keltikangas-Järvinen, Liisa A1 - Pulkki-Raback, Laura A1 - Schmidt, Helena A1 - Jacqui Smith A1 - Iacono, William G A1 - McGue, Matt A1 - David A Bennett A1 - Nancy L Pedersen A1 - Patrik K E Magnusson A1 - Ian J Deary A1 - Nicholas G Martin A1 - Dorret I Boomsma A1 - Bartels, Meike A1 - Luciano, Michelle KW - Genetics KW - Happiness KW - Polygenic Prediction KW - SSGAC KW - Well-being AB -

Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.

VL - 19 IS - 5 ER - TY - JOUR T1 - Physical, Cognitive, Social, and Emotional Mediators of Activity Involvement and Health in Later Life. JF - Res Aging Y1 - 2016 A1 - Matz-Costa, Christina A1 - Dawn C Carr A1 - Tay K. McNamara A1 - Jacquelyn Boone James KW - Aged KW - depression KW - Efficiency KW - Employment KW - Exercise KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Quality of Life KW - Volunteers AB -

The current study tests the indirect effect of activity-related physical activity, cognitive activity, social interaction, and emotional exchange on the relationship between activity involvement and health (physical and emotional) in later life. Longitudinal data from the Health and Retirement Study (N = 5,442) were used to estimate a series of linear regression models. We found significant indirect effects for social interaction and benefit to others (emotional exchange) on emotional health (depressive symptoms) and indirect effects for use of body and benefit to others (physical) on physical health (frailty). The most potent indirect effect associated with emotional and physical health was experienced by those engaged in all four domains (use of body, use of mind, social interaction, and benefit to others). While effect sizes are small and results should be interpreted with caution, findings shed light on ways in which public health interventions aimed toward increasing role engagement in later life could be improved.

VL - 38 UR - http://roa.sagepub.com/content/early/2015/09/30/0164027515606182.abstract IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26429863?dopt=Abstract U4 - activity levels/productivity/employment/volunteer activity/health outcomes ER - TY - JOUR T1 - A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf. JF - BMC Health Serv Res Y1 - 2016 A1 - Frederic D Wolinsky A1 - Ayres, Lioness A1 - Michael P Jones A1 - Yiyue Lou A1 - George L Wehby A1 - Fred A Ullrich KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Epidemiologic Methods KW - Female KW - Health Status KW - Hospitalization KW - Humans KW - Iowa KW - Male KW - Medicare KW - Middle Aged KW - Patient Acceptance of Health Care KW - Physicians KW - Proxy KW - Spouses KW - United States AB -

BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.

METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.

RESULTS: PABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = -0.21 to 0.60) for health ratings, and physician and dental visits.

CONCLUSIONS: These results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses' Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.

VL - 16 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27612571?dopt=Abstract ER - TY - JOUR T1 - Predictors of bone mineral density testing among older women on Medicare. JF - Osteoporos Int Y1 - 2016 A1 - Yiyue Lou A1 - Edmonds, S. W. A1 - Michael P Jones A1 - Fred A Ullrich A1 - George L Wehby A1 - Cram, P. A1 - Frederic D Wolinsky KW - Absorptiometry, Photon KW - Aged KW - Bone density KW - Delivery of Health Care KW - Female KW - Humans KW - Medicare KW - Osteoporosis KW - Prospective Studies KW - United States AB -

Although dual-energy X-ray absorptiometry (DXA) is recommended for all women ≥65 and is covered by Medicare, 40 % of women on Medicare report never having had a DXA. In a longitudinal cohort of 3492 women followed for two decades, we identified several risk factors that should be targeted to improve DXA testing rates.

INTRODUCTION: DXA is used to measure bone mineral density, screen for osteoporosis, and assess fracture risk. DXA is recommended for all women ≥65 years old. Although Medicare covers DXA every 24 months for women, about 40 % report never having had a DXA test, and little is known from prospective cohort studies about which subgroups of women have low use rates and should be targeted for interventions. Our objective was to identify predictors of DXA use in a nationally representative cohort of women on Medicare.

METHODS: We used baseline and biennial follow-up survey data (1993-2012) for 3492 women ≥70 years old from the nationally representative closed cohort known as the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The survey data for these women were then linked to their Medicare claims (1991-2012), yielding 17,345 person years of observation. DXA tests were identified from the Medicare claims, and Cox proportional hazard regression models were used with both fixed and time-dependent predictors from the survey interviews including demographic characteristics, socioeconomic factors, health status, health habits, and the living environment.

RESULTS: DXA use was positively associated with being Hispanic American, better cognition, higher income, having arthritis, using other preventative services, and living in Florida or other southern states. DXA use was negatively associated with age, being African-American, being overweight or obese, having mobility limitations, and smoking.

CONCLUSIONS: Interventions to increase DXA use should target the characteristics that were observed here to be negatively associated with such screening.

VL - 27 UR - http://link.springer.com/10.1007/s00198-016-3688-2 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27358177?dopt=Abstract JO - Osteoporos Int ER - TY - JOUR T1 - Prescription Drug Insurance and Cost-Related Medication Nonadherence among Medicare Seniors: Findings from Two National Surveys JF - Journal of Pharmaceutical Health Services Research Y1 - 2016 A1 - Gail A Jensen A1 - Xiao Xu KW - Healthcare AB - Objectives Numerous studies suggest that cost-related nonadherence (CRN) to prescribed medications can have potentially devastating consequences, particularly for seniors with chronic illnesses, such as cardiovascular disease or diabetes. In this study, we examined if and how having drug insurance was associated with the occurrence of CRN among older adults, and assessed the role of chronic health conditions in moderating this relationship. Methods Using two independent and nationally representative data sources, the ongoing Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS), we estimated the prevalence of CRN among Medicare seniors who reported regularly taking prescribed medication. We then ran multivariable regression models to quantify the relationship between drug insurance and the occurrence of CRN. The potential endogeneity of drug insurance was carefully investigated. Key findings We observed CRN among 2.4 of seniors over the past 12 months (based on MEPS data), and 7.0 of seniors over the past 24 months (based on HRS data). Among seniors with multiple chronic conditions, having insurance was associated with a lower likelihood of CRN, both over the past 12 months (OR = 0.483, 95 CI, 0.281 to 0.830), and over the past 24 months (OR = 0.321, 95 CI, 0.258 to 0.398). Among seniors with one or no chronic conditions this relationship was weaker, both over the past 12 months (OR = 0.667, 95 CI, 0.299 to 1.489), and over the past 24 months (OR = 0.346, 95 CI, 0.247 to 0.486). Conclusions Drug insurance was associated with a lower rate of CRN, particularly among seniors with multiple chronic conditions. PB - 7 VL - 7 UR - http://dx.doi.org/10.1111/jphs.12116 IS - 1 U4 - cost-related/drug insurance/medication nonadherence/Prescription drug costs/Chronic health conditions ER - TY - JOUR T1 - Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study. JF - J Am Geriatr Soc Y1 - 2016 A1 - David C. Currow A1 - Amy P Abernethy A1 - Miriam J Johnson A1 - Yinghui Miao A1 - W John Boscardin A1 - Christine S Ritchie KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Anxiety KW - Chronic disease KW - Comorbidity KW - depression KW - Dyspnea KW - Female KW - Geriatric Assessment KW - Hospitalization KW - Humans KW - Male KW - Prevalence KW - Proportional Hazards Models KW - Risk Assessment KW - Risk Factors KW - Symptom Assessment KW - United States AB -

OBJECTIVES: To determine the prevalence and outcomes of breathlessness in older Americans.

SETTING: Community-dwelling older adults.

PARTICIPANTS: Individuals aged 70 and older in the nationally representative Health and Retirement Study (2008, follow-up through 2012) (N = 3,671; mean age 78).

MEASUREMENTS: Breathlessness was assessed by asking the question, "How often do you become short of breath while awake?" Responses of often or sometimes were considered to represent a level of breathlessness sufficient to warrant clinical attention. The prevalence of breathlessness is described overall and in subpopulations, then rates of associated symptoms, well-being, and health services use of participants who were breathless are compared with rates of those who were not. The risk of decline in activities of daily living (ADLs) and death through 2012 was estimated by creating a multivariable Cox proportional hazards model, adjusting for age, sex, race and ethnicity, and education.

RESULTS: Twenty-five percent of participants reported breathlessness. The prevalence of breathlessness was higher in certain subpopulations: chronic lung disease (63%), multimorbidity (≥2 chronic conditions) (45%), current smokers (38%), heart disease (36%), obesity (body mass index ≥30.0 kg/m ) (33%), and education less than high school (32%). Breathlessness was associated with higher rates of depression, anxiety, and severe fatigue; lower ratings of well-being; and higher rates of clinic and emergency department visits and hospitalizations (all P < .001). Breathlessness predicted ADL decline over 5 years (adjusted hazard ratio (aHR) = 1.43, 95% confidence interval (CI) = 1.22-1.68) and death (aHR 1.62, 95% CI = 1.32-2.02).

CONCLUSION: One in four adults aged 70 and older in the United States experiences breathlessness, which is associated with lack of well-being, greater health services use, and a 40% greater risk of worsened function and 60% greater risk of death over the next 5 years.

VL - 64 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27603500?dopt=Abstract ER - TY - JOUR T1 - Savings After Retirement: A Survey JF - Annual Review of Economics Y1 - 2016 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones VL - 8 UR - http://www.annualreviews.org/doi/10.1146/annurev-economics-080315-015127 IS - 1 JO - Annu. Rev. Econ. ER - TY - JOUR T1 - Cognitive function and the concordance between survey reports and Medicare claims in a nationally representative cohort of older adults. JF - Med Care Y1 - 2015 A1 - Frederic D Wolinsky A1 - Michael P Jones A1 - Fred A Ullrich A1 - Yiyue Lou A1 - George L Wehby KW - Aged KW - Aging KW - Cognition Disorders KW - Data collection KW - Female KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare KW - Mental Health KW - Psychiatric Status Rating Scales KW - Self Report KW - United States AB -

BACKGROUND: While age-related cognitive decline may affect all stages in the response process--comprehension, retrieval, judgment, response selection, and response reporting--the associations between objective cognitive tests and the agreement between self-reports and Medicare claims has not been assessed. We evaluate those associations using the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD).

METHODS: Eight waves of reinterviews (1995-2010) were linked to Medicare claims for 3661 self-respondents yielding 12,313 person-period observations. Cognitive function was measured by 2 episodic memory tests (immediate and delayed recall of 10 words) and 1 mental status test (backward counting, dates, and names). Survey reports on 12 diseases and 4 health services were mapped to Medicare claims to derive counts of concordant reports, underreports, and overreports, as were the numbers of hospital episodes and physician visits. GEE negative binomial and logistic regression models were used.

RESULTS: Better mental status was associated with more concordant reporting and less underreporting on disease history and the number of hospital episodes. Better mental status and delayed word recall were associated with more concordant reporting and less underreporting on health services use. Better delayed recall was significantly associated with less underreporting on the number of physician visits. These associations were not appreciably altered by adjustment for demographic characteristics, socioeconomic status, self-rated health, or secular trends.

CONCLUSION: We recommend that future surveys of older adults include an objective measure of mental status (rather than memory), especially when those survey reports cannot be verified by access to Medicare claims or chart review.

VL - 53 UR - https://www.ncbi.nlm.nih.gov/pubmed/25793268 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25793268?dopt=Abstract ER - TY - JOUR T1 - Contribution of common non-synonymous variants in PCSK1 to body mass index variation and risk of obesity: a systematic review and meta-analysis with evidence from up to 331 175 individuals. JF - Human Molecular Genetics Y1 - 2015 A1 - Nead, Kevin T A1 - Li, Aihua A1 - Wehner, Mackenzie R A1 - Neupane, Binod A1 - Gustafsson, Stefan A1 - Adam S Butterworth A1 - Engert, James C A1 - Davis, A Darlene A1 - Hegele, Robert A A1 - Miller, Ruby A1 - den Hoed, Marcel A1 - Khaw, Kay-Tee A1 - Kilpeläinen, Tuomas O A1 - Wareham, Nick A1 - Edwards, Todd L A1 - Hallmans, Göran A1 - Varga, Tibor V A1 - Sharon L R Kardia A1 - Smith, Jennifer A A1 - Zhao, Wei A1 - Jessica Faul A1 - David R Weir A1 - Mi, Jie A1 - Xi, Bo A1 - Quinteros, Samuel Canizales A1 - Cooper, Cyrus A1 - Sayer, Avan Aihie A1 - Jameson, Karen A1 - Grøntved, Anders A1 - Myriam Fornage A1 - Stephen Sidney A1 - Hanis, Craig L A1 - Highland, Heather M A1 - Häring, Hans-Ulrich A1 - Heni, Martin A1 - Lasky-Su, Jessica A1 - Weiss, Scott T A1 - Gerhard, Glenn S A1 - Still, Christopher A1 - Melka, Melkaey M A1 - Pausova, Zdenka A1 - Paus, Tomáš A1 - Grant, Struan F A A1 - Hakonarson, Hakon A1 - Price, R Arlen A1 - Wang, Kai A1 - Scherag, Andre A1 - Hebebrand, Johannes A1 - Hinney, Anke A1 - Franks, Paul W A1 - Timothy M Frayling A1 - McCarthy, Mark I A1 - Hirschhorn, Joel N A1 - Ruth J F Loos A1 - Ingelsson, Erik A1 - Gerstein, Hertzel C A1 - Yusuf, Salim A1 - Beyene, Joseph A1 - Anand, Sonia S A1 - Meyre, David KW - Alleles KW - Body Mass Index KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Humans KW - Obesity KW - Odds Ratio KW - Polymorphism, Single Nucleotide KW - Proprotein Convertase 1 AB -

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

VL - 24 IS - 12 ER - TY - JOUR T1 - Cost of informal caregiving for patients with heart failure. JF - Am Heart J Y1 - 2015 A1 - Heesoo Joo A1 - Fang, Jing A1 - Jan L Losby A1 - Wang, Guijing KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Heart Failure KW - Humans KW - Linear Models KW - Male KW - Middle Aged KW - Models, Econometric AB -

BACKGROUND: Heart failure is a serious health condition that requires a significant amount of informal care. However, informal caregiving costs associated with heart failure are largely unknown.

METHODS: We used a study sample of noninstitutionalized US respondents aged ≥50 years from the 2010 HRS (n = 19,762). Heart failure cases were defined by using self-reported information. The weekly informal caregiving hours were derived by a sequence of survey questions assessing (1) whether respondents had any difficulties in activities of daily living or instrumental activities of daily living, (2) whether they had caregivers because of reported difficulties, (3) the relationship between the patient and the caregiver, (4) whether caregivers were paid, and (5) how many hours per week each informal caregiver provided help. We used a 2-part econometric model to estimate the informal caregiving hours associated with heart failure. The first part was a logit model to estimate the likelihood of using informal caregiving, and the second was a generalized linear model to estimate the amount of informal caregiving hours used among those who used informal caregiving. Replacement approach was used to estimate informal caregiving cost.

RESULTS: The 943 (3.9%) respondents who self-reported as ever being diagnosed with heart failure used about 1.6 more hours of informal caregiving per week than those who did not have heart failure (P < .001). Informal caregiving hours associated with heart failure were higher among non-Hispanic blacks (3.9 hours/week) than non-Hispanic whites (1.4 hours/week). The estimated annual informal caregiving cost attributable to heart failure was $3 billion in 2010.

CONCLUSION: The cost of informal caregiving was substantial and should be included in estimating the economic burden of heart failure. The results should help public health decision makers in understanding the economic burden of heart failure and in setting public health priorities.

PB - 169 VL - 169 UR - http://search.proquest.com/docview/1634498117/abstract/1B5FA0446C27487FPQ/46http://ac.els-cdn.com/S0002870314006176/1-s2.0-S0002870314006176-main.pdf?_tid=0594e8aa-b649-11e5-862d-00000aab0f6bandacdnat=1452286224_94f2bbbda86fc78991ea145942769029http://medi IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25497259?dopt=Abstract U2 - PMC4392718 U4 - Caregivers/Chronic illnesses/Costs/Cardiovascular Diseases/Mortality/Older people/Informal caregiver/Health Care Costs ER - TY - JOUR T1 - Couples' and Singles' Savings after Retirement JF - SSRN Electronic Journal Y1 - 2015 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones KW - Marriage KW - Older Adults KW - Retirement Planning and Satisfaction KW - Singles AB - We model the saving problem of retired couples and singles facing uncertain longevity and medical expenses in presence of means-tested social insurance. Households can save to self-insure against uncertain longevity and medical expenses, and to leave bequests. Individuals in a couple can be altruistic towards their spouse and other heirs and split bequests optimally. Single people can care about leaving bequests to children and others. Using AHEAD data, we first estimate the model and we then evaluate the relative importance of the various savings motives and the risk exposure of couples’ versus singles. UR - http://www.ssrn.com/abstract=2664111 JO - SSRN Journal ER - TY - JOUR T1 - Directional dominance on stature and cognition in diverse human populations. JF - Nature Y1 - 2015 A1 - Joshi, Peter K A1 - Tõnu Esko A1 - Mattsson, Hannele A1 - Eklund, Niina A1 - Gandin, Ilaria A1 - Nutile, Teresa A1 - Jackson, Anne U A1 - Schurmann, Claudia A1 - Albert Vernon Smith A1 - Zhang, Weihua A1 - Okada, Yukinori A1 - Stančáková, Alena A1 - Jessica Faul A1 - Wei Zhao A1 - Traci M Bartz A1 - Maria Pina Concas A1 - Franceschini, Nora A1 - Enroth, Stefan A1 - Vitart, Veronique A1 - Trompet, Stella A1 - Guo, Xiuqing A1 - Daniel I Chasman A1 - Jeff O'Connell A1 - Corre, Tanguy A1 - Nongmaithem, Suraj S A1 - Chen, Yuning A1 - Mangino, Massimo A1 - Ruggiero, Daniela A1 - Traglia, Michela A1 - Farmaki, Aliki-Eleni A1 - Kacprowski, Tim A1 - Bjonnes, Andrew A1 - van der Spek, Ashley A1 - Wu, Ying A1 - Giri, Anil K A1 - Yanek, Lisa R A1 - Wang, Lihua A1 - Edith Hofer A1 - Cornelius A Rietveld A1 - McLeod, Olga A1 - Marilyn C Cornelis A1 - Pattaro, Cristian A1 - Verweij, Niek A1 - Baumbach, Clemens A1 - Abdel Abdellaoui A1 - Warren, Helen R A1 - Vuckovic, Dragana A1 - Mei, Hao A1 - Bouchard, Claude A1 - Perry, John R B A1 - Cappellani, Stefania A1 - Saira S Mirza A1 - Benton, Miles C A1 - Broeckel, Ulrich A1 - Sarah E Medland A1 - Penelope A Lind A1 - Malerba, Giovanni A1 - Alexander W Drong A1 - Yengo, Loic A1 - Bielak, Lawrence F A1 - Zhi, Degui A1 - van der Most, Peter J A1 - Daniel Shriner A1 - Mägi, Reedik A1 - Hemani, Gibran A1 - Karaderi, Tugce A1 - Wang, Zhaoming A1 - Tian Liu A1 - Demuth, Ilja A1 - Jing Hua Zhao A1 - Meng, Weihua A1 - Lataniotis, Lazaros A1 - van der Laan, Sander W A1 - Bradfield, Jonathan P A1 - Andrew R Wood A1 - Bonnefond, Amelie A1 - Ahluwalia, Tarunveer S A1 - Hall, Leanne M A1 - Salvi, Erika A1 - Yazar, Seyhan A1 - Carstensen, Lisbeth A1 - de Haan, Hugoline G A1 - Abney, Mark A1 - Afzal, Uzma A1 - Matthew A. Allison A1 - Amin, Najaf A1 - Asselbergs, Folkert W A1 - Bakker, Stephan J L A1 - Barr, R Graham A1 - Baumeister, Sebastian E A1 - Daniel J. Benjamin A1 - Bergmann, Sven A1 - Boerwinkle, Eric A1 - Erwin P Bottinger A1 - Campbell, Archie A1 - Chakravarti, Aravinda A1 - Chan, Yingleong A1 - Chanock, Stephen J A1 - Chen, Constance A1 - Yii-Der I Chen A1 - Collins, Francis S A1 - Connell, John A1 - Correa, Adolfo A1 - Cupples, L Adrienne A1 - Gail Davies A1 - Dörr, Marcus A1 - Georg B Ehret A1 - Ellis, Stephen B A1 - Feenstra, Bjarke A1 - Feitosa, Mary F A1 - Ford, Ian A1 - Caroline S Fox A1 - Timothy M Frayling A1 - Friedrich, Nele A1 - Geller, Frank A1 - Scotland, Generation A1 - Gillham-Nasenya, Irina A1 - Gottesman, Omri A1 - Graff, Misa A1 - Grodstein, Francine A1 - Gu, Charles A1 - Haley, Chris A1 - Hammond, Christopher J A1 - Sarah E Harris A1 - Tamara B Harris A1 - Nicholas D Hastie A1 - Heard-Costa, Nancy L A1 - Heikkilä, Kauko A1 - Lynne J Hocking A1 - Homuth, Georg A1 - Jouke-Jan Hottenga A1 - Huang, Jinyan A1 - Huffman, Jennifer E A1 - Hysi, Pirro G A1 - Mohammed Arfan Ikram A1 - Ingelsson, Erik A1 - Joensuu, Anni A1 - Johansson, Åsa A1 - Jousilahti, Pekka A1 - Jukema, J Wouter A1 - Kähönen, Mika A1 - Kamatani, Yoichiro A1 - Kanoni, Stavroula A1 - Kerr, Shona M A1 - Khan, Nazir M A1 - Philipp D Koellinger A1 - Koistinen, Heikki A A1 - Kooner, Manraj K A1 - Kubo, Michiaki A1 - Kuusisto, Johanna A1 - Lahti, Jari A1 - Lenore J Launer A1 - Lea, Rodney A A1 - Lehne, Benjamin A1 - Lehtimäki, Terho A1 - David C Liewald A1 - Lars Lind A1 - Loh, Marie A1 - Lokki, Marja-Liisa A1 - London, Stephanie J A1 - Loomis, Stephanie J A1 - Loukola, Anu A1 - Lu, Yingchang A1 - Lumley, Thomas A1 - Lundqvist, Annamari A1 - Männistö, Satu A1 - Marques-Vidal, Pedro A1 - Masciullo, Corrado A1 - Matchan, Angela A1 - Mathias, Rasika A A1 - Matsuda, Koichi A1 - Meigs, James B A1 - Meisinger, Christa A1 - Meitinger, Thomas A1 - Menni, Cristina A1 - Mentch, Frank D A1 - Mihailov, Evelin A1 - Lili Milani A1 - Montasser, May E A1 - Grant W Montgomery A1 - Alanna C Morrison A1 - Myers, Richard H A1 - Nadukuru, Rajiv A1 - Navarro, Pau A1 - Nelis, Mari A1 - Nieminen, Markku S A1 - Ilja M Nolte A1 - O'Connor, George T A1 - Ogunniyi, Adesola A1 - Padmanabhan, Sandosh A1 - Walter R Palmas A1 - Pankow, James S A1 - Patarcic, Inga A1 - Pavani, Francesca A1 - Peyser, Patricia A A1 - Pietilainen, Kirsi A1 - Neil Poulter A1 - Prokopenko, Inga A1 - Ralhan, Sarju A1 - Redmond, Paul A1 - Rich, Stephen S A1 - Rissanen, Harri A1 - Robino, Antonietta A1 - Rose, Lynda M A1 - Rose, Richard A1 - Cinzia Felicita Sala A1 - Babatunde Salako A1 - Veikko Salomaa A1 - Sarin, Antti-Pekka A1 - Saxena, Richa A1 - Schmidt, Helena A1 - Scott, Laura J A1 - Scott, William R A1 - Sennblad, Bengt A1 - Seshadri, Sudha A1 - Peter Sever A1 - Shrestha, Smeeta A1 - Smith, Blair H A1 - Jennifer A Smith A1 - Soranzo, Nicole A1 - Sotoodehnia, Nona A1 - Southam, Lorraine A1 - Stanton, Alice V A1 - Stathopoulou, Maria G A1 - Strauch, Konstantin A1 - Strawbridge, Rona J A1 - Suderman, Matthew J A1 - Tandon, Nikhil A1 - Tang, Sian-Tsun A1 - Kent D Taylor A1 - Bamidele O Tayo A1 - Töglhofer, Anna Maria A1 - Tomaszewski, Maciej A1 - Tšernikova, Natalia A1 - Tuomilehto, Jaakko A1 - André G Uitterlinden A1 - Vaidya, Dhananjay A1 - van Hylckama Vlieg, Astrid A1 - van Setten, Jessica A1 - Vasankari, Tuula A1 - Vedantam, Sailaja A1 - Vlachopoulou, Efthymia A1 - Vozzi, Diego A1 - Vuoksimaa, Eero A1 - Waldenberger, Melanie A1 - Erin B Ware A1 - Wentworth-Shields, William A1 - Whitfield, John B A1 - Sarah Wild A1 - Gonneke Willemsen A1 - Yajnik, Chittaranjan S A1 - Yao, Jie A1 - Zaza, Gianluigi A1 - Zhu, Xiaofeng A1 - Salem, Rany M A1 - Melbye, Mads A1 - Bisgaard, Hans A1 - Nilesh J Samani A1 - Cusi, Daniele A1 - Mackey, David A A1 - Cooper, Richard S A1 - Froguel, Philippe A1 - Pasterkamp, Gerard A1 - Grant, Struan F A A1 - Hakonarson, Hakon A1 - Luigi Ferrucci A1 - Scott, Robert A A1 - Morris, Andrew D A1 - Palmer, Colin N A A1 - George Dedoussis A1 - Deloukas, Panos A1 - Bertram, Lars A1 - Lindenberger, Ulman A1 - Berndt, Sonja I A1 - Lindgren, Cecilia M A1 - Nicholas J Timpson A1 - Tönjes, Anke A1 - Munroe, Patricia B A1 - Thorkild I. A. Sørensen A1 - Charles N Rotimi A1 - Donna K Arnett A1 - Oldehinkel, Albertine J A1 - Sharon L R Kardia A1 - Balkau, Beverley A1 - Gambaro, Giovanni A1 - Morris, Andrew P A1 - Johan G Eriksson A1 - Margaret J Wright A1 - Nicholas G Martin A1 - Hunt, Steven C A1 - John M Starr A1 - Ian J Deary A1 - Griffiths, Lyn R A1 - Henning Tiemeier A1 - Nicola Pirastu A1 - Kaprio, Jaakko A1 - Wareham, Nicholas J A1 - Pérusse, Louis A1 - Wilson, James G A1 - Giorgia G Girotto A1 - Caulfield, Mark J A1 - Olli T Raitakari A1 - Dorret I Boomsma A1 - Gieger, Christian A1 - van der Harst, Pim A1 - Hicks, Andrew A A1 - Kraft, Peter A1 - Sinisalo, Juha A1 - Knekt, Paul A1 - Johannesson, Magnus A1 - Patrik K E Magnusson A1 - Hamsten, Anders A1 - Schmidt, Reinhold A1 - Ingrid B Borecki A1 - Vartiainen, Erkki A1 - Becker, Diane M A1 - Bharadwaj, Dwaipayan A1 - Mohlke, Karen L A1 - Boehnke, Michael A1 - Cornelia M van Duijn A1 - Sanghera, Dharambir K A1 - Teumer, Alexander A1 - Zeggini, Eleftheria A1 - Andres Metspalu A1 - Paolo P. Gasparini A1 - Ulivi, Sheila A1 - Ober, Carole A1 - Toniolo, Daniela A1 - Rudan, Igor A1 - David J Porteous A1 - Ciullo, Marina A1 - Timothy Spector A1 - Caroline Hayward A1 - Dupuis, Josée A1 - Ruth J F Loos A1 - Alan F Wright A1 - Chandak, Giriraj R A1 - Vollenweider, Peter A1 - Alan R Shuldiner A1 - Ridker, Paul M A1 - Rotter, Jerome I A1 - Sattar, Naveed A1 - Gyllensten, Ulf A1 - Kari E North A1 - Pirastu, Mario A1 - Psaty, Bruce M A1 - David R Weir A1 - Laakso, Markku A1 - Gudnason, Vilmundur A1 - Takahashi, Atsushi A1 - Chambers, John C A1 - Kooner, Jaspal S A1 - David P Strachan A1 - Campbell, Harry A1 - Joel N Hirschhron A1 - Markus Perola A1 - Polasek, Ozren A1 - James F Wilson KW - Biological Evolution KW - Blood pressure KW - Body Height KW - Cholesterol KW - Cognitive Ability KW - Cohort Studies KW - Education KW - Female KW - Forced Expiratory Volume KW - Genome KW - Homozygote KW - Humans KW - Lung Volume Measurements KW - Male KW - Phenotype AB -

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

VL - 523 IS - 7561 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26131930?dopt=Abstract ER - TY - THES T1 - Dynamic models of health and labor supply in later life Y1 - 2015 A1 - Lindsay Jacobs KW - Disabilities KW - Employment and Labor Force KW - Methodology KW - Retirement Planning and Satisfaction AB - In these essays, I develop and estimate life-cycle models aimed at explaining various patterns in labor supply behavior at older ages. The first study measures the extent to which later-life differences in health and disability risks across occupations affect retirement behavior and how these risks influence initial career choice. In the second essay, I look at the degree to which the changing composition of occupations over time--from more to less physically demanding--has contributed to the increase in labor force participation at older ages. The final study examines the effects of wage and health transition processes as well as the role of accrued work-related strain on the labor force participation decisions of older males, aimed particularly at accounting for the high rates of "reverse retirement" seen in the data. PB - The University of Wisconsin - Madison CY - Madison, WI VL - 3708322 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1697922475?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/Dissertations+%26+Theses+%40+CIC+Institutions&rft_val_fmt=info:of N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-27 First page - n/a U4 - 0501:Economics JO - Dynamic models of health and labor supply in later life ER - TY - JOUR T1 - The English are healthier than the Americans: really? JF - International Journal of Epidemiology Y1 - 2015 A1 - Cieza, Alarcos A1 - Oberhauser, Cornelia A1 - Bickenbach, Jerome A1 - Richard N Jones A1 - Tevfik Bedirhan Üstün A1 - Kostanjsek, Nenad A1 - John N Morris A1 - Chatterji, Somnath KW - Cross-National KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Background: When comparing the health of two populations, it is not enough to compare the prevalence of chronic diseases. The objective of this study is therefore to propose a metric of health based on domains of functioning to determine whether the English are healthier than the Americans.Methods: We analysed representative samples aged 50 to 80 years from the 2008 wave of the Health and Retirement Study (N = 10 349) for the US data, and wave 4 of the English Longitudinal Study of Ageing (N = 9405) for English counterpart data. We first calculated the age-standardized disease prevalence of diabetes, hypertension, all heart diseases, stroke, lung disease, cancer and obesity. Second, we developed a metric of health using Rasch analyses and the questions and measured tests common to both surveys addressing domains of human functioning. Finally, we used a linear additive model to test whether the differences in health were due to being English or American.Results: The English have better health than the Americans when population health is assessed only by prevalence of selected chronic health conditions. The English health advantage disappears almost completely, however, when health is assessed with a metric that integrates information about functioning domains.Conclusions: It is possible to construct a metric of health, based on data directly collected from individuals, in which health is operationalized as domains of functioning. Its application has the potential to tackle one of the most intractable problems in international research on health, namely the comparability of health across countries. VL - 44 UR - http://ije.oxfordjournals.org/content/early/2014/09/16/ije.dyu182.abstract IS - 1 U4 - Health Care Use/functioning/health state/cross-cultural comparison/cross-cultural comparison/Rasch model/health metric/ELSA_/cross-national comparison ER - TY - THES T1 - Essays on the economics of aging T2 - Economics Y1 - 2015 A1 - Zhao, Zhendong KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - The increase in life expectancy in the US and the changing labor supply of older workers have raised issues about the fiscal solvency of health care and pension systems, as well as labor market stability and employment opportunities for younger workers. In light of these facts, this dissertation consists of three essays that focus on the economic causes and consequences of changes in the labor supply of older workers due to population aging. The first essay examines the effect of longevity on older Americans' labor supply decisions of retirement and un-retirement. Instead of using self-rated survival probabilities as the proxy of longevity expectations, I use data from the Health and Retirement Study to predict longevity from a Gompertz survival model with a rich set of variables including parental mortality information, current health and socio-economic variables. I find that the predicted longevity fits actual longevity better than subjective survival rates. Using predicted longevity as one of the independent variables in a sequential logit model of retiring and un-retiring, I find that individuals retire and re-enter the labor market as if they knew their true potential longevity, i.e., individuals with higher predicted objective longevity retire later, and are more likely to return to the labor market after initial retirement. I further investigate the consequences of extreme mismatch between subjective survival rates and objective longevity implied by the model's prediction, and I find that the misperception leads to retirees' sub-optimal saving behaviors. The second essay makes an effort to explore the theoretical foundation for the mechanism through which the risk of mortality affects individuals' decisions about work. I construct a life-cycle model of labor supply with health investment and heterogeneous risk of mortality. The heterogeneity in mortality risk is modeled as a frailty parameter which shifts the mortality hazard proportionally. Individuals can invest in health in order to recover from an adverse health shock and revert the high propensity of death which they were born with. I estimate and calibrate the model using data from Health and Retirement Survey. I simulate the life cycle path of labor supply for two groups of representative individuals under the same condition except for different survival curves, one in year 2000 and one projected in 2100 where life expectancy is predicted to be increased by 9 years. I find that in a more favorable survival environment, individuals would choose to work more and spend more on health. The third essay examines a natural follow-up question about the consequence of a larger labor supply of older workers: does the higher labor force participation rate of the elderly crowd out employment opportunities of younger workers? I utilize the Social Security "Notch", a reduction in Social Security benefits for cohorts born after 1916 due to the 1977 Amendments, as an exogenous policy change to identify the effect on younger workers' employment. Using data from Current Population Survey from 1972 to 1981, I do not find any significant crowding-out effect of the notch generation on younger workers age 25-39. I further investigate the variations in different occupational categories and find that changes in employment rates of younger workers vary across occupations. Last, I do not find significant suppressing effect of increasing labor supply of older workers on younger workers' wage income. JF - Economics PB - City University of New York VL - Ph.D. IS - 3729044 U4 - Social sciences JO - Essays on the economics of aging 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 - Genetic studies of body mass index yield new insights for obesity biology. JF - Nature Y1 - 2015 A1 - Locke, Adam E A1 - Kahali, Bratati A1 - Berndt, Sonja I A1 - Justice, Anne E A1 - Pers, Tune H A1 - Day, Felix R A1 - Powell, Corey A1 - Vedantam, Sailaja A1 - Buchkovich, Martin L A1 - Yang, Jian A1 - Croteau-Chonka, Damien C A1 - Tõnu Esko A1 - Fall, Tove A1 - Ferreira, Teresa A1 - Gustafsson, Stefan A1 - Kutalik, Zoltán A1 - Luan, Jian'an A1 - Mägi, Reedik A1 - Randall, Joshua C A1 - Thomas W Winkler A1 - Andrew R Wood A1 - Workalemahu, Tsegaselassie A1 - Jessica Faul A1 - Jennifer A Smith A1 - Jing Hua Zhao A1 - Wei Zhao A1 - Chen, Jin A1 - Rudolf Ferhmann A1 - Hedman, Åsa K A1 - Karjalainen, Juha A1 - Schmidt, Ellen M A1 - Absher, Devin A1 - Amin, Najaf A1 - Anderson, Denise A1 - Beekman, Marian A1 - Bolton, Jennifer L A1 - Bragg-Gresham, Jennifer L A1 - Buyske, Steven A1 - Demirkan, Ayse A1 - Deng, Guohong A1 - Georg B Ehret A1 - Feenstra, Bjarke A1 - Feitosa, Mary F A1 - Fischer, Krista A1 - Goel, Anuj A1 - Gong, Jian A1 - Jackson, Anne U A1 - Kanoni, Stavroula A1 - Kleber, Marcus E A1 - Kristiansson, Kati A1 - Lim, Unhee A1 - Lotay, Vaneet A1 - Mangino, Massimo A1 - Irene Mateo Leach A1 - Medina-Gomez, Carolina A1 - Sarah E Medland A1 - Michael A Nalls A1 - Palmer, Cameron D A1 - Pasko, Dorota A1 - Pechlivanis, Sonali A1 - Peters, Marjolein J A1 - Prokopenko, Inga A1 - Shungin, Dmitry A1 - Stančáková, Alena A1 - Strawbridge, Rona J A1 - Yun Ju Sung A1 - Toshiko Tanaka A1 - Teumer, Alexander A1 - Trompet, Stella A1 - van der Laan, Sander W A1 - van Setten, Jessica A1 - Jana V. van Vliet-Ostaptchouk A1 - Wang, Zhaoming A1 - Yengo, Loic A1 - Zhang, Weihua A1 - Isaacs, Aaron A1 - Albrecht, Eva A1 - Ärnlöv, Johan A1 - Arscott, Gillian M A1 - Attwood, Antony P A1 - Bandinelli, Stefania A1 - Barrett, Amy A1 - Bas, Isabelita N A1 - Bellis, Claire A1 - Bennett, Amanda J A1 - Berne, Christian A1 - Blagieva, Roza A1 - Blüher, Matthias A1 - Böhringer, Stefan A1 - Bonnycastle, Lori L A1 - Böttcher, Yvonne A1 - Boyd, Heather A A1 - Bruinenberg, Marcel A1 - Caspersen, Ida H A1 - Yii-Der I Chen A1 - Robert Clark A1 - Daw, E Warwick A1 - de Craen, Anton J M A1 - Delgado, Graciela A1 - Dimitriou, Maria A1 - Doney, Alex S F A1 - Eklund, Niina A1 - Estrada, Karol A1 - Eury, Elodie A1 - Folkersen, Lasse A1 - Fraser, Ross M A1 - Melissa E Garcia A1 - Geller, Frank A1 - Giedraitis, Vilmantas A1 - Gigante, Bruna A1 - Alan S Go A1 - Golay, Alain A1 - Goodall, Alison H A1 - Gordon, Scott D A1 - Gorski, Mathias A1 - Hans-Jörgen Grabe A1 - Grallert, Harald A1 - Grammer, Tanja B A1 - Gräßler, Jürgen A1 - Grönberg, Henrik A1 - Groves, Christopher J A1 - Gusto, Gaëlle A1 - Jeffrey Haessler A1 - Hall, Per A1 - Haller, Toomas A1 - Hallmans, Göran A1 - Catharina A Hartman A1 - Hassinen, Maija A1 - Caroline Hayward A1 - Heard-Costa, Nancy L A1 - Helmer, Quinta A1 - Hengstenberg, Christian A1 - Oddgeir L Holmen A1 - Jouke-Jan Hottenga A1 - James, Alan L A1 - Janina Jeff A1 - Johansson, Åsa A1 - Jolley, Jennifer A1 - Juliusdottir, Thorhildur A1 - Kinnunen, Leena A1 - Koenig, Wolfgang A1 - Koskenvuo, Markku A1 - Kratzer, Wolfgang A1 - Laitinen, Jaana A1 - Lamina, Claudia A1 - Leander, Karin A1 - Lee, Nanette R A1 - Lichtner, Peter A1 - Lars Lind A1 - Lindström, Jaana A1 - Ken Sin Lo A1 - Lobbens, Stéphane A1 - Lorbeer, Roberto A1 - Lu, Yingchang A1 - Mach, François A1 - Patrik K E Magnusson A1 - Mahajan, Anubha A1 - McArdle, Wendy L A1 - McLachlan, Stela A1 - Menni, Cristina A1 - Merger, Sigrun A1 - Mihailov, Evelin A1 - Lili Milani A1 - Moayyeri, Alireza A1 - Monda, Keri L A1 - Morken, Mario A A1 - Mulas, Antonella A1 - Müller, Gabriele A1 - Müller-Nurasyid, Martina A1 - Musk, Arthur W A1 - Nagaraja, Ramaiah A1 - Markus M Nöthen A1 - Ilja M Nolte A1 - Pilz, Stefan A1 - Nigel W Rayner A1 - Renstrom, Frida A1 - Rettig, Rainer A1 - Ried, Janina S A1 - Ripke, Stephan A1 - Neil R Robertson A1 - Rose, Lynda M A1 - Sanna, Serena A1 - Scharnagl, Hubert A1 - Scholtens, Salome A1 - Schumacher, Fredrick R A1 - Scott, William R A1 - Seufferlein, Thomas A1 - Jianxin Shi A1 - Albert Vernon Smith A1 - Smolonska, Joanna A1 - Stanton, Alice V A1 - Steinthorsdottir, Valgerdur A1 - Kathleen E Stirrups A1 - Heather M Stringham A1 - Sundström, Johan A1 - Swertz, Morris A A1 - Swift, Amy J A1 - Syvänen, Ann-Christine A1 - Tan, Sian-Tsung A1 - Bamidele O Tayo A1 - Thorand, Barbara A1 - Thorleifsson, Gudmar A1 - Tyrer, Jonathan P A1 - Uh, Hae-Won A1 - Vandenput, Liesbeth A1 - Verhulst, Frank C A1 - Vermeulen, Sita H A1 - Verweij, Niek A1 - Vonk, Judith M A1 - Lindsay L Waite A1 - Warren, Helen R A1 - Dawn M Waterworth A1 - Michael N Weedon A1 - Wilkens, Lynne R A1 - Willenborg, Christina A1 - Wilsgaard, Tom A1 - Wojczynski, Mary K A1 - Wong, Andrew A1 - Alan F Wright A1 - Zhang, Qunyuan A1 - Brennan, Eoin P A1 - Murim Choi A1 - Dastani, Zari A1 - Alexander W Drong A1 - Eriksson, Per A1 - Franco-Cereceda, Anders A1 - Gådin, Jesper R A1 - Gharavi, Ali G A1 - Goddard, Michael E A1 - Handsaker, Robert E A1 - Huang, Jinyan A1 - Karpe, Fredrik A1 - Kathiresan, Sekar A1 - Keildson, Sarah A1 - Kiryluk, Krzysztof A1 - Kubo, Michiaki A1 - Lee, Jong-Young A1 - Liang, Liming A1 - Lifton, Richard P A1 - Ma, Baoshan A1 - McCarroll, Steven A A1 - McKnight, Amy J A1 - Min, Josine L A1 - Moffatt, Miriam F A1 - Grant W Montgomery A1 - Joanne M Murabito A1 - Nicholson, George A1 - Nyholt, Dale R A1 - Okada, Yukinori A1 - Perry, John R B A1 - Dorajoo, Rajkumar A1 - Reinmaa, Eva A1 - Salem, Rany M A1 - Sandholm, Niina A1 - Scott, Robert A A1 - Stolk, Lisette A1 - Takahashi, Atsushi A1 - Tanaka, Toshihiro A1 - Ferdinand M van 't Hooft A1 - Anna A E Vinkhuyzen A1 - Westra, Harm-Jan A1 - Wei Zhang A1 - Krina T Zondervan A1 - Andrew C Heath A1 - Arveiler, Dominique A1 - Bakker, Stephan J L A1 - Beilby, John A1 - Bergman, Richard N A1 - Blangero, John A1 - Bovet, Pascal A1 - Campbell, Harry A1 - Caulfield, Mark J A1 - Cesana, Giancarlo A1 - Chakravarti, Aravinda A1 - Daniel I Chasman A1 - Chines, Peter S A1 - Collins, Francis S A1 - Crawford, Dana C A1 - Cupples, L Adrienne A1 - Cusi, Daniele A1 - Danesh, John A1 - de Faire, Ulf A1 - Hester M den Ruijter A1 - Dominiczak, Anna F A1 - Erbel, Raimund A1 - Erdmann, Jeanette A1 - Johan G Eriksson A1 - Farrall, Martin A1 - Felix, Stephan B A1 - Ferrannini, Ele A1 - Ferrières, Jean A1 - Ford, Ian A1 - Forouhi, Nita G A1 - Forrester, Terrence A1 - Franco, Oscar H A1 - Gansevoort, Ron T A1 - Gejman, Pablo V A1 - Gieger, Christian A1 - Gottesman, Omri A1 - Gudnason, Vilmundur A1 - Gyllensten, Ulf A1 - Hall, Alistair S A1 - Tamara B Harris A1 - Andrew T Hattersley A1 - Hicks, Andrew A A1 - Hindorff, Lucia A A1 - Aroon Hingorani A1 - Hofman, Albert A1 - Homuth, Georg A1 - Hovingh, G Kees A1 - Humphries, Steve E A1 - Hunt, Steven C A1 - Hyppönen, Elina A1 - Illig, Thomas A1 - Jacobs, Kevin B A1 - Järvelin, Marjo-Riitta A1 - Jöckel, Karl-Heinz A1 - Johansen, Berit A1 - Jousilahti, Pekka A1 - Jukema, J Wouter A1 - Jula, Antti M A1 - Kaprio, Jaakko A1 - Kastelein, John J P A1 - Keinanen-Kiukaanniemi, Sirkka M A1 - Lambertus A Kiemeney A1 - Knekt, Paul A1 - Kooner, Jaspal S A1 - Charles Kooperberg A1 - Kovacs, Peter A1 - Kraja, Aldi T A1 - Kumari, Meena A1 - Kuusisto, Johanna A1 - Lakka, Timo A A1 - Langenberg, Claudia A1 - Loic Le Marchand A1 - Lehtimäki, Terho A1 - Lyssenko, Valeriya A1 - Männistö, Satu A1 - Marette, André A1 - Matise, Tara C A1 - McKenzie, Colin A A1 - McKnight, Barbara A1 - Moll, Frans L A1 - Morris, Andrew D A1 - Morris, Andrew P A1 - Murray, Jeffrey C A1 - Nelis, Mari A1 - Ohlsson, Claes A1 - Oldehinkel, Albertine J A1 - Ong, Ken K A1 - Pamela A F Madden A1 - Pasterkamp, Gerard A1 - Peden, John F A1 - Peters, Annette A1 - Postma, Dirkje S A1 - Pramstaller, Peter P A1 - Price, Jackie F A1 - Qi, Lu A1 - Olli T Raitakari A1 - Rankinen, Tuomo A1 - Rao, D C A1 - Rice, Treva K A1 - Ridker, Paul M A1 - Rioux, John D A1 - Ritchie, Marylyn D A1 - Rudan, Igor A1 - Veikko Salomaa A1 - Nilesh J Samani A1 - Saramies, Jouko A1 - Sarzynski, Mark A A1 - Schunkert, Heribert A1 - Schwarz, Peter E H A1 - Peter Sever A1 - Alan R Shuldiner A1 - Sinisalo, Juha A1 - Stolk, Ronald P A1 - Strauch, Konstantin A1 - Tönjes, Anke A1 - Trégouët, David-Alexandre A1 - Tremblay, Angelo A1 - Tremoli, Elena A1 - Virtamo, Jarmo A1 - Vohl, Marie-Claude A1 - Völker, Uwe A1 - Waeber, Gérard A1 - Gonneke Willemsen A1 - Witteman, Jacqueline C A1 - Zillikens, M Carola A1 - Adair, Linda S A1 - Amouyel, Philippe A1 - Asselbergs, Folkert W A1 - Assimes, Themistocles L A1 - Bochud, Murielle A1 - Boehm, Bernhard O A1 - Boerwinkle, Eric A1 - Bornstein, Stefan R A1 - Erwin P Bottinger A1 - Bouchard, Claude A1 - Cauchi, Stéphane A1 - Chambers, John C A1 - Chanock, Stephen J A1 - Cooper, Richard S A1 - de Bakker, Paul I W A1 - George Dedoussis A1 - Luigi Ferrucci A1 - Franks, Paul W A1 - Froguel, Philippe A1 - Leif C Groop A1 - Christopher A Haiman A1 - Hamsten, Anders A1 - Hui, Jennie A1 - Hunter, David J A1 - Hveem, Kristian A1 - Kaplan, Robert C A1 - Mika Kivimäki A1 - Kuh, Diana A1 - Laakso, Markku A1 - Yongmei Liu A1 - Nicholas G Martin A1 - März, Winfried A1 - Melbye, Mads A1 - Andres Metspalu A1 - Moebus, Susanne A1 - Munroe, Patricia B A1 - Njølstad, Inger A1 - Ben A Oostra A1 - Palmer, Colin N A A1 - Nancy L Pedersen A1 - Markus Perola A1 - Pérusse, Louis A1 - Peters, Ulrike A1 - Power, Chris A1 - Quertermous, Thomas A1 - Rauramaa, Rainer A1 - Fernando Rivadeneira A1 - Saaristo, Timo E A1 - Saleheen, Danish A1 - Sattar, Naveed A1 - Eric E Schadt A1 - Schlessinger, David A1 - Eline P Slagboom A1 - Snieder, Harold A1 - Timothy Spector A1 - Thorsteinsdottir, Unnur A1 - Stumvoll, Michael A1 - Tuomilehto, Jaakko A1 - André G Uitterlinden A1 - Uusitupa, Matti A1 - van der Harst, Pim A1 - Walker, Mark A1 - Wallaschofski, Henri A1 - Wareham, Nicholas J A1 - Watkins, Hugh A1 - David R Weir A1 - Wichmann, H-Erich A1 - James F Wilson A1 - Zanen, Pieter A1 - Ingrid B Borecki A1 - Deloukas, Panos A1 - Caroline S Fox A1 - Iris M Heid A1 - Jeff O'Connell A1 - David P Strachan A1 - Stefansson, Kari A1 - Cornelia M van Duijn A1 - Gonçalo R Abecasis A1 - Lude L Franke A1 - Timothy M Frayling A1 - McCarthy, Mark I A1 - Peter M Visscher A1 - Scherag, Andre A1 - Willer, Cristen J A1 - Boehnke, Michael A1 - Mohlke, Karen L A1 - Lindgren, Cecilia M A1 - Beckmann, Jacques S A1 - Barroso, Inês A1 - Kari E North A1 - Ingelsson, Erik A1 - Joel N Hirschhron A1 - Ruth J F Loos A1 - Elizabeth K Speliotes KW - Age Factors KW - BMI KW - Continental Population Groups KW - Energy Metabolism KW - Europe KW - Female KW - Genome-Wide Association Study KW - Glutamic Acid KW - Humans KW - Insulin KW - Male KW - Obesity KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Synapses AB -

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

VL - 518 IS - 7538 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25673413?dopt=Abstract ER - TY - JOUR T1 - Health literacy and the digital divide among older Americans. JF - J Gen Intern Med Y1 - 2015 A1 - Helen G Levy A1 - Alexander T Janke A1 - Kenneth M. Langa KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Digital Divide KW - Female KW - Health Literacy KW - Humans KW - Internet KW - Male KW - Prospective Studies KW - Retrospective Studies KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND: Among the requirements for meaningful use of electronic medical records (EMRs) is that patients must be able to interact online with information from their records. However, many older Americans may be unprepared to do this, particularly those with low levels of health literacy.

OBJECTIVE: The purpose of the study was to quantify the relationship between health literacy and use of the Internet for obtaining health information among Americans aged 65 and older.

DESIGN: We performed retrospective analysis of 2009 and 2010 data from the Health and Retirement Study, a longitudinal survey of a nationally representative sample of older Americans.

PARTICIPANTS: Subjects were community-dwelling adults aged 65 years and older (824 individuals in the general population and 1,584 Internet users).

MAIN MEASURES: Our analysis included measures of regular use of the Internet for any purpose and use of the Internet to obtain health or medical information; health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) and self-reported confidence filling out medical forms.

KEY RESULTS: Only 9.7% of elderly individuals with low health literacy used the Internet to obtain health information, compared with 31.9% of those with adequate health literacy. This gradient persisted after controlling for sociodemographic characteristics, health status, and general cognitive ability. The gradient arose both because individuals with low health literacy were less likely to use the Internet at all (OR = 0.36 [95% CI 0.24 to 0.54]) and because, among those who did use the Internet, individuals with low health literacy were less likely to use it to get health or medical information (OR = 0.60 [95% CI 0.47 to 0.77]).

CONCLUSION: Low health literacy is associated with significantly less use of the Internet for health information among Americans aged 65 and older. Web-based health interventions targeting older adults must address barriers to substantive use by individuals with low health literacy, or risk exacerbating the digital divide.

VL - 30 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84914171477andpartnerID=40andmd5=41b0823f4329aba89308dad7c476949a IS - 3 N1 - Export Date: 20 January 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25387437?dopt=Abstract U4 - health literacy/health literacy/electronic health records/internet use/sociodemographic characteristics/sociodemographic characteristics ER - TY - JOUR T1 - HEALTHY AGING IN OLDER ADULTS: THE ROLE OF CHILDHOOD CIRCUMSTANCES AND LIFECYCLE FACTORS JF - The Gerontologist Y1 - 2015 A1 - Nasim B Ferdows A1 - Gail A Jensen A1 - Wassim Tarraf KW - childhood effects KW - healthy aging KW - lifecycle factors AB - Objectives. We examine the direct and indirect effects of childhood and later-life circumstances on “healthy aging” among U.S adults ages 65-years and older. Methods. Using 2010 Health and Retirement Study data, we estimate “healthy aging” as the output of a health production function, produced by childhood health and socioeconomic status, adult socioeconomic achievements, health habits and pertinent demographics. In addition to the direct effects of these factors on healthy aging, we examine the indirect effects of childhood factors that operate through adult achievements. Results. The proportion of respondents satisfying our criteria for “healthy aging” was 0.12. Good childhood health status (vs. average) had both a positive direct effect (0.0461; p\<0.01) and indirect effect (0.0026; p\<0.05) on healthy aging, for a total effect of 0.0487. The direct effect of father’s education (0.0166; p=0.161) and mother’s education (0.0177; p=0.128) were not significant. However, having a father with a high-school or above education (0.0047; p\<0.05), having a mother with a high-school or above education (0.0054; p\<0.05) had clear indirect positive effects on healthy aging. Finally, respondent’s own education, personal finances, and all current period health habits were also strongly associated with healthy aging. Conclusion. Our findings complement available research on the health of US older adults by showing that healthy aging is a function of both childhood and adult factors and later life habits. The pathways from childhood factors to healthy aging, however, could be more complex than previously reported. VL - 55 UR - https://doi.org/10.1093/geront/gnv287.05 ER - TY - JOUR T1 - How well do individuals predict the selling prices of their homes? JF - Journal of Housing Economics Y1 - 2015 A1 - Hugo Benítez-Silva A1 - Selçuk Eren A1 - Frank Heiland A1 - Jimenez-Martin, Sergi KW - Housing KW - Methodology AB - The accuracy of property values estimated by homeowners is an open empirical question that requires an evaluation of the reported values using a market assessment. Using information on selling prices from the Health and Retirement Study and the American Housing Survey, and after accounting for possible measurement error in reporting and selection regarding those who we observe selling, we find evidence that homeowners overestimate the value of their properties by around 8 with an estimated range between 3.4 and 12.7 (95 CI). 2015. PB - 29 VL - 29 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84936102548andpartnerID=40andmd5=17ba0e3e060e90bbe8714681ba524863 N1 - Export Date: 9 September 2015 U4 - American Housing Survey/Health and Retirement Study/Housing prices/Instrumental variables/Panel data/Self-reported housing values ER - TY - JOUR T1 - The Impact of a Randomly Assigned Time and Place Management Initiative on Work and Retirement Expectations JF - Work Aging and Retirement Y1 - 2015 A1 - Kevin E. Cahill A1 - Jacquelyn Boone James A1 - Pitt-Catsouphes, Marcie KW - Employment and Labor Force KW - Retirement Planning and Satisfaction AB - This article examines the causal relationship between a workplace flexibility arrangement and retirement expectations. The data come from a unique large-scale randomly assigned time and place management (TPM) initiative that recently took place at a regional healthcare system in the United States with more than 9,000 employees. A difference-in-differences approach was used to assess treatment impacts among older full-time career employees and comparisons were made with a nationally representative group of older Americans from the Health and Retirement Study (HRS). We found evidence that the TPM initiative had a statistically significant impact on employees' retirement expectations; employees in the treatment group were more likely than those in the control group to expect to remain with the organization until retirement, though treatment impacts dissipated somewhat toward the end of the study. The results indicate that workplace flexibility could be one solution to promote continued work later in life, as flexible work arrangements have the potential to impact retirement expectations and patterns of labor force withdrawal. PB - 1 VL - 1 IS - 4 N1 - Times Cited: 0 0 U4 - workplace/time and place management/labor Force Participation/retirement planning ER - TY - JOUR T1 - Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair. JF - Nat Genet Y1 - 2015 A1 - Day, Felix R A1 - Ruth, Katherine S A1 - Thompson, Deborah J A1 - Kathryn L Lunetta A1 - Pervjakova, Natalia A1 - Daniel I Chasman A1 - Stolk, Lisette A1 - Finucane, Hilary K A1 - Sulem, Patrick A1 - Bulik-Sullivan, Brendan A1 - Tõnu Esko A1 - Andrew D Johnson A1 - Elks, Cathy E A1 - Franceschini, Nora A1 - He, Chunyan A1 - Altmaier, Elisabeth A1 - Brody, Jennifer A A1 - Lude L Franke A1 - Huffman, Jennifer E A1 - Keller, Margaux F A1 - McArdle, Patrick F A1 - Nutile, Teresa A1 - Porcu, Eleonora A1 - Robino, Antonietta A1 - Rose, Lynda M A1 - Schick, Ursula M A1 - Jennifer A Smith A1 - Teumer, Alexander A1 - Traglia, Michela A1 - Vuckovic, Dragana A1 - Yao, Jie A1 - Wei Zhao A1 - Albrecht, Eva A1 - Amin, Najaf A1 - Corre, Tanguy A1 - Jouke-Jan Hottenga A1 - Mangino, Massimo A1 - Albert Vernon Smith A1 - Toshiko Tanaka A1 - Gonçalo R Abecasis A1 - Andrulis, Irene L A1 - Anton-Culver, Hoda A1 - Antoniou, Antonis C A1 - Arndt, Volker A1 - Alice M. Arnold A1 - Barbieri, Caterina A1 - Beckmann, Matthias W A1 - Beeghly-Fadiel, Alicia A1 - Benitez, Javier A1 - Bernstein, Leslie A1 - Bielinski, Suzette J A1 - Blomqvist, Carl A1 - Boerwinkle, Eric A1 - Bogdanova, Natalia V A1 - Bojesen, Stig E A1 - Manjeet K. Bolla A1 - Borresen-Dale, Anne-Lise A1 - Boutin, Thibaud S A1 - Brauch, Hiltrud A1 - Brenner, Hermann A1 - Brüning, Thomas A1 - Burwinkel, Barbara A1 - Campbell, Archie A1 - Campbell, Harry A1 - Chanock, Stephen J A1 - Chapman, J Ross A1 - Yii-Der I Chen A1 - Chenevix-Trench, Georgia A1 - Couch, Fergus J A1 - Coviello, Andrea D A1 - Cox, Angela A1 - Czene, Kamila A1 - Darabi, Hatef A1 - De Vivo, Immaculata A1 - Ellen W Demerath A1 - Joe G Dennis A1 - Devilee, Peter A1 - Dörk, Thilo A1 - Dos-Santos-Silva, Isabel A1 - Dunning, Alison M A1 - John D Eicher A1 - Fasching, Peter A A1 - Jessica Faul A1 - Figueroa, Jonine A1 - Flesch-Janys, Dieter A1 - Gandin, Ilaria A1 - Melissa E Garcia A1 - García-Closas, Montserrat A1 - Giles, Graham G A1 - Giorgia G Girotto A1 - Goldberg, Mark S A1 - González-Neira, Anna A1 - Goodarzi, Mark O A1 - Grove, Megan L A1 - Gudbjartsson, Daniel F A1 - Guénel, Pascal A1 - Guo, Xiuqing A1 - Christopher A Haiman A1 - Hall, Per A1 - Hamann, Ute A1 - Henderson, Brian E A1 - Lynne J Hocking A1 - Hofman, Albert A1 - Homuth, Georg A1 - Hooning, Maartje J A1 - John L Hopper A1 - Hu, Frank B A1 - Huang, Jinyan A1 - Humphreys, Keith A1 - Hunter, David J A1 - Jakubowska, Anna A1 - Jones, Samuel E A1 - Kabisch, Maria A1 - Karasik, David A1 - Knight, Julia A A1 - Kolcic, Ivana A1 - Charles Kooperberg A1 - Kosma, Veli-Matti A1 - Kriebel, Jennifer A1 - Kristensen, Vessela A1 - Lambrechts, Diether A1 - Langenberg, Claudia A1 - Li, Jingmei A1 - Li, Xin A1 - Lindström, Sara A1 - Yongmei Liu A1 - Luan, Jian'an A1 - Lubinski, Jan A1 - Mägi, Reedik A1 - Mannermaa, Arto A1 - Manz, Judith A1 - Margolin, Sara A1 - Marten, Jonathan A1 - Nicholas G Martin A1 - Masciullo, Corrado A1 - Meindl, Alfons A1 - Michailidou, Kyriaki A1 - Mihailov, Evelin A1 - Lili Milani A1 - Milne, Roger L A1 - Müller-Nurasyid, Martina A1 - Michael A Nalls A1 - Neale, Benjamin M A1 - Nevanlinna, Heli A1 - Neven, Patrick A1 - Anne B Newman A1 - Børge G Nordestgaard A1 - Olson, Janet E A1 - Padmanabhan, Sandosh A1 - Peterlongo, Paolo A1 - Peters, Ulrike A1 - Petersmann, Astrid A1 - Peto, Julian A1 - Pharoah, Paul D P A1 - Nicola Pirastu A1 - Pirie, Ailith A1 - Pistis, Giorgio A1 - Polasek, Ozren A1 - David J Porteous A1 - Psaty, Bruce M A1 - Pylkäs, Katri A1 - Radice, Paolo A1 - Raffel, Leslie J A1 - Fernando Rivadeneira A1 - Rudan, Igor A1 - Rudolph, Anja A1 - Ruggiero, Daniela A1 - Cinzia Felicita Sala A1 - Sanna, Serena A1 - Sawyer, Elinor J A1 - Schlessinger, David A1 - Schmidt, Marjanka K A1 - Schmidt, Frank A1 - Schmutzler, Rita K A1 - Schoemaker, Minouk J A1 - Scott, Robert A A1 - Seynaeve, Caroline M A1 - Simard, Jacques A1 - Sorice, Rossella A1 - Southey, Melissa C A1 - Stöckl, Doris A1 - Strauch, Konstantin A1 - Swerdlow, Anthony A1 - Kent D Taylor A1 - Thorsteinsdottir, Unnur A1 - Toland, Amanda E A1 - Tomlinson, Ian A1 - Truong, Thérèse A1 - Tryggvadottir, Laufey A1 - Stephen T Turner A1 - Vozzi, Diego A1 - Wang, Qin A1 - Wellons, Melissa A1 - Gonneke Willemsen A1 - James F Wilson A1 - Winqvist, Robert A1 - Wolffenbuttel, Bruce B H R A1 - Alan F Wright A1 - Yannoukakos, Drakoulis A1 - Zemunik, Tatijana A1 - Wei Zhang A1 - Zygmunt, Marek A1 - Bergmann, Sven A1 - Dorret I Boomsma A1 - Buring, Julie E A1 - Luigi Ferrucci A1 - Grant W Montgomery A1 - Gudnason, Vilmundur A1 - Timothy Spector A1 - Cornelia M van Duijn A1 - Alizadeh, Behrooz Z A1 - Ciullo, Marina A1 - Crisponi, Laura A1 - Easton, Douglas F A1 - Paolo P. Gasparini A1 - Gieger, Christian A1 - Tamara B Harris A1 - Caroline Hayward A1 - Sharon L R Kardia A1 - Kraft, Peter A1 - McKnight, Barbara A1 - Andres Metspalu A1 - Alanna C Morrison A1 - Reiner, Alex P A1 - Ridker, Paul M A1 - Rotter, Jerome I A1 - Toniolo, Daniela A1 - André G Uitterlinden A1 - Ulivi, Sheila A1 - Völzke, Henry A1 - Wareham, Nicholas J A1 - David R Weir A1 - Laura M Yerges-Armstrong A1 - Price, Alkes L A1 - Stefansson, Kari A1 - Visser, Jenny A A1 - Ong, Ken K A1 - Chang-Claude, Jenny A1 - Joanne M Murabito A1 - Perry, John R B A1 - Murray, Anna KW - Age Factors KW - Aging KW - BRCA1 Protein KW - Breast Neoplasms KW - DNA Repair KW - Female KW - Genome KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Hypothalamus KW - Menopause KW - Middle Aged KW - Models, Genetic KW - Older Adults KW - Phenotype KW - Reproduction KW - Signal Transduction AB -

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in ∼70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (∼6% increase in risk per year; P = 3 × 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

VL - 47 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26414677?dopt=Abstract ER - TY - JOUR T1 - Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults JF - American journal of public health Y1 - 2015 A1 - Kerstin Gerst A1 - Jayawardhana, Jayani KW - Health Conditions and Status KW - Healthcare AB - OBJECTIVES: We aimed to determine whether loneliness is associated with higher health care utilization among older adults in the United States. METHODS: We used panel data from the Health and Retirement Study (2008 and 2012) to examine the long-term impact of loneliness on health care use. The sample was limited to community-dwelling persons in the United States aged 60 years and older. We used negative binomial regression models to determine the impact of loneliness on physician visits and hospitalizations. RESULTS: Under 2 definitions of loneliness, we found that a sizable proportion of those aged 60 years and older in the United States reported loneliness. Regression results showed that chronic loneliness (those lonely both in 2008 and 4 years later) was significantly and positively associated with physician visits (beta=0.075, SE=0.034). Loneliness was not significantly associated with hospitalizations. CONCLUSIONS: Loneliness is a significant public health concern among elders. In addition to easing a potential source of suffering, the identification and targeting of interventions for lonely elders may significantly decrease physician visits and health care costs. PB - 105 VL - 105 IS - 5 N1 - Times Cited: 0 0 U4 - Loneliness/health Care Use/hospitalization ER - TY - THES T1 - Obesity Over the Life Course: A Study of How Obesity Produces Health Disadvantage and Excess Mortality in the United States Y1 - 2015 A1 - Heide Jackson KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - This dissertation explores the influence of obesity on U.S. population morbidity and mortality. Across three essays, I examine the relation of obesity to work disability, activity impairment, and mortality. Chapter 1 looks at how obesity in early adulthood affects work disability at young and middle ages. Using data from the National Longitudinal Study of Youth 1979, I employ logistic regression to assess whether an early onset of obesity affects the likelihood of developing a work disabling condition and use event history analysis to predict the time at which that work disability occurs. Results indicate that early obesity increases the likelihood that a person will develop a work disability and uniformly increases the relative hazard of the disability occurring. The association of obesity and work disability remains robust to the inclusion of covariates and modeling the process that selects a person to become obese. Chapter 2 shifts to looking at how mid-life obesity may alter the effect of occupational exposures on later life limitations in activities of daily living. Using data from the Health and Retirement Study and latent growth curve models, I find that the effects of past occupational exposures differ by whether or not a respondent is obese around retirement. For non-obese respondents, physically demanding occupations are associated with a lower risk of developing health impairments, but no such association is found for obese persons. Instead, although not statistically significant, physically demanding occupations are associated with a greater rate of accumulation in health limitations for obese persons. Chapter 3 moves to examine why it is that older obese adults appear more likely to get sick but less likely to die. Using data from the Health and Retirement Survey and a multi-state modelling framework, I find that the obesity-mortality paradox may be explained by obese adults having a higher risk of becoming ill, losing weight, and subsequently dying having a history of obesity. Together, these three chapters suggest important influences of obesity on the health and well-being of adults throughout the life course and highlight the importance of studying the obesity-health relationship in a longitudinal framework. PB - The University of Wisconsin - Madison CY - Madison, WI VL - 3718769 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1708675891?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/Dissertations+%26+Theses+%40+CIC+Institutions&rft_val_fmt=info:of N1 - Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-09-02 First page - n/a U4 - 0573:Public health JO - Obesity Over the Life Course: A Study of How Obesity Produces Health Disadvantage and Excess Mortality in the United States ER - TY - JOUR T1 - Polygenic risk, stressful life events and depressive symptoms in older adults: a polygenic score analysis. JF - Psychol Med Y1 - 2015 A1 - Musliner, Katherine L. A1 - Seiffudin, Fayaz A1 - Judy, J. A. A1 - Pirooznia, Mehdi A1 - Goes, Fernando S. A1 - Zandi, Peter P. KW - depression KW - Depressive Disorder, Major KW - Female KW - Genetic Predisposition to Disease KW - Humans KW - Life Change Events KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Odds Ratio KW - Risk Factors KW - United States AB -

BACKGROUND: Previous studies suggest that the relationship between genetic risk and depression may be moderated by stressful life events (SLEs). The goal of this study was to assess whether SLEs moderate the association between polygenic risk of major depressive disorder (MDD) and depressive symptoms in older adults.

METHOD: We used logistic and negative binomial regressions to assess the associations between polygenic risk, SLEs and depressive symptoms in a sample of 8761 participants from the Health and Retirement Study. Polygenic scores were derived from the Psychiatric Genomics Consortium genome-wide association study of MDD. SLEs were operationalized as a dichotomous variable indicating whether participants had experienced at least one stressful event during the previous 2 years. Depressive symptoms were measured using an eight-item Center for Epidemiologic Studies Depression Scale subscale and operationalized as both a dichotomous and a count variable.

RESULTS: The odds of reporting four or more depressive symptoms were over twice as high among individuals who experienced at least one SLE (odds ratio 2.19, 95% confidence interval 1.86-2.58). Polygenic scores were significantly associated with depressive symptoms (β = 0.21, p ⩽ 0.0001), although the variance explained was modest (pseudo r 2 = 0.0095). None of the interaction terms for polygenic scores and SLEs was statistically significant.

CONCLUSIONS: Polygenic risk and SLEs are robust, independent predictors of depressive symptoms in older adults. Consistent with an additive model, we found no evidence that SLEs moderated the association between common variant polygenic risk and depressive symptoms.

VL - 45 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25488392?dopt=Abstract ER - TY - RPRT T1 - The Role of Occupations in Differentiating Health Trajectories in Later Life Y1 - 2015 A1 - Michal Engelman A1 - Heide Jackson KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare AB - This study characterizes heterogeneous trajectories of health among older Americans and investigates how employment histories differentiate them. Using the 1998-2010 waves of the Health and Retirement Study, we examine the impact of longest-held occupations on patterns of limitations in activities of daily living. We use latent class growth analysis to identify distinct health trajectory classes and linear growth curve analysis to model the pattern of limitation accumulation for individuals. All analyses are stratified by sex and race, to account for differential labor markets and health experiences of these demographic groups. A limitation of this analysis is its reliance on broad occupational categories rather than specific measures of working conditions. In future work, we plan to incorporate data on specific occupations and merge them with detailed information on occupational characteristics available in the O NET database (an online repository that has updated the Dictionary of Occupational Titles used in previous research on aging and retirement and occupational epidemiology: http://www.onetonline.org/). The paper found that: White respondents (both male and female) are substantially more likely to be in the healthiest class compared to black respondents. Certain occupations are protective against membership in poor health classes, but the list of protective occupational categories differs substantially by sex and race. The impact of occupations on health trajectories was diminished when we controlled for educational attainment and smoking, suggesting the important role of education in sorting individuals into occupations that differ in physical and cognitive demands that likely influence health. The policy implications of the findings are: Life expectancy alone does not capture all the health information that would be relevant for assessing the capacity of American workers to stay on the job beyond traditional retirement ages. Legislators should consider differences in health and in the trajectories of functional decline across demographic groups defined by sex, race, and occupational exposures when debating further increases in the Social Security retirement age. PB - Boston College U4 - health trajectories/health trajectories/ADL and IADL Impairments/occupation/labor force participation/employment history/O NET/educational attainment ER - TY - JOUR T1 - Subjective health expectations JF - Journal of Policy Modeling Y1 - 2015 A1 - Kim P. Huynh A1 - Jung, Juergen KW - Employment and Labor Force KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - Subjective health expectations are derived using data from the U.S. Health and Retirement Study (HRS). We first use a Bayesian updating mechanism to correct for focal point responses and reporting errors of the original health expectations variable. We then test the quality of the health expectations measure and describe its correlation with various health indicators and other individual characteristics. Our results indicate that subjective health expectations do contain additional information that is not incorporated in subjective mortality expectations and that the rational expectations assumption cannot be rejected for subjective health expectations. Finally, the data suggest that individuals younger than 70 years of age seem to be more pessimistic about their health than individuals in their 70s. 2015 Society for Policy Modeling. PB - 37 VL - 37 IS - 4 N1 - Export Date: 29 May 2015 Article in Press U4 - Bayesian updating of expectations/Focal points/Rational health expectations/Work limiting health problems/Statistical analysis/expectations/health indicators/subjective Expectations ER - TY - THES T1 - Three Essays in Health Economics Y1 - 2015 A1 - Jamal, Taha KW - Cross-National KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare AB - This thesis comprises three essays that empirically explore two important areas in health economics and policy: the valuation of medical innovations, and access to healthcare. The first essay explores the role of new medical technologies in improving labor market outcomes by conducting a case study of a class of drugs used in the treatment of arthritis called Cox-2 inhibitors. Cox-2 drugs make an excellent case study for investigating the labor supply effects of medical innovation because the potential labor supply effects are large, and the market introduction of these drugs generates plausibly exogenous variation in their use. Using data from the Health and Retirement Study (HRS) and applying a difference-in-differences approach that compares individuals with arthritis to individuals without arthritis, I find that the introduction of Cox-2 drugs had a positive and significant impact on the probability of working among individuals with long-term arthritis. The effects are stronger among older individuals, the less-educated, and those working in physical occupations. These results highlight the importance of evaluating economic outcomes such as labor supply as part of an assessment of the overall benefits of medical technology. The second essay builds on work by Allin et al. (2010) and Hurley et al. (2011) that systematically analyzes the relationship between subjective unmet need and healthcare utilization. However, unlike previous work that uses cross-sectional data, I use panel data from the National Population Health Survey (NPHS) to control for fixed unobserved individual heterogeneity. In addition, healthcare utilization is modeled using latent class models for panel data, which outperform traditional hurdle models. The results of this study confirm previous findings of different patterns of healthcare utilization among individuals with system-related unmet needs, personal-related unmet needs, and no unmet needs. Individuals with personal-related unmet needs tended to use the same amount of services as expected based on their needs. On the other hand, individuals with system-related unmet needs were found to not only be high users of GP and specialist visits, they were also higher-than-expected users. The third essay examines long-term changes in socioeconomic inequality and inequity in influenza immunization in Canada. The concentration index framework is applied using data from the following two Statistics Canada surveys: the cross-sectional component of the 1996/97 National Population Health Survey (NPHS), and the 2007/08 Canadian Community Health Survey (CCHS). The results show large variations in both coverage and inequity across provinces. In addition, increases in coverage levels across many provinces seem to have drawn disproportionately from those of higher socioeconomic status, contributing to a growing pro-rich inequity in utilization. These results highlight the need for more targeted efforts to help reduce inequities in vaccination. PB - McMaster University CY - Hamilton, Ontario U4 - cross-national comparison JO - Three Essays in Health Economics ER - TY - JOUR T1 - Wealth shocks, unemployment shocks and consumption in the wake of the Great Recession JF - Journal of Monetary Economics Y1 - 2015 A1 - Christelis, Dimitris A1 - Dimitris Georgarakos A1 - Jappelli, Tullio KW - Consumption and Savings KW - Employment and Labor Force KW - Net Worth and Assets KW - Public Policy AB - Data from the 2009 Internet Survey of the Health and Retirement Study show that many US households experienced large capital losses in housing and financial wealth, and that 5 of respondents lost their job during the Great Recession. For every loss of 10 in housing and financial wealth, the estimated drop in household expenditure was about 0.56 and 0.9 , respectively. Those who became unemployed reduced spending by 10 . In line with predictions of standard inter-temporal choice models, households who perceived the stock market shock to be permanent adjusted spending much more than those who perceived the shock to be temporary. PB - 72 VL - 72 UR - http://www.sciencedirect.com/science/article/pii/S0304393215000069 U4 - Wealth shocks/Unemployment/Consumption/Great Recession ER - TY - JOUR T1 - Word Recall: Cognitive Performance Within Internet Surveys. JF - JMIR Ment Health Y1 - 2015 A1 - Shannon K Runge A1 - Benjamin M. Craig A1 - Heather S Jim AB -

BACKGROUND: The use of online surveys for data collection has increased exponentially, yet it is often unclear whether interview-based cognitive assessments (such as face-to-face or telephonic word recall tasks) can be adapted for use in application-based research settings.

OBJECTIVE: The objective of the current study was to compare and characterize the results of online word recall tasks to those of the Health and Retirement Study (HRS) and determine the feasibility and reliability of incorporating word recall tasks into application-based cognitive assessments.

METHODS: The results of the online immediate and delayed word recall assessment, included within the Women's Health and Valuation (WHV) study, were compared to the results of the immediate and delayed recall tasks of Waves 5-11 (2000-2012) of the HRS.

RESULTS: Performance on the WHV immediate and delayed tasks demonstrated strong concordance with performance on the HRS tasks (ρc=.79, 95% CI 0.67-0.91), despite significant differences between study populations (P<.001) and study design. Sociodemographic characteristics and self-reported memory demonstrated similar relationships with performance on both the HRS and WHV tasks.

CONCLUSIONS: The key finding of this study is that the HRS word recall tasks performed similarly when used as an online cognitive assessment in the WHV. Online administration of cognitive tests, which has the potential to significantly reduce participant and administrative burden, should be considered in future research studies and health assessments.

PB - 2 VL - 2 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26543924?dopt=Abstract U2 - PMC4607399 U4 - cognition/online surveys/episodic memory/Health and Retirement Study/Women s Health Valuation Study ER - TY - JOUR T1 - The Association Between Socioeconomic Status and Cardiovascular Risk Factors Among Middle-Aged and Older Men and Women JF - Women and Health Y1 - 2014 A1 - Kristi Rahrig Jenkins A1 - Mary Beth Ofstedal KW - Demographics KW - Health Conditions and Status KW - Women and Minorities AB - Studies of gender differences in the association between socioeconomic status (SES) and cardiovascular risk factors have produced mixed findings. The purpose of this research was to examine whether the association between SES and cardiovascular risk factors differed between older men and women. Using data on physical measures and biomarkers from the 2006 Health and Retirement Study (N = 2,502 men; N = 3,474 women), linear regression models were used to estimate the association between SES and seven cardiovascular risk factors. Interactions between gender and SES were tested. For all seven risks assessed, we observed significant associations of selected SES factors to cardiovascular risk for men and/or women. In all of these cases, lower SES was associated with higher cardiovascular risk. However, for six of the factors, we also observed gender differences in the association between SES and cardiovascular risk, such that lower SES was associated with higher cardiovascular risk for women but not for men. These findings suggest that the association between SES and cardiovascular risk is more pronounced for women than for men. Implementing interventions to reduce cardiovascular risk factors, particularly among older women with lower SES, might, over time, reduce cardiovascular disease in women and improve quality of life. PB - 54 VL - 54 IS - 1 N1 - Times Cited: 0 U4 - socioeconomic status/cardiovascular risk/WOMEN ER - TY - THES T1 - Burden and self-efficacy in Alzheimer's disease caregivers Y1 - 2014 A1 - Jackson, Maybelle F. KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Alzheimer's disease (AD), the most common type of dementia occurring in older adults, has reached epidemic proportions. An estimated 5.2 million Americans are living with this chronic, irreversible brain disease (Alzheimer's Association, 2014). Research has shown that providing care for persons with dementia is associated with higher levels of stress than providing care for other chronic medical conditions, often resulting in negative outcomes for the caregiver. Although self-efficacy has been identified as a potential factor in predicting an individual's ability to cope with stress, limited research has examined this concept within the context of AD caregiving and its impact on caregiving outcomes. Based on this significant gap in the caregiving literature, the purpose of this study was to examine the relationship between caregiver self-efficacy and caregiver burden in family caregivers of persons with AD. Utilizing a predictive cross-sectional research design, the predictive potential of the independent variables on the outcome variable, caregiver burden, was also examined. Theoretical underpinnings that formed the overall conceptual framework for this study were drawn from Lazarus and Folkman's (1984) stress and coping framework. This study's sample of caregivers' racial composition was 74.7 percent African American and 25.3 percent Caucasian. Major findings revealed that the caregiver's self-reported health status, duration in years of caregiving, and self-efficacy for controlling upsetting thoughts explained 42 percent of the variation in caregiver burden scores. Overall findings from this investigation support the significance of caregiving self-efficacy and other independent variables impact on caregiving outcomes, namely, caregiver burden. The identification of factors that mediate the negative outcomes of caregiving is critical to the development of targeted strategies aimed at reducing caregiver burden and improving health outcomes of caregivers of persons with AD. PB - Southern University and Agricultural and Mechanical College CY - Baton Rouge, LA VL - 3667108 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2015-01-10 First page - n/a U4 - Health care management JO - Burden and self-efficacy in Alzheimer's disease caregivers ER - TY - JOUR T1 - Common genetic variants associated with cognitive performance identified using the proxy-phenotype method. JF - Proc Natl Acad Sci U S A Y1 - 2014 A1 - Cornelius A Rietveld A1 - Tõnu Esko A1 - Gail Davies A1 - Pers, Tune H A1 - Turley, Patrick A1 - Benyamin, Beben A1 - Chabris, Christopher F A1 - Emilsson, Valur A1 - Andrew D Johnson A1 - Lee, James J A1 - Christiaan de Leeuw A1 - Riccardo E Marioni A1 - Sarah E Medland A1 - Michael B Miller A1 - Rostapshova, Olga A1 - Sven J van der Lee A1 - Anna A E Vinkhuyzen A1 - Amin, Najaf A1 - Dalton C Conley A1 - Derringer, Jaime A1 - Cornelia M van Duijn A1 - Fehrmann, Rudolf A1 - Lude L Franke A1 - Edward L Glaeser A1 - Narelle K Hansell A1 - Caroline Hayward A1 - Iacono, William G A1 - Carla A Ibrahim-Verbaas A1 - Vincent Jaddoe A1 - Karjalainen, Juha A1 - David I Laibson A1 - Paul Lichtenstein A1 - David C Liewald A1 - Patrik K E Magnusson A1 - Nicholas G Martin A1 - McGue, Matt A1 - McMahon, George A1 - Nancy L Pedersen A1 - Pinker, Steven A1 - David J Porteous A1 - Posthuma, Danielle A1 - Fernando Rivadeneira A1 - Smith, Blair H A1 - John M Starr A1 - Henning Tiemeier A1 - Nicholas J Timpson A1 - Trzaskowski, Maciej A1 - André G Uitterlinden A1 - Verhulst, Frank C A1 - Mary E Ward A1 - Margaret J Wright A1 - George Davey Smith A1 - Ian J Deary A1 - Johannesson, Magnus A1 - Plomin, Robert A1 - Peter M Visscher A1 - Daniel J. Benjamin A1 - Cesarini, David A1 - Philipp D Koellinger KW - Cell Adhesion Molecules, Neuronal KW - Cognition KW - Female KW - Humans KW - Learning KW - Male KW - Memory KW - Multifactorial Inheritance KW - Nerve Tissue Proteins KW - Neuronal Plasticity KW - Octamer Transcription Factors KW - Polymorphism, Single Nucleotide KW - Synaptic Transmission AB -

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

VL - 111 IS - 38 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25201988?dopt=Abstract ER - TY - JOUR T1 - The Concordance of Survey Reports and Medicare Claims in a Nationally Representative Longitudinal Cohort of Older Adults JF - Medical Care Y1 - 2014 A1 - Frederic D Wolinsky A1 - Michael P Jones A1 - Fred A Ullrich A1 - Yiyue Lou A1 - George L Wehby KW - Medicare linkage KW - Medicare/Medicaid/Health Insurance KW - Meta-analyses KW - Survey Methodology AB - Background: Concordance between survey reports and claims data is not well established. We compared them for disease histories, preventative, and other health services use in a large, nationally representative sample of older Medicare beneficiaries with special attention given to evaluating age, aging, memory, and respondent status effects. Methods: Baseline (1993) and biennial follow-up data (through 2010) from the Survey on Assets and Health Dynamics among the Oldest-Old were linked to Medicare claims from 1991 to 2010, for 4910 participants yielding 19,556 person-periods. Concordance was measured by simple, weighted, and prevalence and bias-adjusted κ, and Lin’s concordance statistics. Generalized estimating equation negative binomial models were used to predict the summary counts of concordant reports, survey underreports, and survey overreports. Results: Concordance was highly variable overall, unacceptably low for arthritis and physician visits, and less than substantial for angina, heart disease, hypertension, and outpatient surgery. Generalized estimating equation negative binomial models revealed reductions in reporting accuracy (more underreporting and overreporting) associated with both age (interindividual) and aging (intraindividual) effects, countervailing memory effects on concordance due to less underreporting but more overreporting, and countervailing proxy-respondent effects on concordance due to less underreporting but more overreporting. Conclusions: Further research should explore whether these findings are time or cohort bound, address the potential heterogeneity of the proxy-respondent effects based on the reason for and relationship of the proxy to the target person, and evaluate the effects of a broader spectrum of performance-based cognitive abilities. In the interim, the significant predictors identified here should be included in future studies. VL - 52 UR - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005650-201405000-00014 IS - 5 JO - Medical Care ER - TY - JOUR T1 - Connecting Social Environment Variables to the Onset of Major Specific Health Outcomes JF - Psychology and Health Y1 - 2014 A1 - Patrick L Hill A1 - Sara J Weston A1 - Joshua J Jackson KW - Adult children KW - Demographics KW - Health Conditions and Status AB - Abstract Objective: The present research examined the effects of the social environment on the onset of specific health ailments. Design: Using data from the Health and Retirement Study, we examined participants? responses to social environment questions in 2006 as predictors of onset of different health conditions over the next four years. Main Outcome Measures: Healthy participants (n = 7514) reported on their number of social partners, interaction frequency, positive social support, and negative social support with respect to both their family and friends. These variables were used to predict onset of seven conditions in 2010: high blood pressure, heart condition, lung disease, cancer, stroke, diabetes, and arthritis. Results: Logistic regressions indicated that the social environment provided some predictive value for onset of most health outcomes, with more positive and less negative social support appearing to buffer against onset. Social environmental variables related to friendships appeared to play a greater role than the family indicators. However, no variable proved universally adaptive, and social indicators had little value in predicting onset of chronic conditions. Conclusion: The current findings point to the potential for the social environment to influence later health, while demonstrating the nuanced role that our social lives play with respect to health. Objective: The present research examined the effects of the social environment on the onset of specific health ailments. Design: Using data from the Health and Retirement Study, we examined participants? responses to social environment questions in 2006 as predictors of onset of different health conditions over the next four years. Main Outcome Measures: Healthy participants (n = 7514) reported on their number of social partners, interaction frequency, positive social support, and negative social support with respect to both their family and friends. These variables were used to predict onset of seven conditions in 2010: high blood pressure, heart condition, lung disease, cancer, stroke, diabetes, and arthritis. Results: Logistic regressions indicated that the social environment provided some predictive value for onset of most health outcomes, with more positive and less negative social support appearing to buffer against onset. Social environmental variables related to friendships appeared to play a greater role than the family indicators. However, no variable proved universally adaptive, and social indicators had little value in predicting onset of chronic conditions. Conclusion: The current findings point to the potential for the social environment to influence later health, while demonstrating the nuanced role that our social lives play with respect to health. PB - 29 VL - 29 UR - http://dx.doi.org/10.1080/08870446.2014.884221 IS - 7 U4 - Social Environment/Ailment Onset/Social Support/Social Network Size ER - TY - JOUR T1 - The conscientious retiree: The relationship between conscientiousness, retirement, and volunteering. JF - J Res Pers Y1 - 2014 A1 - Mike, Anissa A1 - Joshua J Jackson A1 - Thomas F Oltmanns AB -

The current study examined the relationship between conscientiousness, work status, and volunteering utilizing two large samples, the St. Louis Personality and Aging Network (SPAN) and the Health and Retirement Study (HRS). It was hypothesized that conscientious adults who were retired would be more likely to volunteer because, after retirement, they gain a substantial amount of free time, while losing an outlet for their industrious and achievement-striving tendencies. Cross-sectional and longitudinal analyses revealed that conscientious, retired individuals were more likely to volunteer than conscientious, working individuals. Further analyses revealed that facets of conscientiousness provide differential information from the general trait. These findings indicate that volunteering during retirement fills an important niche for high-striving, conscientious individuals.

PB - 52 VL - 52 UR - http://www.sciencedirect.com/science/article/pii/S0092656614000695 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25843985?dopt=Abstract U2 - PMC4380150 U4 - Conscientiousness/Conscientiousness/Facets/Retirement/Social investment/Volunteering/Work status ER - TY - JOUR T1 - Cost of informal caregiving associated with stroke among the elderly in the United States JF - Neurology Y1 - 2014 A1 - Heesoo Joo A1 - Dunet, Diane O. A1 - Fang, Jing A1 - Wang, Guijing KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Objectives: We estimated the informal caregiving hours and costs associated with stroke. Methods: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. We compared informal caregiving hours between case and control groups in 2006 (prestroke period for case group) and in 2008 (poststroke period for case group) and estimated incremental informal caregiving hours attributable to stroke by applying a difference-in-differences technique to propensity score-matched populations. We used a replacement approach to estimate the economic value of informal caregiving. Results: The weekly incremental informal caregiving hours attributable to stroke were 8.5 hours per patient. The economic value of informal caregiving per stroke survivor was 8,211 per year, of which 4,356 (53 ) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at 14.2 billion in 2008. Conclusions: Recent changes in public health and social support policies recognize the economic burden of informal caregiving. Our estimates reinforce the high economic burden of stroke in the United States and provide up-to-date information for policy development and decision-making. PB - 83 VL - 83 IS - 20 N1 - Times Cited: 1 0 1 U4 - informal caregiving/informal caregiving/Stroke/public policy/social Support/economic burden ER - TY - JOUR T1 - Determinants of socioeconomic inequalities in subjective well-being in later life: a cross-country comparison in England and the USA JF - Quality of Life Research Y1 - 2014 A1 - Jivraj, S. A1 - James Nazroo KW - Cross-National KW - Expectations KW - Health Conditions and Status KW - Net Worth and Assets KW - Public Policy KW - Retirement Planning and Satisfaction AB - Purpose To explore country-specific influences on the determinants of two forms of subjective well-being (life satisfaction and quality of life) among older adults in England and the USA. Methods Harmonised data from two nationally representative panel studies of individuals aged 50 and over, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), are used. Linear regression models are fitted separately for life satisfaction and quality of life scales using cross-sectional samples in 2004. The ELSA sample was 6,733, and the HRS sample was 2,300. Standardised coefficients are reported to determine the country-specific importance of explanatory variables, and predicted values are shown to highlight the relative importance of statistically significant country-level interaction effects. Results Having a disability, been diagnosed with a chronic conditions or having low household wealth are strongly associated with poorer life satisfaction and quality of life. These statistical effects are consistent in England and the USA. The association of years spent in education, however, varied between the two countries: educational inequalities have a greater adverse effect on subjective well-being in the USA compared with England. Conclusion Interventions are required to counterbalance health and socioeconomic inequalities that restrict sections of the population from enjoying satisfying and meaningful lives in older age. The differential association between education and well-being in England and the USA suggests that the provision of welfare benefits and state-funded public services in England may go some way to protect against the subsequent adverse effect of lower socioeconomic status on subjective well-being. PB - 23 VL - 23 IS - 9 N1 - Export Date: 6 August 2014 Article in Press U4 - Cross-country comparison/Inequalities/Life satisfaction/Life satisfaction/Older age/Quality of life/Subjective well-being/ELSA_/cross-national comparison/household wealth/chronic conditions ER - TY - THES T1 - Economic analysis of preventive care utilization among older adults Y1 - 2014 A1 - Ng, Boon Peng KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - This dissertation seeks to examine the economic determinants of the use of preventive services among older adults. It contains two studies that focus on the effects of public health policy and health shocks on the initiation of use of preventive services among older adults. In January 2005, Medicare began covering a one-time initial preventive physical examination (IPPE), also called a "Welcome to Medicare" visit, for new beneficiaries. This benefit was only available during a beneficiary's first six months after enrolling in Part B. The first study examines the effects of covering an IPPE on the use of mammograms, breast self-exams, Pap smears, prostate cancer screenings, cholesterol screenings, and flu vaccines among beneficiaries new to Medicare Part B. Using data from the 1996-2008 Health and Retirement Study (HRS) and the RAND HRS, I estimate multivariate logit models to quantify the effects of Medicare coverage of an IPPE on the utilization of each of these preventive care services. The findings indicate that, among both men and women, the introduction of Medicare IPPE coverage during a beneficiary's first six months under Part B did not increase the utilization of any of the preventive services examined. Although about 70% of older adults will have one chronic condition and 50% will have more than one chronic illness such as heart disease, cancer, stroke etc. (CDC 2009), only 25% of adults ages 50-64, and fewer than 40% of adults ages 65 and older are up-to-date on recommended preventive healthcare services. The second study evaluates whether new information, acquired through the occurrence of unexpected adverse health events, leads an individual to begin using preventive care services. Using data from the longitudinal Health and Retirement Study (HRS) and the RAND HRS, multivariate logit models are estimated to model the dynamic effects of exogenous health shocks on the initiation of use of mammograms, breast self-exams, Pap smears, prostate cancer screening, cholesterol tests, and flu vaccinations. Findings reveal that among adults with a history of not using preventive care, an unexpected adverse health event often spurs them to begin using such services. Among women ages 40 and older, those who experience an adverse health shock are 1.87 times more likely to begin getting mammograms, 1.48 times more likely to begin getting Pap smears, 1.79 times more likely to begin getting cholesterol tests, and 1.46 times more likely to begin getting flu vaccinations. Among men ages 40 and older, those who experience an adverse health shock are 2.24 times more likely to begin getting prostate cancer screenings, 2.75 times more likely to begin getting cholesterol checks, and 1.64 times more likely to begin getting flu vaccinations. These findings provide strong evidence that people change their health behaviors in positive ways following the occurrence of a negative health experience. PB - Wayne State University CY - Detroit VL - 3640123 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1615117270?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: N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-11-05 First page - n/a U4 - health Behavior JO - Economic analysis of preventive care utilization among older adults ER - TY - JOUR T1 - Effects of cost-related medication nonadherence on financial health and retirement decisions among adults in late midlife JF - Journal of Pharmaceutical Health Services Research Y1 - 2014 A1 - Gail A Jensen A1 - Yong Li KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Other KW - Retirement Planning and Satisfaction AB - Objectives Suboptimal adherence to prescribed medications due to cost is known to adversely affect physical health. In this study, we examine whether cost-related nonadherence (CRN) also affects financial health , e.g. an individual's personal finances or the timing of their retirement. Methods We examine this issue for 2927 adults in late midlife with chronic medical conditions who participated in the Health and Retirement Study and who reported regularly taking medication(s) for their condition over the period 1994 to 2004. We hypothesize CRN may indirectly influence financial health by contributing to the occurrence of negative health shocks. We estimate two sets of models, one to quantify the effects of CRN on the occurrence of adverse health events, and another to quantify the effects of adverse health events on personal finances in 2004 and the timing of retirement. We then derive estimates of the indirect effects of CRN on financial health and on retirement decisions. Key findings Among adults in late midlife, CRN contributes significantly to reduced earnings and premature retirements. These effects happen because CRN raises the risk that serious health shocks occur over time, and such adverse events subsequently limit an individual's ability to continue working and accumulating wealth. Conclusions CRN can threaten more than just personal health. In late midlife, CRN can threaten an individual's ability to continue working and saving towards retirement. PB - 5 VL - 5 UR - http://dx.doi.org/10.1111/jphs.12076 IS - 4 U4 - chronic care/financial health/cost-related nonadherence/long-run outcomes/medications/retirement planning/spillover effects/labor Force Participation ER - TY - JOUR T1 - Grandparenting Roles and Volunteer Activity JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2014 A1 - Jennifer R. Bulanda A1 - Jendrek, Margaret Platt KW - Adult children KW - Demographics KW - Methodology KW - Public Policy AB - Objectives. We examine whether grandparenting roles are related to formal volunteering among older adults.Method. Logistic regression is used to examine the likelihood of volunteering based on grandchild care using data from the 2004 wave of the Health and Retirement Study (n = 13,785). Longitudinal analyses utilize treatment effects models to examine changes in volunteering for grandparents who begin nonresidential grandchild care between the 2004 and 2008 waves (n = 10,811).Results. Results show that grandparents raising coresidential grandchildren have lower odds of volunteering than grandparents providing no regular grandchild care. However, grandparents who provide nonresidential grandchild care are more likely to volunteer than grandparents not providing grandchild care and those raising a coresidential grandchild. Grandparents who provide nonresidential care for grandchildren engage in more volunteering before assuming grandchild care, and their volunteerism increases after becoming a caregiver for a grandchild.Discussion. Consistent with resource theory and the accumulation of roles, providing nonresidential grandchild care may draw grandparents into formal volunteer activity. The lower human capital resources evidenced by grandparents raising coresidential grandchildren may play a role in their lower likelihood of formal volunteering. PB - 17 VL - 17 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/04/10/geronb.gbu033.abstract IS - 1 U4 - Civic engagement/Grandchildren/Grandparents/Volunteerism/Resource theory/family roles/residence ER - TY - JOUR T1 - The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US JF - Bmc Cancer Y1 - 2014 A1 - Sarah E Jackson A1 - Williams, Kate A1 - Andrew Steptoe A1 - Wardle, Jane KW - Health Conditions and Status AB - Background: Obesity is a risk factor for cancer incidence and survival, but data on patterns of weight change in cancer survivors are scarce and few stratify by pre-diagnosis weight status. In two population-based cohorts of older adults, we examined weight change in cancer survivors and cancer-free controls in relation to baseline weight status. Methods: In the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), we identified participants diagnosed with cancer who had pre- and post-diagnosis BMI data (ELSA n = 264; HRS n = 2553), and cancer-free controls (ELSA n = 1538; HRS n = 4946). Repeated-measures ANOVAs tested three-way interactions by group (cancer/control), time (pre-/post-diagnosis), and pre-diagnosis weight status (normal-weight/overweight/obese). Results: Mean BMI change was -0.07 (SD = 2.22) in cancer survivors vs. 0.14 (SD = 1.11) in cancer-free controls in ELSA, and -0.20 (SD = 2.84) vs. 0.11 (SD = 0.93) respectively in HRS. Three-way interactions were significant in both cohorts (ELSA p = .015; HRS p .001). In ELSA, mean BMI change in normal-weight cancer survivors was 0.19 (SD = 1.53) compared with -0.33 (SD = 3.04) in obese survivors. In ELSA controls, the respective figures were 0.09 (SD = 0.81) and 0.16 (SD = 1.50). In HRS, mean change in normal-weight cancer survivors was 0.07 (SD = 2.30) compared with -0.72 (SD = 3.53) in obese survivors. In HRS controls, the respective figures were 0.003 (SD = 0.66) and 0.27 (SD = 1.27). Conclusion: Over a four-year period, in two cohorts of older adults, cancer survivors lost weight relative to cancer-free controls. However, cancer survivors who were obese pre-diagnosis were more likely to lose weight than healthy-weight survivors or obese adults without a cancer diagnosis. Whether this was due to differences in clinical status or deliberate lifestyle change triggered by the cancer diagnosis is not known. Further research is needed to establish why weight loss occurs more frequently in cancer survivors who were obese at diagnosis, and whether this has favourable effects on mortality. PB - 14 VL - 14 N1 - Times Cited: 0 0 U4 - Weight loss/Body weight changes/Cancer diagnosis/Overweight/Obese/Cancer survivors ER - TY - JOUR T1 - Personality and long-term reproductive success measured by the number of grandchildren JF - Evolution and Human Behavior Y1 - 2014 A1 - Berg, Venla A1 - Lummaa, Virpi A1 - Lahdenper , Mirkka A1 - Rotkirch, Anna A1 - Markus Jokela KW - Adult children KW - Health Conditions and Status KW - Other AB - Personality, that is, individual behavioral tendencies that are relatively stable across situations and time, has been associated with number of offspring in many animals, including humans, suggesting that some personality traits may be under natural selection. However, there are no data on whether these associations between personality and reproductive success extend over more than one generation to numbers of grandchildren. Using a large representative sample of contemporary Americans from the Health and Retirement Study (n = 10,688; mean age 67.7 years), we studied whether personality traits of the Five Factor Model were similarly associated with number of children and grandchildren, or whether antagonistic effects of personality on offspring number and quality lead to specific personality traits differently maximizing short and long-term fitness measures. Higher extraversion, lower conscientiousness, and lower openness to experience were similarly associated with both higher number of children and grandchildren in both sexes. In addition, higher agreeableness was associated with higher number of grand-offspring only. Our results did not indicate any quality-quantity trade-offs in the associations between personality and reproductive success. These findings represent the first robust evidence for any species that personality may affect reproductive success over several generations. PB - 35 VL - 35 UR - http://www.sciencedirect.com/science/article/pii/S1090513814000865 IS - 6 N1 - Ar1pf Times Cited:0 Cited References Count:48 U4 - Personality/Personality/long-term fitness/quality-quantity trade-off/Families/grandchildren/transfers/reproductive success/psychological aspects ER - TY - JOUR T1 - Is personality associated with cancer incidence and mortality? An individual-participant meta-analysis of 2156 incident cancer cases among 42843 men and women JF - British journal of cancer Y1 - 2014 A1 - Markus Jokela A1 - G David Batty A1 - Hintsa, T. A1 - Marko Elovainio A1 - Hakulinen, C. A1 - Mika Kivimäki KW - Health Conditions and Status AB - Background:The putative role of personality in cancer risk has been controversial, and the evidence remains inconclusive.Methods:We pooled data from six prospective cohort studies (British Household Panel Survey; Health and Retirement Study; Household, Income, and Labour Dynamics in Australia; Midlife in the United Survey; Wisconsin Longitudinal Study Graduate; and Sibling samples) for an individual-participant meta-analysis to examine whether personality traits of the Five Factor Model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) were associated with the incidence of cancer and cancer mortality in 42843 cancer-free men and women at baseline (mean age 52.2 years, 55.6 women).Results:During an average follow-up of 5.4 years, there were 2156 incident cancer cases. In random-effects meta-analysis adjusted for age, sex, and race/ethnicity, none of the personality traits were associated with the incidence of all cancers or any of the six site-specific cancers included in the analysis (lung, colon, breast, prostate, skin, and leukaemia/lymphoma). In the three cohorts with cause-specific mortality data (421 cancer deaths among 21835 participants), none of the personality traits were associated with cancer mortality.Conclusions:These data suggest that personality is not associated with increased risk of incident cancer or cancer-related mortality. PB - 110 VL - 110 IS - 7 N1 - Times Cited: 0 U4 - personality/personality/cancer/big five/psychosomatic medicine ER - TY - JOUR T1 - Personality change associated with chronic diseases: pooled analysis of four prospective cohort studies JF - Psychological Medicine Y1 - 2014 A1 - Markus Jokela A1 - Hakulinen, C. A1 - Archana Singh-Manoux A1 - Mika Kivimäki KW - Health Conditions and Status KW - Methodology AB - Background: Common chronic conditions, such as heart disease and cancer, are associated with increased psychological distress, functional limitations and shortened life expectancy, but whether these diseases alter aspects of personality remains unclear. Method: To examine whether the onset of heart disease, stroke, diabetes, cancer, hypertension, arthritis and respiratory disease is associated with subsequent changes in personality traits of the five-factor model, we pooled data from the Health and Retirement Study, the Midlife in the United States Survey, and the graduate and sibling samples of the Wisconsin Longitudinal Study for an individual-participant meta-analysis (total n = 17 493; mean age at baseline 55.8 years). Results: After adjustment for age, we observed consistent decreases in extraversion -0.25 T-scores per one disease; 95 confidence interval (CI) -0.40 to -0.10 , emotional stability (-0.40, 95 CI -0.61 to -0.19), conscientiousness (-0.44, 95 CI -0.57 to -0.30) and openness to experience (-0.25, 95 CI -0.37 to -0.13) but not in agreeableness (-0.05, 95 CI -0.19 to 0.08) after the onset of chronic diseases. The onset of each additional chronic disease accelerated the average age-related personality change by 2.5 years in decreasing extraversion, 5.5 years in decreasing conscientiousness, and 1.6 years in decreasing openness to experience, and attenuated the increasing levels of emotional stability by 1.9 years. Co-morbid conditions were associated with larger changes than single diseases, suggesting a dose-response association between morbidity and personality change. Conclusions: These results support the hypothesis that chronic diseases influence personality development in adulthood. Copyright Cambridge University Press 2014. PB - 44 VL - 44 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84893979073andpartnerID=40andmd5=090e38b137f79e574d4bd8d0e6c36699 IS - 12 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U4 - Chronic disease/longitudinal studies/meta-analyses/morbidity/personality development ER - TY - JOUR T1 - Personality traits as risk factors for stroke and coronary heart disease mortality: pooled analysis of three cohort studies JF - Journal of Behavioral Medicine Y1 - 2014 A1 - Markus Jokela A1 - Pulkki-Raback, Laura A1 - Marko Elovainio A1 - Mika Kivimäki KW - Health Conditions and Status KW - Methodology AB - We examined whether personality traits are differently associated with coronary heart disease and stroke mortality. Participants were pooled from three prospective cohort studies (Health and Retirement Study, Wisconsin Longitudinal Study graduate and sibling samples; n = 24,543 men and women, mean age 61.4 years, mortality follow-up between 3 and 15 years). There were 423 coronary heart disease deaths and 88 stroke deaths during 212,542 person-years at risk. Higher extraversion was associated with an increased risk of stroke (hazard ratio per each standard deviation increase in personality trait HR = 1.41, 95 CI 1.10 1.80) but not with coronary heart disease mortality (HR = 0.93, 0.83 1.05). High neuroticism, in turn, was more strongly related to the risk of coronary heart disease (HR = 1.16, 1.04 1.29) than stroke deaths (HR = 0.95, 0.78 1.17). High conscientiousness was associated with lower mortality risk from both coronary heart disease (HR = 0.74, 0.67 0.81) and stroke (HR = 0.78, 0.63 0.97). Cardiovascular risk associated with personality traits appears to vary between main cardiac and cerebral disease endpoints. VL - 37 UR - http://dx.doi.org/10.1007/s10865-013-9548-z IS - 5 U4 - Personality/Personality/Stroke/Coronary heart disease/Meta-analysis ER - TY - JOUR T1 - Personality Traits Predict the Onset of Disease JF - Social Psychological and Personality Science Y1 - 2014 A1 - Sara J Weston A1 - Patrick L Hill A1 - Joshua J Jackson KW - Health Conditions and Status KW - Healthcare AB - While personality traits have been linked concurrently to health status and prospectively to outcomes such as mortality, it is currently unknown whether traits predict the diagnosis of a number of specific diseases (e.g., lung disease, heart disease, and stroke) that may account for their mortality effects more generally. A sample (N = 6,904) of participants from the Health and Retirement Study, a longitudinal study of older adults, completed personality measures and reported on current health conditions. Four years later, participants were followed up to see if they developed a new disease. Initial cross-sectional analyses replicated past findings that personality traits differ across disease groups. Longitudinal logistic regression analyses predicting new disease diagnosis suggest that traits are associated with the risk of developing disease most notably the traits of conscientiousness, neuroticism, and openness. Findings are discussed as a means to identify pathways between personality and health. VL - 6 UR - http://spp.sagepub.com/content/early/2014/10/13/1948550614553248.abstract IS - 3 U4 - personality/personality/health outcomes/disease groups/conscientiousness/conscientiousness/openness/neuroticism/personality traits ER - TY - JOUR T1 - Predictors of falls among community-dwelling older adults with cancer: results from the health and retirement study JF - Supportive Care in Cancer Y1 - 2014 A1 - Tuo-Yu Chen A1 - Megan C Janke KW - Health Conditions and Status KW - Risk Taking AB - Cancer symptoms and the side effects of its treatment can increase the risk of falling among older adults with cancer. This study aimed to identify predictors of falling and recurrent falls among community-dwelling older adults with cancer over a 2-year period. Data from the Health and Retirement Study were used (N = 1,630) in this study. The sample had a mean age of 75 years and was mostly female (53 ) and white (89 ). Descriptive analyses, correlation analyses, and logistic regressions were used to analyze the data. The results showed that functional limitations (OR = 1.13, 95 CI = 1.03-1.24), the full-tandem stance (OR = 1.48, 95 CI = 1.01-2.16), and self-reported difficulties with balance (OR = 1.50, 95 CI = 1.23-1.83) at time 1 were significant predictors of falling at time 2. Only difficulties with self-reported balance (OR = 1.84, 95 CI = 1.44-2.36) at time 1 were found to be a predictor of recurrent falls at time 2. The consequences of falling can complicate the course of cancer treatment. Measures of functional limitations and balance have the potential to be quick and useful clinical tools to detect falling among seniors with cancer living in communities. PB - 22 VL - 22 UR - http://www.ncbi.nlm.nih.gov/pubmed/24122385 IS - 2 N1 - Times Cited: 0 U4 - Cancer/Risk-Factors/Functional Status/Frailty ER - TY - JOUR T1 - Predictors of older adults' personal and community mobility: using a comprehensive theoretical mobility framework. JF - Gerontologist Y1 - 2014 A1 - M. Renée Umstattd Meyer A1 - Megan C Janke A1 - Beaujean, A. Alexander KW - Aged KW - Female KW - Humans KW - Male KW - Mobility Limitation KW - Models, Theoretical AB -

PURPOSE OF THE STUDY: Forty-six percent of older adults report limitations in their mobility, and maintaining mobility is considered an important factor in keeping adults independent and active in later life. This study tests a comprehensive theoretical framework of mobility (Webber, S. C., Porter, M. M., & Menec, V. H. [2010]. Mobility in older adults: A comprehensive framework. The Gerontologist, 50[4], 443-450. doi:10.1093/geront/gnq013) identifying multiple determinants that additively influence mobility (financial, psychosocial, environmental, physical, and cognitive), as well as cross-cutting influences of gender, culture, and biography.

DESIGN AND METHODS: Structural equation modeling was used to examine several models of mobility using data from 6,112 respondents in the Health and Retirement Study (mean age: 74.74, 85% white, 41% male, 57% married).

RESULTS: The original measurement model fit the data well. When both personal and community mobility were simultaneously predicted, only the physical, cognitive, psychosocial, and environmental determinants were retained in the independent models. Age and marital status also predicted personal and community mobility. Although most of these relationships were in the expected direction, interestingly when both forms of mobility were included in the model, poorer cognitive ability was associated with greater personal mobility in the final model.

IMPLICATIONS: Results indicate the importance of accounting for and examining comprehensive models of mobility. The factors affecting older adults' mobility are complex, and these relationships need to be explored in more depth to ensure the maintenance of individuals' independence and quality of life.

PB - 54 VL - 54 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23749391?dopt=Abstract U4 - Health and Retirement Study/Structural equation modeling/Theory testing ER - TY - JOUR T1 - Predictors of Weight Loss in Obese Older Adults: Findings from the USA and the UK JF - Obesity Facts Y1 - 2014 A1 - Sarah E Jackson A1 - Rebecca J. Beeken A1 - Wardle, Jane KW - Adult children KW - Health Conditions and Status KW - Women and Minorities AB - Objective: To examine the prevalence and demographic predictors of clinically meaningful weight loss in community samples of obese older adults in the USA and the UK. Methods: Data were from obese older adults (BMI 30 kg/m2; age 52 years), free of a cancer diagnosis, from the Health and Retirement Study (HRS; n = 3398) and the English Longitudinal Study of Ageing (ELSA; n = 998). Weight change was assessed from 2004 to 2008. Multivariable logistic regression tested whether age, sex, ethnicity, marital status, education, or BMI predicted 5 weight loss. Results: Over a quarter (28.7 ) of obese participants from HRS and 16.6 from ELSA lost 5 weight. Being female (odds ratio (OR) = 1.31, 95 confidence interval (CI) = 1.11-1.54) and heavier (BMI 35 kg/m2) (OR = 1.60, 95 CI = 1.37-1.87) predicted weight loss in HRS. Trends were similar in ELSA (female: OR = 1.18, 95 CI = 0.83-1.69; BMI 35 kg/m2: OR = 1.24, 95 CI = 0.85-1.82). ORs were increased in 65-year-olds in HRS (OR = 1.55, 95 CI = 1.33-1.81), and reduced in married people in ELSA (OR = 0.69, 95 CI = 0.48-1.00). Neither education nor ethnicity predicted weight loss in either cohort. Conclusion: A high proportion of obese older adults experience clinically meaningful weight loss, but few demographic variables consistently predict weight loss in this population. 2014 S. Karger GmbH, Freiburg. PB - 7 VL - 7 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84897119471andpartnerID=40andmd5=f9f70f628dc5b0a20a721ff7288b13f4 IS - 2 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U4 - Weight loss/Obesity/WOMEN/Married couples ER - TY - RPRT T1 - Wealth Shocks, Unemployment Shocks and Consumption in the Wake of the Great Recession Y1 - 2014 A1 - Christelis, Dimitris A1 - Dimitris Georgarakos A1 - Jappelli, Tullio KW - Consumption and Savings KW - Employment and Labor Force KW - Net Worth and Assets KW - Public Policy AB - We use data from the 2009 Internet Survey of the Health and Retirement Study to examine the consumption impact of wealth shocks and unemployment during the Great Recession in the US. We find that many households experienced large capital losses in housing and in their financial portfolios, and that a non-trivial fraction of respondents have lost their job. As a consequence of these shocks, many households reduced substantially their expenditures. We estimate that the marginal propensities to consume with respect to housing and financial wealth are 1 and 3.3 percentage points, respectively. In addition, those who became unemployed reduced spending by 10 percent. We also distinguish the effect of perceived transitory and permanent wealth shocks, splitting the sample between households who think that the stock market is likely to recover in a year s time, and those who do not. In line with the predictions of standard models of intertemporal choice, we find that the latter group adjusted much more than the former its spending in response to financial wealth shocks. PB - London, Centre for Economic Policy Research U4 - consumption/great recession/unemployment/wealth shocks/household wealth/stock Market ER - TY - THES T1 - Weight loss in overweight and obese older adults T2 - Institute of Epidemiology and Health Care Y1 - 2014 A1 - Sarah E Jackson KW - Cross-National KW - Demographics KW - Health Conditions and Status AB - The prevalence of obesity has reached dramatic proportions over recent years, and obesity among older adults is becoming an increasingly important concern in developed countries with ageing populations. Weight loss is recommended for all obese individuals, regardless of age, yet while there has been a vast amount of research into factors surrounding weight loss across younger and middle-aged populations, the evidence base on weight loss in older adults is lacking. This thesis uses data from a cross-sectional survey of UK adults, and two large epidemiological studies of ageing, the English Longitudinal Study of Ageing and the Health and Retirement Study in the US, to address this gap in the literature. Study 1 highlights the high prevalence of desire to weigh less and attempts at weight loss among older adults, and Study 2 reveals that a surprisingly high proportion of those who are overweight or obese are achieving clinically meaningful (≥5%) weight loss. Studies 3 and 4 show that despite reductions in cardio-metabolic risk, weight loss in overweight/obese older adults is associated with increased risk of depressed mood, and this association grows stronger with each decade of age. However, Study 5 finds some evidence to suggest that rates of depressed mood might only be increased during the process of weight loss, and that if weight loss is maintained there might be benefits for mood relative to baseline. This research contributes to the understanding of weight loss in older adults – particularly that which occurs in the general population, outside of the trial context – and emphasises the need for health professionals to take into consideration patients' psychological wellbeing when recommending or responding to weight loss at older ages. Limitations of this work and directions for future research are discussed. JF - Institute of Epidemiology and Health Care PB - University College London CY - London U4 - cross-national study JO - Weight loss in overweight and obese older adults ER - TY - CHAP T1 - What Impact Does Old-Age Pension Receipt Have on the Use of Public Assistance Programs Among the Elderly? T2 - Safety Nets and Benefit Dependence Y1 - 2014 A1 - Norma B Coe A1 - April Yanyuan Wu ED - Carcillo, Stéphane ED - Immervoll, Herwig ED - Stephen P. Jenkins ED - Königs, Sebastian ED - Tatsiramos, Konstantinos KW - Health Conditions and Status KW - Public Policy KW - Retirement Planning and Satisfaction KW - Social Security JF - Safety Nets and Benefit Dependence PB - Emerald Group Publishing CY - Bingley, UK U4 - social Security/old age pensions/retirement planning/Public assistance JO - What Impact Does Old-Age Pension Receipt Have on the Use of Public Assistance Programs Among the Elderly? ER - TY - JOUR T1 - Analysis of Cognitive, Functional, Health Service Use, and Cost Trajectories Prior to and Following Memory Loss JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2013 A1 - Joseph E Gaugler A1 - Hovater, Martha A1 - David L. Roth A1 - Johnston, Joseph A. A1 - Robert L Kane A1 - Sarsour, Khaled KW - Health Conditions and Status KW - Healthcare AB - Objectives. This brief report examines whether significant changes in cognition, functional dependence, health service use, and out-of-pocket medical expenditures (OOPMD) occur in the years prior to a physician-identified memory problem in a nationally representative sample of older adults. Method. Longitudinal data from the RAND-Health and Retirement Survey were utilized. Those who reported a physician-identified memory problem (n = 387) were compared with a randomly selected control group of similar age, race, and gender who did not indicate a memory problem (n = 387). Multilevel linear models were used to construct trajectories for various measures of cognition, function, health service use, and OOPMD in the years prior to and following memory problem identification. Results. Several trajectories demonstrated significant rates of change in the years leading up to a physician-identified memory problem, including symptoms (mental status, fine motor skills, and instrumental activities of daily living) and utilization (OOPMD and overnight stays in hospital). Discussion. Preclinical declines in mental status and function and increases in hospital use and OOPMD are apparent prior to the formal identification of memory problems. Earlier identification of these changes might provide a basis for interventions that could alter the clinical course of dementia. PB - 68 VL - 68 UR - http://psychsocgerontology.oxfordjournals.org/content/68/4/562.abstract IS - 4 U4 - Cognition/health Care Utilization/Out of pocket costs/functional decline/functional decline/Cognitive Function/HOSPITALIZATION/IADLs ER - TY - JOUR T1 - The association of diabetes complications with physical activity in a representative sample of older adults in the United States JF - Chronic illness Y1 - 2013 A1 - Mary R Janevic A1 - Sara J McLaughlin A1 - Cathleen M. Connell KW - Health Conditions and Status AB - OBJECTIVE Most adults with diabetes do not engage in the level of physical activity recommended for optimal disease management. Diabetes complications are not generally considered a clinical contraindication to exercise. No prior national studies have examined the associations of these complications with physical activity. METHODS Data are from the 2003 Diabetes Supplement to the nationally representative US Health and Retirement Study (n=1811; age 50 years). Multiple logistic regression was used to examine the association between diabetes complications and the odds of meeting physical activity guidelines. RESULTS Forty-three percent of the sample met physical activity guidelines. Adjusting for sociodemographic variables, retinopathy (odds ratios (OR) OR=0.54, 95 confidence intervals (CI)=0.36-0.81), nephropathy (OR=0.70, 95 CI=0.50-0.99), neuropathy (OR=0.75, 95 CI=0.59-0.95), and heart disease (OR=0.69, 95 CI=0.51-0.94) were all independently associated with reduced odds of meeting guidelines. A borderline significant association was observed for stroke. DISCUSSION Adults with diabetes with complications of the eyes, kidneys, or nerves and those with heart disease are less likely to meet physical activity guidelines compared to those without these complications. These individuals may require additional support from health professionals to achieve recommended amounts of physical activity. More studies are needed to clarify the barriers and benefits to engaging in physical activity in the presence of diabetes complications. PB - 9 VL - 9 IS - 4 N1 - Times Cited: 1 U4 - Diabetes/Heart Disease/Physical Activity ER - TY - THES T1 - Essays on elderly asset management the role of medical expenses and housing Y1 - 2013 A1 - Li, Li KW - Housing KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Net Worth and Assets KW - Public Policy AB - With baby-boomers approaching their retirement age, the financial security of elderly Americans has become increasingly crucial for both policy-makers and retirees themselves. Based on the data from the Health and Retirement Survey (HRS), this dissertation examines how healthcare costs and housing affect retirees' saving and investment decisions. In chapter 1, I investigate the pattern of asset allocation among elderly Americans and test if large out-of-pocket (OOP) medical expenses were preventing older households from holding risky assets. My results show that the elderly are more likely to own risky financial assets while less likely to own housing assets as their OOP medical expenses go up. And conditional on ownership, relatively large OOP medical expenses are significantly correlated with high share of risky financial assets and low share of housing assets. These results imply that large OOP medical expenses may be capturing something other than poor health, which I explain by a "mechanical" effect that older households sell their houses to finance their large OOP medical expenses, driving up the risky financial assets share. In chapter 2, I develop a life-cycle dynamic programming model that particularly assumes elder homeowners would sell their houses to finance large medical expenses such as nursing home costs. My model finds that retirees with housing are less sensitive to the magnitude of medical expense shocks and thus maintain fewer precautionary savings. Without housing assets, retirees tend to take fewer risks while investing at the early stage of their retirement, but may have to take chances to finance elevated medical expenses as they approach the end of their life cycle. In chapter 3, I relax the borrowing constraint assumed in the prior two chapters and study the impact of health problems and related expenses on elderly households' financial security. I estimate the probability of medical default among 65 and above age group using various qualitative choice models. Results indicate that high medical debt to income ratio rather than OOP medical expense itself contributes to the high probability of default. PB - State University of New York at Albany CY - Albany, NY VL - 3591686 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1434876559?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 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2014-01-22 First page - n/a U4 - 0501:Economics JO - Essays on elderly asset management the role of medical expenses and housing ER - TY - JOUR T1 - Financial Ratios and Perceived Household Financial Satisfaction JF - Journal of Financial Therapy Y1 - 2013 A1 - Garrett, Scott A1 - Russell N. James III KW - Methodology KW - Net Worth and Assets AB - This paper tests the relative strength of three objective measures of financial health (using the solvency, liquidity, and investment asset ratio) in predicting a household s subjective feeling of current financial satisfaction. Using a sample of 6,923 respondents in the 2008 Health and Retirement Study this paper presents evidence of two main findings: 1) the solvency ratio is most strongly associated with financial satisfaction levels based on a cross-sectional design and 2) changes in the investment asset ratio are most strongly associated with changes in financial satisfaction over time. PB - 4 VL - 4 IS - 1 U4 - Financial Satisfaction/Ratios/Financial Planning/Financial Counseling ER - TY - JOUR T1 - Financial Ratios and Perceived Household Financial Satisfaction JF - Journal of Financial Therapy Y1 - 2013 A1 - Garrett, Scott A1 - Russell N. James III KW - Methodology KW - Net Worth and Assets AB - This paper tests the relative strength of three objective measures of financial health (using the solvency, liquidity, and investment asset ratio) in predicting a household s subjective feeling of current financial satisfaction. Using a sample of 6,923 respondents in the 2008 Health and Retirement Study this paper presents evidence of two main findings: 1) the solvency ratio is most strongly associated with financial satisfaction levels based on a cross-sectional design and 2) changes in the investment asset ratio are most strongly associated with changes in financial satisfaction over time. PB - 4 VL - 4 IS - 1 U4 - financial satisfaction/ratios/financial therapy/financial planning/financial exploitation/Financial counseling ER - TY - JOUR T1 - Genome-wide association analysis of blood-pressure traits in African-ancestry individuals reveals common associated genes in African and non-African populations. JF - Am J Hum Genet Y1 - 2013 A1 - Franceschini, Nora A1 - Fox, Ervin A1 - Zhang, Zhaogong A1 - Edwards, Todd L A1 - Michael A Nalls A1 - Yun Ju Sung A1 - Bamidele O Tayo A1 - Yan V Sun A1 - Gottesman, Omri A1 - Adebawole Adeyemo A1 - Andrew D Johnson A1 - Young, J Hunter A1 - Kenneth Rice A1 - Duan, Qing A1 - Chen, Fang A1 - Yun Li A1 - Tang, Hua A1 - Myriam Fornage A1 - Keene, Keith L A1 - Andrews, Jeanette S A1 - Jennifer A Smith A1 - Jessica Faul A1 - Guangfa, Zhang A1 - Guo, Wei A1 - Liu, Yu A1 - Murray, Sarah S A1 - Musani, Solomon K A1 - Srinivasan, Sathanur A1 - Digna R Velez Edwards A1 - Wang, Heming A1 - Becker, Lewis C A1 - Bovet, Pascal A1 - Bochud, Murielle A1 - Broeckel, Ulrich A1 - Burnier, Michel A1 - Carty, Cara A1 - Daniel I Chasman A1 - Georg B Ehret A1 - Chen, Wei-Min A1 - Chen, Guanjie A1 - Wei Chen A1 - Ding, Jingzhong A1 - Dreisbach, Albert W A1 - Michele K Evans A1 - Guo, Xiuqing A1 - Melissa E Garcia A1 - Jensen, Rich A1 - Keller, Margaux F A1 - Lettre, Guillaume A1 - Lotay, Vaneet A1 - Martin, Lisa W A1 - Moore, Jason H A1 - Alanna C Morrison A1 - Thomas H Mosley A1 - Ogunniyi, Adesola A1 - Walter R Palmas A1 - George J Papanicolaou A1 - Alan Penman A1 - Polak, Joseph F A1 - Ridker, Paul M A1 - Babatunde Salako A1 - Andrew B Singleton A1 - Daniel Shriner A1 - Kent D Taylor A1 - Ramachandran S Vasan A1 - Kerri Wiggins A1 - Williams, Scott M A1 - Yanek, Lisa R A1 - Wei Zhao A1 - Alan B Zonderman A1 - Becker, Diane M A1 - Berenson, Gerald A1 - Boerwinkle, Eric A1 - Erwin P Bottinger A1 - Cushman, Mary A1 - Charles B Eaton A1 - Nyberg, Fredrik A1 - Gerardo Heiss A1 - Joel N Hirschhron A1 - Howard, Virginia J A1 - Karczewsk, Konrad J A1 - Lanktree, Matthew B A1 - Liu, Kiang A1 - Yongmei Liu A1 - Ruth J F Loos A1 - Margolis, Karen A1 - Snyder, Michael A1 - Psaty, Bruce M A1 - Schork, Nicholas J A1 - David R Weir A1 - Charles N Rotimi A1 - Sale, Michele M A1 - Tamara B Harris A1 - Sharon L R Kardia A1 - Hunt, Steven C A1 - Donna K Arnett A1 - Redline, Susan A1 - Cooper, Richard S A1 - Neil Risch A1 - Rao, D C A1 - Rotter, Jerome I A1 - Chakravarti, Aravinda A1 - Reiner, Alex P A1 - Levy, Daniel A1 - Keating, Brendan J A1 - Zhu, Xiaofeng KW - Africa KW - African Continental Ancestry Group KW - Blood pressure KW - Cohort Studies KW - Databases, Genetic KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Polymorphism, Single Nucleotide KW - Quantitative Trait, Heritable KW - Reproducibility of Results AB -

High blood pressure (BP) is more prevalent and contributes to more severe manifestations of cardiovascular disease (CVD) in African Americans than in any other United States ethnic group. Several small African-ancestry (AA) BP genome-wide association studies (GWASs) have been published, but their findings have failed to replicate to date. We report on a large AA BP GWAS meta-analysis that includes 29,378 individuals from 19 discovery cohorts and subsequent replication in additional samples of AA (n = 10,386), European ancestry (EA) (n = 69,395), and East Asian ancestry (n = 19,601). Five loci (EVX1-HOXA, ULK4, RSPO3, PLEKHG1, and SOX6) reached genome-wide significance (p < 1.0 × 10(-8)) for either systolic or diastolic BP in a transethnic meta-analysis after correction for multiple testing. Three of these BP loci (EVX1-HOXA, RSPO3, and PLEKHG1) lack previous associations with BP. We also identified one independent signal in a known BP locus (SOX6) and provide evidence for fine mapping in four additional validated BP loci. We also demonstrate that validated EA BP GWAS loci, considered jointly, show significant effects in AA samples. Consequently, these findings suggest that BP loci might have universal effects across studied populations, demonstrating that multiethnic samples are an essential component in identifying, fine mapping, and understanding their trait variability.

VL - 93 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23972371?dopt=Abstract ER - TY - JOUR T1 - GWAS of 126,559 individuals identifies genetic variants associated with educational attainment. JF - Science Y1 - 2013 A1 - Cornelius A Rietveld A1 - Sarah E Medland A1 - Derringer, Jaime A1 - Yang, Jian A1 - Tõnu Esko A1 - Martin, Nicolas W A1 - Westra, Harm-Jan A1 - Shakhbazov, Konstantin A1 - Abdel Abdellaoui A1 - Agrawal, Arpana A1 - Albrecht, Eva A1 - Alizadeh, Behrooz Z A1 - Amin, Najaf A1 - Barnard, John A1 - Baumeister, Sebastian E A1 - Benke, Kelly S A1 - Bielak, Lawrence F A1 - Boatman, Jeffrey A A1 - Patricia A. Boyle A1 - Gail Davies A1 - Christiaan de Leeuw A1 - Eklund, Niina A1 - Daniel S Evans A1 - Rudolf Ferhmann A1 - Fischer, Krista A1 - Gieger, Christian A1 - Gjessing, Håkon K A1 - Hägg, Sara A1 - Harris, Jennifer R A1 - Caroline Hayward A1 - Holzapfel, Christina A1 - Carla A Ibrahim-Verbaas A1 - Ingelsson, Erik A1 - Jacobsson, Bo A1 - Joshi, Peter K A1 - Jugessur, Astanand A1 - Marika A Kaakinen A1 - Kanoni, Stavroula A1 - Karjalainen, Juha A1 - Kolcic, Ivana A1 - Kristiansson, Kati A1 - Kutalik, Zoltán A1 - J. Lahti A1 - Lee, Sang H A1 - Lin, Peng A1 - Penelope A Lind A1 - Yongmei Liu A1 - Kurt Lohman A1 - Loitfelder, Marisa A1 - McMahon, George A1 - Vidal, Pedro Marques A1 - Osorio Meirelles A1 - Lili Milani A1 - Myhre, Ronny A1 - Nuotio, Marja-Liisa A1 - Christopher J Oldmeadow A1 - Katja E Petrovic A1 - Wouter J Peyrot A1 - Polasek, Ozren A1 - Quaye, Lydia A1 - Reinmaa, Eva A1 - Rice, John P A1 - Rizzi, Thais S A1 - Schmidt, Helena A1 - Schmidt, Reinhold A1 - Albert Vernon Smith A1 - Jennifer A Smith A1 - Toshiko Tanaka A1 - Antonio Terracciano A1 - van der Loos, Matthijs J H M A1 - Vitart, Veronique A1 - Völzke, Henry A1 - Jürgen Wellmann A1 - Lei Yu A1 - Wei Zhao A1 - Allik, Jüri A1 - John R. Attia A1 - Bandinelli, Stefania A1 - Bastardot, François A1 - Jonathan P. Beauchamp A1 - David A Bennett A1 - Klaus Berger A1 - Laura Bierut A1 - Dorret I Boomsma A1 - Bültmann, Ute A1 - Campbell, Harry A1 - Chabris, Christopher F A1 - Cherkas, Lynn A1 - Chung, Mina K A1 - Francesco Cucca A1 - de Andrade, Mariza A1 - Philip L de Jager A1 - De Neve, Jan-Emmanuel A1 - Ian J Deary A1 - George Dedoussis A1 - Deloukas, Panos A1 - Dimitriou, Maria A1 - Guðny Eiríksdóttir A1 - Elderson, Martin F A1 - Johan G Eriksson A1 - Jessica Faul A1 - Luigi Ferrucci A1 - Melissa E Garcia A1 - Grönberg, Henrik A1 - Guðnason, Vilmundur A1 - Hall, Per A1 - Harris, Juliette M A1 - Tamara B Harris A1 - Nicholas D Hastie A1 - Andrew C Heath A1 - Dena G Hernandez A1 - Hoffmann, Wolfgang A1 - Hofman, Adriaan A1 - Holle, Rolf A1 - Holliday, Elizabeth G A1 - Jouke-Jan Hottenga A1 - Iacono, William G A1 - Illig, Thomas A1 - Järvelin, Marjo-Riitta A1 - Kähönen, Mika A1 - Kaprio, Jaakko A1 - Kirkpatrick, Robert M A1 - Kowgier, Matthew A1 - Latvala, Antti A1 - Lenore J Launer A1 - Lawlor, Debbie A A1 - Lehtimäki, Terho A1 - Li, Jingmei A1 - Paul Lichtenstein A1 - Lichtner, Peter A1 - David C Liewald A1 - Pamela A F Madden A1 - Patrik K E Magnusson A1 - Mäkinen, Tomi E A1 - Masala, Marco A1 - McGue, Matt A1 - Andres Metspalu A1 - Mielck, Andreas A1 - Michael B Miller A1 - Grant W Montgomery A1 - Mukherjee, Sutapa A1 - Nyholt, Dale R A1 - Ben A Oostra A1 - Palmer, Lyle J A1 - Aarno Palotie A1 - Brenda W J H Penninx A1 - Markus Perola A1 - Peyser, Patricia A A1 - Preisig, Martin A1 - Katri Räikkönen A1 - Olli T Raitakari A1 - Realo, Anu A1 - Ring, Susan M A1 - Ripatti, Samuli A1 - Fernando Rivadeneira A1 - Rudan, Igor A1 - Rustichini, Aldo A1 - Veikko Salomaa A1 - Sarin, Antti-Pekka A1 - Schlessinger, David A1 - Rodney J Scott A1 - Snieder, Harold A1 - St Pourcain, Beate A1 - John M Starr A1 - Sul, Jae Hoon A1 - Surakka, Ida A1 - Svento, Rauli A1 - Teumer, Alexander A1 - Henning Tiemeier A1 - van Rooij, Frank J A A1 - Van Wagoner, David R A1 - Vartiainen, Erkki A1 - Viikari, Jorma A1 - Vollenweider, Peter A1 - Vonk, Judith M A1 - Waeber, Gérard A1 - David R Weir A1 - Wichmann, H-Erich A1 - Elisabeth Widen A1 - Gonneke Willemsen A1 - James F Wilson A1 - Alan F Wright A1 - Dalton C Conley A1 - Davey-Smith, George A1 - Lude L Franke A1 - Groenen, Patrick J F A1 - Hofman, Albert A1 - Johannesson, Magnus A1 - Sharon L R Kardia A1 - Krueger, Robert F A1 - David I Laibson A1 - Nicholas G Martin A1 - Meyer, Michelle N A1 - Posthuma, Danielle A1 - A. Roy Thurik A1 - Nicholas J Timpson A1 - André G Uitterlinden A1 - Cornelia M van Duijn A1 - Peter M Visscher A1 - Daniel J. Benjamin A1 - Cesarini, David A1 - Philipp D Koellinger KW - Cognition KW - Educational Status KW - Endophenotypes KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Humans KW - Male KW - Multifactorial Inheritance KW - Polymorphism, Single Nucleotide AB -

A genome-wide association study (GWAS) of educational attainment was conducted in a discovery sample of 101,069 individuals and a replication sample of 25,490. Three independent single-nucleotide polymorphisms (SNPs) are genome-wide significant (rs9320913, rs11584700, rs4851266), and all three replicate. Estimated effects sizes are small (coefficient of determination R(2) ≈ 0.02%), approximately 1 month of schooling per allele. A linear polygenic score from all measured SNPs accounts for ≈2% of the variance in both educational attainment and cognitive function. Genes in the region of the loci have previously been associated with health, cognitive, and central nervous system phenotypes, and bioinformatics analyses suggest the involvement of the anterior caudate nucleus. These findings provide promising candidate SNPs for follow-up work, and our effect size estimates can anchor power analyses in social-science genetics.

VL - 340 IS - 6139 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23722424?dopt=Abstract ER - TY - JOUR T1 - Health, retirement, and migration from metro counties: evidence from the health and retirement study JF - Biodemography and Social Biology Y1 - 2013 A1 - Nan E. Johnson KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status KW - Retirement Planning and Satisfaction AB - Event history analyses and difference-in-proportions tests are used to analyze 1994-2003 data from the Health and Retirement Survey. For young-old metropolitan adults who had never retired, self-rated health (SRH) was unrelated to the odds of becoming a migrant, but for those who had retired, better SRH raised the odds. Neither SRH nor its interwave change was related to the risk of a nonmetro or metro destination. Metro-metro and metro-nonmetro migrants were indistinguishable in their recalled reasons for migration. The implications of the findings for theory and future research are discussed. PB - 59 VL - 59 IS - 2 U4 - DEMOGRAPHY/NET MIGRATION/retirement planning/Self assessed health/Migration/event history ER - TY - JOUR T1 - The impact of house price movements on non-durable goods consumption of older households JF - Annals of Economics and Finance Y1 - 2013 A1 - Shenyi Jiang A1 - Wei Sun A1 - Anthony Webb KW - Net Worth and Assets AB - Using Health and Retirement Study (HRS) data, we create a new, up-to-date panel dataset to investigate the impact of house price movements on the non-durable goods consumption of older households. We find that older homeowners respond asymmetrically when experiencing house price gains and house price losses. More specifically, they increase total non-durable goods expenditure when house prices appreciate, but fail to reduce consumption when house prices fall. PB - 14 VL - 14 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84874026500andpartnerID=40andmd5=9b24de128cf6ceeaf4346ecc7151389a IS - 2 N1 - Export Date: 24 September 2013 Source: Scopus U4 - House price fluctuations/Household consumption/Asset accumulation ER - TY - JOUR T1 - Impact of social integration on metabolic functions: evidence from a nationally representative longitudinal study of US older adults JF - Bmc Public Health Y1 - 2013 A1 - Yang Claire Yang A1 - Li, Ting A1 - Ji, Yinchun KW - Demographics KW - Health Conditions and Status KW - Other AB - Background: Metabolic functions may operate as important biophysiological mechanisms through which social relationships affect health. It is unclear how social embeddedness or the lack thereof is related to risk of metabolic dysregulation. To fill this gap we tested the effects of social integration on metabolic functions over time in a nationally representative sample of older adults in the United States and examined population heterogeneity in the effects. Methods: Using longitudinal data from 4,323 adults aged over 50 years in the Health and Retirement Study and latent growth curve models, we estimated the trajectories of social integration spanning five waves, 1998-2006, in relation to biomarkers of energy metabolism in 2006. We assessed social integration using a summary index of the number of social ties across five domains. We examined six biomarkers, including total cholesterol, high-density lipoprotein cholesterol, glycosylated hemoglobin, waist circumference, and systolic and diastolic blood pressure, and the summary index of the overall burden of metabolic dysregulation. Results: High social integration predicted significantly lower risks of both individual and overall metabolic dysregulation. Specifically, adjusting for age, sex, race, and body mass index, having four to five social ties reduced the risks of abdominal obesity by 61 (odds ratio OR 95 confidence interval Cl = 0.39 0.23, 0.67 , p = .007), hypertension by 41 (OR 95 Cl = 0.59 0.42, 0.84 , p = .021), and the overall metabolic dysregulation by 46 (OR 95 Cl = 0.54 0.40, 0.72 , p .001). The OR for the overall burden remained significant when adjusting for social, behavioral, and illness factors. In addition, stably high social integration had more potent metabolic impacts over time than changes therein. Such effects were consistent across subpopulations and more salient for the younger old (those under age 65), males, whites, and the socioeconomically disadvantaged. Conclusions: This study addressed important challenges in previous research linking social integration to metabolic health by clarifying the nature and direction of the relationship as it applies to different objectively measured markers and population subgroups. It suggests additional psychosocial and biological pathways to consider in future research on the contributions of social deficits to disease etiology and old-age mortality. PB - 13 VL - 13 N1 - Times Cited: 0 U4 - Social integration/Metabolic functions/Total cholesterol/High-density lipoprotein cholesterol/Glycosylated hemoglobin/Waist circumference/CARDIOVASCULAR-DISEASE/SEX-DIFFERENCES ER - TY - RPRT T1 - Level-of-Effort Paradata and Nonresponse Adjustment Models for a National Face-to-Face Survey Y1 - 2013 A1 - James Wagner A1 - Valliant, Richard A1 - Hubbard, Frost A1 - Jiang, Charley KW - Bias KW - Data collection KW - Meta-analyses KW - Sample weight KW - Survey Methodology AB - Survey samples are designed to produce unbiased estimates. Unfortunately, nonresponse may lead to bias if the responders and nonresponders are different with respect to the survey variables. One common approach to addressing nonresponse after data collection has been completed is to differentially weight responding cases such that the respondents match the full sample on the selected characteristics. The selection of the characteristics is a modeling step that assumes that conditional upon the selected characteristics, responders and nonresponders are equivalent. This method is known as nonresponse weighting. The method relies upon having data available for the entire sample that predicts both response and the survey variables themselves. These data can come from either the sampling frame or from paradata (Couper, 1998; Couper and Lyberg, 2005), that is, from process data created during data collection. If the available data are only useful for predicting response and not for predicting the survey variables, then adjustments based upon these data can only add noise to estimates. This is true even when the true probability of responding is known. In practice, the true probability is never known and estimates of it have associated sampling error and, possibly, misspecification error which may also add noise to estimates. PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan ER - TY - JOUR T1 - Life expectancy as a constructed belief: Evidence of a live-to or die-by framing effect JF - Journal of Risk and Uncertainty Y1 - 2013 A1 - Payne, John W. A1 - Sagara, Namika A1 - Shu, Suzanne B. A1 - Appelt, Kirstin C. A1 - Johnson, Eric J KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Life expectations are essential inputs for many important personal decisions. We propose that longevity beliefs are responses constructed at the time of judgment, subject to irrelevant task and context factors, and leading to predictable biases. Specifically, we examine whether life expectancy is affected by the framing of expectations questions as either live-to or die-by, as well as by factors that actually affect longevity such as age, gender, and self-reported health. We find that individuals in a live-to frame report significantly higher chances of being alive at ages 55 through 95 than people in a corresponding die-by frame. Estimated mean life expectancies across three studies and 2300 respondents were 7.38 to 9.17 years longer when solicited in a live-to frame. We are additionally able to show how this framing works on a process level and how it affects preference for life annuities. Implications for models of financial decision making are discussed. PUBLICATION ABSTRACT PB - 46 VL - 46 IS - 1 U4 - Longevity/Annuities/Retirement planning/Economic models/methodology/Life expectancy/behavior ER - TY - JOUR T1 - Pain among older Hispanics in the United States: is acculturation associated with pain? JF - Pain Med Y1 - 2013 A1 - Jimenez, Nathalia A1 - Dansie, Elizabeth A1 - Buchwald, Dedra A1 - Goldberg, Jack KW - Acculturation KW - Aged KW - Confidence Intervals KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Language KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - pain KW - Pain Measurement KW - Prevalence KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Previous studies suggest that acculturation may influence the experience of pain.

STUDY DESIGN: We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States.

METHODS SUBJECTS: Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008.

MEASURES: We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain.

ANALYSIS: We applied logistic regression using generalized estimating equations, with NHW as the reference category.

RESULTS: Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95% confidence interval [CI  = 1.1-1.4) and intensity (OR = 1.6; 95% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95% CI 0.6-0.9).

CONCLUSION: Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference.

PB - 14 VL - 14 UR - http://www.ncbi.nlm.nih.gov/pubmed/23718576 IS - 8 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23718576?dopt=Abstract U2 - PMC3748254 U4 - Acculturation/Language/Older Hispanics/Hispanic ER - TY - JOUR T1 - Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults. JF - Am J Epidemiol Y1 - 2013 A1 - Markus Jokela A1 - G David Batty A1 - Solja T. Nyberg A1 - Virtanen, Marianna A1 - Nabi, Hermann A1 - Archana Singh-Manoux A1 - Mika Kivimäki KW - Age Factors KW - Anxiety Disorders KW - Cohort Studies KW - Extraversion, Psychological KW - Female KW - Humans KW - Male KW - Middle Aged KW - Mortality KW - Neuroticism KW - Personality KW - Prospective Studies KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors AB -

Personality may influence the risk of death, but the evidence remains inconsistent. We examined associations between personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and the risk of death from all causes through individual-participant meta-analysis of 76,150 participants from 7 cohorts (the British Household Panel Survey, 2006-2009; the German Socio-Economic Panel Study, 2005-2010; the Household, Income and Labour Dynamics in Australia Survey, 2006-2010; the US Health and Retirement Study, 2006-2010; the Midlife in the United States Study, 1995-2004; and the Wisconsin Longitudinal Study's graduate and sibling samples, 1993-2009). During 444,770 person-years at risk, 3,947 participants (54.4% women) died (mean age at baseline = 50.9 years; mean follow-up = 5.9 years). Only low conscientiousness-reflecting low persistence, poor self-control, and lack of long-term planning-was associated with elevated mortality risk when taking into account age, sex, ethnicity/nationality, and all 5 personality traits. Individuals in the lowest tertile of conscientiousness had a 1.4 times higher risk of death (hazard ratio = 1.37, 95% confidence interval: 1.18, 1.58) compared with individuals in the top 2 tertiles. This association remained after further adjustment for health behaviors, marital status, and education. In conclusion, of the higher-order personality traits measured by the five-factor model, only conscientiousness appears to be related to mortality risk across populations.

PB - 178 VL - 178 UR - http://www.ncbi.nlm.nih.gov/pubmed/23911610 IS - 5 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23911610?dopt=Abstract U2 - PMC3755650 U4 - Meta-analysis/Mortality/Personality/Personality/Psychology/Survival analysis/cross-national comparison/Death ER - TY - CHAP T1 - Physical and biological indicators of health and functioning in U.S. oldest old T2 - Annual Review of Gerontology and Geriatrics Y1 - 2013 A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins ED - Robine, Jean-Marie ED - Jagger, Carol ED - Eileen M. Crimmins KW - End of life decisions KW - Health Conditions and Status KW - Healthcare AB - This chapter examines biomarkers of aging, including indicators of physical performance and biomarkers of physiological dysregulation, among a representative national sample of U.S. adults aged 80 years and older with the aim of addressing three questions about the oldest old U.S. population: (a) How do levels of biomarkers of aging vary by age? (b) Are biomarkers of aging patterned by gender, race, ethnicity, and education? and (c) Which biomarkers of aging predict health and mortality. Data for this study come from the Health and Retirement Study (HRS). This large population-based study of U.S. adults aged 80 years and older provides confirmation of the importance of biomarkers of aging for understanding health and longevity in the oldest old. The results indicate that physical functioning declines across age groups even among the oldest old, and that the oldest adults are more likely to have levels of physical performance, inflammation, and organ function that are considered to be high risk for poor health outcomes. In addition, social disparities in physical functioning continue to be evident among the oldest segment of the U.S. population. We also provide evidence for the value of several biomarkers of aging in predicting poor health outcomes among the oldest old. In particular, indicators of high risk for walking dysfunction and dysregulation in the lungs and kidneys were found to predict hospitalization and short-term mortality. JF - Annual Review of Gerontology and Geriatrics PB - Springer CY - New York VL - 33 U4 - biomarkers/Physical function/health Status/HOSPITALIZATION/Mortality/decline JO - Physical and Biological Indicators of Health and Functioning in U.S. Oldest Old ER - TY - THES T1 - Volunteering among surviving spouses: The impact of volunteer activity on the health of the recently widowed T2 - Gerontology Y1 - 2013 A1 - Kimberly J. Johnson KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Net Worth and Assets AB - Numerous studies link volunteering to positive mental and physical health for older adults, and recent studies have suggested that volunteering may be particularly beneficial for those who are widowed. This research examines the potential of volunteering to buffer participants from stress-related health declines associated with the death of a spouse. Using the Health and Retirement Study (HRS), this research investigates the moderating role of volunteering on the self-rated health and depressive symptoms of recently widowed older adults. Consecutive waves of the HRS are used to identify respondents who experience the death of a spouse or who remain married, and those married or widowed respondents who participate in volunteer work over a two-year period. Waves 1998 through 2004 are used to construct three observation periods: 1998-2000, 2000-2002, and 2002-2004. A series of logistic and negative binomial regression analyses are used to estimate the direct effect and interactive effect of widowed status and volunteer status on self-rated health and depressive symptoms respectively. Results indicate that while volunteering decreases the odds of being in fair or poor health and decreases the expected number of depressive symptoms for volunteers compared with nonvolunteers, volunteering does not buffer recent widows from declines in self-rated health or reduce the risk of more depressive symptoms. The results do not support the idea that volunteering serves as a source of social support for older adults when dealing with the stress of spousal loss. However, the findings do support the idea that participating in volunteering helps older adults remain socially integrated through a meaningful role in their community. JF - Gerontology PB - University of Massachusetts, Boston CY - Boston, MA VL - Ph.D. UR - https://scholarworks.umb.edu/doctoral_dissertations/114/ U4 - Aging ER - TY - JOUR T1 - What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline. JF - Neuroepidemiology Y1 - 2013 A1 - Hector M González A1 - Wassim Tarraf A1 - Mary E Bowen A1 - Michelle D Johnson-Jennings A1 - Gwenith G Fisher KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cognitive Reserve KW - Cohort Studies KW - Female KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Parents KW - Prospective Studies KW - Socioeconomic factors KW - United States AB -

BACKGROUND/AIMS: To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans.

METHODS: We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n=8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health.

RESULTS: Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time.

CONCLUSIONS: Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered.

PB - 41 VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23860477?dopt=Abstract U2 - PMC3811933 U4 - Cognitive reserve/Older adults/Life course/Development/CHILDHOOD/Socioeconomic Status ER - TY - JOUR T1 - Why are the oldest old less generous? Explanations for the unexpected age-related drop in charitable giving JF - Ageing and Society Y1 - 2013 A1 - Wiepking, Pamala A1 - Russell N. James III KW - Adult children KW - Demographics KW - Health Conditions and Status AB - Previous research has demonstrated that the generally positive relationship between age and the presence of charitable giving becomes negative at the oldest ages. We investigate potential causes of this drop in charitable giving among the oldest old including changes in health, cognition, egocentric networks, religious attendance, and substitution of charitable bequest planning. A longitudinal analysis of data from the United States Health and Retirement Survey indicates that the drop in charitable giving is mediated largely by changes in the frequency of church attendance, with only modest influences from changes in health and cognition. PB - 33 VL - 33 IS - 3 U4 - Oldest old people/Altruism/charitable giving/Donations/church Membership ER - TY - JOUR T1 - Beware of being unaware: racial/ethnic disparities in chronic illness in the USA. JF - Health Econ Y1 - 2012 A1 - Chatterji, Pinka A1 - Heesoo Joo A1 - Kajal Chatterji Lahiri KW - Aged KW - Biomarkers KW - Black People KW - Chronic disease KW - Data collection KW - Diabetes Mellitus KW - ethnicity KW - Female KW - Health Knowledge, Attitudes, Practice KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Hypertension KW - Male KW - Racial Groups KW - Self Report KW - United States KW - White People AB -

We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness - the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes.

VL - 21 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22764038?dopt=Abstract U3 - 22764038 U4 - African-americans/biomarker data/trivariate probit model/Hispanics/self assessed health/diabetes/Hypertension ER - TY - JOUR T1 - Cohort differences in the availability of informal caregivers: are the Boomers at risk? JF - Gerontologist Y1 - 2012 A1 - Lindsay H Ryan A1 - Jacqui Smith A1 - Toni C Antonucci A1 - James S Jackson KW - Aged KW - Aged, 80 and over KW - Aging KW - Caregivers KW - Censuses KW - Family Characteristics KW - Female KW - Health Status KW - Humans KW - Likelihood Functions KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Nuclear Family KW - Population Growth KW - Residence Characteristics KW - Retirement KW - Risk KW - Socioeconomic factors AB -

PURPOSE OF THE STUDY: We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age.

DESIGN AND METHODS: Population data from the U.S. Census and from the Health and Retirement Study (HRS) are used to identify a cohort similar to the BBs on marital status and fertility rates. Using generalized linear mixed models and 10-year longitudinal data from Depression and WWII parents (DWP; n = 1,052) and the parents of BBs (PBB; n = 3,573) in the HRS, we examine cohort differences in the time-varying likelihoods of being married and of having an adult child living within 10 miles.

RESULTS: The DWP had similar informal care resources at entry to old age as is expected in the BB. Longitudinal analyses of the DWP and PBB cohorts in HRS reveal that the availability of family changes over time and that the DWP cohort was significantly less likely to have a spouse or a grown child living nearby.

IMPLICATIONS: These findings, and future projections based on them, have significant implications for institutions and public policy concerned with the informal caregiving needs of the Boomer cohort as they age.

PB - 52 VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22298747?dopt=Abstract U2 - PMC3304892 U4 - Baby boomers/Caregivers/Older people/Public policy/Generalized linear models/Generalized linear models ER - TY - JOUR T1 - Does health insurance reduce illness-related worker absenteeism? JF - Applied Economics Y1 - 2012 A1 - Xu Xu A1 - Gail A Jensen KW - Employment and Labor Force KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Other AB - The objective of this article is to examine whether having health insurance reduces illness-related absenteeism among older workers. A nationally representative sample of 1780 workers in the United States, aged 52-64, are drawn from the 2004-2006 Health and Retirement Study (HRS). Binary logistic regressions and censored Tobit models are estimated for workers' likelihood of missing work days due to illness and the number of illness-related work days missed, respectively, while explicitly addressing the possibility of insurance-selection effects. The findings suggest that over a 12-month period, older workers without health insurance are as likely as insured workers to miss work days due to illness and there are no differences in the number of days missed between insured and uninsured workers. However, there is strong evidence that poor baseline health, onset of new diseases and longer hospitalization significantly increase an older worker's absenteeism at work. These results suggest that having health insurance does not affect illness-related absenteeism among older workers in the US. Future research examining other aspects of worker productivity, such as 'presenteeism', and the longer term effects of insurance on productivity can extend our understanding of the role of health insurance in the workplace. PUBLICATION ABSTRACT PB - 44 VL - 44 IS - 35 U4 - Absenteeism/Health insurance/Studies/Older workers/Economic models/Productivity ER - TY - THES T1 - Essays on gender and health Y1 - 2012 A1 - Medalia, Carla KW - Demographics KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Women and Minorities AB - The relationship between gender and health is complex. Although women live longer than men in almost every country throughout the world, women also tend to be sicker than men. While biological sex differences likely contribute to sex gaps in health, cross-national, historical, and life course variation suggest that social factors also play a role. This dissertation is composed of three chapters which examine social explanations for gender gaps in mortality and morbidity. The first chapter looks at the relationship between gender equality in the public sphere, and sex gaps in life expectancy throughout the world. I find that influence of gender equality on the sex gap in life expectancy depends on the level of economic development. The second chapter takes an historical perspective to examine the trend in the sex gap in depression in the United States between 1971 and 2008. In examining this trend, I find that the sex gap in depression has decreased over the past forty years, due to a decrease in depression among women that is primarily attributable to an increase in women's labor force participation and attachment. In the third chapter, I examine the relationship between gender, aging, and depression using longitudinal data for the population over age fifty in the United States. In doing so, I find that age does not increase depression until age 75, after which point depression increases for both sexes, but particularly for men, leading to a reversal in the sex gap in depression at the end of the lifespan. Furthermore, while the majority of the age effect on depression is explained by social and health changes, I conclude that there is a net effect of age per se on depression after age 75. PB - University of Pennsylvania CY - Philadelphia, PA VL - Ph.D. UR - https://repository.upenn.edu/dissertations/AAI3509214/ U4 - WOMEN ER - TY - THES T1 - Essays on human capital, expectations and behaviors Y1 - 2012 A1 - Jia, Man KW - Demographics KW - Expectations KW - Health Conditions and Status KW - Net Worth and Assets KW - Risk Taking AB - Chapter 1: While previous theoretical analysis suggests that racial differences in death rates might play an important role in explaining the black-white education gap in the U.S., there is little empirical research to test this implication. This paper estimates the extent to which differences in expected mortality risks prior to entering college can explain differences in adult educational attainment in the 2000s, using data from the 1997 National Longitudinal Survey of Youth (NLSY). This study finds that the impact of mortality is not as important as suggested by prior research. Specifically, of the total black-white education gap (roughly 1.12 schooling years), only about 0.05 years or less can be attributed to differences in mortality expectations. As this study confirms, the role of self-reported mortality expectations in explaining black-white education gap is small, and the impacts of death expectations from actual death rates on education are statistically insignificant for reference groups. Chapter 2: The second chapter examines whether individuals are likely to alter personal health-related behaviors once they increase their subjective longevity expectations. To determine if there is a relationship between health behaviors and longevity beliefs, I test one of implications of the Cutler-Glaeser (2009) smoking decision model, which suggests that nonsmokers whose expected survival probabilities have increased are unlikely to start smoking. This study uses data from the Health and Retirement Study (HRS), which is conducted every two years, from 1992 to 2010 (Waves 1-10). Specifically, the HRS data show that a certain share (2.13%) of nonsmokers at Wave t-1 whose subjective expected longevity beliefs increased across two waves did start smoking at Wave t. This small percentage is close to the fraction of new smokers who have steady or decreased survival beliefs (1.99% and 2.19%, respectively). This finding also holds true for other behaviors including heavy drinking, obesity, and physical inactivity. Thus, the findings I present based on the HRS data contrasts with the Cutler-Glaeser model. Chapter 3: Using scores from the Armed Forces Qualification Test (AFQT), Herrnstein and Murray (1994) reported that intelligence can be a powerful predictor of a range of outcomes related to social behaviors (e.g., incarceration, marriage, out-of-wedlock birth, low birth weight and poverty). In contrast, a recent study found that measured intelligence using the same AFQT scores plays a considerably smaller role on an important socioeconomic indicator, namely, hourly wages as measured from 2000 to 2010. My third paper attempts to replicate the Herrnstein and Murray study using a different data set, the 1997 National Longitudinal Survey of Youth to look into several behaviorally-related social outcomes. The main finding is that, in general, the role of AFQT scores in predicting social behaviors has not substantially changed over the last 20 years. I provide a few possible explanations for this finding. PB - Northeastern University CY - Boston, MA VL - Ph.D. UR - https://repository.library.northeastern.edu/files/neu:1044 U4 - Intelligence ER - TY - JOUR T1 - An examination of healthy aging across a conceptual continuum: prevalence estimates, demographic patterns, and validity. JF - J Gerontol A Biol Sci Med Sci Y1 - 2012 A1 - Sara J McLaughlin A1 - Alan M Jette A1 - Cathleen M. Connell KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Female KW - health KW - Humans KW - Male KW - Odds Ratio KW - Prevalence KW - Reproducibility of Results AB -

BACKGROUND: Although the notion of healthy aging has gained wide acceptance in gerontology, measuring the phenomenon is challenging. Guided by a prominent conceptualization of healthy aging, we examined how shifting from a more to less stringent definition of healthy aging influences prevalence estimates, demographic patterns, and validity.

METHODS: Data are from adults aged 65 years and older who participated in the Health and Retirement Study. We examined four operational definitions of healthy aging. For each, we calculated prevalence estimates and examined the odds of healthy aging by age, education, gender, and race-ethnicity in 2006. We also examined the association between healthy aging and both self-rated health and death.

RESULTS: Across definitions, the prevalence of healthy aging ranged from 3.3% to 35.5%. For all definitions, those classified as experiencing healthy aging had lower odds of fair or poor self-rated health and death over an 8-year period. The odds of being classified as "healthy" were lower among those of advanced age, those with less education, and women than for their corresponding counterparts across all definitions.

CONCLUSIONS: Moving across the conceptual continuum--from a more to less rigid definition of healthy aging--markedly increases the measured prevalence of healthy aging. Importantly, results suggest that all examined definitions identified a subgroup of older adults who had substantially lower odds of reporting fair or poor health and dying over an 8-year period, providing evidence of the validity of our definitions. Conceptualizations that emphasize symptomatic disease and functional health may be particularly useful for public health purposes.

PB - 67 VL - 67 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22367432?dopt=Abstract U2 - PMC3536546 U4 - Gerontology/Aging/Demographics/Personal health/Older people/Public health ER - TY - JOUR T1 - Gardening as a potential activity to reduce falls in older adults. JF - J Aging Phys Act Y1 - 2012 A1 - Tuo-Yu Chen A1 - Megan C Janke KW - Accidental Falls KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Chi-Square Distribution KW - Confidence Intervals KW - Exercise Test KW - Female KW - Gait KW - Gardening KW - Humans KW - Leisure activities KW - Male KW - Motor Activity KW - Odds Ratio KW - Postural Balance KW - Risk Assessment KW - Self Report KW - Task Performance and Analysis AB -

This study examines whether participation in gardening predicts reduced fall risk and performance on balance and gait-speed measures in older adults. Data on adults age 65 and older (N = 3,237) from the Health and Retirement Study and Consumption and Activities Mail Survey were analyzed. Participants who spent 1 hr or more gardening in the past week were defined as gardeners, resulting in a total of 1,585 gardeners and 1,652 nongardeners. Independent t tests, chi square, and regression analyses were conducted to examine the relationship between gardening and health outcomes. Findings indicate that gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardeners. Significantly fewer gardeners than nongardeners reported a fall in the past 2 yr. The findings suggest that gardening may be a potential activity to incorporate into future fall-prevention programs.

PB - 20 VL - 20 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22190117?dopt=Abstract U3 - 22190117 U4 - gardening/gardeners/Balance/Balance/gait-speed/gait-speed/Motor Activity - physiology/Accidental Falls/fall prevention/chronic conditions ER - TY - THES T1 - Health Disparities among the U.S. Elderly Y1 - 2012 A1 - Heesoo Joo KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - This dissertation examines health disparities related to race/ethnicity and socioeconomic status among the U.S. elderly taking into account empirical challenges including: (1) self-selection and unobserved factors; (2) subjective and objective measures of disease; and (3) attrition bias. Using the 2006 Health and Retirement Study, we find that current estimates of racial/ethnic disparities in awareness of chronic disease are sensitive to self-selection and unobserved factors. Contrary to prior studies reporting that African-Americans are more aware of having hypertension than non-Latino whites, we do not find this conclusion to be true after controlling for self-selection and disease severity. Likewise, prior studies show mixed evidence of racial/ethnic disparities in awareness of diabetes, but after accounting for selection, we find that African-Americans and Latinos are less aware of having diabetes compared to non-Latino whites. Using the National Health and Nutrition Examination Survey from 1999-2008, we find that education is not associated with self-reported measures of diabetes and hypertension, and it is positively associated with self-reported high cholesterol. However, there is a strong negative association between education and diabetes and hypertension when we use objective measures. There is no association between education and objective measures of high cholesterol. When we account for the possibility of shared, unmeasured determinants of disease prevalence and diagnosis that are correlated with education, we find that education is negatively associated with having undiagnosed hypertension and diabetes. In addition, we find that trends in cardiovascular disease (CVD) risk factors, including (1) high blood glucose, (2) high blood pressure, (3) high cholesterol, and (4) smoking, improved over the past two decades among individuals with diabetes, but racial/ethnic and education-related disparities have emerged in some areas. Finally, we estimate income-related health inequality, measured by the concentration index with an unbalanced panel dataset, explicitly accounting for attrition due to mortality, using the RAND version of HRS. We find that income-related health inequality improves as people age, but this improvement primarily comes from the high mortality rate among poorer individuals. A balanced panel dataset analysis generates misleading results of progressive health deterioration, while an unbalanced panel dataset analysis brings out this regressive deterioration. PB - State University of New York at Albany CY - Albany, NY VL - Ph.D. U4 - racial differences ER - TY - JOUR T1 - How do the risks of living long and facing high medical expenses affect the elderly's saving behavior? JF - Chicago Fed Letter Y1 - 2012 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones KW - Adult children KW - Consumption and Savings KW - Health Conditions and Status KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Although the elderly have a lot of wealth, people still do not fully understand their patterns of saving behavior. Many elderly individuals keep large amounts of wealth even as they near the ends of their lives. Furthermore, as one study shows, income-rich households are especially frugal. Among the motivations for saving are the risks of living long and having high medical expenses in old age. In recent research, the authors quantify the importance of forces by estimating and simulating a rich model of saving behavior. Life spans vary greatly in both predictable and unpredictable ways. Using mortality rates estimated from the AHEAD, they find that rich people, women, and healthy people live much longer than their poor, male, and sick counterparts. The risk of living far past one's expected life span is large and, under incomplete annuitization, a potentially important reason why so many elderly people run down their assets so slowly. PB - 294 VL - 294 UR - https://www.chicagofed.org/publications/chicago-fed-letter/2012/january-294 U4 - transfers/saving behavior/wealth/retirement planning/mortality ER - TY - BOOK T1 - Longitudinal Data Analysis: a Practical Guide for Researchers In Aging, Health, And Social Sciences Y1 - 2012 A1 - Jason T Newsom A1 - Richard N Jones A1 - Scott M Hofer KW - Cross-National KW - Health Conditions and Status KW - Methodology AB - This book provides accessible treatment to state-of-the-art approaches to analyzing longitudinal studies. Comprehensive coverage of the most popular analysis tools allows readers to pick and choose the techniques that best fit their research. The analyses are illustrated with examples from 12 major longitudinal data sets including practical information about their content and design. Illustrations from popular software packages offer tips on how to interpret the results. Each chapter features suggested readings fur further study and a list of articles that further illustrate how to implement the analysis and report the results. An accompanying website provides syntax examples for several software packages for each of the chapter examples. Although many of the examples address health or social science questions related to aging, readers from other disciplines will find the analyses relevant to their work. In addition to demonstrating statistical analysis of longitudinal data, the book shows how to interpret and analyze the results within the context of the research design. Although most chapters emphasize the use of large studies collected over long term periods, much of the book is also relevant to researchers who analyze data collected in shorter time periods. The book opens with issues related to using publicly available data sets including a description of the goals, designs, and measures of the data. The next 10 chapters provide non-technical, practical introductions to the concepts and issues relevant to longitudinal analysis, including: weighting samples and adjusting designs for longitudinal studies; missing data and attrition; measurement issues related to longitudinal research; the use of ANOVA and regression for averaging change over time; mediation analysis for analyzing causal processes; growth curve models using multilevel regression; longitudinal hypotheses using structural equation modeling (SEM); latent growth curve models for evaluating individual trajectories of change; dynamic SEM models of change; and survival (event) analysis. Examples from longitudinal data sets such as the Health and Retirement Study, the Longitudinal Study of Aging, and Established Populations for Epidemiologic Studies of the Elderly as well as international data sets such as the Canadian National Population Health Survey and the English Longitudinal Study of Aging, illustrate key concepts. An ideal supplement for graduate level courses on data analysis and/or longitudinal modeling taught in psychology, gerontology, human development, family studies, medicine, sociology, social work, and other behavioral, social, and health sciences, this multidisciplinary book will also appeal to researchers in these fields. PB - Routledge CY - New York U4 - Methodology/longitudinal Studies/cross-national/Statistical analysis/Aging ER - TY - RPRT T1 - Medicaid Insurance in Old Age Y1 - 2012 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones KW - Income KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - 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. JF - MRDRC Research Paper PB - Michigan Retirement and Disability Research Center, University of Michigan CY - Ann Arbor, MI UR - https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2192557 U4 - Medicaid/Redistribution/public policy/poverty ER - TY - JOUR T1 - Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes. JF - Med Care Y1 - 2012 A1 - Mary R Janevic A1 - Sara J McLaughlin A1 - Cathleen M. Connell KW - Age Factors KW - Data collection KW - Diabetes Mellitus KW - Disclosure KW - Dyspnea KW - Exercise KW - Female KW - Guideline Adherence KW - Guidelines as Topic KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Sedentary Behavior KW - Sex Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation."

RESEARCH DESIGN: Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation.

RESULTS: Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95% CI, 0.19-0.61).

CONCLUSIONS: Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients' beliefs about how much physical activity is adequate.

VL - 50 IS - 5 N1 - Medical care Med Care. 2011 Dec 20. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22193415?dopt=Abstract U3 - 22193415 U4 - Diabetes/Physical Activity/African American/Hispanic/Self assessed health ER - TY - JOUR T1 - Self-rated health and the "first move" around retirement: a longitudinal study of older Americans. JF - J Rural Health Y1 - 2012 A1 - Nan E. Johnson KW - Aged KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Population Dynamics KW - Retirement AB -

PURPOSE: I examine whether less favorable self-rated health raises the risk of outmigration more for young-old adults (aged 53-63 at the start of the 10-year longitudinal study in 1994) in nonmetro than metro counties and increases the odds that both groups of outmigrants will choose metro over nonmetro destinations. Finally, I examine whether nonmetro outmigrants are more likely than metro outmigrants to cite a health concern or a desire to get closer to relatives or friends as a reason for the migration.

METHODS: I use the Health and Retirement Study (HRS) to track the main residences of nonmetro and metro older adults from 1994-2003. With a discrete-time Event History Analysis, I assess the joint effects of nonmetro/metro residence in 1994 and self-rated health (updated at each biennial wave) upon the risk of a first migration. Those who migrated were asked to recall why.

FINDINGS: At worse levels of self-rated health, the odds of remaining in a nonmetro county of residence drop in favor of migrating to another nonmetro county. Among migrants, the worse the self-rated health, the higher the odds of within-type migration (nonmetro-nonmetro and metro-metro) over cross-type migration (nonmetro-metro and metro-nonmetro). The percentages of migrants citing a health concern or a desire to live closer to relatives or friends as a reason for migration do not differ by county type of origin.

CONCLUSIONS: An implication for rural health policy is that young-old adults with worse self-rated health tend to remain in nonmetro areas, even when they migrate.

PB - 28 VL - 28 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22458319?dopt=Abstract U4 - metropolitan/nonmetropolitan/reasons for migration/Public policy/urban areas/health Status/outmigration ER - TY - JOUR T1 - Why Do People Let Their Long-Term Care Insurance Lapse? Evidence from the Health and Retirement Study JF - Applied Economic Perspectives and Policy Y1 - 2012 A1 - Yong Li A1 - Gail A Jensen KW - Consumption and Savings KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - This paper empirically analyzes how often and why individuals drop their long-term care insurance (LTCI) coverage, using data from the 2002-2008 Health and Retirement Study. It finds that over a two-year period 13 of LTCI policies lapse. It also finds that the probability of an LTCI lapse increases with a lack of consumer knowledge about their policy's benefit provisions, with prior encounters with the long-term care system, with less expensive policies, and with less generous policies. These findings raise the possibility that some policyholders may not understand their coverage limitations, and learn about them only after actually using long-term care services. Greater consumer awareness of LTCI policy features and limitations may help reduce lapse rates and increase the stability of the LTCI market. PB - 34 VL - 34 IS - 2 N1 - Date revised - 2012-07-01 Language of summary - English Pages - 220-237 ProQuest ID - 1030495712 Availability - URL:http://aepp.oxfordjournals.org Publisher's URL Last updated - 2012-08-02 British nursing index edition - Applied Economic Perspectives and Policy, vol. 34, no. 2, Summer 2012, pp. 220-37 Corporate institution author - Li, Yong; Jensen, Gail A DOI - econlit-1303901; 1303901; 2040-5790 U4 - long term care insurance/public policy/consumer economics ER - TY - THES T1 - Working for life: An analysis of life satisfaction and delayed retirement among older college faculty Y1 - 2012 A1 - Lawrence, Kendall E. KW - Delaying retirement KW - Life Satisfaction AB - Purpose: The aging of the professoriate may be the most important issue in higher education today. When faculty members will choose to retire and how effectively they are replaced is a crucial problem for many institutions. Yet very little data are available on faculty retirement timing. The purpose of this study was to test life-span trajectory theory by comparing individual life-span factors to individual retirement decisions, thus yielding results that may be useful to college administrators. Longitudinal data from the Health and Retirement Study (FIRS) were used to investigate any differences in life satisfaction, marital status, gender, ethnicity, and region among members of college faculty who delayed their retirement ( n = 420) and those faculty who retired when eligible (n = 931). By analyzing which factors are correlated with the decision to delay retirement, this study should provide data to assist college administrators in improving their recruitment and hiring practices. Method: In this study, the research design was non-experimental causal comparative. Separate Pearson chi-square analyses were performed for (a) delayed retirement status and life satisfaction rating, (b) delayed retirement status and gender, (c) delayed retirement status and marital status, (d) delayed retirement status and ethnicity, and (e) delayed retirement status and region. A discriminant analysis was performed to determine if the dependent variables could predict membership in the two groups (i.e., delayed retirement, did not delay retirement). Findings: The most significant predictors of delayed retirement were gender, ethnicity, and region. Results indicate that faculty who were male, Hispanic and from the Northeast region were more inclined to delay retirement, whereas faculty members who were female, White, from the South or West region were more inclined to retire when eligible. Results are discussed and suggestions are made in terms of the need for greater study of the relationship between gender, ethnicity, region, life satisfaction, marital status, and retirement decisions. KEY WORDS: Delayed retirement, Academic labor planning, Life-span theory, Productive aging, Life-course theory, Life satisfaction, College faculty retirement, Successful aging, Continuity theory, Defined benefit pension plan, Defined cost pension plan. PB - Sam Houston State University CY - Huntsville, TX VL - Ed.D. UR - https://eric.ed.gov/?id=ED550752 U4 - retirement planning ER - TY - JOUR T1 - Consumer Financial Protection. JF - J Econ Perspect Y1 - 2011 A1 - Campbell, John Y. A1 - Howell E. Jackson A1 - Brigitte C. Madrian A1 - Peter Tufano PB - 25 VL - 25 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24991083?dopt=Abstract U4 - Economic crisis/Securities markets/Securities markets ER - TY - JOUR T1 - Development and validation of a brief cognitive assessment tool: the sweet 16. JF - Arch Intern Med Y1 - 2011 A1 - Tamara G Fong A1 - Richard N Jones A1 - James L Rudolph A1 - Frances Margaret Yang A1 - Tommet, Douglas A1 - Habtemariam, Daniel A1 - Edward R Marcantonio A1 - Kenneth M. Langa A1 - Sharon K Inouye KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Surveys and Questionnaires AB -

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

PB - 171 VL - 171 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21059967?dopt=Abstract U3 - 21059967 U4 - Older people/Cognition/reasoning/Correlation analysis/Medical diagnosis/Dementia/Hospitalization ER - TY - JOUR T1 - The Effects of Health Insurance and Self-Insurance on Retirement Behavior JF - Econometrica Y1 - 2011 A1 - Eric French A1 - John Bailey Jones KW - Consumption and Savings KW - Medicare/Medicaid/Health Insurance KW - Other KW - Public Policy KW - Retirement Planning and Satisfaction AB - This paper provides an empirical analysis of the effects of employer-provided health insurance, Medicare, and Social Security on retirement behavior. Using data from the Health and Retirement Study, we estimate a dynamic programming model of retirement that accounts for both saving and uncertain medical expenses. Our results suggest that Medicare is important for understanding retirement behavior, and that uncertainty and saving are both important for understanding the labor supply responses to Medicare. Half the value placed by a typical worker on his employer-provided health insurance is the value of reduced medical expense risk. Raising the Medicare eligibility age from 65 to 67 leads individuals to work an additional 0.074 years over ages 60-69. In comparison, eliminating 2 years worth of Social Security benefits increases years of work by 0.076 years. PB - 79 VL - 79 IS - 3 U4 - health Insurance/retirement Behavior/medicare/savings/uncertainty/public Policy ER - TY - JOUR T1 - The impact of private long-term care insurance on the use of long-term care. JF - Inquiry Y1 - 2011 A1 - Yong Li A1 - Gail A Jensen KW - Aged KW - Aged, 80 and over KW - Decision making KW - Female KW - Health Services Accessibility KW - Home Care Services KW - Home Nursing KW - Humans KW - Insurance, Long-Term Care KW - Likelihood Functions KW - Long-term Care KW - Male KW - Models, Econometric KW - Nursing homes KW - Private Sector KW - Regression Analysis KW - United States AB -

This paper investigates the effects of privately purchased long-term care insurance (LTCI) on three major types of long-term care services: nursing home care, paid home care, and informal care received from Family and friends. Using 2002-2008 data from the ongoing Health and Retirement Study, we analyze the determinants of long-term care utilization simultaneously with the determinants of holding LTCI. We find that LTCI has modest effects on the likelihood of using long-term care services. For the very frail elderly, private LTCI enhances their access to nursing home care. For those with moderate disability, LTCI makes it more likely that they can remain at home and receive home care services, instead of going to a nursing home. We find no evidence that formal care substitutes for informal care in the presence of LTCI. These findings suggest that if LTCI becomes much more prevalent in the future, many older adults will be able to choose the type of long-term care arrangement that best suits their needs.

PB - 48 VL - 48 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21634261?dopt=Abstract U3 - 21634261 U4 - Life insurance/health insurance/Experiment/theoretical treatment/Long term care insurance/Impact analysis/Long term health care/Elder care/Health services utilization ER - TY - JOUR T1 - Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. JF - BMC Geriatr Y1 - 2011 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Jason Hockenberry A1 - Michael P Jones A1 - Maksym Obrizan A1 - Paula A Weigel A1 - Kaskie, Brian A1 - Robert B Wallace KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Insurance Benefits KW - Longitudinal Studies KW - Male KW - Medicare KW - Mobility Limitation KW - Prospective Studies KW - Time Factors KW - United States AB -

BACKGROUND: Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

PB - 11 VL - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21846400?dopt=Abstract U2 - PMC3167753 U4 - SELF-RATED HEALTH/Medicare/Functional decline/Functional decline/ADL/IADL/risk Factors ER - TY - JOUR T1 - Memory predicts changes in depressive symptoms in older adults: a bidirectional longitudinal analysis. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Jajodia, Archana A1 - Borders, Ashley KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Dementia, Vascular KW - depression KW - Female KW - Geriatric Assessment KW - Humans KW - Longitudinal Studies KW - Male KW - Mental Recall KW - Middle Aged KW - Models, Psychological KW - Retirement KW - Statistics as Topic KW - United States AB -

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.

PB - 66B VL - 66 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21742642?dopt=Abstract U2 - PMC3155030 U4 - Older people/Mental depression/Memory/Gerontology/Cardiovascular disease ER - TY - JOUR T1 - Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns. JF - BMC Geriatrrics Y1 - 2011 A1 - Kaskie, Brian A1 - Maksym Obrizan A1 - Michael P Jones A1 - Suzanne E Bentler A1 - Paula A Weigel A1 - Jason Hockenberry A1 - Robert B Wallace A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Frederic D Wolinsky KW - Emergency services KW - Health Shocks KW - Medicare/Medicaid/Health Insurance KW - Older Adults AB -

BACKGROUND: It is well known that older adults figure prominently in the use of emergency departments (ED) across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates.

METHODS: Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects.

RESULTS: We identified 948 individuals (17.2% of the entire sample) who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5%) who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52), men (AOR 1.28), current smokers (AOR 1.60), experience diabetes (AOR (AOR 1.80), heart disease (AOR 1.70), hypertension (AOR 1.32) and have a greater amount of morbidity (AOR 1.48) than those who persistently presented to the ED with non-severe episodes. When contrasted with 1,177 individuals with a persistent pattern of indeterminate severity ED use, persons with severe patterns were older (AOR 1.36), more likely to be obese (AOR 1.36), and experience heart disease (AOR 1.49) and hypertension (AOR 1.36) while persons with non-severe patterns were less likely to smoke (AOR 0.63) and have diabetes (AOR 0.67) or lung disease (AOR 0.58).

CONCLUSIONS: We distinguished three large, readily identifiable groups of older adults which figure prominently in the use of EDs across the United States. Our results suggest that one group affects the general capacity of the ED to provide care as they persistently present with severe episodes requiring urgent staff attention and greater resource allocation. Another group persistently presents with non-severe episodes and creates a considerable share of the excess demand for ED care. Future research should determine how chronic disease management programs and varied co-payment obligations might impact the use of the ED by these two large and distinct groups of older adults with consistent ED use patterns.

VL - 11 ER - TY - JOUR T1 - Personality Measurement and Assessment in Large Panel Surveys*. JF - Forum Health Econ Policy Y1 - 2011 A1 - Brent W Roberts A1 - Joshua J Jackson A1 - Angela Lee Duckworth A1 - Von Culin, Katherine AB -

Personality tests are being added to large panel studies with increasing regularity, such as the Health and Retirement Study (HRS). To facilitate the inclusion and interpretation of these tests, we provide some general background on personality psychology, personality assessment, and the validity of personality tests. In this review, we provide background on definitions of personality, the strengths and weaknesses of the self-report approaches to personality testing typically used in large panel studies, and the validity of personality tests for three outcomes: genetics, income, and health. We conclude with recommendations on how to improve personality assessment in future panel studies.

PB - 14 VL - 14 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23503719?dopt=Abstract U4 - Personality Assessment/Methodology/self Assessment (Psychology)/mid-term review/mid-term review/Methodology ER - TY - JOUR T1 - A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. JF - BMC Public Health Y1 - 2011 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Jason Hockenberry A1 - Michael P Jones A1 - Paula A Weigel A1 - Kaskie, Brian A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Medicare KW - Mental Health KW - Outcome Assessment, Health Care KW - Prospective Studies KW - Regression Analysis KW - Risk Factors KW - United States AB -

BACKGROUND: Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function.

METHODS: We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests.

RESULTS: Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status.

CONCLUSIONS: In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

PB - 11 VL - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21933430?dopt=Abstract U2 - PMC3190354 U4 - Cognition/Cognitive decline/public policy/Medicare/cognitive Function/TICS Scale ER - TY - JOUR T1 - Which Questions in the Health and Retirement Study are Used by Researchers? Evidence from Academic Journals, 2006-2009 JF - Forum for Health Economics and Policy Y1 - 2011 A1 - Jackson, Tina A1 - Balduf, Mabel A1 - Laura Yasaitis A1 - Jonathan S Skinner KW - Methodology AB - Since 2002, the average number of questions asked per respondent in the Health and Retirement Study (HRS) has risen by 39 percent, from 413 to 581. Yet there is little or no understanding of which questions, or how many in total, should be included and more importantly, maintained in longitudinal surveys. In this paper, we propose a simple approach to assessing the value of survey questions: journal citation counts. A sample of journal articles and book chapters published in 2006-09 (N = 206) is used to document which questions, and categories of questions, were used most and least frequently. A disproportionate number of published articles used a relatively small number of questions regarding health, wealth, income, and employment. By contrast, several categories of questions were rarely used, and many specific questions were never used. This evidence-based approach to measuring the value of survey questions can have applications for other surveys beyond the HRS. PB - 14 VL - 14 IS - 3 U4 - method of Questioning/survey Methods/Methodology/journal citation counts/journal citation counts/survey questions ER - TY - JOUR T1 - The association of earnings with health in middle age: Do self-reported earnings for the previous year tell the whole story? JF - Social Science and Medicine Y1 - 2010 A1 - David Rehkopf A1 - Jencks, Christopher A1 - M. Maria Glymour KW - Health Conditions and Status KW - Healthcare KW - Income KW - Social Security AB - Research on earnings and health frequently relies on self-reported earnings (SRE) for a single year, despite repeated criticism of this measure. We use 31 years (1961-1991) of earnings recorded by the United States Social Security Administration (SSA) to predict the 1992 prevalence of disability, diabetes, stroke, heart disease, cancer, depression and death by 2002 in a subset of Health and Retirement Study participants (n = 5951). We compare odds ratios (ORs) for each health outcome associated with self-reported or administratively recorded earnings. Individuals with no 1991 SSA earnings had worse health in multiple domains than those with positive earnings. However, this association diminished as the time lag between earnings and health increased, so that the absence of earnings before approximately 1975 did not predict health in 1992. Among those with positive earnings, lengthening the lag between SSA earnings and health did not significantly diminish the magnitude of the association with diabetes, heart disease, stroke, or death. Longer lags did reduce but did not eliminate the association between earnings and both disability and depression. Despite theoretical limitations of single year SRE, there were no statistically significant differences between the ORs estimated with single-year SRE and those estimated with a 31-year average of SSA earnings. For example, a one unit increase in logged SRE for 1991 predicted a 19 reduction in the odds of dying by 2002 (OR = 0.81; 95 confidence interval: 0.72,0.90), while a similar increase in average SSA earnings for 1961-1991 had an OR of 0.72 (0.6,0.82). The point estimates for the OR associated with 31 year average SSA earnings were further from the null than the ORs associated with single year SRE for heart disease, depression, and death, and closer to the null for disability, diabetes, and stroke, but none of these differences was statistically significant. PB - 71 VL - 71 IS - 3 N1 - Using Smart Source Parsing pp. Aug Elsevier Science, Amsterdam The Netherlands U2 - PMC3345288 U4 - earnings history/Income/health outcomes/depression/diabetes/Heart disease/MORTALITY ER - TY - JOUR T1 - Continuity of care with a primary care physician and mortality in older adults. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - John F Geweke A1 - Elizabeth A Cook A1 - Maksym Obrizan A1 - Elizabeth A Chrischilles A1 - Kara B Wright A1 - Michael P Jones A1 - Gary E Rosenthal A1 - Robert L. Ohsfeldt A1 - Robert B Wallace KW - Aged KW - Continuity of Patient Care KW - Female KW - Health Services for the Aged KW - Humans KW - Male KW - Mortality KW - Physicians, Family AB -

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

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

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

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

PB - 65A VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19995831?dopt=Abstract U2 - PMC2844057 U4 - continuity of care/medicare/primary care physician/MORTALITY ER - TY - JOUR T1 - Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries. JF - BMC Health Serv Res Y1 - 2010 A1 - Kaskie, Brian A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Michael P Jones A1 - Li Liu A1 - Suzanne E Bentler A1 - Robert B Wallace A1 - John F Geweke A1 - Kara B Wright A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Frederic D Wolinsky KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Emergency Service, Hospital KW - Humans KW - Insurance Claim Review KW - Medicare KW - Prospective Studies KW - Severity of Illness Index KW - United States AB -

BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.

RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).

CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.

PB - 8 VL - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20565949?dopt=Abstract U2 - PMC2903585 U4 - HOSPITALIZATION/emergency department service use/emergency department service use/medicare/predictive validity/predictive validity ER - TY - RPRT T1 - The Effects of Health Insurance and Self-Insurance on Retirement Behavior Y1 - 2010 A1 - John Bailey Jones A1 - Eric French KW - Employment and Labor Force KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction KW - Social Security AB - This paper provides an empirical analysis of the effects of employer-provided health insurance, Medicare, and Social Security on retirement behavior. Using data from the Health and Retirement Study, we estimate a dynamic programming model of retirement that accounts for both saving and uncertain medical expenses. Our results suggest that Medicare is important for understanding retirement behavior, and that uncertainty and saving are both important for understanding the labor supply responses to Medicare. Half the value placed by a typical worker on his employer-provided health insurance is the value of reduced medical expense risk. Raising the Medicare eligibility age from 65 to 67 leads individuals to work an additional 0.074 years over ages 60-69. In comparison, eliminating two years worth of Social Security benefits increases years of work by 0.076 years. N1 - Using Smart Source Parsing University at Albany, SUNY, Department of Economics, Discussion Papers U4 - health Insurance/employment/medicare/social Security/retirement Planning/labor Force Participation ER - TY - RPRT T1 - The Effects of Medicaid and Medicare Reforms on the Elderly s Savings and Medical Expenditures Y1 - 2010 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones A1 - Michigan Retirement Research Center KW - Health Conditions and Status KW - Net Worth and Assets AB - This study explores the relationship between general human capital investment, financial knowledge, occupational spillovers, and the accumulation of wealth in a primarily descriptive manner. Drawing upon human capital theory and following previous related work by Delavande, Rohwedder and Willis (2008), we hypothesized that individuals with daily exposure to financial knowledge through their occupation would benefit by having greater financial knowledge that would translate into greater wealth accumulation than individuals who do not enjoy such spillovers from their occupation. Using data from the Cognitive Economics Study and the Health and Retirement Study, we find strong evidence that individuals in financial occupations tend to have greater financial knowledge and moderate evidence that they also have greater wealth accumulation. JF - Michigan Retirement Research Center Research Working Paper PB - The University of Michigan, Michigan Retirement Research Center CY - Ann Arbor, MI UR - https://mrdrc.isr.umich.edu/pubs/the-effects-of-medicaid-and-medicare-reforms-on-the-elderlys-savings-and-medical-expenditures-2/ U4 - human Capital/financial knowledge/wealth Accumulation/Cognitive Economics Study ER - TY - JOUR T1 - Housing Dissatisfaction and Cognitive Decline in Older Adults JF - Journal of Housing for the Elderly Y1 - 2010 A1 - Russell N. James III A1 - Sweaney, Anne L. KW - Consumption and Savings KW - Health Conditions and Status KW - Housing AB - Analysis of a nationally representative, longitudinal survey of community-dwelling Americans over age 50 indicated that rating the physical condition of one s dwelling unit as poor predicted significantly more rapid cognitive decline in subsequent years. This relationship persisted after controlling for a variety of factors such as wealth, income, education, health, family status, neighborhood safety, depression, and initial cognitive ability. Dissatisfaction with the physical conditions of one s housing may have a direct effect on the rate of cognitive decline in older adults. Addressing housing inadequacy for older adults may thus produce a wider range of societal benefits than previously realized. PB - 24 VL - 24 IS - 1 U4 - Housing/Cognitive Function/Cognitive decline/Neighborhood Characteristics ER - TY - THES T1 - The impact of health insurance on cancer prevention: Ex ante and ex post moral hazards T2 - Economics Y1 - 2010 A1 - Tang, Li KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Other AB - The classic model of moral hazard suggests that health insurance may reduce preventive care because the insurer will pay for part of the treatment in case of disease. However, if health insurance covers preventive care as well, the reduced cost of preventive care will encourage the insured to consume more preventive care. These two countervailing effects are referred to as ex ante and ex post moral hazards (Zweifel & Manning 2000). Most studies do not distinguish the two effects, leading to a potentially wrong characterization of moral hazard. Using Medicare coverage as an example, this thesis identifies ex ante and ex post moral hazard effects of health insurance on cancer prevention. As we know, Medicare eligibility rules increase health insurance coverage at age 65. However, some preventive screenings were not covered in Medicare until recently. The different timing of Medicare eligibility and Medicare expansion of preventive care allows me to use a difference-in-differences framework to separate ex ante and ex post moral hazards. I focus on female uptake of breast cancer screening and male uptake of prostate cancer screening, using the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS). In both datasets, I find evidence in support of ex ante and ex post moral hazards. No evidence shows that people try to delay screening until it has been covered by Medicare. Moreover, the level of prevention and responsiveness to insurance changes vary with demographics, with larger effects among whites and the better-educated. Then I take a second look at the moral hazard problem in the health insurance market using the Health and Retirement Study (HRS). Compared with MEPS or NHIS, the panel nature of HRS allows me to control for individual fixed effects and therefore provides a more stringent test. The major findings on female uptake of breast cancer screening are consistent. I find strong ex ante and ex post moral hazard effects in female uptake of breast cancer screening, and individual reactions to Medicare enrollment and Medicare's preventive care coverage vary by factors such as race and income. However, moral hazards on male uptake of prostate cancer screening is not found, mainly due to poor quality of data. JF - Economics PB - University of Maryland, College Park VL - Ph.D. N1 - (Ginger)ISBN 9781124268521 U4 - prostate cancer JO - The impact of health insurance on cancer prevention: Ex ante and ex post moral hazards ER - TY - JOUR T1 - A longitudinal study of chiropractic use among older adults in the United States. JF - Chiropr Osteopat Y1 - 2010 A1 - Paula A Weigel A1 - Jason Hockenberry A1 - Suzanne E Bentler A1 - Maksym Obrizan A1 - Kaskie, Brian A1 - Michael P Jones A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Robert B Wallace A1 - Frederic D Wolinsky AB -

BACKGROUND: Longitudinal patterns of chiropractic use in the United States, particularly among Medicare beneficiaries, are not well documented. Using a nationally representative sample of older Medicare beneficiaries we describe the use of chiropractic over fifteen years, and classify chiropractic users by annual visit volume. We assess the characteristics that are associated with chiropractic use versus nonuse, as well as between different levels of use.

METHODS: We analyzed data from two linked sources: the baseline (1993-1994) interview responses of 5,510 self-respondents in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD), and their Medicare claims from 1993 to 2007. Binomial logistic regression was used to identify factors associated with chiropractic use versus nonuse, and conditional upon use, to identify factors associated with high volume relative to lower volume use.

RESULTS: There were 806 users of chiropractic in the AHEAD sample yielding a full period prevalence for 1993-2007 of 14.6%. Average annual prevalence between 1993 and 2007 was 4.8% with a range from 4.1% to 5.4%. Approximately 42% of the users consumed chiropractic services only in a single calendar year while 38% used chiropractic in three or more calendar years. Chiropractic users were more likely to be women, white, overweight, have pain, have multiple comorbid conditions, better self-rated health, access to transportation, higher physician utilization levels, live in the Midwest, and live in an area with fewer physicians per capita. Among chiropractic users, 16% had at least one year in which they exceeded Medicare's "soft cap" of 12 visits per calendar year. These over-the-cap users were more likely to have arthritis and mobility limitations, but were less likely to have a high school education. Additionally, these over-the-cap individuals accounted for 58% of total chiropractic claim volume. High volume users saw chiropractors the most among all types of providers, even more than family practice and internal medicine combined.

CONCLUSION: There is substantial heterogeneity in the patterns of use of chiropractic services among older adults. In spite of the variability of use patterns, however, there are not many characteristics that distinguish high volume users from lower volume users. While high volume users accounted for a significant portion of claims, the enforcement of a hard cap on annual visits by Medicare would not significantly decrease overall claim volume. Further research to understand the factors causing high volume chiropractic utilization among older Americans is warranted to discern between patterns of "need" and patterns of "health maintenance".

PB - 18 VL - 18 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21176137?dopt=Abstract U2 - PMC3019203 U4 - Chiropractic/Medicare/health Services/Arthritis/Mobility ER - TY - JOUR T1 - Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Brian J Ayotte A1 - Frances Margaret Yang A1 - Richard N Jones KW - Age Factors KW - Aged KW - Chi-Square Distribution KW - Chronic disease KW - Cohort Studies KW - depression KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Least-Squares Analysis KW - Male KW - Marriage KW - Middle Aged KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors KW - Spouses KW - Stroke AB -

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses. Additionally, post hoc analyses indicated that husbands' stroke and high blood pressure were related to increased depressive symptomatology among wives. Beyond the reciprocal relationship, husbands were unaffected by wives' health. These results suggest sex differences underlying psychological distress in the context of physical health among older adults and that older women with husbands who have high levels of depressive symptomatology, high blood pressure, or a history of stroke may be at particular risk of experiencing depressive symptoms.

VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20498455?dopt=Abstract U2 - PMC2883871 U4 - Chronic Disease/depression/Stroke/Stress/Sex Differences ER - TY - JOUR T1 - Predicting positive well-being in older men and women. JF - Int J Aging Hum Dev Y1 - 2010 A1 - Erin L. Waddell A1 - Joy M Jacobs-Lawson KW - Aged KW - Aged, 80 and over KW - Aging KW - depression KW - Female KW - Health Status KW - Humans KW - Male KW - Marriage KW - Middle Aged KW - Personal Satisfaction KW - Predictive Value of Tests KW - Quality of Life KW - Regression Analysis KW - Religion and Psychology KW - Self Concept KW - Sex Distribution KW - Social Behavior KW - Surveys and Questionnaires KW - Volunteers AB -

The purpose of this study was to examine the effects of background, psychological, and social variables on older adults' well-being, and how this may differ for men and women. Participants included 800 adults from the 2002 Health and Retirement Study (HRS), aged 60 to 101 years old (M = 71.22, SD = 8.46), who completed the optional positive well-being module. Gender-based regression models revealed that for men, marital status, self-rated health, and depression were significant predictors and accounted for 32% of the variability in positive well-being. Similar to men, self-rated health and depression were significant predictors of well-being for women. Additional significant predictors for women included age, the importance of religion, and volunteer work. Combined, these variables explained 35% of the variance in women's positive well-being. These results can help us understand which variables are important to target when developing interventions to improve the well-being of older men and women.

PB - 70 VL - 70 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20503804?dopt=Abstract U3 - 20503804 U4 - Well Being/Elderly/Women/Health/Depression/Marital Status/Psycho-social ER - TY - JOUR T1 - Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - Michael P Jones A1 - Kaskie, Brian A1 - Jason Hockenberry A1 - Elizabeth A Chrischilles A1 - Kara B Wright A1 - John F Geweke A1 - Maksym Obrizan A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Robert B Wallace KW - Aged KW - Educational Status KW - Female KW - Hospitalization KW - Humans KW - Male KW - Marital Status KW - Medicare KW - Myocardial Infarction KW - Patient Discharge KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Sex Factors KW - United States AB -

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8%) suffered postbaseline heart attacks, with 423 participants (7.7%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

PB - 65 VL - 65 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20106961?dopt=Abstract U2 - PMC2904597 U4 - HOSPITALIZATION/heart disease/risk Factors/Medicare/Public Policy ER - TY - THES T1 - Is private long-term care insurance affordable for older adults? T2 - Economics Y1 - 2010 A1 - Kim, Nayoung KW - Healthcare KW - Income KW - Insurance KW - Retirement Planning and Satisfaction AB - Nationwide there are fewer than 7 million long-term care (LTC) insurance policies in force. Why do so few Americans buy private long-term care (LTC) insurance? Several theories have been offered as possible explanations, including the availability of Medicaid, misperceptions that Medicare or other policies cover LTC, beliefs that one's own risk of needing LTC services is small, or desires to simply rely on children and spouses for LTC. This study examines another possible explanation - that private LTC insurance is simply "unaffordable" for most older Americans, which may be why they don't buy it. This study begins by investigating the meaning of affordability in the context of private LTC insurance. I propose several definitions for affordability, drawing on concepts recently developed to gauge the affordability of acute-care health insurance and housing. Then using nationally representative data from the ongoing Health and Retirement Study (HRS) and the Rand HRS data the study examines the incidence of "unaffordability" of LTC insurance premiums among Americans over age 50, given each of our alternative definitions for it. I consider definitions for affordability, first, based on simple normative standards, such as whether remaining household income after paying for LTC insurance is above some (arbitrarily-set) threshold, and ratio definition, such as whether the ratio of premiums to income is less than some target amount, and more behavioral definitions of affordability, such as whether other adults with similar economic, demographic, and family circumstances are seen to purchase LTC insurance. In each case, the affordability definitions take into account the steep positive relationship between LTC insurance premiums and age-at-time-of-purchase. This analysis offers researchers and policymakers an operational framework for defining affordability, and for evaluating its relative importance as an explanation for non-purchase. JF - Economics PB - Wayne State University CY - Detroit, MI VL - Doctor of Philosophy UR - https://digitalcommons.wayne.edu/oa_dissertations/49/ U4 - income ER - TY - JOUR T1 - The prospective relationship between binge drinking and physician visits among older adults. JF - J Aging Health Y1 - 2010 A1 - Kristi Rahrig Jenkins A1 - Robert A. Zucker KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Alcoholic Intoxication KW - Female KW - Health Resources KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Health Status Indicators KW - Humans KW - Linear Models KW - Male KW - Michigan KW - Multivariate Analysis KW - Patient Satisfaction KW - Physicians KW - Prospective Studies KW - Psychometrics KW - Risk Assessment KW - Risk Factors KW - Self Report AB -

OBJECTIVES: The objectives are to (a) determine if binge drinking is related to physician visits and (b) estimate the degree to which the relationship between binge drinking and physician visits can be explained by other health characteristics.

METHOD: Data on a sample of 4,960 older adults (70+ years of age in 2002) from the Health and Retirement Study (HRS) were used. Three linear regression models estimated the impact of binge drinking on physician visits.

RESULTS: In the fully adjusted models, binge drinking did have an effect on the number of physician visits by older adults, with more frequent binge drinkers having fewer physician visits. This negative relationship exists even when demographic as well as other current health characteristics are controlled.

DISCUSSION: The implications of these results are discussed in terms of more broadly communicating the risks associated with binge drinking and more effectively targeting interventions to older binge drinkers.

PB - 22 VL - 22 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20693519?dopt=Abstract U3 - 20693519 U4 - Drunkenness/Alcohol Abuse/Elderly/Health/Physicians/Sociodemographic/Socioeconomic Differences/Factors/Intervention/Retirement ER - TY - RPRT T1 - Racial, Ethnic, and Gender Differentials in Employer-Sponsored Pensions Y1 - 2010 A1 - Barbara A Butrica A1 - Richard W. Johnson KW - Demographics KW - Pensions AB - The best approaches to narrowing racial, ethnic, and gender differentials in retirement wealth are outside the current employer-sponsored pension system, Barbara Butrica and Richard Johnson told the U.S. Department of Labor's ERISA Advisory Council. These tactics include automatic IRAs for employees, efforts to raise wages earned by blacks and Hispanics, more federal funding for training and workforce development, better educational opportunities for future workers, and more financial education for workers and students. Protecting Social Security for low-income seniors is also crucial. Their testimony presents detailed information about differences in pension coverage and wealth. JF - Testimony PB - Urban Institute CY - Washington, D.C. UR - http://www.urban.org/UploadedPDF/901357-racial-ethnic-gender-differentials.pdf?RSSFeed=UI_RetirementandOlderAmericans.xml U4 - Racial Differences/ethnic differences/pensions ER - TY - JOUR T1 - Using the Health and Retirement Study to Analyze Housing Decisions, Housing Values, and Housing Prices JF - Cityscape: A Journal of Policy Development and Research Y1 - 2010 A1 - Hugo Benítez-Silva A1 - Selçuk Eren A1 - Frank Heiland A1 - Jimenez-Martin, Sergi KW - Consumption and Savings KW - Demographics KW - Housing KW - Income KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Few existing surveys provide detailed longitudinal information on households and their homes. This article introduces a data source, the Health and Retirement Study (HRS), which has this detailed information but has received little attention by housing researchers to date. The HRS is a rich longitudinal data set that provides information on house values, house prices, and detailed personal characteristics of those who own and sell their homes. The HRS is a nationally representative longitudinal survey that originally sampled 7,700 households headed by an individual aged 51 to 61 in the first interviews in 1992 and 1993. It now also samples additional cohorts of older Americans. Although the HRS is the data set of choice when analyzing the retirement behavior, savings, and health status of older Americans, given its wealth of demographic, health, and socioeconomic data, it has been rarely used to answer questions regarding the housing market. A seldom used section of the questionnaire provides detailed information about real estate transactions by households, however, enabling researchers to repeatedly observe both self-reported house values and the actual selling prices of properties sold since 1992 (originally bought in the past five decades). The article describes a number of important housing-related measures available in the HRS and illustrates the usefulness of these data by conducting a statistical analysis of the accuracy of self-reported home values. Specifically, we analyze the predictive power of self-reported housing wealth when estimating housing prices using the HRS data. The evidence shows a slight overestimation of housing values by older Americans. PB - 12 VL - 12 IS - 2 N1 - Using Smart Source Parsing pp U4 - Personal Income, Wealth, and Their Distributions/Housing Demand/Housing/Wealth/Asset accumulation/retirement planning/Mobility/property values ER - TY - JOUR T1 - Why Do the Elderly Save? The Role of Medical Expenses JF - The Journal of Political Economy Y1 - 2010 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones KW - Consumption and Savings KW - Expectations KW - Healthcare KW - Other KW - Retirement Planning and Satisfaction AB - This paper constructs a model of saving for retired single people that includes heterogeneity in medical expenses and life expectancies, and bequest motives. We estimate the model using Assets and Health Dynamics of the Oldest Old data and the method of simulated moments. Out-of-pocket medical expenses rise quickly with age and permanent income. The risk of living long and requiring expensive medical care is a key driver of saving for many higher-income elderly. Social insurance programs such as Medicaid rationalize the low asset holdings of the poorest but also benefit the rich by insuring them against high medical expenses at the ends of their lives. PB - 118 VL - 118 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2021386431andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 1 U4 - Health care expenditures/Retirees/Single persons/Life expectancy/Savings/Out of pocket costs/Studies ER - TY - RPRT T1 - Work Ability and the Social Insurance Safety Net in the Years Prior to Retirement Y1 - 2010 A1 - Richard W. Johnson A1 - Melissa Favreault A1 - Corina D Mommaerts KW - Disabilities KW - Employment and Labor Force KW - Public Policy KW - Social Security AB - A patchwork of public programs primarily Social Security Disability Insurance, workers compensation, Supplemental Security Income, and veterans benefits provides income supports to people who are unable to work. Yet, questions persist about the effectiveness of these programs. This report examines the economic consequences of disability in the years leading to retirement. Using data from the Health and Retirement Study, the analysis follows a sample of Americans age 51 to 55 in 1992 and computes their disability status, disability benefit receipt, and income until age 64, just before they qualify for full Social Security retirement benefits. The results underscore the precarious financial state of most people approaching traditional retirement age with disabilities. Fewer than half of people who meet our disability criteria ever receive disability benefits in their fifties or early sixties. Poverty rates for those who do are more than three times as high after benefit receipt than before disability onset. PB - The Urban Institute UR - http://www.urban.org/UploadedPDF/412008_work_ability.pdf?RSSFeed=UI_RetirementandOlderAmericans.xml U4 - social Security Disability Insurance/Public Policy/DISABILITY/DISABILITY/workers compensation/workers compensation/Supplemental Security Income/labor Force Participation ER - TY - RPRT T1 - Work and Retirement Patterns for the G.I. Generation, Silent Generation, and Early Boomers: Thirty Years of Change Y1 - 2010 A1 - Richard W. Johnson A1 - Barbara A Butrica A1 - Corina D Mommaerts KW - Demographics KW - Employment and Labor Force KW - Pensions KW - Retirement Planning and Satisfaction AB - This study examines how the shifting choices and constraints facing older workers have changed work and retirement patterns over the past 30 years. Health improvements, declines in physical job demands, changes in Social Security rules, and the erosion in traditional defined benefit pension coverage and employer-sponsored retiree health insurance have altered work incentives at older ages. This paper compares labor force exits by older workers born 1913 to 1917 (part of the G.I. Generation), 1933 to 1937 (part of the Silent Generation), and 1943 to 1947 (part of the Baby Boom Generation). The analysis uses 16-year longitudinal panels from the Health and Retirement Study and decades-long administrative earnings records linked to respondents in the Survey of Income and Program Participation. The results show that early boomers worked longer than members of the Silent Generation, and that the pathways older workers follow out of the labor force have become more complex over time. The median retirement age for men was about one-half year higher in the 1943-47 cohort than in the 1933-37 cohort (62 vs. 61.5), but differences were more pronounced at older ages. By age 65, for example, 40 percent of early boomer men had not yet retired, compared with only 20 percent of Silent Generation men. Both male and female workers in the 1933-37 cohort were much less likely than their counterparts in the 1913-17 cohort to follow the traditional retirement path of exiting the labor force from full-time employment and never returning to work. JF - Center for Retirement Research at Boston College Working Papers PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/working-papers/work-and-retirement-patterns-for-the-gi-generation-silent-generation-and-early-boomers-thirty-years-of-change/ N1 - Using Smart Source Parsing pp Center for Retirement Research, Working Papers, Center for Retirement Research at Boston College U4 - labor force/pensions/retirement planning/early boomers/work incentives ER - TY - JOUR T1 - A 12-year prospective study of stroke risk in older Medicare beneficiaries. JF - BMC Geriatr Y1 - 2009 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Elizabeth A Cook A1 - Elizabeth A Chrischilles A1 - Li Liu A1 - Kara B Wright A1 - John F Geweke A1 - Maksym Obrizan A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Michael P Jones A1 - Robert B Wallace A1 - Gary E Rosenthal KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Insurance Benefits KW - Male KW - Medicare KW - Prospective Studies KW - Risk Factors KW - Socioeconomic factors KW - Stroke KW - United States AB -

BACKGROUND: 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability. Therefore, it is prudent to identify all possible risk factors and their effects so that appropriate intervention points may be targeted.

METHODS: Baseline (1993-1994) interview data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to 1993-2005 Medicare claims. Participants were 5,511 self-respondents >or= 70 years old. Two ICD9-CM case-identification approaches were used. Two approaches to stroke case-identification based on ICD9-CM codes were used, one emphasized sensitivity and the other emphasized specificity. Participants were censored at death or enrollment into managed Medicare. Baseline risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline non-stroke hospitalizations was included to reflect health shocks, and sensitivity analyses were conducted to identify its peak effect. Competing risk, proportional hazards regression was used.

RESULTS: Post-baseline strokes occurred for 545 (9.9%; high sensitivity approach) and 374 (6.8%; high specificity approach) participants. The greatest static risks involved increased age, being widowed or never married, living in multi-story buildings, reporting a baseline history of diabetes, hypertension, or stroke, and reporting difficulty picking up a dime, refusing to answer the delayed word recall test, or having poor cognition. Risks were similar for both case-identification approaches and for recurrent and first-ever vs. only first-ever strokes. The time-dependent health shock (recent hospitalization) marker did not alter the static model effect estimates, but increased stroke risk by 200% or more.

CONCLUSION: The effect of our health shock marker (a time-dependent recent hospitalization indicator) was large and did not mediate the effects of the traditional risk factors. This suggests an especially vulnerable post-hospital transition period from adverse effects associated with both their underlying health shock (the reasons for the recent hospital admission) and the consequences of their treatments.

PB - 9 VL - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19426528?dopt=Abstract U2 - PMC2683849 U4 - Stroke/risk factors/DISABILITY/DISABILITY/Health Shocks ER - TY - JOUR T1 - The aftermath of hip fracture: discharge placement, functional status change, and mortality. JF - Am J Epidemiol Y1 - 2009 A1 - Suzanne E Bentler A1 - Li Liu A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Kara B Wright A1 - John F Geweke A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert B Wallace A1 - Robert L. Ohsfeldt A1 - Michael P Jones A1 - Gary E Rosenthal A1 - Frederic D Wolinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Status KW - Health Status Indicators KW - Hip Fractures KW - Humans KW - Interviews as Topic KW - Iowa KW - Length of Stay KW - Logistic Models KW - Medicare KW - Patient Discharge KW - Prospective Studies KW - Psychometrics KW - Socioeconomic factors KW - Time Factors KW - Treatment Outcome KW - United States AB -

The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993-2005. There were 495 postbaseline hip fractures among 5,511 respondents aged >or=69 years. Mean age at hip fracture was 85 years; 73% of fracture patients were white women, 45% had pertrochanteric fractures, and 55% underwent surgical pinning. Most patients (58%) were discharged to a nursing facility, with 14% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7%, 19%, and 26%, respectively. Declines in functional-status-scale scores ranged from 29% on the fine motor skills scale to 56% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture.

PB - 170 VL - 170 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19808632?dopt=Abstract U2 - PMC2781759 U4 - Functional Status/Mortality/Nursing Homes ER - TY - JOUR T1 - Compensatory conscientiousness and health in older couples. JF - Psychol Sci Y1 - 2009 A1 - Brent W Roberts A1 - Jacqui Smith A1 - Joshua J Jackson A1 - Edmonds, Grant KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Aging KW - Conscience KW - Female KW - Health Status KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Neurotic Disorders KW - Personality Inventory KW - Social Conformity KW - Spouses AB -

The present study tested the effect of conscientiousness and neuroticism on health and physical limitations in a representative sample of older couples (N= 2,203) drawn from the Health and Retirement Study. As in past research, conscientiousness predicted better health and physical functioning, whereas neuroticism predicted worse health and physical functioning. Unique to this study was the finding that conscientiousness demonstrated a compensatory effect, such that husbands' conscientiousness predicted wives' health outcomes above and beyond wives' own personality. The same pattern held true for wives' conscientiousness as a predictor of husbands' health outcomes. Furthermore, conscientiousness and neuroticism acted synergistically, such that people who scored high for both traits were healthier than others. Finally, we found that the combination of high conscientiousness and high neuroticism was also compensatory, such that the wives of men with this combination of personality traits reported better health than other women.

PB - 20 VL - 20 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19476589?dopt=Abstract U2 - PMC2698025 U4 - aging/Couples/Personal relationships ER - TY - RPRT T1 - Do Health Problems Reduce Consumption at Older Ages? Y1 - 2009 A1 - Barbara A Butrica A1 - Richard W. Johnson A1 - Mermin, Gordon B.T. KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - High out-of-pocket health care costs may have serious repercussions for older people and their families. If their incomes are not sufficient to cover these expenses, older adults with health problems may have to deplete their savings, turn to family and friends for financial help, or forego necessary care. Or they may be forced to reduce their consumption of other goods and services to pay their medical bills. This paper uses data from the Health and Retirement Study (HRS) and the related Consumption and Activities Mail Survey (CAMS) to examine the impact of health problems at older ages on out-of-pocket health care spending and other types of expenditures. The analysis estimates fixed effects models of total out-of-pocket health care spending, out-of-pocket health care spending exclusive of premiums, total spending on all items except health care, and total spending on all items except health care and housing. The models are estimated separately for households ages 65 and older and those ages 51 to 64. The results show that medical conditions increase health spending, particularly for households ages 51 to 64, but that health conditions do not generally reduce nonhealth spending. Medical conditions do, however, reduce nonhealth spending for low-income households ages 51 to 64, suggesting that holes in the health safety net before the Medicare eligibility age force some low-income people to lower their living standards to cover medical expenses. JF - Center for Retirement Research at Boston College Working Papers PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/working-papers/do-health-problems-reduce-consumption-at-older-ages/ U4 - HEALTH-CARE COSTS/Medical Expenditures ER - TY - JOUR T1 - Does caring for your spouse harm one's health? Evidence from a United States nationally-representative sample of older adults. JF - Ageing Soc Y1 - 2009 A1 - Kristi Rahrig Jenkins A1 - Mohammed U Kabeto A1 - Kenneth M. Langa AB -

The purpose of this article is to investigate the relationship between spousal care-giving and declines in functioning and self-rated health among older care-givers. The authors used data from the 2000 and 2002 waves of the United States Health and Retirement Study, a biennial longitudinal survey of a nationally representative cohort of adults aged 50 or more years. Two outcomes were examined, declines in functioning and declines in self-rated health. Care-givers were classified into three groups: no care-giving, less than 14 hours of care-giving per week, and 14 or more hours care-giving per week. To assess declines in functioning, two summary scores were created of limitations in basic and instrumental Activities of Daily Living. To assess declines in self-rated health, we compared responses from 2000 and 2002. In the fully adjusted models, care-giving hours did not have an independent effect on declines in functioning or self-rated health. The relationship between care-giving hours and declines in functioning and self-rated health is probably attributable to socio-demographic characteristics, mainly age. The findings suggest that spousal care-giving does not of itself harm functional health or perceived health among older adult care-givers. Understanding the differential effects of these socio-economic characteristics with care-giving hours on health will be useful in promoting the health of older adult care-givers and treating their disorders.

PB - 29 VL - 29 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24567660?dopt=Abstract U4 - Couples/Caregiving/Health Status--ADL limitations ER - TY - JOUR T1 - The Growth of Charitable Estate Planning among Americans Nearing Retirement JF - Financial Services Review Y1 - 2009 A1 - Russell N. James III A1 - Lauderdale, Mitzi K. A1 - Robb, Cliff A. KW - Adult children AB - A trend analysis of 41,965 Americans aged 55-64 reveals that charitable estate planning within this age group steadily increased from 1996 to 2006 (both absolutely and as a share of planned estates). Descriptive statistics and probit analyses suggest that this increase was driven in large part by higher levels of education and childlessness and by an increasing propensity for those without children to make charitable estate plans. As future cohorts of Americans nearing retirement age are projected to have even higher levels of education and childlessness, the trend of increased charitable estate planning is likely to continue for some time. PB - 18 VL - 18 UR - https://go.gale.com/ps/anonymous?id=GALE%7CA219649564&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=10570810&p=AONE&sw=w IS - 2 U4 - Bequests ER - TY - JOUR T1 - Health, Wealth, and Charitable Estate Planning: A longitudinal examination of testamentary charitable giving plans JF - Nonprofit and Voluntary Sector Quarterly Y1 - 2009 A1 - Russell N. James III KW - Adult children AB - Anticipated generational wealth transfers hold much potential for nonprofits. However, a weighted cross-sectional analysis of 18,469 respondents in the 2006 Health and Retirement Study (HRS) and data from respondents dying between the 2004 and 2006 HRS waves indicated that 88 to 90.5 of donors ( 500/year) more than the age of 50 will die without a charitable bequest. Cross-sectional probit analysis of the 2006 HRS and longitudinal conditional fixed-effects logistic analysis of the 1995-2006 HRS indicated that charitable estate planning was positively associated with age, wealth, education, religious attendance, volunteering, charitable giving, and the absence of children or grandchildren. In all specifications, the absence of children was a dominant predictor of charitable estate planning. PB - 38 VL - 38 IS - 6 U4 - Bequests/Estate Values ER - TY - JOUR T1 - Healthy Minds in Healthy Bodies: An International Comparison of Education-Related Inequality in Physical Health among Older Adults JF - Scottish Journal of Political Economy Y1 - 2009 A1 - Jurges, Hendrik KW - Cross-National KW - Demographics KW - Health Conditions and Status KW - Methodology AB - We study education-related inequality in the physical health of older adults across 11 European countries and the United States. Combining the data from Health and Retirement Study 2002, the English Longitudinal Study of Ageing 2002 and the Survey of Health, Ageing and Retirement in Europe 2004, our results suggest that education is strongly correlated with health both across and within countries. Education-related inequality in health is larger in Mediterranean and Anglo-Saxon countries than in western European countries. We find no evidence of a trade-off between health levels and equity in health. Education-related inequality in health is hardly driven by income or wealth effects (except in the United States), and differences in health behaviours (smoking) by education level contribute little to health differences across education groups. Copyright (c) 2009 The Author. Journal compilation (c) 2009 Scottish Economic Society. PB - 56 VL - 56 IS - 3 U4 - Cross Cultural Comparison/Education/health status/ELSA_/SHARE/cross-national comparison ER - TY - JOUR T1 - The Myth of the Coming Charitable Estate Windfall JF - The American Review of Public Administration Y1 - 2009 A1 - Russell N. James III KW - Adult children KW - Net Worth and Assets AB - 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. PB - 39 VL - 39 IS - 6 U4 - Bequests/financial resources ER - TY - RPRT T1 - Older Workers on the Move: Recareering in Later Life Y1 - 2009 A1 - Richard W. Johnson A1 - Kawachi, Janette A1 - Lewis, Eric K. KW - Employment and Labor Force KW - Retirement Planning and Satisfaction AB - Recareering or career change is common at older ages. Workers who change careers typically move into jobs that pay less then their previous jobs and are less likely to offer pension and health benefits. On the positive side, new careers tend to offer more flexible employment arrangements, less stressful working conditions, and fewer managerial responsibilities. This report examines the extent and nature of career change by older workers and its consequences for later-life employment. Using data from the Health and Retirement Study (HRS), the analysis tracks a sample of workers ages 51 to 55 and employed full time in 1992 and computes the percentage who changed employers, occupations, or industries by 2006, when they were ages 65 to 69. In addition, the report measures the impact of personal and job characteristics on the likelihood that older workers switch employers and occupations. The report also examines how job characteristics such as wages, health insurance coverage, and pension coverage change when older workers move into new careers. Tabulations compare the new and old jobs in terms of occupation, industry, selfemployment, flexible work options, part-time work, stressful work conditions, managerial responsibilities, overall job satisfaction, and prestige scores that rank occupations in terms of social standing. Special attention is paid to the circumstances surrounding later-life job separations that influence career change. Older job changers who say they are retiring from their previous employers are especially likely to downshift into less demanding, more flexible new careers that pay less than their former positions. Laid-off workers and those who simply say they quit their former jobs are more likely than retirees to take new jobs in the same occupation. For this study, recareering involves a move to a new employer in a new occupation. The terms occupational change and career change or recareering are used interchangeably. PB - AARP's Public Policy Institute UR - https://assets.aarp.org/rgcenter/econ/2009_08_recareering.pdf U4 - career change/career change/occupational Characteristics/labor Force Participation/retirement planning ER - TY - JOUR T1 - Recent hospitalization and the risk of hip fracture among older Americans. JF - J Gerontol A Biol Sci Med Sci Y1 - 2009 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Kara B Wright A1 - John F Geweke A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Michael P Jones A1 - Kelly K Richardson A1 - Gary E Rosenthal A1 - Robert B Wallace KW - Accidental Falls KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Aging KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Hip Fractures KW - Hospitalization KW - Humans KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Probability KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Sex Distribution KW - Survival Analysis KW - United States AB -

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

PB - 64 VL - 64 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19196641?dopt=Abstract U2 - PMC2655029 U4 - Accidental Falls/Aged, 80 and over/Geriatric Assessment/Hip Fractures/Hospitalization/Prospective Studies/Risk Factors/Sex Distribution/Survival Analysis ER - TY - JOUR T1 - Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. JF - Alzheimers Dement Y1 - 2009 A1 - Tamara G Fong A1 - Michael A Fearing A1 - Richard N Jones A1 - Peilin Shi A1 - Edward R Marcantonio A1 - James L Rudolph A1 - Frances Margaret Yang A1 - Dan K Kiely A1 - Sharon K Inouye KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cognition Disorders KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Interviews as Topic KW - Male KW - Mass Screening KW - Models, Statistical KW - Neuropsychological tests KW - Predictive Value of Tests KW - Psychiatric Status Rating Scales KW - Remote Consultation KW - Reproducibility of Results KW - Sensitivity and Specificity AB -

BACKGROUND: Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point scores to rate global cognitive function.

METHODS: The MMSE, TICS-30, and TICS-40 scores from 746 community-dwelling elders who participated in the Aging, Demographics, and Memory Study (ADAMS) were analyzed with equipercentile equating, a statistical process of determining comparable scores based on percentile equivalents for different forms of an examination.

RESULTS: Scores from the MMSE and TICS-30 and TICS-40 corresponded well, and clinically relevant cut-point scores were determined. For example, an MMSE score of 23 is equivalent to 17 and 20 on the TICS-30 and TICS-40, respectively.

CONCLUSIONS: These findings indicate that TICS and MMSE scores can be linked directly. Clinically relevant and important MMSE cut points and the respective ADAMS TICS-30 and TICS-40 cut-point scores are included, to identify the degree of cognitive impairment among respondents with any type of cognitive disorder. These results will help in the widespread application of TICS in both research and clinical practice.

PB - 5 VL - 5 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19647495?dopt=Abstract U2 - PMC278332 U4 - Cognitive Function/Survey Methods ER - TY - JOUR T1 - Volunteer dynamics of older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Barbara A Butrica A1 - Richard W. Johnson A1 - Sheila R Zedlewski KW - Aged KW - Aging KW - Cross-Sectional Studies KW - Female KW - Humans KW - Life Change Events KW - Male KW - Middle Aged KW - Probability KW - Retirement KW - United States KW - Volunteers AB -

OBJECTIVES: The impending retirement of boomers has spurred interest in tapping their productive energies to benefit society. This study examined volunteer transitions among older adults to understand the factors that affect volunteer dynamics.

METHODS: Using data from the Health and Retirement Study, the analysis examined entries into and exits from formal volunteer activities between 1996 and 2004 by adults aged 55-65 at study baseline. The study showed the duration of volunteer activities, the probability that older adults start and stop volunteering, and the factors that significantly predict volunteer transitions.

RESULTS: The findings reveal considerable stability among both volunteers and nonvolunteers; however, older adults are more likely to stop volunteering than to start. Volunteers who contribute intensely and for many years and who are married to volunteers are the least likely to quit. And nonvolunteers are more likely to start volunteering if they have been uninvolved for few years and their spouses volunteer.

CONCLUSIONS: The results point to the need to focus efforts on retaining older volunteers to maximize volunteer engagement during later years. Recruiting older adults in volunteer activities early on, ideally before they retire, could also help meet volunteer needs.

PB - 64B VL - 64 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19213847?dopt=Abstract U3 - 19213847 U4 - ADULTS/Time Utilization/Volunteering ER - TY - JOUR T1 - Wills, Trusts, and Charitable Estate Planning: A panel study of document effectiveness JF - Financial Counseling and Planning Y1 - 2009 A1 - Russell N. James III KW - Adult children KW - Net Worth and Assets AB - This paper compares pre-death charitable testamentary expectations with post-death distributions for deceased panel members in the 1995-2006 Health and Retirement Study. Most respondents who reported having a charitable estate plan in the survey wave immediately prior to their death ultimately generated no charitable estate gift after death. Cross-tabulations, linear probability models, and probit analysis all demonstrated that the likelihood of generating a charitable estate gift was significantly higher for respondents who had a funded inter vivos trust than for respondents who had only a will. This difference persisted even after controlling for wealth, income, and other demographic differences. Reasons for the differential effectiveness of these planning documents and implications for financial and gift planners are examined. PB - 20 VL - 20 IS - 1 U4 - financial resources/Bequests/Estate Values ER - TY - RPRT T1 - Documentation of Health Behaviors and Risk Factors Measured in the Health and Retirement Study (HRS/AHEAD) Y1 - 2008 A1 - Kristi Rahrig Jenkins A1 - Mary Beth Ofstedal A1 - David R Weir KW - Health Conditions and Status KW - Methodology AB - The two most important negative behaviors for population health are smoking, which is declining over time, and obesity, which is on the rise. Recognizing the important role of health behaviors and risk factors with respect to issues of key importance to the HRS (health, employment, wealth, timing of retirement), the original designers of the HRS incorporated a set of core measures of health behaviors at the outset. These measures have been expanded over time. The health behaviors and risk factors that are covered in the HRS include: Cigarette smoking (current and past behavior); Alcohol consumption (current behavior and past drinking problems); Body mass index (derived from self-reports of height and weight); Exercise (current level); Preventive health screenings. This report is organized as follows. Section II provides an inventory of the measures of health behaviors and risk factors that are covered in HRS, noting additions and changes that have occurred across waves. Special methodological issues that must be considered when using these data are covered in Section III. Section IV (and corresponding Tables 2-28) presents prevalence estimates and frequency counts for each of the health behavior and risk factor measures over time. Lastly, Section V addresses data quality by comparing HRS prevalence estimates with those from other surveys, reviewing results from some of the studies that have used HRS data to study health behaviors and risk factors, and investigating the level of missing data for these measures. PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan U4 - survey measurement/methodology/health Behavior/alcohol consumption/Body Mass Index ER - TY - JOUR T1 - Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments. JF - J Epidemiol Community Health Y1 - 2008 A1 - M. Maria Glymour A1 - Ichiro Kawachi A1 - Jencks, Christopher A1 - Lisa F Berkman KW - Aged KW - Aging KW - Censuses KW - Child KW - Cognition KW - Education KW - Educational Status KW - Female KW - Health Status KW - Humans KW - Least-Squares Analysis KW - Male KW - Massachusetts KW - Memory KW - Schools KW - Socioeconomic factors AB -

BACKGROUND: The association between schooling and old age cognitive outcomes such as memory disorders is well documented but, because of the threat of reverse causation, controversy persists over whether education affects old age cognition. Changes in state compulsory schooling laws (CSL) are treated as natural experiments (instruments) for estimating the effect of education on memory and mental status among the elderly. Changes in CSL predict changes in average years of schooling completed by children who are affected by the new laws. These educational differences are presumably independent of innate individual characteristics such as IQ.

METHODS: CSL-induced changes in education were used to obtain instrumental variable (IV) estimates of education's effect on memory (n = 10,694) and mental status (n = 9751) for white, non-Hispanic US-born Health and Retirement Survey participants born between 1900 and 1947 who did not attend college.

RESULTS: After adjustment for sex, birth year, state of birth and state characteristics, IV estimates of education's effect on memory were large and statistically significant. IV estimates for mental status had very wide confidence intervals, so it was not possible to draw meaningful conclusions about the effect of education on this outcome.

CONCLUSIONS: Increases in mandatory schooling lead to improvements in performance on memory tests many decades after school completion. These analyses condition on individual states, so differences in memory outcomes associated with CSL changes cannot be attributed to differences between states. Although unmeasured state characteristics that changed contemporaneously with CSL might account for these results, unobserved genetic variation is unlikely to do so.

VL - 62 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18477752?dopt=Abstract ER - TY - THES T1 - Essays on Reforming Health Care and Public Transfer Programs Y1 - 2008 A1 - Jung, Juergen KW - Methodology AB - My dissertation is focused on the effects of re-distributional policies with an emphasis on health care reform. In the first essay I analyze whether a consumer driven health care plan like the newly established Health Savings Accounts (HSAs) can reduce health care expenditures in the United States and increase the fraction of the population with health insurance. My results indicate that HSAs can decrease total health expenditures by up to 3% of GDP but can also increase the number of uninsured individuals by almost 5%. Furthermore, HSAs decrease the aggregate level of health capital and therefore decrease output. In the second essay I construct subjective health expectations curves and empirically evaluate its components using data from the Health and Retirement Study. I find that (i) subjective health expectations do contain additional information that is not incorporated in subjective mortality expectations and (ii) that the rational expectations assumption cannot be rejected for subjective health expectations. In the third essay I investigate whether a redistribution program that targets older individuals can "dominate" a redistribution program that targets younger individuals in terms of output and some measure of welfare. I find that late redistribution can dominate early redistribution in terms of welfare if the program is kept moderate in size by using the possibility of targeting the transfers. Late redistribution does not dominate early redistribution in terms of output. Better targeting of low income households cannot offset savings distortions. PB - Indiana University CY - Bloomington, IN VL - Doctor of Philosophy U4 - Economics ER - TY - CHAP T1 - Family Care and Assisted Living: An Uncertain Future? T2 - The Assisted Living Residence: A Vision for the Future Y1 - 2008 A1 - Douglas A. Wolf A1 - Jenkins, Carol ED - Golant, Steven M. ED - Hyde, Joan KW - Healthcare KW - Retirement Planning and Satisfaction JF - The Assisted Living Residence: A Vision for the Future PB - Johns Hopkins University Press CY - Baltimore N1 - ProCite field 6 : In ProCite field 8 : eds U4 - Assisted Living/Caregiving JO - Family Care and Assisted Living: An Uncertain Future? ER - TY - RPRT T1 - How Well Do Individuals Predict the Selling Prices of Their Homes? Y1 - 2008 A1 - Hugo Benítez-Silva A1 - Selçuk Eren A1 - Frank Heiland A1 - Jimenez-Martin, Sergi KW - Housing KW - Net Worth and Assets AB - Self-reported home values are widely used as a measure of housing wealth by researchers employing a variety of data sets and studying a number of different individual and household level decisions. The accuracy of this measure is an open empirical question, and requires some type of market assessment of the values reported. In this research, we study the predictive power of self-reported housing wealth when estimating sales prices utilizing the Health and Retirement Study. We find that homeowners, on average, overestimate the value of their properties by between 5 and 10 . We also find a strong correlation between accuracy and the economic conditions (measured by the prevalent interest rate, the growth of household income, and the growth of median housing prices) at the time of the purchase of the property. While most individuals overestimate the value of their properties, those who bought during more difficult economic times tend to be more accurate, and in some cases even underestimate the value of their house. This cyclicality of the overestimation of house prices can provide some clues regarding the reasons for the difficulties currently faced by many homeowners. JF - Levy Economics Institute Working Paper PB - The Levy Economics Institute CY - New York, New York U4 - Housing Equity/Wealth ER - TY - JOUR T1 - Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans. JF - Psychosom Med Y1 - 2008 A1 - Frances Margaret Yang A1 - Richard N Jones KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cohort Studies KW - Comorbidity KW - Confounding Factors, Epidemiologic KW - Culture KW - depression KW - Diabetes Mellitus KW - Educational Status KW - ethnicity KW - Factor Analysis, Statistical KW - Female KW - Heart Diseases KW - Humans KW - Hypertension KW - Interviews as Topic KW - Lung Diseases KW - Male KW - Self-Assessment KW - Sex Factors KW - Stroke KW - United States AB -

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.

PB - 70 VL - 70 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18981269?dopt=Abstract U2 - PMC2746732 U4 - Chronic Disease/Demographics/Depressive Symptoms/Psychology ER - TY - JOUR T1 - Within-group differences in depression among older Hispanics living in the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Frances Margaret Yang A1 - Cazorla-Lancaster, Yamileth A1 - Richard N Jones KW - Aged KW - Culture KW - Depressive Disorder, Major KW - Female KW - Hispanic or Latino KW - Humans KW - Insurance, Health KW - Male KW - Middle Aged KW - Prevalence KW - Severity of Illness Index KW - Socioeconomic factors KW - United States AB -

Using the Health and Retirement Study, we examine the prevalence of depression in different groups of Hispanic older adults. Respondents (n = 759) were aged 59 and older and identified themselves as Mexican American (56%), Cuban American (13%), Puerto Rican (8%), other (8%), or not specified (15%). We used a modified version of the Center for Epidemiologic Studies-Depression scale and the Composite International Diagnostic Interview to assess depressive symptoms and the presence of major depression. Relative to Puerto Ricans, each Hispanic group had significantly lower levels of depressive symptoms, except for Cuban Americans; and each Hispanic group had lower prevalence rates for major depression, except for other Hispanics, even after we adjusted for sociodemographic, cultural factors, socioeconomic, functional limitations, and chronic health conditions.

PB - 63B VL - 63 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18332191?dopt=Abstract U2 - PMC2366970 U4 - Hispanic Americans/Depression ER - TY - JOUR T1 - The economic consequences of widowhood for older minority women. JF - Gerontologist Y1 - 2007 A1 - Jacqueline L. Angel A1 - Maren A. Jimenez A1 - Ronald J. Angel KW - Aged KW - Black or African American KW - Female KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - United States KW - White People KW - Widowhood AB -

PURPOSE: We compare the economic consequences of widowhood for pre-retirement age and early-retirement age Black, Hispanic, and non-Hispanic White women.

METHODS: We use the 1992 and 2000 waves of the Health and Retirement Study to assess the effects of widowhood on the household incomes and assets of non-Hispanic White, Black, and Hispanic women who were 51 years of age or older at baseline (N = 4,544).

RESULTS: For women of all racial and ethnic groups, marital disruption, including widowhood, results in a substantial decline in household income and assets. Net of demographic controls, the relative loss is far greater for Black and Hispanic widows than for non-Hispanic White widows.

IMPLICATIONS: The data reveal a substantial widowhood penalty for total household income and net worth for women in each racial and ethnic group. However, the findings suggest that minority widows are at a particularly high risk of poverty in late life, given that they have lower incomes and fewer assets to begin with. Implications of the results for the financial security of women approaching retirement are discussed.

PB - 47 VL - 47 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17440127?dopt=Abstract U4 - Widowhood/Minorities/Assets/income ER - TY - RPRT T1 - Enhancing the Quality of Data on the Measurement of Income and Wealth Y1 - 2007 A1 - Juster, F. Thomas A1 - Cao, Honggao A1 - Mick P. Couper A1 - Daniel H. Hill A1 - Michael D Hurd A1 - Joseph P. Lupton A1 - Michael M. Perry A1 - James P Smith KW - Income KW - Methodology KW - Net Worth and Assets AB - Over the last decade or so, a substantial effort has gone into the design of a series of methodological investigations aimed at enhancing the quality of survey data on income and wealth. These investigations have largely been conducted at the Survey Research Center at the University of Michigan, and have mainly involved two longitudinal surveys: the Health and Retirement Study (HRS), with a first wave beginning in 1992 and continued thereafter every other year through 2004; and the Assets and Health Dynamics Among the Oldest Old (AHEAD) Study, begun in 1993 and continued in 1995 and 1998, then in every other year through 2004. Surveys for the year 2006 are currently in the field. This paper provides an overview of the main studies and summarizes what has been learned so far. The studies include; a paper by Juster and Smith (Improving the Quality of Economic Data: Lessons from the HRS and AHEAD, JASA, 1997); a paper by Juster, Cao, Perry and Couper (The Effect of Unfolding Brackets on the Quality of Wealth Data in HRS, MRRC Working Paper, WP 2006-113, January 2006); a paper by Hurd, Juster and Smith (Enhancing the Quality of Data on Income: Recent Innovations from the HRS, Journal of Human Resources, Summer 2003); a paper by Juster, Lupton and Cao (Ensuring Time-Series Consistency in Estimates of Income and Wealth, MRRC Working Paper, WP 2002-030, July 2002); a paper by Cao and Juster (Correcting Second-Home Equity in HRS/AHEAD: MRRC Working Paper WP 2004-081, June 2004); and a paper by Rohwedder, Haider and Hurd (RAND Working Paper, 2004). JF - Michigan Retirement and Disability Research Center Research Paper PB - Michigan Retirement and Disability Research Center, University of Michigan CY - Ann Arbor, MI UR - https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1095815 U4 - Methodology/Data Quality/income/Wealth ER - TY - JOUR T1 - Informal caregiving and Body Mass Index among older adults. JF - J Gerontol Nurs Y1 - 2007 A1 - Kristi Rahrig Jenkins A1 - Mohammed U Kabeto A1 - Fultz, Nancy H. A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Body Weight KW - Caregivers KW - Female KW - Geriatric Assessment KW - Humans KW - Male KW - Social Class AB -

The authors sought to obtain nationally representative estimates of the time of informal caregiving provided to older adults classified into the four standard Body Mass Index (BMI) classifications. They estimated multivariate regression models using data from the 2000 Health and Retirement Study to determine the weekly hours of informal caregiving for older adults classified into the four standard BMI classifications. In the fully adjusted models, being underweight was associated with receiving significantly more informal care, however, obesity was not associated with more informal care. The implications of these findings are discussed in terms of nursing practice and research to prevent weight loss and frailty.

PB - 33 VL - 33 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17436868?dopt=Abstract U4 - Caregiving/Body Mass Index/Obesity ER - TY - JOUR T1 - Managed Care and the Near-Elderly: Effects of plan enrollment on functionality JF - Applied Economics Y1 - 2007 A1 - Xiao Xu A1 - Gail A Jensen KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - 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. PB - 39 VL - 39 IS - 16 U4 - Health Insurance/Health Services--type of insurance coverage/Health Status--ADL limitations ER - TY - JOUR T1 - Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Muramatsu, Naoko A1 - yin, Hongjun A1 - Richard T. Campbell A1 - Ruby L Hoyem A1 - Martha A. Jacob A1 - Christopher Ross KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cohort Studies KW - Cost Savings KW - Cost-Benefit Analysis KW - Female KW - Financing, Government KW - Health Expenditures KW - Home Care Services KW - Homes for the Aged KW - Humans KW - Insurance Coverage KW - Long-term Care KW - Male KW - Medicaid KW - Medicare KW - Nursing homes KW - Patient Admission KW - Patient Readmission KW - Risk Assessment KW - Risk Factors KW - State Health Plans KW - United States AB -

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%.

DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507592?dopt=Abstract U4 - Home Care Services/Nursing Homes/Health Policy/Elderly ER - TY - RPRT T1 - What Happens to Health Benefits After Retirement? Y1 - 2007 A1 - Richard W. Johnson KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction AB - Because most workers receive health benefits from their employers, retirement often disrupts health insurance coverage. Some employers offer health insurance to retirees, but many firms are cutting retiree health benefits by passing more costs to retirees or eliminating benefits altogether. Few alternatives exist. Private nongroup coverage is generally quite expensive, and few people in their 50s and early 60s qualify for publicly financed benefits. Many workers who cannot obtain retiree benefits from their own employers or their spouses employers delay retirement to age 65, when Medicare coverage begins. This brief examines the availability and cost of health insurance coverage at ages 55 to 64 and changes in coverage after retirement. Today most workers with employer health benefits retain their coverage when they retire early, although their required premium contributions have increased sharply over the past ten years. In the future, however, steady declines in the share of younger workers with access to retiree health benefits may jeopardize income security for the next generations of retirees. PB - Boston College, Center for Retirement Research at Boston College UR - http://crr.bc.edu/briefs/what_happens_to_health_benefits_after_retirement_.html U4 - Health Insurance Coverage/RETIREMENT ER - TY - JOUR T1 - Why Do Boomers Plan to Work Longer? JF - The Journals of Gerongology, Series B: Psychological Sciences and Social Sciences Y1 - 2007 A1 - Mermin, Gordon B.T. A1 - Richard W. Johnson A1 - Daniel P. Murphy KW - Employment and Labor Force KW - Retirement Planning and Satisfaction AB - OBJECTIVE: Recent changes in retirement trends and patterns have raised questions about the likely retirement behavior of baby boomers, the large cohort born between 1946 and 1964. This study examined recent changes in retirement expectations and the factors that drove them. METHODS: Using data from the Health and Retirement Study, the analysis compared self-reported probabilities of working full time past ages 62 and 65 among workers aged 51 to 56 in 1992 and 2004. The study modeled retirement expectations for both generations and used the estimated regression coefficients to identify the forces that accounted for generational differences. RESULTS: Between 1992 and 2004, the mean self-reported probability of working full time past age 65 among workers aged 51 to 56 increased from 27 to 33 . Lower rates of retiree health insurance offers from employers, higher levels of educational attainment, and lower rates of defined benefit pension coverage accounted for most of the growth. DISCUSSION: Given the continued erosion in employer-sponsored retiree health benefits and defined benefit pension plans, boomers will likely remain at work longer than members of the previous generation. Lengthier careers will likely promote economic growth, increase government revenue, and improve individual financial security at older ages. PB - 62 VL - 62 UR - http://psychsoc.gerontologyjournals.org/ IS - 5 U4 - Job Characteristics/Labor Force Participation/RETIREMENT ER - TY - BOOK T1 - Women, Marriage and Wealth: The impact of marital status on the economic well-being of women through the life course Y1 - 2007 A1 - Joyce, Joyce Ann KW - Adult children KW - Net Worth and Assets KW - Women and Minorities PB - Gordon Knot Books CY - New York, NY U4 - Women/Economic Status/Marital Status/Wealth ER - TY - THES T1 - Depression, activities of daily living, and retirement Y1 - 2006 A1 - Jackson, Lauren Innes KW - Health Conditions and Status KW - Healthcare AB - Depression is a common clinical and subclinical psychiatric disorder in the middle-age to older adult population. This study examined the relationship between depression and activities of daily living (ADLs) in middle-age to older adults. This study examined longitudinal data from the 1998, wave 4, and 2000, wave 5, of the Health and Retirement Study (HRS), a National Panel Study sponsored by the National Institute on Aging. A negative cross-sectional and longitudinal relationship between higher ADL scores and depression was hypothesized. A goal of the present study was to determine the temporal precedence of these two constructs using a cross-lag panel design to first examine the cross-sectional relationship between ADLs and depression at time-one and at time-two, and then the time-one to time-two longitudinal relationships to examine temporal precedence possible causal relationships. Finally, differences in these correlational relationships by retirement status and then by marital status were tested. There were several interesting findings, including those who were retired in both 1998 and 2000 reported fewer ADLs (i.e., worse functioning), but also reported better health than those who were working in both 1998 and 2000. Similarly, those people who were not married in both 1998 and 2000 reported fewer ADLs but better health than those who were married in both 1998 and 2000. Married individuals reported fewer depressive symptoms than those who were not married. PB - University of North Texas U4 - Activities of Daily Living JO - Depression, activities of daily living, and retirement ER - TY - RPRT T1 - Differential Mortality, Uncertain Medical Expenses, and the Saving of Elderly Singles Y1 - 2006 A1 - Mariacristina De Nardi A1 - Eric French A1 - John Bailey Jones KW - Medical Expenses KW - Mortality KW - Older Adults KW - Savings KW - Singles AB - People have heterogenous life expectancies: women live longer than men, rich people live longer than poor people, and healthy people live longer than sick people. People are also subject to heterogenous out-of-pocket medical expense risk. We construct a rich structural model of saving behavior for retired single households that accounts for this heterogeneity, and we estimate the model using AHEAD data and the method of simulated moments. We find that the risk of living long and facing high medical expenses goes a long way toward explaining the elderly's savings decisions. Specifically, medical expenses that rise quickly with both age and permanent income can explain why the elderly singles, and especially the richest ones, run down their assets so slowly. We also find that social insurance has a big impact on the elderly's savings. PB - National Bureau of Economic Research CY - Cambridge, MA UR - http://www.nber.org/papers/w12554.pdf ER - TY - RPRT T1 - The Effect of Unfolding Brackets on the Quality of Wealth Data in HRS Y1 - 2006 A1 - Juster, F. Thomas A1 - Cao, Honggao A1 - Michael M. Perry A1 - Mick P. Couper KW - Methodology KW - Net Worth and Assets AB - A characteristic feature of survey data on household wealth is the high incidence of missing data roughly one in three respondents who report owning an asset are unable or unwilling to provide an estimate of the exact amount of their holding. A partial solution to that problem is to devise a series of questions that put the respondent s holdings into a quantitative range (less than x, more than x, or what?). These quantitative ranges are called unfolding brackets, and they represent a survey innovation that aims to improve the quality of wealth data by substituting range data for completely missing data. In this paper, we examine the effect of unfolding brackets on the quality of HRS wealth data. Special attention is given to the impact of unfolding bracket entry points on the distribution of asset holdings in HRS 1998. Although there is a small positive relationship between mean asset holdings and entry point, there are many cases where that relationship does not hold. In general, our conclusion is that entry point bias problems are not a major concern in the evaluation of quality in the 1998 HRS wealth data. PB - The University of Michigan, Michigan Retirement Research Center U4 - Assets/unfolding bracket design/Wealth ER - TY - JOUR T1 - Health Effects of Managed Care among the Near-Elderly JF - Journal of Aging and Health Y1 - 2006 A1 - Xiao Xu A1 - Gail A Jensen KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - OBJECTIVE: The authors evaluate whether enrolling in a health maintenance organization (HMO) or preferred provider organization (PPO) affects the health of adults ages 55 to 64, relative to fee-for-service plans. METHODS: A nationwide random sample of 4,044 adults with employer-sponsored health insurance is drawn from the 1994 to 2000 waves of the Health and Retirement Study. Multinomial logit regressions are estimated for self-reported general health status, first using a sample of all near-elders, then using subsamples of near-elders with and without longstanding chronic health conditions. The possibility of selection bias into managed care plans is considered and explicitly addressed in model estimation. RESULTS: We find no ill effects of HMOs on health status, and older adults with a history of chronic health conditions actually fare better upon enrolling in these plans. DISCUSSION: More research is needed to understand the reasons for the observed beneficial effects of managed care. PB - 18 VL - 18 IS - 4 U4 - Health Insurance Coverage/health outcomes ER - TY - RPRT T1 - How Secure Are Retirement Nest Eggs? Y1 - 2006 A1 - Richard W. Johnson A1 - Mermin, Gordon B.T. A1 - Cori E. Uccello KW - Adult children KW - Consumption and Savings KW - Health Conditions and Status KW - Net Worth and Assets AB - Life s uncertainties can upend the best-laid retirement plans. Health can fail as people grow older, or their spouses can become ill. Older people can lose their jobs, and often have trouble finding new ones. Marriages can end in widowhood or divorce. Health, employment, and marital shocks near retirement can have serious financial repercussions, raising out-of-pocket medical spending, reducing earnings, disrupting retirement saving, and forcing people to dip prematurely into their nest eggs. This brief examines different types of negative events that can strike near retirement. It reports the incidence of widowhood, divorce, job layoffs, disability, and various medical conditions over a 10-year period, and estimates their impact on household wealth. Data come from the Health and Retirement Study (HRS), a nationally representative survey of older Americans conducted by the University of Michigan for the National Institute on Aging. The survey interviewed a large sample of non-institutionalized adults ages 51 to 61 in 1992 and re-interviewed them every other year. The analysis uses data through 2002, the most recent year available. The results show that many people in their 50s and 60s experience negative shocks that threaten retirement security. Job layoffs, divorce, and the onset of work disabilities near retirement substantially erode retirement savings. The findings highlight the limitations of the safety net when things go wrong in late midlife. PB - Boston College, Center for Retirement Research UR - http://www.bc.edu/centers/crr/ib_45.shtml U4 - Retirement Saving/Health Shocks/Divorce/Widowhood ER - TY - JOUR T1 - The Impact of Elder Care on Women's Labor Supply JF - Inquiry Y1 - 2006 A1 - Richard W. Johnson A1 - LoSasso, Anthony T. KW - Adult children KW - Demographics KW - Healthcare AB - Adult daughters traditionally have served as primary caregivers for frail unmarried adults, but the levels of care they have provided in the past may interfere with their growing work responsibilities. This paper examines the impact of time transfers to elderly parents on labor supply at midlife. Using a sample of women ages 55 to 67 in the Health and Retirement Study, we estimate panel data models of annual hours of paid work controlling for the endogeneity of time assistance to parents. The results indicate that time help to parents strongly reduces female labor supply at midlife. PB - 43 VL - 43 IS - 3 U4 - Caregiving/Elderly/Family transfers, structure/Female ER - TY - JOUR T1 - A longitudinal study of the relationship between health behavior risk factors and dependence in activities of daily living. JF - J Prev Med Public Health Y1 - 2006 A1 - Sang-Hyuk Jung A1 - Truls Ostbye A1 - Kyoung-Ok Park KW - Activities of Daily Living KW - Alcohol Drinking KW - Body Mass Index KW - ethnicity KW - Exercise KW - Female KW - Health Behavior KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Factors KW - Smoking KW - United States AB -

OBJECTIVES: The purpose of this study was to shed further light on the effect of modifiable health behavior risk factors on dependence in activities of daily living, defined in a multidimensional fashion.

METHODS: The study participants were 10,278 middle aged Americans in a longitudinal health study, the Health and Retirement Survey (HRS). A multi-stage probability sampling design incorporating the effect of population sizes (Metropolitan and non-metropolitan), ethnicity (the non-Hispanic White, the Hispanic, and the Black), and age (age 51-61) was utilized. Basic Activities of Daily Living (ADL) were measured using five activities necessary for survival (impairment in dressing, eating, bathing, sleeping, and moving across indoor spaces). Explanatory variables were four health behavior risk factors included smoking, exercise, Body Mass Index (BMI), and alcohol consumption.

RESULTS: Most participants at baseline were ADL independent (1992). 97.8% of participants were independent in all ADL's at baseline and 78.2% were married. Approximately 27.5% were current smokers at baseline, and the subjects reported moderate or heavy exercise were 74.8%. All demographic characteristics and behavioral risk factors were significantly associated with the ADL status at Wave 4 except alcohol consumption. Risk behaviors such as current smoking, sedentary life style and high BMI at Wave 1 were associated with ADL status deterioration; however, moderate alcohol consumption tended to be more related to better ADL status than abstaining at Wave 4. ADL status at Wave 1 was the strongest factor and the next was exercise and smoking affecting ADL status at Wave 4. People who were in ADL dependent at Wave 1 were 15.17 times more likely to be ADL dependent at Wave 4 than people who were in ADL independent at Wave 1. Concerning smoking cigarettes, people who kept only light exercise or sedentary life style at Wave 1 were 1.70 times more likely to be died at Wave 4 than the people who did not smoke at Wave 1.

CONCLUSIONS: All demographics and health behaviors at wave 1 had consistently similar OR trends for ADL status to each other except alcohol consumption. Smoking and exercise in health behaviors, and age and gender in demographics at Wave 1 were significant factors associated with ADL group separation at Wave 4.

PB - 39 VL - 39 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16764496?dopt=Abstract U4 - Health Behavior/risk factors/Activities of Daily Living ER - TY - JOUR T1 - The Persistence of Depressive Symptoms in Older Workers Who Experience Involuntary Job Loss: Results from the Health and Retirement Study JF - Journals of Gerontology, Series B: Psychological and Social Sciences Y1 - 2006 A1 - William T Gallo A1 - Elizabeth H Bradley A1 - J. A. Dubin A1 - Richard N Jones A1 - Tracy Falba A1 - Teng, H.M. A1 - Stanislav V Kasl KW - Employment and Labor Force KW - Health Conditions and Status KW - Net Worth and Assets AB - Objectives. The purpose of this study was to investigate the association between involuntary job loss among workers nearing retirement and long-term changes in depressive symptoms. Methods. Analyzing data from the first four waves (1992 1998) of the Health and Retirement Survey, we used longitudinal multiple regression in order to assess whether involuntary job loss between Wave 1 and Wave 2 was associated with depressive symptoms at Wave 3 and Wave 4. The study sample included 231 workers who had experienced job loss in the Wave 1 Wave 2 interval and a comparison group of 3,324 nondisplaced individuals. We analyzed the effect of job loss on depressive symptoms both in the full study sample and in subsamples determined by wealth. Results. Among individuals with below median net worth, Wave 1 Wave 2 involuntary job loss was associated with increased depressive symptoms at Wave 3 and Wave 4. We found no effect of involuntary job loss for high net worth individuals at the later survey waves. Discussion. Our findings identify older workers with limited wealth as an important group for which the potential effect of involuntary job separation in the years preceding retirement is ongoing (enduring) adverse mental health. PB - 61 VL - 61 IS - 4 U4 - Job Loss/Depressive Symptoms/Wealth ER - TY - RPRT T1 - A Profile of Frail Older Americans and their Caregivers Y1 - 2006 A1 - Joshua M Wiener A1 - Richard W. Johnson KW - Health Conditions and Status KW - Healthcare PB - Washington, DC, The Urban Institute UR - http://www.urban.org/UploadedPDF/311284_older_americans.pdf U4 - Frail Elderly/Caregivers ER - TY - JOUR T1 - Why don't people buy long-term-care insurance? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2006 A1 - Cramer, Anne Theisen A1 - Gail A Jensen KW - Aged KW - Choice Behavior KW - Commerce KW - Decision making KW - Demography KW - Female KW - Humans KW - Insurance, Health KW - Long-term Care KW - Male KW - Middle Aged KW - United States AB -

OBJECTIVES: The objective of this article was to assess the determinants of an individual's decision to purchase long-term-care (LTC) insurance. This article focuses on the decision to purchase a new policy as opposed to renewing an existing policy. This study gave special consideration to the role of policy price, the savings associated with buying a policy now as opposed to later, the purchaser's education, and the purchaser's income.

METHODS: Using data from the 2002 Health and Retirement Survey, we estimated logistic regressions to model consumer decisions to purchase LTC insurance. We explored several alternative measures of the price of a policy.

RESULTS: Price was a significant determinant in decisions to purchase coverage. The demand for coverage, however, was price inelastic, with elasticities ranging from -0.23 to -0.87, depending on the specification of the model. The education level and income of the purchaser were also important.

DISCUSSION: This analysis provides the first estimates of price elasticity of demand for LTC insurance. The finding that demand is very price inelastic suggests that state initiatives that effectively subsidize premiums as a way of stimulating purchases are likely to meet with very limited success in the present environment.

PB - 61B VL - 61 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16855039?dopt=Abstract U4 - Insurance, Long Term Care ER - TY - RPRT T1 - Enhancing the Quality of Data on Income and Wealth Y1 - 2005 A1 - Cao, Honggao A1 - Daniel H. Hill A1 - Juster, F. Thomas A1 - Michael M. Perry KW - Income KW - Methodology KW - Net Worth and Assets AB - Over the last decade or so, a substantial effort has gone into the design of a series of methodological investigations aimed at enhancing the quality of survey data on income and wealth. These investigations have largely been conducted at the Survey Research Center at the University of Michigan, and have mainly involved two longitudinal surveys: the Health and Retirement Study (HRS), with a first wave beginning in 1992 and continued thereafter every other year through 2004; and the Assets and Health Dynamics Among the Oldest Old (AHEAD) Study, begun in 1993 and continued in 1995 and 1998, then in every other year through 2004. This provides and overview of the main studies and summarizes what has been learned about correcting longitudinal inconsistencies that arise. PB - The University of Michigan, Michigan Retirement Research Center UR - http://www.mrrc.isr.umich.edu/publications/papers/ U4 - Assets/income/Methodology 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 - THES T1 - The Impact of Marital Status on the Economic Well-Being of Women in Later Life T2 - Sociology Y1 - 2005 A1 - Joyce, Joyce Ann KW - Adult children KW - Demographics KW - Income KW - Net Worth and Assets KW - Women and Minorities AB - Although there have been significant improvements in the economic status of the elderly in the United States because of the Social Security retirement program and the Supplemental Security Income (SSI) program, poverty among older women remains high. The economic vulnerability of women in older age has been directly linked to their greater likelihood of being unmarried, with marriage viewed as generally protecting the elderly from poverty. The economic status of older women also has been linked to their employment histories, in that women tend to have discontinuous work histories and often work at jobs that pay lower salaries than men. Moreover, their employment is often tied to marriage and childrearing. These factors mean many women will receive lower income in older age. Hence, a lifetime of weak attachment to the labor force leaves many women ill-prepared for economic security without a spouse. Other characteristics of women may further impact their income security in older age. Minority women, for example, are at an even greater disadvantage than white women; and women with high educational attainment may have strong work histories resulting in more favorable outcomes for income in later life. Within the context of a combination of viewpoints that include the life course, political economy, and feminist perspectives, this dissertation examines the relationship of gender, race, employment histories, number of children, and marital status on the economic security of women in later life. Economic security is measured by total household income and total wealth, or accumulated assets minus debt. A sample of women age 50 and over who are married, divorced, widowed, or have never been married are included in the study. Data are from the Rand Data File of the Health and Retirement Study. The Rand HRS Data File is a longitudinal data set based on the Health and Retirement Study (HRS) data. The HRS is a national panel study sponsored by the National Institute of Aging and conducted by the University of Michigan. From the data analysis, it was found that married women, overall, have greater income and wealth and, therefore, the largest number of sources of income compared to women in the other marital status groups. This was due largely to their access to their spouse's income and assets. The widowed women were shown to have the least amount of wage and salary income, but received the most from Social Security retirement. The widows in the study, however, had the least amount of total household income. Those women who had never been married had the strongest employment histories among the women in the four marital status groups, but they had less income and wealth than the married women in the sample. The race and ethnicity of the women were shown to have negative consequences for their economic security, with nonwhite women having fewer sources of income than their white counterparts. Education had a significant positive effect on the incomes and wealth of the women across all the marital status groups, while number of children had no effect on either the income or assets of women in this analysis. JF - Sociology PB - State University of New York - Buffalo CY - Buffalo, NY VL - Doctor of Philosophy UR - https://search.proquest.com/openview/8c849816074ff7095b8942c9c7b78a28/1?cbl=18750&diss=y&pq-origsite=gscholar U4 - Widowhood ER - TY - JOUR T1 - The impact of own and spouse's urinary incontinence on depressive symptoms. JF - Soc Sci Med Y1 - 2005 A1 - Fultz, Nancy H. A1 - Kristi Rahrig Jenkins A1 - Truls Ostbye A1 - Donald H. Taylor Jr. A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Aged KW - Caregivers KW - Cohort Studies KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States KW - Urinary incontinence AB -

This study investigated the impact of own and spouse's urinary incontinence on depressive symptoms. Attention was paid to the possibility that gender and caregiving might be important factors in understanding significant effects. We used negative binomial regression to analyze survey data for 9974 middle-aged and older respondents to the Health and Retirement Study in the USA. Results supported the hypothesis that the respondents' own urinary incontinence was associated with depressive symptoms (unadj. IRR = 1.73, 95% CIs = 1.53, 1.95 for men; unadj. IRR = 1.50, 95% CIs = 1.38, 1.63 for women). Controlling sociodemographic and health variables reduced this relationship, but it remained statistically significant for both men and women. Having an incontinent wife put men at greater risk for depressive symptoms (unadj. IRR = 1.13, 95% CIs = 1.02, 1.25), although this relation became nonsignificant with the addition of control variables. No relation between women's depressive symptoms and husbands' (in)continence status was found. Caregiving was not a significant variable in the adjusted analyses, but spouses' depressive symptoms emerged as a significant predictor of the respondents' own depressive symptoms. Health care providers must be sensitive to the emotional impact of urinary incontinence. Our findings also suggest the importance of considering the patient's mental health within a wider context, particularly including the physical and mental health of the patient's spouse.

PB - 60 VL - 60 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15814179?dopt=Abstract U4 - Depression Symptoms/Incontinence/Health Services/Mental Health ER - TY - JOUR T1 - Perceived Discrimination, Cumulative Disadvantage and the Life Course: Women's mental health in retirement/old age JF - The Gerontologist Y1 - 2005 A1 - Martha A. Jacob KW - Health Conditions and Status KW - Women and Minorities PB - 45 VL - 45 U4 - WOMEN/Mental Health ER - TY - JOUR T1 - A socioeconomic profile of older adults with HIV. JF - J Health Care Poor Underserved Y1 - 2005 A1 - Joyce, Geoffrey F. A1 - Dana P Goldman A1 - Leibowitz, Arleen A. A1 - Abby Alpert A1 - Bao, Yuhua KW - Female KW - HIV Infections KW - Humans KW - Insurance, Health KW - Male KW - Middle Aged KW - Social Class AB -

The objective of this study was to assess the socioeconomic circumstances of older patients with HIV and acquired immunodeficiency syndrome (AIDS). The investigators compared subjects from a national probability sample of 2,864 respondents from the HIV Cost and Services Utilization Study (HCSUS, 1996) with 9,810 subjects from Wave 1 (1992) of the Health and Retirement Survey (HRS). Bivariate analyses compare demographic characteristics, financial resources, and health insurance status between older and younger adults and between older adults with HIV and the general population. It was found that nearly 10% of the HIV-positive population is between the ages of 50 and 61 years. Older whites with HIV are mostly homosexual men who are more well educated, more often privately insured, and more financially stable than the HIV population as a whole. In contrast, older minorities with HIV possess few economic resources in either absolute or relative terms. The success of new drug therapies and the changing demographics of the HIV population necessitate innovative policies that promote labor force participation and continuous access to antiretroviral therapies.

PB - 16 VL - 16 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15741706?dopt=Abstract U4 - ADULT HEALTH ER - TY - RPRT T1 - Understanding Expenditure Patterns in Retirement Y1 - 2005 A1 - Barbara A Butrica A1 - Joshua H. Goldwyn A1 - Richard W. Johnson KW - Consumption and Savings KW - Income AB - Understanding the consumption needs of retirees is critical to assessing the adequacy of retirement income and the possible impact of Social Security reform on the well-being of older Americans. This study uses data from the Health and Retirement Study, including a recent supplemental expenditure survey, to analyze spending patterns and consumption needs for adults ages 65 and older. Results indicate that typical older married adults spend 84 percent of after-tax household income, and nonmarried adults spend 92 percent of after-tax income. Even at older ages individuals devote a larger share of their expenditures and income to housing than any other category of goods and services, including health care. Fully 8 percent of married adults report after-tax incomes that fall short of our estimated basic-needs threshold, consisting of housing, health care, food, and clothing. By comparison, only 3 percent of married adults have incomes below the official poverty level. JF - Urban Institute Research Report PB - Center for Retirement Research at Boston College CY - Boston UR - https://www.urban.org/research/publication/understanding-expenditure-patterns-retirement U4 - Retirement Incomes/Consumption ER - TY - JOUR T1 - What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings. JF - Med Care Y1 - 2005 A1 - Peter A. Ubel A1 - Jankovic, Aleksandra A1 - Dylan M Smith A1 - Kenneth M. Langa A1 - Angela Fagerlin KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Analysis of Variance KW - Attitude to Health KW - Calibration KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Interviews as Topic KW - Male KW - Prospective Studies KW - Psychometrics KW - Self Concept AB -

BACKGROUND: If an 85-year-old man rates his health as 90 on a scale in which 100 represents "perfect health," would his rating mean the same thing as a 90 rating from a 25-year-old? We conducted a randomized trial of 3 different ways of eliciting subjective health ratings from participants in the Health and Retirement Study to test whether the meaning of perfect health changes as people age, causing people to recalibrate their self-reported health ratings to account for their age.

METHODS: The Health and Retirement Study (HRS) is a nationally representative, prospective study of 22,000 persons born in 1947 or earlier. The data analyzed in this study come from the self-assessed health utilities module administered in 2002 to 1031 randomly selected HRS respondents. Respondents were randomized to receive one of 3 versions of a subjective health rating task. In the perfect health version, they were asked how they would rate their "current health on a scale from 0 to 100, in which 0 represents death and 100 represents perfect health." In the your-age version, the phrase "for someone your age" was added to the end of the question to encourage people to recalibrate their responses based on age, and in the 20-year-old version, the phrase "for a 20-year-old" was added to minimize recalibration.

RESULTS: A total of 1015 subjects responded to the rating task (98% response rate). Health ratings varied significantly across versions, with subjects responding to the 20-year-old version reporting lower health (mean rating 66 of 100) than those responding to the your-age version (mean rating of 73, P<0.001) or the perfect health version (mean rating of 73, P<0.001). This result suggests that subjects interpret perfect health to mean "perfect health for someone your age." However, additional analysis showed that the interpretation of the phrase perfect health lies somewhere between the other 2 versions. For example, responses to the perfect health and 20-year-old versions varied significantly by respondent age (both P's<0.075), whereas responses to the your-age scale did not (P=0.8).

CONCLUSION: The phrase "perfect health" is ambiguous, causing some people to recalibrate their responses based on their age. Such ambiguity threatens the validity of common subjective health ratings, thereby reducing the comparability of responses across people of different ages or different circumstances.

PB - 43 VL - 43 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16166876?dopt=Abstract U4 - Subjective phenomena/Methodology ER - TY - RPRT T1 - What Makes Older Women Work? Y1 - 2005 A1 - Alicia H. Munnell A1 - Natalia A. Jivan KW - Employment and Labor Force KW - Women and Minorities JF - Center for Retirement Research at Boston College Briefs PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/briefs/what-makes-older-women-work/ U4 - Older Workers/Women, Working ER - TY - RPRT T1 - What Makes Retirees Happy? Y1 - 2005 A1 - Bender, Keith A. A1 - Natalia A. Jivan KW - Retirement Planning and Satisfaction AB - Economic well-being in retirement has been of increasing interest for economic researchers. The policy implications are large. As the baby boom generation nears retirement, understanding the factors that determine economic well-being enables policymakers to evaluate and possibly reform present retirement institutions, such as public and private pension programs. Of particular interest in this field has been the focus on retirement income adequacy, that is, the financial resources retirees need to be above some minimal level… JF - Center for Retirement Research at Boston College Briefs PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/briefs/what-makes-retirees-happy/ U4 - Retirement/Satisfaction ER - TY - JOUR T1 - Who foregoes survivor protection in employer-sponsored pension annuities? JF - Gerontologist Y1 - 2005 A1 - Richard W. Johnson A1 - Cori E. Uccello A1 - Joshua H. Goldwyn KW - Female KW - Humans KW - Male KW - Multivariate Analysis KW - Pensions KW - Socioeconomic factors KW - Spouses KW - United States AB -

PURPOSE: Retirees in traditional pension plans must generally choose between single life annuities, which provide regular payments until death, and joint and survivor annuities, which pay less each month but continue to make payments to the spouse after the death of the retired worker. This article examines the payout decision and measures the share of married retirees with pension annuities who forego survivor protection.

DESIGN AND METHODS: The analysis consists of a probit model of the pension payout decision, based on data from the 1992-2000 waves of the Health and Retirement Study.

RESULTS: More than one quarter (28%) of married men and two thirds of married women receiving employer-sponsored retirement annuities declined survivor protection. Men with small pensions and limited household wealth, men in better health than their spouses, and men whose spouses have pension coverage from their own employers are more likely than other men to reject survivor protection.

IMPLICATIONS: Most workers appear to make payout decisions by rationally balancing the costs and benefits of each type of annuity, suggesting that existing measures to encourage joint and survivor annuities are adequate. However, the growth in 401(k) plans, which are generally not covered by existing laws protecting spousal pension rights, may leave widows vulnerable.

PB - 45 VL - 45 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15695415?dopt=Abstract U4 - Annuities/Pensions/Survivors/Female/Multivariate Analysis/Socioeconomic Factors/Spouses/United States ER - TY - RPRT T1 - Annuitized Wealth at Older Ages: Evidence from the Health and Retirement Study Y1 - 2004 A1 - Richard W. Johnson A1 - Burman, Leonard E. A1 - Kobes, Deborah I. KW - Net Worth and Assets PB - Washington, DC, The Urban Institute U4 - Annuities/Retirement Wealth ER - TY - JOUR T1 - Body-weight change and physical functioning among young old adults. JF - J Aging Health Y1 - 2004 A1 - Kristi Rahrig Jenkins KW - Activities of Daily Living KW - Aged KW - Body Weight KW - Demography KW - Exercise KW - Health Behavior KW - Humans KW - Movement Disorders KW - Socioeconomic factors AB -

OBJECTIVES: The main purpose of this study is to examine if body weight change is a potential risk factor for the onset of functional impairment across time among various functional domains.

METHODS: Using longitudinal data from the Health and Retirement Study, logistic regression models on the onset of functional impairment over three time points are estimated for young old adults.

RESULTS: Results indicate that weight gain is associated with greater risk of lower body mobility impairment. An increase in body mass index of greater than 5% increases the likelihood of the onset of lower body mobility functional impairment.

DISCUSSION: Study findings support the promotion of healthy weight management. Future studies in this area may want to investigate effective interventions that contribute to healthy weight maintenance among this cohort.

PB - 16 VL - 16 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15030665?dopt=Abstract U4 - Body Mass Index/Health Physical ER - TY - JOUR T1 - On the Distribution and Dynamics of Health Costs JF - Journal of Applied Econometrics Y1 - 2004 A1 - Eric French A1 - John Bailey Jones KW - Health Conditions and Status KW - Healthcare AB - Using data from the Health and Retirement Survey and the Assets and Health Dynamics of the Oldest Old survey, we estimate the stochastic process that determines both the distribution and dynamics of health care costs. We find that the data-generating process for log health costs is well represented as the sum of a white noise process and a highly persistent AR(1) process. We also find that the innovations to this process can be modelled with a normal distribution that has been adjusted to capture the risk of catastrophic health care costs. Simulating this model, we find that in any given year 0.1 of households receive a health cost shock with a present value of at least 125,000. Copyright 2004 John Wiley and Sons, Ltd. PB - 19 VL - 19 UR - http://jae.wiley.com IS - 6 N1 - US Social Security Administration (SSA) // Center for Retirement Research at Boston College U4 - Health Shocks/Health Care Costs ER - TY - RPRT T1 - Do Spouses Coordinate Their Retirement Decisions? Y1 - 2004 A1 - Richard W. Johnson KW - Adult children KW - Retirement Planning and Satisfaction AB - The movement of married women into the labor market is transforming retirement behavior. A generation ago, when few married women spent many years in the labor force, it was relatively simple for spouses to coordinate their retirement decisions. Couples typically focused on the generosity of the husbands retirement benefits and the impact of his retirement decision on future benefits. Today, however, retirement decisions are more difficult to coordinate, because many women have accumulated substantial retirement benefits in their own names. As a result, many couples now need to consider how the decision to stop work will affect income and retirement benefits for both spouses. The evidence suggests that couples like to retire together and, since husbands tend to be older than their wives, the increased labor force participation of women may lead to later retirement of men. This brief examines retirement behavior and measures the extent to which husbands and wives appear to coordinate their retirement decisions. PB - Center for Retirement Research at Boston College UR - http://www.bc.edu/crr U4 - Couples/etirement Behavior ER - TY - JOUR T1 - Does urinary incontinence affect middle-aged and older women's time use and activity patterns? JF - Obstet Gynecol Y1 - 2004 A1 - Fultz, Nancy H. A1 - Gwenith G Fisher A1 - Kristi Rahrig Jenkins KW - Aged KW - Female KW - Humans KW - Interpersonal Relations KW - Leisure activities KW - Logistic Models KW - Middle Aged KW - Quality of Life KW - Urinary incontinence AB -

OBJECTIVE: To investigate the relationship between urinary incontinence and women's levels and hours of participation in 31 activities.

METHODS: A subset of panel members from the Health and Retirement Study completed the self-administered Consumption and Activities Mail Survey questionnaire in 2001. These data were linked with Health and Retirement Study 2000 data. Analyses were limited to 2,190 female Consumption and Activities Mail Survey self-respondents born in 1947 or earlier. Logistic regression was used to predict activity participation. Linear regression was used to predict the number of hours of participation.

RESULTS: The hypothesis that urinary incontinence affects women's time use and activity patterns was supported. Compared with the continent women, the incontinent women were less likely to have house cleaned, shopped, physically shown affection, or attended religious services in the recent past; and were more likely to have watched television or made music by singing or playing an instrument. Compared with continent activity participants, incontinent participants reported significantly fewer hours spent walking, communicating with friends and family by telephone or e-mail, working for pay, using a computer, and engaging in personal grooming and hygiene.

CONCLUSION: These findings substantiate prior work on the relationship between urinary incontinence and quality of life, and suggest a useful route for educating patients about the impact of urinary incontinence. Clinicians must be alert to opportunities for encouraging incontinent women to be active. It is also important to consider the implications for time use and activity patterns when advising patients about treatment and management options.

LEVEL OF EVIDENCE: II-2.

PB - 104 VL - 104 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15572498?dopt=Abstract U4 - Womens Health/Urinary Incontinence ER - TY - JOUR T1 - Economic status in later life among women who raised children outside of marriage. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2004 A1 - Richard W. Johnson A1 - Melissa Favreault KW - Adolescent KW - Adult KW - Aged KW - Aging KW - Child KW - Child Rearing KW - Demography KW - Female KW - Humans KW - Illegitimacy KW - Middle Aged KW - Single-Parent Family KW - Social Support KW - Socioeconomic factors AB -

OBJECTIVE: Many single mothers are likely to face special economic challenges in old age, because they often have limited employment histories and cannot rely on husbands for financial support. This article examines the economic status of these women in later life.

METHODS: The analysis uses nationally representative data from the Health and Retirement Study to estimate multivariate models of income, assets, and poverty rates for women aged 65-75 in 1999.

RESULT: Controlling for education, current marital status, and race and ethnicity, the models indicate that women who spent > or =10 years raising dependent children outside of marriage are 55% more likely to live in poverty at ages 65-75 than women who were always married when their children were young.

DISCUSSION: The financial difficulties confronting single mothers raising children persist into later life. Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for these vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.

PB - 59B VL - 59 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15576862?dopt=Abstract U4 - Women/Marital Status/Children ER - TY - RPRT T1 - The Effects of Health Insurance and Self-Insurance on Retirement Behavior Y1 - 2004 A1 - Eric French A1 - John Bailey Jones KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction AB - Using the first estimable dynamic programming model of retirement behavior that accounts for both savings and uncertain medical expenses, we assess the importance of employer-provided health insurance and Medicare in determining retirement behavior. Including both of these features allows us to determine whether workers value employer- provided health insurance because the subsidy contained in the insurance lowers their average medical expenses, or because health insurance also reduces their medical expense risk. Using data from the Health and Retirement Study, we find that the reduction in expected medical expenses explains about 60 of a typical individual s valuation of health insurance, with the reduction in volatility explaining the remaining 40 . We find that for workers whose insurance is tied to their job, shifting the Medicare eligibility age to 67 will significantly delay retirement. However, we find that the plan to shift the Social Security normal retirement age to 67 will cause an even larger delay. JF - Center for Retirement Research at Boston College Working Papers PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/working-papers/the-effects-of-health-insurance-and-self-insurance-on-retirement-behavior/ U4 - Health Insurance Coverage/Retirement Behavior ER - TY - JOUR T1 - Estate and Gift Tax Incentives and Inter Vivos Giving JF - National Tax Journal Y1 - 2004 A1 - Joulfaian, David A1 - Kathleen McGarry KW - Adult children KW - Consumption and Savings KW - Event History/Life Cycle KW - Income AB - The estate tax has received a great deal of attention from policy makers and the public in recent years. Yet we know little about its effect on the transfer of wealth. In this paper we explore the effect of the tax on inter vivos giving. In particular, we look at the degree to which wealthy individuals exploit the potential for tax-free transfers as a means of spending-down their estates, and examine the responsiveness of inter vivos transfers over time to changes in the tax law. To address these questions we employ two data sets, each with important strengths and weaknesses. Using panel data from the Health and Retirement Study (HRS) we find that many of the wealthy fail to take advantage of the gift tax annual exemption to make tax-free transfers in any given year. Even those who do make a transfer in one year, often do not repeat the transfer annually and transfer far less than the tax law would allow. We then use data from linked gift and estate tax returns to examine giving over a much longer period. We find in the aggregate that there are sizable shifts in the timing of giving in response to tax changes, but again, the wealthy appear to transfer very little during their lifetimes. Overall, we conclude that while taxes are an important consideration in transfer behavior of the rich, their behavior is not universally consistent with a tax minimization strategy. PB - 57 VL - 57 IS - 2 U4 - Altruism/Intertemporal Consumer Choice/Life Cycle Models and Saving/Personal Income and Wealth Distribution/Estate Tax ER - TY - RPRT T1 - Family Care, Nursing Home Transitions, and States' Long-Term Care Policies Y1 - 2004 A1 - Muramatsu, Naoko A1 - Richard T. Campbell A1 - Ruby L Hoyem A1 - Martha A. Jacob A1 - Chris Ross A1 - yin, Hongjun KW - Healthcare PB - University of Illinois-Chicago N1 - RDA U4 - Caregiving/Nursing Homes/Long-Term Care ER - TY - RPRT T1 - How Do Families Allocate Elder Care Responsibilities Between Siblings? Y1 - 2004 A1 - Richard W. Johnson A1 - LoSasso, Anthony T. A1 - Lurie, Ithai Z. KW - Adult children KW - Healthcare PB - The Urban Institute U4 - Caregiving/Family Characteristics ER - TY - RPRT T1 - How Do Pensions Affect Expected and Actual Retirement Ages Y1 - 2004 A1 - Alicia H. Munnell A1 - Triest, Robert K. A1 - Natalia A. Jivan KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - This paper uses the first six waves of the Health and Retirement Study to investigate the impact of pensions on expected retirement age, on the probability of being retired in each wave given employment in the previous wave, and on the probability of retiring earlier than planned. Pension coverage per se and the type of pension are important in each case. Pension wealth reduces the expected retirement age by 0.6 year, and the incentives in defined benefit plans lower the expected age by another 1.1 years. Pension wealth increases the probability of retiring in a given wave, and pension accruals reduce the probability. Other characteristics of defined benefit plans, as measured by the pension dummy, further raise the probability of being retired. Finally, with regard to the probability of retiring earlier than planned, a change in defined contribution wealth increases the probability, but pension coverage per se reduces it. That is, those with pensions tend to be more accurate planners than those without. JF - Center for Retirement Research at Boston College Working Papers PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/wp-content/uploads/2004/11/wp_2004-271.pdf U4 - Pension Wealth/Retirement Planning ER - TY - JOUR T1 - Nonmetro residence and impaired vision among elderly Americans. JF - J Rural Health Y1 - 2004 A1 - Nan E. Johnson KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Cataract KW - Chronic disease KW - Comorbidity KW - Diabetes Mellitus KW - Humans KW - Hypertension KW - Prevalence KW - Risk Assessment KW - Rural Health KW - United States KW - Urban Health KW - Vision Disorders AB -

PURPOSE: Nonmetro and metro elderly people are contrasted in their risk of having (relative to lacking) an impairment in distance vision and in near vision.

METHODS: Using the 1995-1996 panel (Wave 2) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey, the prevalence of 5 eye-threatening conditions (cardiovascular disease, cataract, diabetes, glaucoma, and hypertension), a variety of medical treatments for these conditions, the number of talks/visits with doctors in the 2 years before Wave 2, and several relevant demographic characteristics of the 6,817 respondents were controlled.

FINDINGS: Nonmetro and metro elders have the same risk of impairment in distance vision. After controlling for other factors, nonmetro elders have a higher risk than their metro peers of an uncorrected impairment in near vision (probably presbyopia).

CONCLUSIONS: Nonmetro elders may confront more impediments to updating their corrective lenses for presbyopia. Implications for public health policy are discussed.

PB - 20 VL - 20 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15085628?dopt=Abstract U4 - Visually Impaired Persons/Residential Segregation ER - TY - JOUR T1 - Nonmetro residence, hearing loss, and its accommodation among elderly people. JF - J Rural Health Y1 - 2004 A1 - Nan E. Johnson KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Female KW - Health Surveys KW - Hearing aids KW - Hearing loss KW - Humans KW - Male KW - Memory Disorders KW - Odds Ratio KW - Rural Health KW - United States KW - Urban Population AB -

BACKGROUND: No previous studies compare the prevalence of physiological hearing loss among older adults by nonmetro/metro residence. Also, there is little information on their relative successes in accommodating hearing loss with a hearing aid.

PURPOSE: This study sought to bridge these gaps by analyzing the 8,222 respondents to Wave 1 (1993-1994) of the national Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey.

METHODS: Respondents were classified into 4 categories of hearing status: (1) physiologically normal hearing; and physiologically abnormal hearing with (2) full accommodation of lost hearing with a hearing aid, (3) partial accommodation, and (4) no hearing aid. A multinomial logistic regression was used to predict the odds of having any of the 3 statuses of physiologically abnormal hearing rather than normal hearing.

FINDINGS: Nonmetro residents had the same odds as metro residents of having no residual hearing loss when a hearing aid was worn (versus having physiologically normal hearing). But nonmetro residents had a much greater risk than their metro counterparts of having a hearing loss but no hearing aid or a residual hearing loss even when wearing an aid. The association of nonmetro residence with either of these latter hearing-loss statuses was greater than that of age, a more traditionally acknowledged hearing-risk factor.

CONCLUSION: Future studies should add nonmetro residence to the list of risk factors for negative hearing outcomes, especially since the percentage of elderly nonmetro residents is expected to grow over the next 2 decades.

PB - 20 VL - 20 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15085627?dopt=Abstract U4 - Hearing Impaired Persons/Residential Segregation ER - TY - JOUR T1 - Obesity's effects on the onset of functional impairment among older adults. JF - Gerontologist Y1 - 2004 A1 - Kristi Rahrig Jenkins KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Body Weight KW - Chronic disease KW - Disabled Persons KW - Exercise KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Motor Activity KW - Movement KW - Obesity KW - Risk-Taking KW - United States AB -

PURPOSE: This study has two purposes. First, it determines if there is a relationship between body weight and the onset of functional impairment across time among this sample of older adults. More specifically, it examines if obese older adults are more likely to experience the onset of functional impairment. Second, it explores how health behaviors and health conditions may explain the relationship between body weight and the onset of functional impairment.

DESIGN AND METHODS: With the use of longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, logistic regression models on the onset of functional impairment over two time points are estimated for older adults.

RESULTS: Results indicate that body weight (more specifically being overweight or obese) makes one more likely to experience the onset of functional impairment across various domains of impairment. Outside of health behaviors and health conditions, obesity has an independent effect on the onset of impairment in strength, lower body mobility, and activities of daily living.

IMPLICATIONS: Study findings support the active treatment of weight problems in older adults. Future directions for research in this area should address effective weight management interventions targeting issues related to older individuals.

PB - 44 VL - 44 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15075417?dopt=Abstract U4 - Obesity/Health Status--ADL limitations ER - TY - JOUR T1 - Reduction of quantity smoked predicts future cessation among older smokers JF - Addiction Y1 - 2004 A1 - Tracy Falba A1 - Jofre-Bonet, Mireia A1 - Susan H. Busch A1 - Duchovny, Noelia A1 - Jody L Sindelar KW - Health Conditions and Status AB - AIM: To examine whether smokers who reduce their quantity of cigarettes smoked between two periods are more or less likely to quit subsequently. STUDY DESIGN: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years from 1992 to 1998. The 2064 participants smoking at baseline and the first follow-up comprise the main sample. MEASUREMENTS: Smoking cessation by 1996 is examined as the primary outcome. A secondary outcome is relapse by 1998. Spontaneous changes in smoking quantity between the first two waves make up the key predictor variables. Control variables include gender, age, education, race, marital status, alcohol use, psychiatric problems, acute or chronic health problems and smoking quantity. FINDINGS: Large (over 50 ) and even moderate (25-50 ) reductions in quantity smoked between 1992 and 1994 predict prospectively increased likelihood of cessation in 1996 compared to no change in quantity (OR 2.96, P 0.001 and OR 1.61, P 0.01, respectively). Additionally, those who reduced and then quit were somewhat less likely to relapse by 1998 than those who did not reduce in the 2 years prior to quitting. CONCLUSIONS: Reducing successfully the quantity of cigarettes smoked appears to have a beneficial effect on future cessation likelihood, even after controlling for initial smoking level and other variables known to impact smoking cessation. These results indicate that the harm reduction strategy of reduced smoking warrants further study. PB - 99 VL - 99 UR - http://www.blackwell-synergy.com/links/doi/10.1111/j.1360-0443.2004.00574.x/full/ IS - 1 U4 - Smoking ER - TY - JOUR T1 - Relationship of Body Mass and Net Worth for Retirement-Aged Men and Women JF - Research on Aging Y1 - 2004 A1 - Stephanie J. Fonda A1 - Fultz, Nancy H. A1 - Kristi Rahrig Jenkins A1 - Wheeler, Laura M. A1 - Linda A. Wray KW - Health Conditions and Status KW - Net Worth and Assets AB - This article examines linkages between body weight and socioeconomic status (SES) among Americans at or near retirement age. The authors hypothesize that (a) body weight relates negatively to SES, (b) this relationship is greater for women than men, and (c) the relationship attenuates when health, employment, and marital status are controlled.We use the 1992 Health and Retirement Study for this examination. SES is measured as net worth. Body weight is measured as body mass index and categorized as normal weight, overweight, and obese. Results indicate that, for women, overweight and obesity relate to lower logged networth. This relationship attenuates once covariates are considered. For men, overweight and obesity relate to higher logged net worth, even when covariates are considered. The findings suggest that greater weight has different meanings for men and women in this cohort; it might be related to success for men but a sociocultural detriment for women. PB - 26 VL - 26 IS - 1 U4 - Body Mass Index/Net Worth ER - TY - RPRT T1 - Should We Raise Social Security's Earliest Eligibility Age? Y1 - 2004 A1 - Alicia H. Munnell A1 - Meme, Kevin B. A1 - Natalia A. Jivan A1 - Kevin E. Cahill KW - Social Security AB - Social Security’s Earliest Eligibility Age (EEA) allows one to claim reduced benefits as early as age 62. For full benefits, individuals must wait until the Normal Retirement Age (NRA), which was traditionally 65 but is gradually increasing to 67. So, Americans have a choice to make when they reach their early 60s: claim a reduced Social Security benefit right away or delay until some further date and receive a larger benefit. The reduction for claiming benefits early is designed to be actuarially fair, i.e. monthly benefits are lowered by an amount that offsets the longer period for which they will be received. The total amount that the average person can expect to receive over his or her lifetime thus does not depend on when benefits are claimed… JF - Center for Retirement Research at Boston College Briefs PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/briefs/should-we-raise-social-securitys-earliest-eligibility-age/ U4 - Social Security ER - TY - JOUR T1 - Trends in Job Demands Among Older Workers, 1992-2002 JF - Monthly Labor Review Y1 - 2004 A1 - Richard W. Johnson KW - Employment and Labor Force AB - The aging of the population raises concerns about the Nation’s ability to support future retirees, whose numbers will soar once members of the “baby-boom” cohort begin reaching old age in coming years. If current employment patterns persist, there will be fewer workers in the future available to produce goods and services, threatening standards of living for Americans of all ages. As long as job demands do not force many older workers into retirement, increasing employment among older adults could relieve these demographic pressures. This article explores the ability of the labor force to accommodate older adults by examining recent trends in job demands among older workers PB - 127 VL - 127 UR - https://www.bls.gov/opub/mlr/2004/07/art4full.pdf IS - 7 U4 - Job Characteristics/Older Workers ER - TY - JOUR T1 - Use of an IRT-based latent variable model to link different forms of the CES-D from the Health and Retirement Study. JF - Soc Psychiatry Psychiatr Epidemiol Y1 - 2004 A1 - Richard N Jones A1 - Stephanie J. Fonda KW - Adult KW - Aged KW - Aging KW - Calibration KW - Depressive Disorder KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Psychological KW - Psychological Tests KW - Psychometrics KW - United States AB -

BACKGROUND: The goal of this study was to calibrate depressive symptoms collected using different versions of the Centers for Epidemiologic Studies - Depression (CES-D) instrument in different waves of the Health and Retirement Study (HRS).

METHOD: The HRS is a prospective and nationally representative cohort study. This analysis included a sample of HRS participants, adults aged 23-85 years in 1992 who had complete data on depressive symptoms at initial 2- and 4-year follow-up interviews (N= 5,734). Depressive symptoms were assessed with the CES-D. Symptom coverage and response categories varied across study wave. The first wave (1992) used a four-category response, whereas subsequent waves (1994 and 1996) used a two-category response. A structural equations model (SEM) based in Item Response Theory (IRT) was used to calibrate symptoms and generate linked depressive symptom burden scores.

RESULTS: Linked depressive symptom burden scores, derived from calibrated symptoms, were distributed similarly across HRS wave.

CONCLUSION: Our results demonstrate the applicability of an IRT-based SEM to address a common challenge in prospective studies: changes in the content and context of symptom assessment. Future investigations may make use of our linked syndrome scores to further explore other aspects of depression from a longitudinal perspective.

PB - 39 VL - 39 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15669664?dopt=Abstract U4 - Depression ER - TY - JOUR T1 - Cash Balance Plans and the Distribution of Pension Wealth JF - Industrial Relations Y1 - 2003 A1 - Richard W. Johnson A1 - Cori E. Uccello KW - Net Worth and Assets KW - Pensions AB - Recent pension plan coversions by numerous large employers have sparked debate about the merits of cash balance plans. This paper compares pension wealth in traditional defined benefit (DB) plans and cash balance plans for a national sample of coverred Americans aged 51 to 61. The simulations indicate that replacing DB plans with cash balance plans would redistribute pension wealth from those with long-term jobs to those with multiple short-term jobs and from those with substantial pension benefits to those with more limited benefits. Perhaps unexpectedly, women ad midlife in 1992 with DB coverage would lose wealth in cash balanace plans, but future cohorts of women are likely to fare better. PB - 42 VL - 42 IS - 4 N1 - RDA 1998-006 U4 - Pension Plans/Retirement Wealth ER - TY - RPRT T1 - The Economic Consequences of Marital Disruption for Pre-Retirement Age African-American, Hispanic and Non-Hispanic White Women Y1 - 2003 A1 - Jacqueline L. Angel A1 - Cynthia J. Buckley A1 - Ronald J. Angel A1 - Maren A. Jimenez KW - Adult children KW - Net Worth and Assets KW - Women and Minorities PB - Population Association of America CY - Minneapolis, MN U4 - Marital Dissolution/Women/Economic Status ER - TY - RPRT T1 - Employment, Social Security, and Future Retirement Outcomes for Single Mothers Y1 - 2003 A1 - Richard W. Johnson A1 - Melissa Favreault A1 - Joshua H. Goldwyn KW - Expectations KW - Social Security KW - Women and Minorities PB - Chestnut Hill, MA, Center for Retirement Research at Boston College U4 - Social Security/Women, Working/Retirement Expectations ER - TY - JOUR T1 - Enhancing the Quality of Data on Income: Recent Innovations from the HRS JF - Journal of Human Resources Y1 - 2003 A1 - Michael D Hurd A1 - Juster, F. Thomas A1 - James P Smith KW - Income KW - Methodology AB - This paper evaluates two survey innovations introduced in the HRS that aimed to improve income measurement. The innovations are (1) the integration of questions for income and wealth and (2) matching the periodicity over which income questions are asked to the typical way such income is received. Both innovations had significant impacts in improving the quality of income reports. For example, the integration of income questions into the asset module produced in HRS an across-wave 63 percent increase in the amount of income derived from financial assets, real estate investments and farm and business equity. Similarly, asking respondents to answer using a time interval consistent with how income is received substantially improved the quality of reports on social security income. Fortunately, we also suggest ways that these innovations can be introduced into other major social science surveys. PB - 38 VL - 38 IS - 3 U4 - HRS content and design/Microeconomic Data Management/Income ER - TY - JOUR T1 - Food Stamps and the Elderly: Why is Participation So Low? JF - Journal of Human Resources Y1 - 2003 A1 - Steven Haider A1 - Robert F. Schoeni A1 - Jacknowitz, Alison KW - Households KW - pension eligibility KW - Public Assistance AB - Estimates imply that only one-third of elderly persons who are eligible for food stamps actually participate in the program, which is half the rate that exists among younger people. This study investigates potential reasons for the relatively low take-up rate among the elderly. Analyzing new data, we conclude that the low take-up rate is not explained by measurement error and little is explained by various behavioral factors. Despite this much lower take-up rate, elderly who are eligible for assistance but not enrolled in the program do not appear to be especially needy. PB - 38 VL - 38 IS - Suppl N1 - National Institute on Aging U4 - food stamps ER - TY - RPRT T1 - Food Stamps and the Elderly: Why is Participation So Low? Y1 - 2003 A1 - Steven Haider A1 - Robert F. Schoeni A1 - Jacknowitz, Alison KW - Households KW - pension eligibility KW - Public Assistance AB - Estimates imply that only one-third of elderly persons who are eligible for food stamps actually participate in the program, which is half the rate that exists among younger people. This study investigates potential reasons for the relatively low take-up rate among the elderly. Analyzing new data, we conclude that the low take-up rate is not explained by measurement error and little is explained by various behavioral factors. Despite this much lower take-up rate, elderly who are eligible for assistance but not enrolled in the program do not appear to be especially needy. JF - National Poverty Center Working Paper Series PB - National Poverty Center, University of Michigan CY - Ann Arbor, MI UR - http://www.npc.umich.edu/publications/working_papers/paper2/03-02.pdf ER - TY - JOUR T1 - Health Insurance Costs and Early Retirement Decisions JF - Industrial and Labor Relations Review Y1 - 2003 A1 - Richard W. Johnson A1 - Davidoff, Amy J. A1 - Perese, Kevin KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction AB - The loss of health insurance may be an important component of the cost of retirement, especially for workers without retiree health insurance coverage. The authors find that insurance costs significantly reduce retirement rates for full-time wage and salary workers ages 51 to 61. Simulations suggest that a 1,000 increase in the net present value of health insurance premium costs reduces the probability of early retirement by 1.17 percentage points for men and by 0.24 percentage points for women, corresponding to elasticities of -0.22 and -0.24, respectively. The authors' models predict that expanding the Medicare program to cover those aged 62-64 would increase retirement rates for workers with employer-sponsored coverage who lack retiree benefits, if the government subsidizes their coverage. However, the impact would be small, increasing overall retirement rates by only 7 . PB - 56 VL - 56 IS - 4 N1 - RDA 1998-006 U4 - Health Insurance/Retirement ER - TY - RPRT T1 - How Has the Shift to 401(k)s Affected the Retirement Age? Y1 - 2003 A1 - Alicia H. Munnell A1 - Kevin E. Cahill A1 - Natalia A. Jivan KW - Pensions KW - Retirement Planning and Satisfaction PB - Boston College, Center for Retirement Research UR - http://www.bc.edu/centers/crr/ U4 - Retirement Behavior/defined contribution pension plans ER - TY - RPRT T1 - Measuring the Optimal Income Replacement Rate: A Panel Data Analysis Y1 - 2003 A1 - An, Chong-Bum A1 - Jeon, Seung-Hoon KW - Consumption and Savings KW - Retirement Planning and Satisfaction AB - 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. PB - Sungkyunkwan University, Korea; Dept. of Economics U4 - Consumption/Retirement Behavior ER - TY - JOUR T1 - Patterns of Body Weight in Middle-Aged and Older Americans by Gender and Race, 1993-2000 JF - Social and Preventative Medicine Y1 - 2003 A1 - Kristi Rahrig Jenkins A1 - Fultz, Nancy H. A1 - Stephanie J. Fonda A1 - Linda A. Wray KW - Demographics KW - Health Conditions and Status AB - Objectives: Despite evidence of poor health outcomes associated with excessive weight gain or loss, longitudinal patterns of body weight over the adult life course have not been fully described. This article seeks to address this by examining body weight patterns for middle-aged and older adults.Methods: Panel data from the Health and Retirement Study (HRS) original cohort and the original cohort of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study are used to compare, by social group, characteristics of respondents and non-respondents, baseline weight (1993 and 1994) to year 2000 weight, and explore various weight change trajectories over time.Results: Overall, a greater proportion of middle-aged adults are heavier over time than at baseline and a greater proportion of older adults lose weight over time compared to baseline. Examining the transitions across weight trajectories for all of the social groups suggests considerable variability.Con clusions: These findings suggest that differing physiologic and social or environmental experiences may have implications for body weight patterns. Understanding these patterns by race/ethnicity and gender could provide insight into health disparities among different social groups. PB - 48 VL - 48 IS - 4 U4 - United States/Obesity/Body Mass Index/Adults ER - TY - JOUR T1 - Racial Bias in the Assessment of Cognitive Functioning of Older Adults JF - Aging and Mental Health Y1 - 2003 A1 - Richard N Jones KW - Demographics KW - Health Conditions and Status AB - This study was undertaken to determine if the difference in assessed cognition between Black/African-American and White older adults was due differential item functioning (DIF)and/or differences in the effect of background variables. Participants were 15,257 adults aged 50 and older surveyed in the Study of Asset and Health Dynamics of the Oldest Old (AHEAD) and Health and Retirement Study (HRS). The cognitive measure was a modified telephone interview for cognitive status. The analytic strategy was a multiple group structural equation model grounded in item response theory. Results suggest that most (89 )of the group difference could be attributed to measurement or structural differences, the remainder being not significantly different from zero (p 0.193). Most items displayed racial DIF,accounting for most of the group difference. After controlling for DIF, the group difference that remained could be attributed to heterogeneity in the effect of background variables. For example, low education was more deleterious for Black/African-Americans,and high income conferred an advantage only for Whites.These findings underscore the importance of efforts to generate culture-fair measurement devices. However, culture-fair assessments may attenuate, but not eliminate, group differences in assessed cognition due to the incommensurate action of background variables. PB - 7 VL - 7 IS - 2 U4 - Cognitive Functioning/Racial Differences ER - TY - JOUR T1 - Raising the Medicare Eligibility Age: Effects on the Young Elderly JF - Health Affairs Y1 - 2003 A1 - Davidoff, Amy J. A1 - Richard W. Johnson KW - Medicare/Medicaid/Health Insurance AB - ABSTRACT: If Medicare eligibility were delayed to age sixty-seven, as proposed periodically by policymakers, most sixty-five- and sixty-six-year-olds (the young elderly ) would find alternative sources of coverage. However, the loss of Medicare eligibility would leave about 9 percent of this age group uninsured, while another 11 percent would be underinsured because they could only afford limited nongroup policies. The impact would be much greater for certain subgroups, including blacks, Hispanics, and the poor. A buy-in plan that allows young elderly people to purchase Medicare coverage could reduce uninsurance rates, but only if it subsidizes premiums for those with limited incomes. PB - 22 VL - 22 IS - 4 U4 - Medicare ER - TY - RPRT T1 - Can Cash Balance Pension Plans Improve Retirement Security for Today's Workers? Y1 - 2002 A1 - Richard W. Johnson A1 - Cori E. Uccello KW - Pensions AB - In recent years several large employers have replaced their traditional defined benefit pension plans with cash balance plans. This brief compares outcomes under each plan for a national sample of Americans near retirement with pension coverage. The findings show that cash balance plans would redistribute pension wealth from those who held long-term jobs to those with a series of short-term jobs. Individuals with limited pension wealth, especially those in the bottom quartile, would also benefit. Surprisingly, many women now approaching retirement age would lose pension wealth under cash balance plans, but future cohorts of older women are likely to fare better. JF - Urban Institute Brief Series: The Retirement Project PB - The Urban Institute UR - https://www.urban.org/research/publication/can-cash-balance-pension-plans-improve-retirement-security-todays-workers N1 - RDA 1998-006 U4 - Pension Plans ER - TY - JOUR T1 - Delays in Claiming Social Security Benefits JF - Journal of Public Economics Y1 - 2002 A1 - Courtney Coile A1 - Diamond, Peter A1 - Gruber, Jonathan A1 - Jousten, Alain KW - Retirement Planning and Satisfaction KW - Social Security AB - This paper focuses on Social Security benefit claiming behavior, a take-up decision that has been ignored in the previous literature. Using financial calculations and simulations based on an expected utility maximization model, we show that delaying benefit claim for a period of time after retirement is optimal in a wide variety of cases and that gains from delay may be significant. We find that approximately 10 of men retiring before their 62nd birthday delay claiming for at least one year after eligibility. We estimate hazard and probit models using data from the New Beneficiary Data System to test four cross-sectional predictions. While the data suggest that too few men delay, we find that the pattern of delays by early retirees is generally consistent with the hypotheses generated by our theoretical model. PB - 84 VL - 84 UR - http://econ-www.mit.edu/faculty/pdiamond/files/claim14.pdf IS - 3 U4 - Social Security benefit claiming/Claiming behavior/Claiming behavior/retirement planning ER - TY - JOUR T1 - Does Informal Care from Adult Children Reduce Nursing Home Admissions for the Elderly? JF - Inquiry Y1 - 2002 A1 - LoSasso, Anthony T. A1 - Richard W. Johnson KW - Adult children KW - Healthcare PB - 39 VL - 39 IS - 2 U4 - Caregiver Status/Nursing Homes/Health Care/Family/Transfers ER - TY - JOUR T1 - Endogenous Fringe Benefits, Compensating Wage Differentials and Older Workers JF - International Journal of Health Care Finance and Economics Y1 - 2002 A1 - Gail A Jensen A1 - Morrisey, Michael A. KW - Employment and Labor Force KW - Insurance KW - Pensions AB - Labor economists tend to think of insurance policies, supposedly paid for by a firm, as truly being paid for by workers, in that they will receive a somewhat smaller wage. It is believed that the wage one will receive is dependent on the type of insurance that they are getting. This research attempts to illustrate the magnitude of wage differences caused by receiving different insurance plans. The researchers feel that thinking of job-insurance choice as exogenous rather than endogenous leads to fundamental errors in ones ability to estimate the wage differentials of these insurance policies. An empirical model is created in order to better analyze the data. Data analysis shows that those people with an insurance plan outside of a corporation are more likely to take jobs that do not offer insurance. People that receive insurance from an outside source are also less likely to have jobs with pensions or a generous vacation plan. From the data they find a wage differential of 6,300 per year. Many other interesting findings are provided. PB - 1 VL - 1 U4 - Insurance Coverage/Benefits/Wages and Compensation/Pension Plans ER - TY - RPRT T1 - Ensuring Time-Series Consistency in Estimates of Income from Wealth Y1 - 2002 A1 - Juster, F. Thomas A1 - Joseph P. Lupton A1 - Cao, Honggao KW - Income KW - Methodology KW - Net Worth and Assets PB - Ann Arbor, MI, The University of Michigan, Michigan Retirement Research Center U4 - Longitudinal Design/Income/Wealth 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 - Household Retirement Saving and Informal Insurance: Getting by with a little help from friends Y1 - 2002 A1 - Jennifer M Mellor A1 - Jensen, Eric R. KW - Adult children KW - Consumption and Savings AB - The literature on wealth accumulation suggests that social insurance programs serve to weaken the precautionary saving motive. Elsewhere, it has been suggested that family members can establish informal insurance arrangements that serve to reduce earnings variation in the same manner as social insurance. Together, these findings imply that another potential explanation for the inadequate retirement saving of many U.S. households is the presence of informal insurance, in the form of intervivos transfers to retired family members. We perform an empirical test of the hypothesis that potential transfers from family members and friends crowd out retirement saving, using data from various waves of the Health and Retirement Study. We estimate two-stage least squares models of welath accumulation, treating the probability of transfer receipt as endogenous and using characteristics of likely donors to identify the model. We find that an increase in the subjective proabability of receiving and intervivos financial transfer reduces wealth accumulation, especially financial wealth in the forms of checking, savings, money market accounts, CDs, and IRAs. A one percentage point (or roughly 8 ) increase in the probability of transfer receipt leads to a 3020 reduction in financial assets. PB - College of William and Mary N1 - RDA 1999-001 U4 - Transfers/Retirement Saving/Social Support ER - TY - JOUR T1 - Insuring the Near Elderly: The Potential Role for Medicare Buy-In Plans JF - The Urban Institute Y1 - 2002 A1 - Richard W. Johnson A1 - Davidoff, Amy J. A1 - Marilyn Moon KW - Aging KW - Demographics KW - Medicare/Medicaid/Health Insurance AB - 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 insurance coverage. This brief summarizes findings from an Urban Institute report that examined potential participation rates in alternative buy-in plans and measured their potential impact on rates of uninsurance. Many individuals younger than 65 would purchase Medicare coverage, but without subsidies participation would be limited to those who could afford substantial premiums. Buy-ins would reduce uninsurance rates only if they provided subsidies to make the plans affordable to those with limited incomes. PB - The Retirement Project Brief Series VL - The Retirement Project Brief Series UR - https://www.urban.org/research/publication/insuring-near-elderly IS - No. 13 U4 - Medicare/Health Insurance Coverage/Middle Aged Adults ER - TY - JOUR T1 - A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey. JF - Prev Med Y1 - 2002 A1 - Truls Ostbye A1 - Donald H. Taylor Jr. A1 - Sang-Hyuk Jung KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Attitude to Health KW - Chi-Square Distribution KW - Exercise KW - Female KW - Health Behavior KW - Health Status KW - Health Surveys KW - Humans KW - Life Style KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Assessment KW - Risk Factors KW - Sex Distribution KW - Smoking KW - Socioeconomic factors KW - Survival Rate KW - United States AB -

BACKGROUND: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health).

METHODS: The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998).

RESULTS: Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health.

CONCLUSIONS: Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.

PB - 34 VL - 34 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11902850?dopt=Abstract U4 - Smoking/Health Status/Health Behavior/Longitudinal Studies ER - TY - RPRT T1 - A Medicare Buy In for the Near Elderly: Design Issues and Potential Effects on Coverage Y1 - 2002 A1 - Richard W. Johnson A1 - Marilyn Moon A1 - Davidoff, Amy J. KW - Demographics KW - Medicare/Medicaid/Health Insurance AB - 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. PB - Henry J. Kaiser Family Foundation CY - Washington, D.C. UR - http://files.kff.org/attachment/report-A-Medicare-Buy-In-for-the-Near-Elderly-Design-Issues-and-Potential-Effects-on-Coverage U4 - Medicare/Health Insurance Coverage/Middle Aged Adults ER - TY - RPRT T1 - Medicare, Retirement Costs, and Labor Supply at Older Ages Y1 - 2002 A1 - Richard W. Johnson KW - Employment and Labor Force KW - Medicare/Medicaid/Health Insurance AB - 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. JF - Center for Retirement Research at Boston College Working Papers PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/working-papers/medicare-retirement-costs-and-labor-supply-at-older-ages/ N1 - RDA 1998-006 U4 - Medicare/Health Insurance/Labor Force Participation ER - TY - RPRT T1 - Modeling Income in the Near Term: Revised Projections of Retirement Income Through 2020 for the 1931-1960 Birth Cohorts Y1 - 2002 A1 - Toder, Eric A1 - Thompson, Lawrence H. A1 - Melissa Favreault A1 - Richard W. Johnson A1 - Perese, Kevin A1 - Ratcliffe, Caroline A1 - Karen E. Smith A1 - Cori E. Uccello A1 - Timothy A Waidmann A1 - Berk, Jillian A1 - Woldemariam, Romina A1 - Gary T. Burtless A1 - Claudia R Sahm A1 - Douglas A. Wolf KW - Disabilities KW - Net Worth and Assets KW - Pensions KW - Social Security AB - 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. JF - Urban Institute Research Report PB - The Urban Institute CY - Washington, D.C. UR - http://www.urban.org/UploadedPDF/410609_ModelingIncome.pdf N1 - RDA 1998-006 U4 - Earnings and Benefits File/Disability/Disability/Pensions/Wealth ER - TY - THES T1 - Research in Population Health Y1 - 2002 A1 - Jones, Nathan Reed KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This dissertation presents three chapters on population health and mortality risk using cause of death and underlying conditions data as well as longitudinal studies that include a wide spectrum of individual, household, and community variables. Although the three studies contained in this dissertation are not directly linked topically, they share a concern about the role of smaller components of a population to the mortality dynamics of the population as a whole. Each of the three papers builds on previous research to provide a level of detail or innovation in measurement to improve understanding of mortality dynamics and their effects on the population of interest. In the first chapter, I hold wealth rank in the poorest and richest global wealth quintiles constant over time to provide estimates of the deaths by primary cause group in 1970, 1990, and 2020. I also provide projections of deaths by cause for the richest and poorest countries in 2020 for twenty-one causes of death. The mortality structure among the poorest countries in the world continues to be dominated by infectious causes of death despite global estimates that suggest the epidemiologic transition has progressed to an advanced stage. The second chapter describes age-graded mortality risk for sub-groups of the U.S. population taking into account several demographic, economic, and health characteristics. Using data from different representative cohorts, I estimate age-specific relative risks of death associated with different health, socioeconomic, marital status, and behavioral characteristics to the mean risk of death. The third chapter describes a method for estimating variance in individual mortality risk based on observed characteristics using representative cohorts of the Health and Retirement Study (HRS). I compare distributions of predicted mortality risk to estimates of the degree of population-level heterogeneity in previous studies that have used parameterized frailty models for unobserved heterogeneity in mortality. Findings in this chapter show that the coefficient of variation for estimates of individual mortality risk decrease with age, thus suggesting that the inverse gaussian distribution may be more appropriate in frailty models than the gamma distribution, which implies a coefficient of variation that is constant with age. PB - University of Pennsylvania U4 - Longitudinal Studies ER - TY - JOUR T1 - Balancing Retirement Security with the Needs of Frail Parents: Caregiving, Financial Transfers, and Work by Women at Midlife JF - North American Actuarial Review Y1 - 2001 A1 - Richard W. Johnson A1 - LoSasso, Anthony T. KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Caring for frail elderly parents can interfere with work responsibilities. People who provide care to their parents may need to take time off from work or retire altogether. However, reductions in labor supply at midlife can have serious implications for retirement wealth and, as a result, on economic well-being in later life. This paper examines how family support for the elderly can affect retirement savings by examining the relationship between labor supply, time help to parents, and financial assistance to parents. Using data from the Health and Retirement Study on a nationally representative sample of women ages 53–63, we found that women who helped their parents with personal care assistance worked significantly fewer hours than did those who did not help their parents, whereas those who provided financial assistance worked significantly more hours. Although few persons at midlife presently spend substantial amounts of time helping their elderly parents in any given year, for those who do, the costs can be high. Pressures on families are likely to mount in the near future as falling mortality and fertility rates continue to increase the proportion of the population that is very old and as women continue to play more important roles in the labor market. PB - 5 VL - 5 IS - 1 U4 - Aged, 80 and Over/Transfers/Caregiving/Women, Working/Middle Age/Parent ER - TY - JOUR T1 - Do Smokers Respond to Health Shocks? JF - The Review of Economics and Statistics Y1 - 2001 A1 - V. Kerry Smith A1 - Donald H. Taylor Jr. A1 - Frank A Sloan A1 - Desvousges, William H. A1 - F. Reed Johnson KW - Health Conditions and Status AB - This paper reports the first effort to use data to evaluate how new information, acquired through exogenous health shocks, affects people's longevity expectations. We find that smokers react differently to health shocks than do those who quit smoking or never smoked. These differences, together with insights from qualitative research conducted along with the statistical analysis, suggest specific changes in the health warnings used to reduce smoking. Our specific focus is on how current smokers responded to health information in comparison to former smokers and nonsmokers. The three groups use significantly different updating rules to revise their assessments about longevity. The most significant finding of our study documents that smokers differ from persons who do not smoke in how information influences their personal longevity expectations. When smokers experience smoking-related health shocks, they interpret this information as reducing their chances of living to age 75 or more. Our estimated models imply smokers update their longevity expectations more dramatically than either former smokers or those who never smoked. Smokers are thus assigning a larger risk equivalent to these shocks. They do not react comparably to general health shocks, implying that specific information about smoking-related health events is most likely to cause them to update beliefs. It remains to be evaluated whether messages can be designed that focus on the link between smoking and health outcomes in ways that will have comparable effects on smokers' risk perceptions. PB - 83 VL - 83 IS - 4 U4 - Smoking/Health Shocks/Longevity ER - TY - THES T1 - The Impact of Body Weight on Physical Functioning Across the Later Years Y1 - 2001 A1 - Kristi Rahrig Jenkins KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - An extensive body of literature analyzes the impact of body weight and various health outcomes documenting that extremes in body weight adversely effect health. Much less is known about how body weight specifically impacts physical functioning. Some studies, however, have shown an association between having excessive body weight and heightened risk for certain diseases and functional impairment. With evidence that the population is becoming heavier in greater proportions than in the past, body weight as it contributes to physical functioning remains a critical health problem. The project addresses some of the questions central to body weight and physical functioning. For example, how do certain socioeconomic and demographic characteristics, health behaviors, and health characteristics effect the relationship between body weight and physical functioning? Is the effect of body weight specific to certain functional domains? In addition, is the basic relationship between body weight and physical functioning different in young old populations than in old old populations? Using longitudinal data from the Health and Retirement Study (sample of young old adults) and asset and health dynamics among the oldest old survey (sample of old old adults) logistic regression models on the loss of physical functioning (1 = impaired) over a two year period are estimated for the young old and old old separately. A model comparing the young old and the old old is also estimated. Results indicate that body weight, more specifically obesity, impacts physical functioning across various domains of impairment. When influencing these domains, body weight acts directly but also indirectly with other factors (socioeconomic and demographic characteristics, health behaviors, and health characteristics). In addition, important differences exist by cohort membership. The project concludes by addressing implications and areas for future research. PB - Wayne State University UR - Database ID: DAI-A 62/12, p. 4349, Jun 2002 U4 - Gerontology (0351) JO - The Impact of Body Weight on Physical Functioning Across the Later Years ER - TY - RPRT T1 - The Impact of Own Children on Retirement Portfolio Composition in the United States Y1 - 2001 A1 - Jennifer M Mellor A1 - Jensen, Eric R. KW - Net Worth and Assets AB - We estimate models of retirement portfolio compositions using Wave 1 of the Health and Retirement Survey. The sample consists largely of pre-retirement individuals in their early 50s. Treating number of own children as endogenous, we find little firm evidence that either levels of specific asset holdings or their shares in a portfolio of assets are affected by number of own children. The exception is housing wealth, which also carries a significant consumption component. While some parents may well come to rely on their children for retirement support, we cannot support the notion that it typically is intentional. PB - College of William and Mary, Dept. of Economics N1 - RDA 1999-001 U4 - Retirement Wealth/Assets ER - TY - RPRT T1 - An Investigation of the Effect of Informal Insurance on Household Retirement Saving Y1 - 2001 A1 - Jensen, Eric R. A1 - Jennifer M Mellor KW - Adult children KW - Consumption and Savings AB - The literature on wealth accumulation suggests that social insurance programs serve to weaken the precautionary saving motive. Elsewhere, it has been suggested that family members can establish informal insurance arrangements that serve to reduce earnings variation in the same manner as social insurance. Together, these findings imply that another potential explanation for the inadequate retirement saving of many low income U.S. households is the presence of informal insurance, in the form of intervivos transfers to retired family members. In this paper, we describe a set of testable conditions that would support this contention, and examine in turn the empirical support for each. We perform an empirical test of the hypothesis that potential transfers from children crowd out retirement saving, using data from Wave 1 of the Health and Retirement Study. We find no evidence that parents with larger families adjust retirement wealth levels downward. WE find some evidence to suggest that parents' retirement portfolio composition is affected by family size. PB - College of William and Mary N1 - RDA 1999-001 U4 - Transfers/Retirement Saving/Social Support ER - TY - RPRT T1 - Medicare and Retirement Decisions Y1 - 2001 A1 - Richard W. Johnson KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction PB - The Urban Institute U4 - Retirement Planning/Medicare ER - TY - RPRT T1 - The Potential Effects of Cash Balance Plans on the Distribution of Pension Wealth at Midlife Y1 - 2001 A1 - Richard W. Johnson A1 - Cori E. Uccello KW - Net Worth and Assets KW - Pensions AB - Recent pension plan conversions by numerous large employers have sparked debate about the merits of cash balance plans. This paper compares pension wealth in traditional defined benefit (DB) plans and cash balance plans for a national sample of covered Americans ages 51 to 61. The simulations indicate that replacing DB plans with cash balance plans would redistribute pension wealth from those who held long-term jobs for many years to those with multiple short-term jobs. Women at midlife in 1992 with DB coverage would have lost wealth in cash balance plans, but future cohorts of women are likely to fare better. JF - The Urban Institute Research Report PB - The Urban Institute CY - Washington, D.C. UR - https://www.urban.org/research/publication/potential-effects-cash-balance-distribution-pension-wealth-midlife U4 - Pension Wealth/Pension Plans/Distribution ER - TY - RPRT T1 - Retiring Together or Working Alone: The Impact of Spousal Employment and Disability on Retirement Decisions. Y1 - 2001 A1 - Richard W. Johnson A1 - Melissa Favreault KW - Adult children KW - Retirement Planning and Satisfaction AB - It is commonly the case that spouses retire at the same time as one another, however, this study examines the effect of one persons decision to retire, because of injury, on their spouses work decisions. Understanding the effects of injury related retirement on the work status of the spouse is of great importance to policy makers. This article focuses on retirement decisions and how they are influenced by spousal health and employment status. Mathematical models and interpretations are made in order to analyze the data. They noticed that a vast majority of women that worked for pay did so when their husband was also employed. When the husband retired voluntarily women were slightly less likely to stay employed. Differences in spousal employment, especially between classes, was greatest when the husband was under 62 and therefore not able to receive Social Security. Men were less likely to work if their wife was not working. If the husband retired involuntarily the wife was more likely then not to return to the workforce or continue to work. JF - Center for Retirement Research at Boston College Working Papers PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/working-papers/retiring-together-or-working-alone-the-impact-of-spousal-employment-and-disability-on-retirement-decisions/ N1 - RDA 1998-006 U4 - Retirement Planning/Marital Status/Labor--retirement decisions ER - TY - JOUR T1 - Attempts to Resolve a Disability in Walking: Different Strategies or Different Outcomes for Nonmetro Elderly Americans? JF - Journal of Family Issues Y1 - 2000 A1 - Nan E. Johnson KW - Disabilities KW - Healthcare AB - This study analyzed the first two waves (1993-1994 and 1995-1996) of the national Survey on Asset and Health Dynamics Among the Oldest Old. It focused on the prevalence of a common intrinsic disability at Wave 1 -- unaided physiological hardship in walking across a room -- and sought which factors eliminated the hardship so that there was no actual disability. Nonmetro and metro elderly people with this intrinsic disability were equally likely to use personal help in walking across a room and to resort to the same walking devices. Yet, nonmetro elderly people were less successful than their metro counterparts in avoiding mild residual hardship in interior ambulation. Reasons included a larger number of lower-body limitations among the nonmetro elderly and the greater absence of accommodative architectural features from nonmetro homes. This article concludes with a discussion of public policies that could assist disabled elders to remain community dwellers. PB - 21 VL - 21 IS - 5 N1 - RDA 2002-016 U4 - Disability/Disability/Health Services for the Aged ER - TY - JOUR T1 - Economic, Cultural, and Social Origins of Emotional Well-Being: Comparisons of Immigrants and Natives at Midlife JF - Research on Aging Y1 - 2000 A1 - Hao, Lingxin A1 - Richard W. Johnson KW - Demographics KW - Health Conditions and Status KW - Other AB - Linking theories of social stratification, ethnicity, and mental health with theories of human and social capital, the authors examine the impact of economic, cultural, and social factors on five different dimensions of emotional well-being for immigrants and natives at midlife. Based on data from the 1992 wave of the Health and Retirement Study, the authors found that economic factors and human capital variables are the most important determinants of emotional health for both immigrants and natives. The results indicate that cultural factors can enhance emotional well-being. Religious affiliation and participation are important for both immigrants and natives, but religious participation appears to be more beneficial for immigrants. Being part of a couple was also associated with better emotional health, especially for immigrants. The effects of several determinants of emotional health differed across immigrant groups. It was found that marriage, education, and the presence of economically stable kin are particularly important for Cubans. 6 Tables, 36 References. Adapted from the source document PB - 22 VL - 22 IS - 6 U4 - Social Stratification/Cultural Capital/Socioeconomic Factors/Mental Health/Well Being/Immigrants/Religiosity/Middle Aged Adults/Nativism ER - TY - RPRT T1 - Family Support of the Elderly and Female Labor Supply: Tradeoffs Among Caregiving, Financial Transfers, and Work Y1 - 2000 A1 - Richard W. Johnson A1 - LoSasso, Anthony T. KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Women and Minorities PB - The Urban Institute U4 - Transfers/Women, Working/Caregiving/Labor Supply ER - TY - JOUR T1 - Health Consequences of Marriage for the Retirement Years JF - Journal of Family Issues Y1 - 2000 A1 - Pienta, Amy M. A1 - Mark D Hayward A1 - Kristi Rahrig Jenkins KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Retirement Planning and Satisfaction AB - Over the last few decades there has been an increasing trend toward divorce, postponed marriage, never marrying, and cohabitation. It is also known that marriage increases ones health, mainly because of the ability to gain from the help of a spouse or other relatives that transfer finances and time to the married person. How will changes in marriage trends effect the health of people as they reach retirement ages? What aspects of health are linked to marriage? Married persons from this data were the least likely to be afflicted by any of the diseases or limitations studied. Widowed and divorced persons were found to have the worst overall health of any two groups. However, cohabiting people were not much better off then the widowed or divorced persons. The authors also break down the data further and compare genders and races. Exiting marriage, surprisingly, was worse then never having been married. PB - 21 VL - 21 IS - 5 U4 - Marital Status/Retirement Planning/Health Status/Gender ER - TY - JOUR T1 - Older adults and financial bequests. JF - Int J Aging Hum Dev Y1 - 2000 A1 - Goetting, Marsha A. A1 - Peter Martin A1 - Johnson, Christine KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Attitude KW - Female KW - Health Care Costs KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Michigan KW - Models, Economic KW - Sampling Studies KW - Sex Factors KW - Socioeconomic factors KW - Spouses KW - Surveys and Questionnaires KW - Wills AB -

Using data from Aging and Health Dynamics (AHEAD), this research investigated a model predicting an older adult's assessment regarding the chances (from 0 to 100) of leaving a financial bequest. Structural equation modeling analyses revealed three significant predictors of a high assessment (i.e., older age, high sense of control, and high socioeconomic status) and three predictors of a low assessment (i.e., race, physical health problems, and assessment of the chances of medical expenses depleting savings). Whites had higher financial bequests assessments than non-Whites. Physical health problems and the depleting savings assessment exerted negative effects on the financial bequest assessment. Marital status and negative psychological functioning exerted indirect effects through sense of control and through the depleting savings assessment.

PB - 50 VL - 50 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10987344?dopt=Abstract U4 - Racial Differences Bequests/Inheritance ER - TY - JOUR T1 - Parental Care at Midlife: Balancing Work and Family Responsibilities near Retirement JF - The Retirement Project Brief Series Y1 - 2000 A1 - Richard W. Johnson A1 - Anthony T. Lo Sasso KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - The costs of providing care informally at home to frail elderly persons can be substantial, especially if caregivers are forced to interrupt their careers or retire early when they provide care. This report describes findings from a recent Urban Institute study of the characteristics of persons in their fifties and early sixties who provide care to their elderly parents and the trade-offs that families face when they divide their time between the provision of informal care and paid work. Estimates were based on a sample of men and women between the ages of 53 and 65 in the 1994 and 1996 waves of the Health and Retirement Study. Only 11 percent of women and 6 percent of men at midlife devoted more than 100 hours per year to assisting their parents in 1994 with personal care, chores, or errands. However, for those who did provide informal care the costs were high. Results from simultaneous panel data models indicated that women who assisted their parents reduced their annual labor supply by 459 hours, which translated on average to about $7,800 in pre-tax lost earnings per year in 1994 dollars. The estimated effect was almost identical for men, who reduced their labor supply by 462 hours when they helped their parents. Although some proposed legislation would compensate caregivers for lost earnings and benefits with tax and Social Security credits, it is difficult to design policies that narrowly target those who reduce hours of work to help their parents. PB - The Retirement Project Brief Series VL - 9 U4 - Aged, 80 and Over/Transfers/Caregiving/Middle Age/Parent ER - TY - JOUR T1 - Pension Wealth at Midlife: Comparing Self-Reports with Provider Data JF - Review of Income and Wealth Y1 - 2000 A1 - Richard W. Johnson A1 - Sambamoorthi, Usha A1 - Crystal, Stephen KW - Employment and Labor Force KW - Methodology KW - Net Worth and Assets KW - Pensions KW - Retirement Planning and Satisfaction AB - This paper evaluates the accuracy of estimates of pension wealth based on self-reports by comparing them to estimates based on provider data. Using data from the Health and Retirement Study, we found that few workers are well informed about their future pension benefits. Self-reports were often incomplete and typically varied widely from those based on information from providers. In defined benefit (DB) plans, discrepancies were greatest for workers who had limited education, earned low wages, and did not expect to retire soon. Differences in median pension wealth were smaller at the aggregate level than the individual level, because individual differences tended to offset each other when aggregated. Provider data appear better than self-reports for DB plans, but not for defined contribution (DC) plans. Where both are available, the best method of computing pension wealth may be to estimate DB wealth from provider data and to estimate DC wealth from self -reports. PB - 461 VL - 461 IS - 1 N1 - ProCite field 3 : Urban Institute; Rutgers U; Rutgers U U4 - Nonwage Labor Costs and Benefits/Private Pensions/Retirement/Retirement Policies/Pension Wealth/Pension Provider Survey/Pension Plans ER - TY - JOUR T1 - The racial crossover in comorbidity, disability, and mortality. JF - Demography Y1 - 2000 A1 - Nan E. Johnson KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Birth Certificates KW - Black People KW - Chronic disease KW - Comorbidity KW - Cross-Over Studies KW - Death Certificates KW - Disabled Persons KW - Female KW - Humans KW - Male KW - United States KW - White People AB -

This study analyzed one respondent per household who was age 70 or more at the time of the household's inclusion in Wave 1 (1993-1994) and whose survival status was determinable at Wave 2 (1995-1996) of the Survey on Asset and Health Dynamics Among the Oldest Old (AHEAD Survey). At age 76 at Wave 1, there was a racial crossover in the cumulative number of six potentially fatal diagnoses (chronic lung disease, cancer, heart disease, hypertension, diabetes, and stroke) from a higher cumulative average number for blacks to a higher average number for whites. Also, there was a racial crossover at age 86 in the cumulative average number of disabilities in the Advanced Activities of Daily Living (AADLs), from a higher average for blacks to a higher average for whites. Between Waves 1 and 2, there was a racial crossover in the odds of mortality from higher odds for blacks to higher odds for whites; this occurred at about age 81. The results are consistent with the interpretation that the racial crossover in comorbidity (but not the crossover in AADL disability) propelled the racial crossover in mortality.

PB - 37 VL - 37 IS - 3 N1 - RDA 2002-016 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10953803?dopt=Abstract U4 - Activities of Daily Living/Classification/Age Factors/Aged, 80 and Over/Birth Certificates/Chronic Disease/Mortality/Comorbidity/Cross Over Studies/Death Certificates/Disabled Persons/Classification/Statistics and Numerical Data/Female/Whites/Blacks/Support, Non U.S. Government/Support, U.S. Government--non PHS/United States/Epidemiology ER - TY - RPRT T1 - The Trade-Off Between Hours of Paid Employment and Time Assistance to Elderly Parents at Midlife Y1 - 2000 A1 - Richard W. Johnson A1 - LoSasso, Anthony T. KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Although the family has traditionally been the primary caregiver for the frail elderly, the rising labor force participation rates of married women may interfere with their historical caregiving responsibilities. This paper explores time transfers to elderly parents and their impact on labor supply for persons at midlife. We estimate simultaneous panel data models of annual hours of paid work and the provision of time assistance to parents for a sample of men and women ages 53-65 in the Health and Retirement Study. Our results indicate that time help to parents substantially reduces labor supply for both women and men. JF - The Urban Institute Research Report PB - The Urban Institute CY - Washington, D.C. UR - https://www.urban.org/research/publication/trade-between-hours-paid-employment-and-time-assistance-elderly-parents-midlife U4 - Aged, 80 and Over/Transfers/Caregiving/Middle Age/Parent ER - TY - JOUR T1 - Uninsured status and out-of-pocket costs at midlife. JF - Health Serv Res Y1 - 2000 A1 - Richard W. Johnson A1 - Crystal, Stephen KW - Age Factors KW - Female KW - Financing, Personal KW - Health Care Surveys KW - Health Services KW - Health Status KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Middle Aged KW - Models, Econometric KW - Multivariate Analysis KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period.

DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline.

STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage.

PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance.

CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.

PB - 35 VL - 35 IS - 5 Pt 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11130804?dopt=Abstract U4 - Age Factors/Comparative Study/Female/Financing, Personal/Statistics and Numerical Data/Health Care Surveys/Health Services/Economics/Utilization/Health Status/Insurance Coverage/Insurance, Health/Longitudinal Studies/Medically Uninsured/Middle Age/Models, Econometric/Multivariate Analysis/Questionnaires/Support, Non U.S. Government/United States ER - TY - RPRT T1 - Examining the Links Between Retirement and Health Insurance: Implications for Medicare Eligibility Y1 - 1999 A1 - Super Jones, Nora KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction U4 - Retirement/Health Insurance/Medicare ER - TY - JOUR T1 - Gender differences in pension wealth: estimates using provider data. JF - Gerontologist Y1 - 1999 A1 - Richard W. Johnson A1 - Sambamoorthi, Usha A1 - Crystal, Stephen KW - Female KW - Humans KW - Male KW - Occupations KW - Pensions KW - Sex Factors KW - United States KW - Women, Working AB -

Information from pension providers was examined to investigate gender differences in pension wealth at midlife. For full-time wage and salary workers approaching retirement age who had pension coverage, median pension wealth on the current job was 76% greater for men than women. Differences in wages, years of job tenure, and industry between men and women accounted for most of the gender gap in pension wealth on the current job. Less than one third of the wealth difference could not be explained by gender differences in education, demographics, or job characteristics. The less-advantaged employment situation of working women currently in midlife carries over into worse retirement income prospects. However, the gender gap in pensions is likely to narrow in the future as married women's employment experiences increasingly resemble those of men.

PB - 39 VL - 39 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10396890?dopt=Abstract U4 - Pension Provider Survey/Pension Plans/Pension Wealth/Female/Occupations/Sex Factors/Support, U.S. Government--non PHS/United States/Women, Working ER - TY - JOUR T1 - The Gender Gap in Pension Wealth: Is Women's Progress in the Labor Market Equalizing Retirement Benefits? JF - The Urban Institute Y1 - 1999 A1 - Richard W. Johnson KW - Demographics KW - Employment and Labor Force KW - Net Worth and Assets KW - Women and Minorities PB - The Retirement Project Brief Series VL - The Retirement Project Brief Series UR - https://www.urban.org/sites/default/files/publication/69736/310238-The-Gender-Gap-in-Pension-Wealth.PDF IS - No. 1 U4 - Pension Wealth/Gender/Women/Labor Force ER - TY - RPRT T1 - Older Adults and Their Health Insurance Y1 - 1999 A1 - Gail A Jensen A1 - Weycker, Derek A. A1 - Gabel, John R. KW - Medicare/Medicaid/Health Insurance PB - AARP Public Policy Institute 9903 U4 - Health Insurance Coverage ER - TY - JOUR T1 - Asset and Health Dynamics Among the Oldest Old (AHEAD): initial results from the longitudinal study. Introduction. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - Myers, George C. A1 - Juster, F. Thomas A1 - Richard M. Suzman KW - Aged KW - Aged, 80 and over KW - Data collection KW - Health Status KW - Humans KW - Income KW - Longitudinal Studies KW - Research Design PB - 52B VL - 52 Spec No UR - https://www.ncbi.nlm.nih.gov/pubmed/9215353 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9215353?dopt=Abstract U4 - Aged, 80 and Over/Data Collection/Health Status/Human/Income/Longitudinal Studies/Research Design ER - TY - JOUR T1 - Health insurance coverage at midlife: characteristics, costs, and dynamics. JF - Health Care Financ Rev Y1 - 1997 A1 - Richard W. Johnson A1 - Crystal, Stephen KW - Age Factors KW - Costs and Cost Analysis KW - Demography KW - Female KW - Health Benefit Plans, Employee KW - Health Care Surveys KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.

PB - 18 VL - 18 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194511/ IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10170345?dopt=Abstract U4 - Age Factors/Costs and Cost Analysis/Demography/Female/Health Benefit Plans, Employee/Health Care Surveys/Human/Insurance Coverage/Insurance, Health/Classification/Statistics and Numerical Data/Logistic Models/Longitudinal Studies/Middle Age/Support, Non U.S. Government/Support, U.S. Government--PHS/United States ER - TY - JOUR T1 - Improving the Quality of Economic Data: Lessons from the HRS and AHEAD JF - Journal of the American Statistical Association Y1 - 1997 A1 - Juster, F. Thomas A1 - James P Smith KW - Methodology AB - Missing data are an increasingly important problem in economic surveys, especially when trying to measure household wealth. However, some relatively simple new survey methods such as follow-up brackets appear to appreciably improve the quality of household economic data. Brackets represent partial responses to asset questions and apparently significantly reduce item nonresponse. Brackets also provide a remedy to deal with nonignorable nonresponse bias, a critical problem with economic survey data. PB - 92 VL - 92 UR - https://ideas.repec.org/p/wpa/wuwpla/0402010.html IS - 440 N1 - ProCite field 3 : Survey Research Center, U MI; RAND U4 - Data Collection and Data Estimation Methodology/Microeconomic Data Management/Survey Methods ER - TY - JOUR T1 - On the Measurement of Expectations, Uncertainty, and Preferences JF - The Journals of Gerontology: Social Sciences Y1 - 1997 A1 - Juster, F. Thomas KW - Demographics KW - Employment and Labor Force KW - Expectations KW - Healthcare KW - Retirement Planning and Satisfaction PB - 52B VL - 52B UR - https://watermark.silverchair.com/52B-5-S237.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAoAwggJ8BgkqhkiG9w0BBwagggJtMIICaQIBADCCAmIGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMiCgceswiPk9X8uhtAgEQgIICM11WTEF-TxPFAjJjpJPFejebIu7VU6ZC9MEME_GUKqX0 IS - 5 U4 - Employment/Female/Life Expectancy/Middle Age/Nursing Homes/Patient Satisfaction/Retirement ER - TY - JOUR T1 - Preference Parameters and Behavioral Heterogeneity: An Experimental Approach in the HRS JF - Quarterly Journal of Economics Y1 - 1997 A1 - Barsky, Robert A1 - Miles S Kimball A1 - Juster, F. Thomas A1 - Matthew D. Shapiro KW - End of life decisions KW - Health Conditions and Status KW - Retirement Planning and Satisfaction AB - This paper reports measures of preference parameters relating to risk tolerance, time preference, and intertemporal substitution. These measures are based on survey responses to hypothetical situations constructed using an economic theorist's concept of the underlying parameters. The individual measures of preference parameters display heterogeneity. Estimated risk tolerance and the elasticity of intertemporal substitution are essentially uncorrelated across individuals. Measured risk tolerance is positively related to risky behaviors, including smoking, drinking, failing to have insurance, and holding stocks rather than Treasury bills. These relationships are both statistically and quantitatively significant, although measured risk tolerance explains only a small fraction of the variation of the studied behaviors. PB - 112 VL - 112 UR - https://www.researchgate.net/publication/5193188_Preference_Parameters_and_Behavioral_Heterogeneity_An_Experimental_Approach_in_the_Health_and_Retirement_Survey IS - May U4 - Criteria for Decision Making under Risk and Uncertainty/Health Production--Nutrition, Mortality, Morbidity, Disability, and Economic Behavior/Retirement/Retirement Policies/Health/Retirement/Smoking ER - TY - JOUR T1 - The Structure of Health Status among Hispanic, African American, and White Older Adults JF - The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences Y1 - 1997 A1 - Timothy E. Stump A1 - Daniel O. Clark A1 - Johnson, R.J. A1 - Frederic D Wolinsky KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - Methodology KW - Women and Minorities AB - Activities of daily living (ADLs), instrumental ADLs, and disability markers have traditionally been the most common indicators of functional status. The study on Asset and Health Dynamics Among the Oldest Old (AHEAD) is used to replicate a five-dimensional measurement model composed of these observable indicators among the older adult self-respondents. The items available to measure upper body disability were found wanting, but the lower body disability, and the basic, household, and advanced ADL constructs were confirmed. Analyses of the measurement model separately among subgroups of women, men, Hispanics, Mexican Americans, African Americans, and Whites found no meaningful differences. Two structural models linking the lower body disability, and the basic, household, and advanced ADL constructs to perceived health and depression were also replicated among the older adult self-respondents, as well as separately among African Americans and among Whites. These models reaffirmed the dominant role of lower body disability on the everyday activities of older adults, and on their perceived health and depression. PB - 52B VL - 52B IS - Spec U4 - Disability/Disability/Activities of Daily Living/Aged, 80 and Over/Blacks/Whites/Female/Geriatric Assessment/Health Status/Hispanic Americans/Models, Theoretical/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS ER - TY - RPRT T1 - Employer-Provided Health Benefits Among Middle-Aged Americans: Coverage Patterns and Transitions Y1 - 1996 A1 - Crystal, Stephen A1 - Richard W. Johnson KW - Medicare/Medicaid/Health Insurance PB - Washington, DC, Department of Labor, Pension and Welfare Benefits Administration U4 - Health Insurance Coverage/Health Benefit Plans, Employee ER - TY - CHAP T1 - Income and Wealth of Older American Households: Modeling Issues for Public Policy Analysis T2 - Assessing Knowledge of Retirement Behavior Y1 - 1996 A1 - Alan L Gustman A1 - Juster, F. Thomas ED - Eric A. Hanushek ED - Nancy L. Maritato KW - Consumption and Savings KW - Pensions KW - Retirement Planning and Satisfaction AB - This paper evaluates the extent to which current knowledge of retirement, savings, pension and related behavior is sufficient for determining the effects of major policy initiatives on the incomes and wealth of the aged population of the United States. Data are presented from two new surveys, the Health and Retirement Study and the Asset and Health Dynamics Among the Oldest Old Survey, describing the distributions of the major components of income and wealth to be explained by these behavioral models. The data suggest that the amount of wealth had by the older population has been severely understated in earlier surveys. Disagreements and inconsistencies in models of savings indicate that there is no agreed upon behavioral model upon which to base policy analysis. Similar problems characterize the pension literature. Most strikingly, central features of these three major branches of behavioral analysis are mutually inconsistent. Although there are important linkages among the behaviors determining retirement, savings and pension outcomes, research in each area ignores or misspecifies the related behavior from other areas. Consequently, significant advances are required before we can confidently predict the effects of contemplated changes in policies on income and wealth in retirement. JF - Assessing Knowledge of Retirement Behavior PB - National Academy Press CY - Washington, DC N1 - ProCite field 6 : In ProCite field 8 : eds. U4 - Economics of the Elderly/Retirement/Retirement Policies/Pension/Retirement JO - Income and Wealth of Older American Households: Modeling Issues for Public Policy Analysis ER - TY - JOUR T1 - Minority perspectives from the Health and Retirement Study. Introduction: health and retirement among ethnic and racial minority groups. JF - Gerontologist Y1 - 1996 A1 - James S Jackson A1 - Lockery, Shirley A. A1 - Juster, F. Thomas KW - Aged KW - Health Status KW - Humans KW - Minority Groups KW - Prospective Studies KW - Quality of Life KW - Retirement KW - United States PB - 36 VL - 36 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8682326?dopt=Abstract U4 - Health Status/Human/Minority Groups/Prospective Studies/Quality of Life/Retirement/United States ER - TY - JOUR T1 - Economic Status Measures in the Health and Retirement Study JF - Journal of Human Resources Y1 - 1995 A1 - Marilyn Moon A1 - Juster, F. Thomas KW - Employment and Labor Force KW - Net Worth and Assets KW - Other AB - Variables measuring economic status represent a straightforward but crucial part of Round 1 of the Health and Retirement Study (HRS). In addition to studies focusing directly on the economic well-being of this cohort of the population, the economic status variables are likely to be inputs into other analyses that focus on retirement and savings behavior, on variations in health status, on intrafamily transfers and support, and on poverty status. As a first look at these data, this paper has several modest goals: to offer a flavor for the major economic status variables on the HRS, to indicate some preliminary analysis of the quality of the data, and to take a preliminary look at the interrelationships among economic status measures like income and wealth and other important variables such as health status, pension rights, and health insurance coverage. PB - 30 VL - 30 IS - 0 Suppl. N1 - ProCite field 3 : U MI Survey Research Center; Urban Institute U4 - Economic Status/Distribution/Wages and Compensation ER - TY - JOUR T1 - An Overview of the Health and Retirement Study JF - Journal of Human Resources Y1 - 1995 A1 - Juster, F. Thomas A1 - Richard M. Suzman KW - Demographics KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - This paper examines the scientific, public policy, and organizational background out of which the Health and Retirement Study emerged. It describes the evolution of the major parameters of the survey and the unique planning structure designed to ensure that the substantive insights of the research community were fully reflected in the content of the database, highlights key survey innovations contained in the HRS, and provides a preliminary assessment of the quality of the data as reflected by sample size, sample composition, response rate, and survey content. The paper also describes the several types of administrative data that are expected to be added to the HRS data: earnings and benefits from Social Security files, and health insurance and pension data from the employers of survey respondents. PB - 30 VL - 30 IS - Suppl. N1 - ProCite field 3 : National Institute on Aging; National Institute on Aging U4 - Demographic Trends and Forecasts/Health Status/Retirement Policies/HRS Sponsorship, Sample, Study Design/HRS content and design ER - TY - RPRT T1 - The Impact of Worker Preferences On Pension Coverage in the HRS Y1 - 1993 A1 - Richard W. Johnson KW - Other KW - Pensions AB - Heterogenous workers place different valuations on employer-provided pensions, depending upon such factors as the individual's degree of risk aversion, life expectancy, personal rates of time preference, earnings and access to alternative sources of retirement income. As a result, workers with relatively strong preferences for deferred compensation may sort themselves into jobs which offer generous pensions. Using primarily experimental data from the first wave of the Health and Retirement Survey, this paper tests the extent to which pension coverage is driven by worker demand. Probit estimates indicate the risk averse workers have significantly higher rates of pension coverage, particularly among those with low earnings. Among workers who recently began their jobs, those expecting to live longer are also more likely to be included in a pension plan. Rates of time preference have a marginally significant impact on pension coverage. There is no evidence that employer pensions substitutes for other forms of retirement saving. PB - University of Michigan UR - http://www.psc.isr.umich.edu/pubs/series.html U4 - Preferences/Pensions ER - TY - JOUR T1 - State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults. JF - Social Science & Medicine (1983) Y1 - 0 A1 - Walsemann, Katrina M A1 - Hair, Nicole L A1 - Farina, Mateo P A1 - Tyagi, Pallavi A1 - Jackson, Heide A1 - Jennifer A Ailshire KW - Education KW - historical data KW - life course KW - school segregation AB -

RATIONALE: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function.

OBJECTIVE: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment.

METHODS: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects.

RESULTS: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment.

CONCLUSIONS: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.

VL - 338 ER -