TY - ICOMM T1 - Financial hardship drives unhappiness in people living with dementia, study finds Y1 - 2024 A1 - Fischer, Kristen KW - Dementia KW - Finances KW - Healthcare KW - Life Satisfaction PB - McKnights UR - https://www.mcknights.com/news/clinical-news/financial-hardship-drives-unhappiness-in-people-living-with-dementia-study-finds/ ER - TY - ICOMM T1 - Financial Instability Is Connected to Increased Mortality Rates Y1 - 2023 A1 - Min, Penny KW - Healthcare KW - Mortality rates KW - socio-economic status PB - HealthNews UR - https://healthnews.com/news/financial-instability-connected-to-increased-mortality-rate/ ER - TY - JOUR T1 - Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels. JF - J Appl Gerontol Y1 - 2023 A1 - Rahemi, Zahra A1 - Malatyali, Ayse A1 - Bacsu, Juanita-Dawne R A1 - Sefcik, Justine S A1 - Petrovsky, Darina V A1 - Baker, Zachary G A1 - Ma, Kris Pui Kwan A1 - Smith, Matthew L A1 - Adams, Swann A KW - Advance care planning KW - cognitive levels KW - Healthcare KW - Older Adults AB -

This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP measure was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.

ER - TY - ICOMM T1 - Tweaking Medicaid eligibility criteria would benefit vulnerable older adults ‘tremendously’ Y1 - 2023 A1 - Bonvissuto, Kimberly KW - Healthcare KW - Medicaid PB - McKnights UR - https://www.mcknightsseniorliving.com/home/news/tweaking-medicaid-eligibility-criteria-would-benefit-vulnerable-older-adults-tremendously/ ER - TY - ICOMM T1 - Older workers fair better in countries that invest more in healthcare resources Y1 - 2022 A1 - Rochelle Koff KW - Healthcare KW - Older workers PB - University of Florida News UR - https://news.ufl.edu/2022/03/silver-tsunami/ ER - TY - THES T1 - DYNAMIC STRUCTURE OF THE U.S. HEALTH SPENDING T2 - Economics Y1 - 2020 A1 - Chen, Xinyan KW - Health Shocks KW - health spending KW - Healthcare AB - Health expenditure is a compelling problem to study in the context of US economic resources allocation. At the individual level, healthcare consumption is high, ranking fifth in consumption categories only after food, housing, apparel and services, and transportation. Additionally, there is a big heterogeneity in individual health spending. For people who face severe health conditions, the health spending burden could be extremely large. In the context of the life-cycle model, De Nardi et al (2011) pointed out that health spending affected households’ saving and consumption decisions over a lifetime. In this dissertation, I look at individuals’ health spending from the lifetime perspective to study the long-term effects of health shocks. The research question of aggregating an individual’s health spending over time is complicated by the inter-temporal relationship of an individuals’ health spending. To address this question, I start by looking at health spending from a cross-sectional perspective, then study the dynamic evolution of individuals’ spending. The research is based on panel data from the Health and Retirement Study (HRS) by RAND Center, focusing on the original HRS cohort from survey year 1996 to year 2014 (wave 3 to wave 12). JF - Economics PB - State University of New York at Buffalo CY - Buffalo, NY VL - Doctor of Philosophy ER - TY - THES T1 - Geriatrics principles in health care of older adults and the use of real-world data in aging-related research Y1 - 2020 A1 - Irena Cenzer KW - Aging KW - Healthcare AB - In this PhD project, we investigate how taking into consideration unique characteristics of older patients, as well as using appropriate research methods and data to study this group, would allow for better healthcare for this growing part of the population. As part of this PhD project, we performed two studies using RWDs, which examined the role of geriatric principles in care of older adults. In the first study, we used national survey of physicians to examine the use of potentially harmful first generation antihistamines in older adults. In the second study, we examined the patient relevant measures of wellbeing in older adults diagnosed with multiple myeloma using longitudinal survey and claims data. The structure of this thesis is as follows. The reminder of Section 1 contains the background on the two topics that the PhD project focuses on – geriatrics principles in health care and RWDs. In subsection 1.2. we starts with describing the geriatric principles of care, and presenting the rationale for using them in clinical care of older adults. Next, in subsection 1.3. we describe what RWDs are, and discuss their potentials and limitations in health care research. Section 2 presents the overall goal of this PhD project, as well as the detailed objectives of each of the two studies that are part of this PhD project. We summarize each study in detail in Section 3, including the methodology, main results, and the studies’ contribution to understanding the two topics of the PhD project (geriatric principles in health care and RWDs). The last subsection of Section 3, subsection 3.3., outlines the main conclusions the two PhD studies. Section 4 includes the bibliography of sources used in this PhD project. Finally, section 5 includes the two publications included in this PhD project, as they were published. PB - Ludwig Maximilian University of Munich CY - Munich VL - Doctor of Philosophy UR - https://edoc.ub.uni-muenchen.de/26876/1/Cenzer_Irena.pdf ER - TY - THES T1 - Essays on Health, Healthcare, Job Insecurity and Health Outcomes T2 - Economics Y1 - 2019 A1 - Nakamoto,Ichiro KW - 0493:Aging KW - 0501:Economics KW - Aging KW - Economics KW - Health and environmental sciences KW - health outcomes KW - Healthcare KW - Job insecurity KW - Social Sciences AB - This doctoral dissertation proposal is comprised of three separate chapters, all of which uses the nationally representative uniform survey Health and Retirement Survey (HRS) to examine the relationship between health, insurance, health care and health outcomes. Below, the brief introduction for each section is provided: Chapter I: Medicare Part D and Patients' Well-being. Chapter II: Parent's Health Insurance and Informal Care. Chapter III: Job Insecurity and Health (with Dr. Ayyagari) In chapter I, I explore how Medicare Part D (MD) affects the well-being of the severely sick patients both in the short- and in the long- term. I employ difference-in-difference (DD) alongside the instrumental variable (IV) model. The estimated results imply MD significantly improves mental health and increases regular drug utilization for the elderly. However, it neither systematically improves out-of-pocket payment (OOP) nor improves mortality across all waves. This suggests that MD provides an efficient mechanism to improve mental health and drug utilization, but might not necessarily enhance survival rate and financial burden for vulnerable patients. Chapter II investigates the relationship between informal care provided by the children and the take-up of health insurance by the near-elderly and elderly parents, and how the correlation is influenced by parent's Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The results indicate that when the endogeneity is controlled for, in-formal care systematically crowds out the take-up of private long-term care (LTC) insurance whereas "crowds in" the take-up of the total plan including supplement insurance plans (TSP). Nevertheless, the degree of both crowding-out and "crowding-in" effect is reduced when the severity of ADLs/IADLs disability level grows. Our study reflects (a) the strong demand for TSP and more additional health coverage within household budget line (b) and the potential gap between healthcare demands by the parents and the informal care provided by the children and the potential gap between the healthcare demands by the parents and the formal care covered by the insurance. Our estimates are robust to alternative measures of informal care. The final chapter III examines the causal effect of subjective job insecurity on health, using pooled ordinary least squares (OLS), fixed-effects (FE) and instrumental variable (IV) specifications. The estimate implies that the negative impact of job insecurity is more pronounced for certain outcomes such as mental health and the emergence of new health conditions. Job insecurity provides a powerful prediction on subsequent job displacement and real income loss. Sub-population such as low-employability/better-educated individuals or males responds more to job insecurity than their counterparts. JF - Economics PB - University of South Florida VL - PhD SN - 9781392227893 UR - https://search.proquest.com/docview/2246502915?pq-origsite=gscholar N1 - Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-07-24 ER - TY - JOUR T1 - EXAMINING LONGITUDINAL HEALTHCARE UTILIZATION, OUTCOMES, AND SATISFACTION IN PRE-FRAIL OLDER ADULTS JF - Innovation in Aging Y1 - 2019 A1 - Vaughn, Ivana A A1 - Marlow, Nicole M A1 - Sonawane, Kalyani A1 - Fillingim, Roger B A1 - Beyth, Rebecca J KW - Healthcare KW - healthcare utilization AB - Frailty is a medical syndrome occurring in nearly 60\% community dwelling older adults and could have insidious origins in middle-adulthood that manifest predominantly as decline and multi-morbidity. Identification of pre-frail states in adults could potentially reduce its impact in late-life. The study used data from the Health and Retirement Study (HRS) to: 1) compare long-term healthcare utilization between pre-frail and non-frail patients, 2) compare risk of pain progression, functional decline, and mortality between pre-frail and non-frail patients, and (3) compare satisfaction with healthcare, self-perceptions of aging and satisfaction with life between pre-frail and non-frail patients. The primary predictor, pre-frailty phenotype, was based on the Paulson-Lichtenberg Frailty Index (PLFI), a validated HRS-version of the Fried criteria. Additional covariates included sociodemographics, comorbidities, smoking status, sleep quality, health status, and body mass index. Statistical analyses consisted of descriptive statistics, univariate analysis, negative binomial regression with log-link function, logistic regression, generalized linear modeling and Cox regression. Pre-frailty status increased the incidence of hospitalizations (IRR: 1.23; 95\%CI: 1.18-1.28) and doctor’s visits (IRR: 1.18; 95\%CI: 0.15-1.22); increased the risk of pain progression (HR: 1.61, 95\%CI: 1.53-1.69), functional decline (HR: 1.77, 95\%CI: 1.67-1.87), and all-cause mortality (HR: 1.09, 95\%CI:1.03-1.16); lowered odds of healthcare satisfaction (OR: 0.79, 95\%CI: 0.62-0.99) and lowered satisfaction with aging ((β: -0.23 95\%CI: -0.36- (-0.10)) and satisfaction with life (β: -0.27 95\%CI: -0.44- (-0.11)). Frailty syndrome is highly prevalent and having a better understanding of its influence on health outcomes at intermediate pre-frail states could provide insight into reducing manifestations in later life. VL - 3 UR - https://doi.org/10.1093/geroni/igz038.2541 ER - TY - THES T1 - Life Satisfaction and Healthcare Utilization Among Immigrants to the United States T2 - Social Work Y1 - 2019 A1 - Harrelson, MC KW - Healthcare KW - Immigration KW - Life Satisfaction AB - Previous research suggests a relationship between life satisfaction and healthcare utilization or HCU (Habibov & Afandi, 2016; Kim, Park, Sun, Smith, & Peterson, 2014). However, no study was found that examined this relationship among elderly American immigrants. The purpose of this study was to determine whether life satisfaction is linked to HCU for this population. The researcher of the current study applied binary logistic regression to data taken from the Health and Retirement Survey to determine whether changes in life satisfaction could be linked to variance in HCU across seven domains, including hospitalization, overnight nursing home stays, doctors visits, dentist visits, use of prescription medications, use of home health, and outpatient surgery. Results of this analysis suggested that a significant relationship did exist between life satisfaction and each of these domains, although the relationships varied in direction and effect size. JF - Social Work PB - Louisiana State University VL - Master UR - https://digitalcommons.lsu.edu/gradschool_theses/4999/ ER - TY - JOUR T1 - MOBILITY TRAJECTORIES, HEALTHCARE SATISFACTION, AND PERCEIVED DISABILITY DISCRIMINATION AMONG OLDER ADULTS JF - Innovation in Aging Y1 - 2019 A1 - Mueller, Collin A1 - Jessica S West KW - Disabilities KW - disability discrimination KW - Discrimination KW - Healthcare KW - healthcare satisfaction KW - Mobility Limitation AB - Although functional mobility limitations are associated with increased healthcare needs in later life, little research explores how older adults with varying functional mobility trajectories experience healthcare quality. To this end, we explore the effects of functional mobility trajectories on differences in healthcare treatment satisfaction, perceived disability discrimination in healthcare settings, and perceived everyday disability discrimination. We analyzed 9 waves of the Health and Retirement Study (n=29,284, 1998-2014, ages 50-84). First, we estimate age-specific group-based trajectories of functional mobility across age using finite mixture models. Second, we use multinomial logistic regression to identify sociodemographic factors that place individuals at elevated risk of membership in each group. Third, we explore how membership in one disability trajectory group over another affects healthcare satisfaction, perceptions of everyday discrimination in the context of healthcare treatment settings, and perceived discrimination in everyday life. Regression models include clustered standard errors to account for heteroscedasticity across repeated observations of individuals over time. We identify six group-based trajectories of functional mobility limitation among aging Americans. Black, female, and less-educated Americans are at higher risk of membership in disadvantaged trajectories, characterized by more rapidly increasing counts of functional mobility limitations, than their counterparts. Disadvantaged functional limitation trajectories are associated with lower levels of healthcare satisfaction, higher levels of perceived physical disability discrimination in healthcare treatment settings, and higher levels of perceived physical discrimination in other contexts of everyday life. The present study advances our knowledge of how older adults experience healthcare settings and discrimination across functional mobility status trajectories. VL - 3 UR - https://doi.org/10.1093/geroni/igz038.1928 ER - TY - RPRT T1 - Cumulative Out-of-Pocket Health Care Expenses After the Age of 70 Y1 - 2018 A1 - Sudipto Banerjee KW - Healthcare KW - Medicare KW - Out-of-pocket payments AB - This study estimates how much retirees spend on out-of-pocket health care expenses after age 70 until their death. Unlike many other studies, it includes only expenses for health care services actually used (i.e., Medicare and insurance premiums are not included), and it is based on self-reported expenses of actual retirees and not on projections for hypothetical individuals. The numbers are adjusted for medical inflation and reported in 2015 dollars. The self-reported expenses are from panel data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort of the Health and Retirement Study (HRS). JF - Issue Brief PB - Employee Benefit Research Institute CY - Washington, DC UR - https://www.ebri.org/pdf/briefspdf/EBRI_IB_446.pdf ER - TY - JOUR T1 - An Examination of Veteran Health Access Around the Medicare Eligibility Age JF - Contemporary Economic Policy Y1 - 2018 A1 - Stype, Amanda C. KW - Healthcare KW - Medicare KW - Preventative Care KW - Veterans AB - Recent news reports suggest that veterans' health care may be inadequate. We use Health and Retirement Study data to compare utilization rates for preventative care by male veterans and nonveterans before and after the near-universal health coverage at Medicare eligibility. Larger increases in utilization rates for preventative services upon reaching Medicare eligibility at age 65 are associated with less health care adequacy before Medicare eligibility. Results suggest that health care adequacy for male veterans between the ages of 56 and 64 is at least as good as that of nonveterans and may be better. (JEL I14, J14). © 2017 Western Economic Association International VL - 36 UR - http://doi.wiley.com/10.1111/coep.2018.36.issue-3http://doi.wiley.com/10.1111/coep.12259http://onlinelibrary.wiley.com/wol1/doi/10.1111/coep.12259/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fcoep.12259 IS - 3 JO - Contemp Econ Policy ER - TY - JOUR T1 - Healthcare satisfaction among older adults. JF - Am Journal of Health Behavior Y1 - 2018 A1 - Hui-Peng Liew KW - Finances KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Nursing homes AB -

OBJECTIVE: This study seeks to examine how older adults rate and identify the importance of attributes associated with healthcare seeking and utilization (eg, affordability, type of facility, and accessibility) in the United States.

METHODS: The empirical work of this cross-sectional study is based on the 2014 Health and Retirement Study. Conjoint analysis and cluster analysis are used to assess the objective.

RESULTS: There is a pressing need for sound policies that seek to reduce the cost of treatment and consultation and to improve the accessibility of care facility for older adults even though satisfaction pertaining to these attributes (ie, affordability, type of facility, and accessibility) differs across clusters.

CONCLUSION: The use of conjoint analysis in conjunction with cluster analysis can serve as a needs assessment tool to help policymakers and practitio- ners gauge older adults' expectations and priorities with respect to healthcare seeking and utilization. By taking the priorities of older adults into account, policymakers and practitioners can allocate healthcare resources more efficiently within budgetary constraints as they redesign and customize their program delivery approaches to meet the specific and relative healthcare needs of older adults in different clusters.

VL - 42 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29320343?dopt=Abstract ER - TY - JOUR T1 - Incidental Bequests and the Choice to Self-Insure Late-Life Risks JF - American Economic Review Y1 - 2018 A1 - Lockwood, Lee M. KW - Annuitization KW - Healthcare KW - Insurance AB - Despite facing significant uncertainty about their lifespans and health care costs, most retirees do not buy annuities or long-term care insurance. In this paper, I find that retirees’ saving and insurance choices are highly inconsistent with standard life-cycle models in which people care only about their own consumption but match well models in which bequests are luxury goods. Bequest motives tend to reduce the value of insurance by reducing the opportunity cost of precautionary saving. The results suggest that bequest motives significantly increase saving and significantly decrease purchases of long-term care insurance and annuities. VL - 108 UR - https://pubs.aeaweb.org/doi/10.1257/aer.20141651https://pubs.aeaweb.org/doi/pdf/10.1257/aer.20141651 IS - 9 JO - American Economic Review ER - TY - JOUR T1 - Social Exclusion and Switching Barriers in Medicare Part D Choices JF - Sustainability Y1 - 2018 A1 - Ko, Dong A1 - Bae, Young A1 - Han, Jayoung KW - Healthcare KW - Medicare KW - Medicare Part D KW - Prescription Medication AB - Previous studies have shown that Medicare beneficiaries do not tend to switch their prescription drug plans (Part D), even though they can greatly save on the money spent on drugs by switching plans. To explore this occurrence, the present study focused on the concept of social exclusion-one of the most important characteristics prevalent in the elderly. This study compared the impact of two types of social exclusion on the association between psychological cost and plan switching: active (or rejected) social exclusion and passive (or ignored) social exclusion. The study's aim was to examine the moderating effect of social exclusion on the relationship between the cost of switching and willingness to switch plan to build sustainable health care system. The Prescription Drug Study supplementary to the Health and Retirement Study (HRS) data were utilized for analysis by applying a Hierarchical Linear Model (HLM) (N = 1042). The findings suggest that active social exclusion moderates the relationship between the switching cost and willingness to switch plan. This study's findings will help policymakers better understand the elderly's decision-making process pertaining to plans and promote their informed plan decisions to build sustainable health care system. VL - 10 UR - http://www.mdpi.com/2071-1050/10/7/2419http://www.mdpi.com/2071-1050/10/7/2419/pdf IS - 7 JO - Sustainability ER - TY - JOUR T1 - Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions. JF - Journal of General Internal Medicine Y1 - 2018 A1 - Thu T Nguyen A1 - Anusha M Vable A1 - M. Maria Glymour A1 - Nuru-Jeter, Amani KW - Chronic conditions KW - Discrimination KW - Healthcare AB -

BACKGROUND: Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to individuals with chronic conditions, who need ongoing clinical care. Although efforts to reduce discrimination are growing, little is known about national trends in discrimination in health care settings.

METHODS: For Black, White, and Hispanic respondents with chronic disease in the 2008-2014 Health and Retirement Study (N = 13,897 individuals and 21,078 reports), we evaluated trends in patient-reported discrimination, defined based on frequency of receiving poorer service or treatment than other people from doctors or hospitals ("never" vs. all other). Respondents also reported the perceived reason for the discrimination. In addition, we evaluated whether wealth predicted lower prevalence of discrimination for Blacks or Whites. We used generalized estimating equation models to account for dependency of repeated measures on individuals and wave-specific weights to represent the US non-institutionalized population aged 54+ .

RESULTS: The estimated prevalence of experiencing discrimination in health care among Blacks with a major chronic condition was 27% (95% CI: 23, 30) in 2008 and declined to 20% (95% CI: 17, 22) in 2014. Reports of receiving poorer service or treatment were stable for Whites (17%, 95% CI: 16, 19 in 2014). The Black-White difference in reporting any health care discrimination declined from 8.2% (95% CI: 4.5, 12.0) in 2008 to 2.5% (95% CI: -1.1, 6.0) in 2014. There was no clear trend for Hispanics. Blacks reported race and Whites reported age as the most common reason for discrimination.

CONCLUSIONS: Findings suggest national declines in patient-reported discrimination in health care among Blacks with chronic conditions from 2008 to 2014, although reports of discrimination remain common for all racial/ethnic groups. Our results highlight the critical importance of monitoring trends in reports of discrimination in health care to advance equity in health care.

VL - 33 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29247435?dopt=Abstract ER - TY - JOUR T1 - Back to work? Not everyone. Examining the longitudinal relationships between informal caregiving and paid work after formal retirement JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2017 A1 - Guillermo Ernest Gonzales A1 - Lee, Yeonjung A1 - Brown, Celeste KW - Employment and Labor Force KW - Healthcare AB - Objectives. Research on unretirement (retirees who re-enter the workforce) is burgeoning. However, no longitudinal study has examined how informal care relates to unretirement. Utilizing role theory, this study aims to explore the heterogeneity of informal care responsibilities in retirement and to examine how informal care informs re-entering the workforce in later life.Method. Data were drawn from the Health and Retirement Study of fully retired individuals aged 62 years and older in 1998 (n = 8,334) and followed to 2008. Informal care responsibilities included helping a spouse/partner with activities of daily living (ADLs) or instrumental activities of daily living (IADLs); helping parent(s) or parent-in-law(s) with ADLs or IADLs; and single or co-occurrence of care roles. Covariates included economic and social factors. Cox proportional hazard models were utilized.Results. When compared with noncaregivers, helping a spouse with ADLs or IADLs reduced the odds of returning-to-work in the subsequent wave by 78 and 55 , respectively (hazard ratio HR : 0.22, confidence interval CI : 0.06 0.87; HR: 0.45, CI: 0.21 0.97). There was no statistical difference to returning-to-work between noncaregivers and helping parents with ADLs/IADLs or multiple caregiving responsibilities.Discussion. Role theory provided a useful framework to understand the relationships of informal care and unretirement. Aspects of role strain emerged, where, spousal caregivers were less likely to come out of retirement. Spousal caregivers may face challenges to working longer, and subsequently, opportunities to bolster their retirement security are diminished. Research and policy implications are discussed. VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/25/geronb.gbv095.abstract IS - 3 U4 - Employment/Informal caregiving/Informal caregiving/Role theory/Unretirement/labor Force Participation/help network ER - TY - JOUR T1 - Depression and Frailty: Concurrent Risks for Adverse Health Outcomes JF - Aging and Mental Health Y1 - 2017 A1 - Matthew C. Lohman A1 - Briana Mezuk A1 - Dumenci, Levent KW - Health Conditions and Status KW - Healthcare AB - Objectives: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury. Methods: Data come from five waves (2004 2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury. Results: Prevalence of frailty increased over the study period (24.1 32.1 ), while the prevalence of depression was relatively constant over time (approximately 13 ). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursing home = 1.33, 95 CI: 1.09 1.66; ORFall = 1.52, 95 CI: 1.12 2.08; Depression: ORNursing home = 3.63, 95 CI: 1.29 9.97; ORFall = 1.16, 95 CI: 1.01 1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression. Conclusion: Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the frailty index which confer most risk for poor health outcomes. VL - 21 UR - http://dx.doi.org/10.1080/13607863.2015.1102199 IS - 4 U4 - depression/frailty/latent growth models/FALLS/NURSING HOMES/HEALTH STATUS/adverse events/adverse events ER - TY - JOUR T1 - Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs. JF - American Journal of Geriatric Psychiatry Y1 - 2017 A1 - Donovan T Maust A1 - Helen C Kales A1 - Ryan J McCammon A1 - Frederic C. Blow A1 - Amanda N Leggett A1 - Kenneth M. Langa KW - Dementia KW - Depressive symptoms KW - Healthcare KW - Stress AB -

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

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

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

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

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

VL - 25 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28754586?dopt=Abstract ER - TY - THES T1 - The Role of Negative Cognitions in Depression, Functional Limitations, and Activity: A National Longitudinal Study of Older Adults T2 - Clinical Psychology Y1 - 2017 A1 - Diane C Wagner KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - This study examines the role of negative cognitions in late life depression, functional limitations, and activity. Participants were 673 adults (36% male) aged 50 to 88 who completed repeated measures in 2004, 2008, and 2012 as part of the Health and Retirement Study, a large nationally representative longitudinal sample. Novel contributions of this study include combining functional limitations and cognitions in a cognitive model of depression to include aspects of depression that are specific to older adults, examining the unique contribution of cognitions in depression, and testing both growth and temporal covariance to capture the interrelatedness of depression and related factors over time. Three bivariate Latent Difference Score models tested time-lagged associations in pairs of variables at three time points. Contrary to expectations, depression levels and negative cognitions were unrelated over time, suggesting that cognitive theories of depression, which place cognitions at the core of depression etiology and maintenance, may not generalize to older adults. Negative cognitions were not related to functional limitations, suggesting that functional limitations do not influence negative cognitions in older adults. Higher levels of negative cognitions were related to increases in activity over time, suggesting that negative cognitions may motivate older adults to increase activity levels. JF - Clinical Psychology PB - George Mason University CY - Fairfax, VA VL - Ph.D. SN - 9781339532547 UR - http://mars.gmu.edu/handle/1920/10134 N1 - Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works. Last updated - 2016-04-06 U4 - 0622:Clinical psychology JO - The Role of Negative Cognitions in Depression, Functional Limitations, and Activity: A National Longitudinal Study of Older Adults ER - TY - JOUR T1 - Differences in Out-of-Pocket Health Care Expenses of Older Single and Couple Households JF - EBRI Notes Y1 - 2016 A1 - Sudipto Banerjee KW - Health Expenses KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Older Adults KW - Prescription Medication AB - This paper examines in detail the differences in out-of-pocket health care spending between couple and single older households. The data for this paper come from the Health and Retirement Study (HRS), a study of a nationally representative sample of U.S. households with individuals over age 50. Throughout the paper participants are classified into three different age groups: ages 65-74 (Age Group I), ages 75-84 (Age Group II), and ages 85 and above (Age Group III). All the numbers reported are for a two-year period between 2010 and 2012. This paper also includes total recurring and total non-recurring expenses for the households studied. It should be noted that health insurance premiums and spending on over-the-counter drugs are not included in this study. The average per-person out-of-pocket spending for households ages 65 and above during a two-year period on doctor visits, dentist visits, and prescription drugs (referred to collectively as recurring health care services) is roughly 2,500 for both single and couple households. This amount does not change with age. There are large differences in non-recurring health care spending (which includes overnight hospital stays, outpatient surgery, home health care, nursing home stays, and other services) between older singles and older couples, and these differences increase with age. For Age Group I, the average total non-recurring expenses were 2,790 for singles and 2,024 for couples, a difference of 766. For Age Group II, the average total non-recurring expenses went up to 5,502 and 3,930 for singles and couples, respectively, a difference of 1,572. For the oldest age group (those 85 and above), the difference went up to 4,825 ( 13,355 for singles and 8,530 for couples). Some of the largest differences in non-recurring health care spending between older singles and older couples are in home health care and nursing home expenses. This suggests that couples benefit from their spouses or partners acting as their caregivers. PB - 37 VL - 37 UR - http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2723591 IS - 1 ER - TY - JOUR T1 - Does Dementia Caregiving Accelerate Frailty? Findings From the Health and Retirement Study JF - The Gerontologist Y1 - 2016 A1 - Kara B. Dassel A1 - Dawn C Carr KW - Adult children KW - End of life decisions KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Purpose of the Study: Numerous studies have discovered negative health consequences associated with spousal caregiving at the end of life; however, little is known about how care-recipient cognitive status impacts caregiver health outcomes, specifically in the area of frailty, and whether health consequences remain over time. This study examines differences in frailty between spousal caregivers of persons with and without a dementia diagnosis. Design and Methods: Using 7 biannual waves of the Health and Retirement Study data (1998 2010), we examined odds of becoming frailer among surviving spouses of individuals who died between 2000 and 2010 (N = 1,246) with and without dementia. To assess increased frailty, we used a Frailty Index, which assesses chronic diseases, mobility, functional status, depressive symptoms, and subjective health. Logistic regression was used to examine the relationship between care-recipient cognitive status and whether, compared with the wave prior to death of the care-recipient, spousal caregivers were frailer: (1) in the wave the death was reported and (2) 2 years after the death was reported.Results: Dementia caregivers had 40.5 higher odds of experiencing increased frailty by the time the death was reported and 90 higher odds in the following wave compared with non-dementia caregivers.Implications: Given our findings, we discuss public health implications regarding the health and well-being of caregivers of persons with dementia. Given projected increases in dementia diagnoses as the population ages, we propose a need for interventions that provide enhanced support for dementia caregivers. VL - 56 UR - http://gerontologist.oxfordjournals.org/content/early/2014/08/25/geront.gnu078.abstract IS - 3 U4 - Dementia/Decline/cognition/spousal caregiving/Frail Elderly/Public Health/caregiver burden ER - TY - JOUR T1 - Dynamic modelling of long-term care decisions JF - Review of Economics of the Household Y1 - 2016 A1 - Sovinsky, Michelle A1 - Steven N. Stern KW - Caregiving KW - Economics KW - Healthcare KW - Older Adults AB - This paper describes and analyzes research on the dynamics of long-term care and the policy relevance of identifying the sources of persistence in caregiving arrangements (including the effect of dynamics on parameter estimates, implications for family welfare, parent welfare, child welfare, and cost of government programs). We discuss sources and causes of observed persistence in caregiving arrangements including inertia/state dependence (confounded by unobserved heterogeneity) and costs of changing caregivers. We comment on causes of dynamics including learning/human capital accumulation; burnout; and game-playing. We suggest how to deal with endogenous geography; dynamics in discrete and continuous choices; and equilibrium issues (multiple equilibria, dynamic equilibria). We also present an overview of commonly used longitudinal data sets and evaluate their relative advantages/disadvantages. We also discuss other data issues related to noisy measures of wealth and family structure. Finally, we suggest some methods to handle econometric problems such as endogeneous geography. VL - 14 UR - http://link.springer.com/10.1007/s11150-013-9236-3http://link.springer.com/content/pdf/10.1007/s11150-013-9236-3http://link.springer.com/content/pdf/10.1007/s11150-013-9236-3.pdfhttp://link.springer.com/article/10.1007/s11150-013-9236-3/fulltext.html IS - 2 JO - Rev Econ Household ER - TY - JOUR T1 - Families and Disability Onset: Are Spousal Resources Less Important for Individuals at High Risk of Dementia? JF - The American Journal of Geriatric Psychiatry Y1 - 2016 A1 - Pamela M. Rist A1 - Sze Y Liu A1 - M. Maria Glymour KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - Objective To determine whether social contacts and spousal characteristics predict incident instrumental or basic activities of daily living (I/ADL) limitations and whether effects differ for individuals with high risk of dementia. Design Cohort study. Setting Biennial interviews of Health and Retirement Study participants over up to 12 years. Participants 4,125 participants aged 65 years and older without baseline I/ADL limitations. Measurements Participants' family characteristics (living arrangements, proximity to children, contacts with friends, marital status, and spouse's depression, employment, and education) and dementia probability (high versus low risk of dementia based on direct and proxy cognitive assessments) were characterized at baseline. Family characteristics and their interactions with dementia probability were used to predict incident I/ADL limitations in pooled logistic regressions. Results ADL limitation incidence was higher among the unmarried (odds ratio OR versus married: 1.14; 95 CI: 1.01 1.30); those married to a depressed spouse (OR versus nondepressed spouse: 1.56, 95 CI: 1.21 2.00); or whose spouse had less than high school education (OR versus spouse with high school or more: 1.29, 95 CI: 1.06 1.57). Living with someone other than a spouse compared with living with a spouse predicted higher risk of both incident ADL (OR: 1.35; 95 CI: 1.11 1.65), and IADL (OR: 1.30; 95 CI: 1.06 1.61) limitations. Effects were similar for respondents with high and low dementia probability. Conclusions Regardless of dementia risk, older adults may receive important marriage benefits, which help delay disability. The salience of spouse's education and depression status implicate modifiable mechanisms, such as information and instrumental support, which may be amenable to interventions. VL - 24 UR - http://www.sciencedirect.com/science/article/pii/S1064748116001561 IS - 7 U4 - disability/disability/cognitive function/epidemiology/social ties ER - TY - JOUR T1 - Feeling older and risk of hospitalization: Evidence from three longitudinal cohorts JF - Health Psychology Y1 - 2016 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Antonio Terracciano KW - Health Conditions and Status KW - Healthcare KW - Risk Taking AB - Objective: Subjective age is a biopsychosocial marker of aging with a range of health-related implications. Using 3 longitudinal samples, this study examined whether subjective age predicts hospitalization among older adults. Method: Participants were adults aged from 24 to 102 years old, drawn from the 1995 1996 and 2004 2005 waves of the Midlife in the United States Survey (MIDUS, N = 3209), the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 3779), and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 3418). In each sample, subjective age and covariates were assessed at baseline and hospitalization was assessed at follow-up. Results: Consistent across the 3 samples, participants who felt subjectively older at baseline had an increased likelihood of hospitalization (combined effect size: 1.17, 95 CI 1.11 1.23), controlling for age, sex, race, and education. Further adjusting for disease burden and depression reduced the magnitude of the association between subjective age and hospitalization in the 3 samples, but it remained significant in the MIDUS and HRS. Conclusion: This study provides consistent evidence that subjective age predicts incident hospitalization. Subjective age assessment can help identify individuals at greater risk of hospitalization, who may benefit from prevention and intervention efforts. (PsycINFO Database Record (c) 2016 APA, all rights reserved) PB - 35 VL - 35 IS - 6 U4 - Aging/Hospitalization/Major Depression/Risk Factors/Subjectivity/Symptoms 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 - How does dementia onset in parents influence unmarried adult children's wealth JF - Social Science and Medicine Y1 - 2016 A1 - Arora, Kanika KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - There is a growing concern that long-term care (LTC) needs of older adults lead to negative financial consequences for their family members. This paper examines whether the onset of dementia in parents influences wealth change among unmarried adult children regardless of their status as informal caregivers. Longitudinal data from seven waves (1998-2010) of the Health and Retirement Study (1540 person-wave observations) are used to analyze this question. Unconditional quantile regressions demonstrate that as a result of parental dementia diagnosis, unmarried adult children have lower wealth accumulation above the median of the wealth change distribution. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent period as well. Both losses in labor income and nursing home expenditures may play a role in leading to wealth declines. PB - 152 VL - 152 N1 - Times Cited: 0 0 U4 - Long Term Care/Dementia/adult Children/informal caregiver/wealth Accumulation 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 - RPRT T1 - The Impact of Systematic Trend and Uncertainty on Mortality and Disability in a Multi-State Latent Factor Model for Transition Rates Y1 - 2016 A1 - Li, Zixi A1 - Shao, Adam Wenqiang A1 - Sherris, Michael KW - Disabilities KW - Healthcare AB - Multiple state functional disability models do not generally include systematic trend and uncertainty. We develop and estimate a multi-state latent factor intensity model with transition and recovery rates depending on a stochastic frailty factor to capture trend and uncertainty. We estimate the model parameters using U.S. Health and Retirement Study (HRS) data between 1998 and 2012 with Monte Carlo maximum likelihood estimation method. The model shows significant reductions in disability and mortality rates during this period and allows us to quantify uncertainty in transition rates arising from the stochastic frailty factor. Recovery rates are very sensitive to the stochastic frailty. There is an increase in expected future lifetimes as well as an increase in future healthy life expectancy. The proportion of lifetime spent in disability on average remains stable with no strong support in the data for either morbidity compression or expansion. The model has widespread application in costing of government funded aged care and pricing and risk management of LTC insurance products. PB - Kensington, Australia, University of New South Wales Business School U4 - long term care/systematic trend and uncertainty/disability/disability/multi-state transitions/latent factor ER - TY - JOUR T1 - In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years JF - American Journal of Hospice and Palliative Medicine Y1 - 2016 A1 - Toni Miles A1 - Joseph C. Allegra A1 - Amara E. Ezeamama A1 - Simpson, Cherie A1 - Kerstin Gerst A1 - Elkins, Jennifer KW - Adult children KW - Healthcare AB - In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87 ). A report of any loss increases risk of health care utilization by 20 to 30 . For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care. PB - 33 VL - 33 IS - 1 N1 - Times Cited: 0 0 U4 - parental Longevity/parent death/health Care Utilization/hospitalization ER - TY - JOUR T1 - Income dynamics and health: A test of competing hypotheses JF - Health Policy and Technology Y1 - 2016 A1 - Hui-Peng Liew KW - Demographics KW - Healthcare KW - Methodology KW - Public Policy AB - Objective: This study aims to examine the temporal processes underlying the relationship between income and health among the elderly to demonstrate the extent to which income histories have an influence on health changes. Methods: The empirical work of this study will be based on the 1992 2010 Health and Retirement Study (HRS). This study will test the low income hypothesis, the permanent income hypothesis, and the transitory income hypothesis using the method of growth curve modeling. Results: Results from growth curve analyses suggest that distinguishing these three income hypotheses is useful on theoretical, empirical, and policy grounds. It shows that the impact of low income, anticipated fluctuations in household income over the long run, as well as unanticipated income change over the short term on the changes in health over time are shaped along both socioeconomic and racial/ethnic lines. Conclusion: Given the present U.S. circumstances, perhaps something like a national healthcare system like the Obamacare and tax incentives and other benefit systems can be implemented to reduce the existing health disparities. VL - 5 UR - http://www.sciencedirect.com/science/article/pii/S2211883716300053 IS - 3 U4 - Growth curve modeling/Socioeconomic disparities/Public Policy/income and health/health disparities ER - TY - JOUR T1 - Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey JF - Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation Y1 - 2016 A1 - Amara E. Ezeamama A1 - Elkins, Jennifer A1 - Simpson, Cherie A1 - Smith, Shaniqua L. A1 - Joseph C. Allegra A1 - Toni Miles KW - Expectations KW - Health Conditions and Status KW - Healthcare AB - OBJECTIVE: To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70years old enrolled in the US 2010 health and retirement survey. METHODS: Multivariable logistic regression models estimated odds ratios (ORs) and 95 confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5 events. HCU included hospitalization (any vs. none) and physician visits ( 20 vs. 20) over 2years. FINDINGS: Hospitalization odds declined by 25 (OR 0.75, 95 CI 0.64-0.86), odds of 20 physician visits declined by 47 (OR 0.53, 95 CI 0.45-0.63) and the odds of SRH improvement increased by 49 (OR 1.49, 95 CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 elevated for participants that reported 1-2, 3-4 and 5 versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations. CONCLUSION: In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU. PB - 25 VL - 25 IS - 4 N1 - Times Cited: 0 0 U4 - Resilience/lifetime adversity/HOSPITALIZATION/subjective well-being ER - TY - MGZN T1 - Lend a hand, help your heart? Y1 - 2016 KW - Cardiovascular disease KW - Emotions KW - Healthcare KW - Heart disease KW - Preventative Medicine KW - Studies KW - Volunteerism AB - Doing volunteer work has been linked to better physical and mental health outcomes. People who volunteer may be more active, have less depression, and have a greater sense of purpose in life-all of which may help lower heart disease risk. JF - Harvard Health Publications. Harvard Heart Letter PB - Harvard Health Publications CY - Boston UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1794519897?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQ%3Apqrl&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=ar N1 - Name - Experience Corps Copyright - Copyright © 2016 by Harvard University. All rights reserved. Last updated - 2016-06-08 JO - Lend a hand, help your heart? ER - TY - JOUR T1 - Medicare Part D and Portfolio Choice JF - American Economic Review Y1 - 2016 A1 - Padmaja Ayyagari A1 - Daifeng He KW - Healthcare KW - Investing KW - Medicare/Medicaid/Health Insurance KW - Older Adults AB - Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk due to the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort. VL - 106 UR - http://pubs.aeaweb.org/doi/10.1257/aer.p20161125 IS - 5 JO - American Economic Review ER - TY - JOUR T1 - Modifiable Risk Factors for New-Onset Slow Gait in Older Adults JF - Journal of the American Medical Directors Association Y1 - 2016 A1 - Joe Verghese A1 - Wang, Cuiling A1 - Allali, Gilles A1 - Holtzer, Roee A1 - Emmeline Ayers KW - Health Conditions and Status KW - Healthcare AB - AbstractObjective Despite the growing importance of slow gait as a universal screen of health, systematic investigation of risk factors for incident slow gait is lacking. Our objective was to identify potentially modifiable risk factors for incident slow gait. Design Prospective cohort study. Setting The Health and Retirement Study, a nationally representative US sample. Participants A total of 2306 individuals age 65 and older (56.5 women) from the 2008 wave with timed walks at baseline and 4 years later. Measurements Incident slow gait (walking speed 1 SD below age and sex means) was the outcome. Fifteen potentially modifiable medical and lifestyle risk factors were examined as predictors. Results Incident slow gait developed in 243 participants (11 ) at 4 years. Physical inactivity (adjusted relative risk aRR 1.94), cognitive impairment (aRR 1.77), muscle weakness (aRR 1.48), pain (aRR 1.45), obesity (aRR 1.35), vision (aRR 1.36), and falls (aRR 1.32) predicted increased risk of developing incident slow gait. Together, these risk factors accounted for 77 (95 confidence interval 14 95) of the Population Attributable Risk for incident slow gait. Conclusion A limited set of potentially modifiable risk factors is associated with new-onset slow gait in older adults. These findings provide a foundation for developing clinical guidelines and preventive interventions for slow gait. PB - 17 VL - 17 UR - http://www.sciencedirect.com/science/article/pii/S1525861016000554 IS - 5 U4 - epidemiology/incidence ER - TY - JOUR T1 - Modifiable risk factors for nursing home admission among individuals with high and low dementia risk JF - Archives of Gerontology and Geriatrics Y1 - 2016 A1 - Pamela M. Rist A1 - Thu T Nguyen A1 - Rachel A Whitmer A1 - M. Maria Glymour KW - Health Conditions and Status KW - Healthcare KW - Risk Taking AB - AbstractBackground Strategies to prevent or delay nursing home admission in individuals with cognitive impairment are urgently needed. We hypothesized that physical inactivity, not consuming alcohol (as opposed to moderate alcohol use), and having a history of smoking predict nursing home admission among individuals with normal cognitive function, but these behavioral factors would have attenuated associations with nursing home admission among individuals with impaired cognition. Methods We performed a prospective cohort study among 7631 Health and Retirement Study participants aged 65 at baseline. Baseline dementia risk (high versus low, based on brief psychometric assessments and proxy reports) and modifiable risk factors (physical inactivity, ever smoking, and not consuming alcohol) were used to predict nursing home admission in pooled logistic regression models. We evaluated whether estimated effects of modifiable factors varied by dementia risk, comparing both relative and absolute effects using interaction terms between dementia risk and each modifiable risk factor. Results Low dementia probability was associated with lower nursing home admission risk (RR = 0.49; 95 CI: 0.41, 0.59). Physical inactivity (RR = 1.27; 95 CI: 1.15, 1.41), ever smoking (RR = 1.12; 95 CI: 1.01, 1.25), and not consuming alcohol (RR = 1.28; 95 CI: 1.13, 1.45) predicted increased relative risk of nursing home admission regardless of cognitive status. The relative effects of modifiable risk factors were similar for those with low and high dementia risk. Conclusion Although cognitive impairment associated with incipient dementia strongly predicts nursing home admission, this risk can be partially ameliorated with modifiable risk factors such as physical activity. PB - 65 VL - 65 UR - http://www.sciencedirect.com/science/article/pii/S0167494316300565 U4 - Nursing home/Risk factors/Cognitive function/Epidemiology ER - TY - JOUR T1 - Ownership of a bank account and health of older Hispanics JF - Economics Letters Y1 - 2016 A1 - Emma Aguila A1 - Marco Angrisani A1 - Blanco, Luisa R. KW - Cross-National KW - Finances KW - Healthcare KW - Older Adults KW - Women and Minorities AB - We study health effects of financial inclusion, particularly ownership of a bank account of older minorities, with focus on Hispanics. Using data from the Health and Retirement Study from 2000 to 2012, we find that, for Hispanics, being banked has a positive effect on mental health but is not associated with effects on physical health. Mental health benefits are likely to be larger for those who face greater hurdles to access formal financial institutions. Hispanics in less well-off neighborhoods and with below-median wealth appear to experience the greatest mental-health benefits associated with ownership of a bank account. PB - 144 VL - 144 UR - http://www.sciencedirect.com/science/article/pii/S0165176516301239 ER - TY - JOUR T1 - Prescription drug coverage and drug utilization: New evidence from the HRS prescription drug study JF - Journal of Economic and Social Measurement Y1 - 2016 A1 - Gary V. Engelhardt KW - Healthcare KW - Insurance KW - Net Worth and Assets AB - The linking of detailed information on health, medical care, and insurance to economic outcomes is a central feature of data collection efforts in the economics of aging. In this paper, I use newly available linked panel data from a unique supplement to the Health and Retirement Study (HRS) known as the Prescription Drug Study (PDS) to examine the impact of insurance coverage on prescription drug utilization for those 65 and older. Fixed-effect estimates suggest that gaining coverage resulted in a 15 increase in utilization. Gaining coverage also was associated with a 20-50 reduction in the incidence of cost-related non-adherence. However, even among the uninsured, only a relatively small proportion of drugs (12 ) were associated with episodes of cost-related non-adherence. PB - 41 VL - 41 IS - 1 U4 - Prescription drug costs/insurance Coverage/economics of Aging 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 - A Random-Effects Pattern-Mixture Model with Application to Comorbidity JF - Bulletin of Sociological Methodology/Bulletin de M thodologie Sociologique Y1 - 2016 A1 - Hui-Peng Liew KW - Demographics KW - Healthcare AB - This study aims to better understand the contribution of potential non-ignorable nonresponse associated with attrition and wave-nonresponse in race/ethnicity disparities in health trajectories. The empirical work of this study is based on the 1992-2010 Health and Retirement Study (HRS). Both growth curve models (direct likelihood maximization and pattern mixture) have very similar results, but the standard errors tended to be slightly underestimated in the former. Results from the growth curve models suggest that with age, racial/ethnic disparities in health decrease for low educated individuals, persist for those with at least a high school education and for Hispanic elderly with a highs school or GED education, and increase among the lower educated. The study concludes that any possible non-ignorable differences between models are not large enough to affect inferences drawn from the data analysis. PB - 129 VL - 129 UR - http://bms.sagepub.com/content/129/1/78.abstract IS - 1 U4 - Growth Curve Models/Pattern-mixture Modeling/Health Trajectories/Health Trajectories/Elderly/race and ethnicity/education ER - TY - JOUR T1 - Relationship Status and Long-Term Care Facility Use in Later Life JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2016 A1 - Thomeer, Mieke Beth A1 - Mudrazija, Stipica A1 - Jacqueline L. Angel KW - Demographics KW - Healthcare KW - Women and Minorities AB - Objectives: Most older adults prefer to age in place and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk.Method: We fit hazard models to a sample of adults aged 65 and older from eight waves (1998 2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays.Results: Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use.Discussion: By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options. VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/11/16/geronb.gbv106.abstract IS - 4 U4 - Family sociology/Gender/Health services use/Longitudinal methods/Long-term care/Minority aging/RACE AND ETHNICITY/Hispanic ER - TY - JOUR T1 - Responses to Financial Loss During the Great Recession: An Examination of Sense of Control in Late Midlife JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2016 A1 - Shannon T. Mejia A1 - Richard A. Settersten Jr. A1 - Michelle C Odden A1 - Hooker, Karen KW - Adult children KW - Demographics KW - Healthcare KW - Net Worth and Assets KW - Other KW - Public Policy AB - Objectives. The Great Recession shocked the primary institutions that help individuals and families meet their needs and plan for the future. This study examines middle-aged adults experiences of financial loss and considers how socioeconomic and interpersonal resources facilitate or hinder maintaining a sense of control in the face of economic uncertainty.Method. Using the 2006 and 2010 waves of the Health and Retirement Study, change in income and wealth, giving help to and receiving help from others, household complexity, and sense of control were measured among middle-aged adults (n = 3,850; age = 51 60 years).Results. Socioeconomic resources predicted both the level of and change in the engagement of interpersonal resources prior to and during the Great Recession. Experiences of financial loss were associated with increased engagement of interpersonal resources and decreased sense of control. The effect of financial loss was dampened by education. Sense of control increased with giving help and decreased with household complexity.Discussion. Findings suggest that, across socioeconomic strata, proportional loss in financial resources resulted in a loss in sense of control. However, responses to financial loss differed by socioeconomic status, which differentiated the ability to maintain a sense of control following financial loss. VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/08/21/geronb.gbv054.abstract IS - 4 U4 - Agency/Financial loss/Great recession/Household complexity/Intergenerational transfers/Interpersonal resources/Sense of control/Structure ER - TY - JOUR T1 - Satisfaction with Aging Results in Reduced Risk for Falling JF - International Psychogeriatrics Y1 - 2016 A1 - Liat Ayalon KW - Health Conditions and Status KW - Healthcare AB - Background: Falls are highly frequent in older adults and are associated with increased morbidity and mortality. The present study was designed to assess the role of satisfaction with one's aging process as a predictor of the risk for falling over a four-year period and to identify potential mediators of this relationship. Methods: The Health and Retirement Study (HRS) is a US nationally representative sample of individuals over the age of 50 years and their spouse of any age. The present study was based on the 2008 2012 waves of the HRS. Analyses were restricted to 4,121 respondents over the age of 50 years, who had fall data in 2008 and 2012 and were eligible to complete the satisfaction with aging measure as part of the 2008 psychosocial questionnaire. Results: Overall, 38.1 of the sample reported having fallen at least once between 2006 and 2008 and 40.7 reported having fallen at least once between 2010 and 2012. Higher levels of satisfaction with aging in 2008 were found to be protective against falls assessed in 2012 (OR 95 CI = 0.88 0.79 0.98 ) even after adjustment for age, gender, education, ethnicity, medical status, functional status, cognitive functioning, walking speed, balance, vision, depressive symptoms, physical activities, and past falls. Bootstrap procedures have shown that the effect of satisfaction with aging on falls is partially accounted for through its effect on functional decline. Conclusions: The findings point to the important role of satisfaction with aging as a potential protective mechanism against falls. The results call for the development of psychosocial interventions to reduce falls in older adults. PB - 28 VL - 28 UR - http://dx.doi.org/10.1017/S1041610215001969 IS - 5 U4 - epidemiology/satisfaction with aging/falls/frailty/subjective aging/MORBIDITY/Mortality ER - TY - JOUR T1 - Service-Related Exposures and Physical Health Trajectories Among Aging Veteran Men JF - The Gerontologist Y1 - 2016 A1 - Miles G Taylor A1 - Urena, Stephanie A1 - Ben Lennox Kail KW - Demographics KW - Healthcare AB - PURPOSE OF THE STUDY: We examined the association of military service-related exposures (SREs) with physical health trajectories to establish whether combat and other hazards have lasting connections to health in later life. We also examined potential confounders and mechanisms to further understand the associations. DESIGN AND METHODS: We used the 2013 HRS Veterans Mail Survey linked to the longitudinal Health and Retirement Study (HRS) to examine military service experiences and health over a decade (2000-2010) among veteran men. We employed latent class analysis to disaggregate trajectories of health in later life. RESULTS: Most veteran men experienced good health over the decade. Although we found a connection between combat and later health, it was driven primarily by hazardous or traumatic exposures. Service-related disability, current health behaviors, and mental health were not likely explanations for these associations. IMPLICATIONS: The measurement of service experiences is primary in understanding health implications of military service and projecting the health service needs of aging veterans. SREs are varied and complex and have differential connections to health. These connections remain unexplained by current behaviors and mental health, suggesting the need to examine earlier life course pathways and mechanisms. PB - 56 VL - 56 IS - 1 N1 - Times Cited: 0 0 U4 - health trajectories/health trajectories/military service/service related exposures/Combat exposure ER - TY - JOUR T1 - Social Supports as Enabling Factors in Nursing Home Admissions: Rural, Suburban, and Urban Differences JF - Journal of Applied Gerontology Y1 - 2016 A1 - Cohen, Adrienne A1 - Jennifer R. Bulanda KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - This study investigates differences in social support and nursing home admission by rurality of residence. We use discrete-time event history models with longitudinal data from seven waves (1998-2010) of the Health and Retirement Study to prospectively examine the risk of spending 30 or more days in a nursing home (n = 5,913). Results show that elders with a health problem who live in rural areas of the South or Midwest have approximately 2 times higher odds of nursing home entry than elders living in urban areas in the Northeast. Rural elders report somewhat higher social support than non-rural elders, and controlling for these forms of social support does not explain the higher risk of a nursing home stay for Southerners and Midwesterners living in rural areas. Results suggest that social support has a similar association with nursing home entry for rural, suburban, and urban elders. VL - 35 UR - http://jag.sagepub.com/content/early/2015/01/09/0733464814566677.abstract IS - 7 U4 - social support/rural aging/nursing home/end-of-life planning/Regional variations ER - TY - JOUR T1 - Volunteering is prospectively associated with health care use among older adults JF - Social Science and Medicine Y1 - 2016 A1 - Eric S Kim A1 - Konrath, Sara H. KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - lthough observational and experimental studies have shown that volunteering is linked with better mental health, physical health, and health behaviors, no studies have examined whether volunteering is associated with patterns of health care use. Objective The purpose of this study was to prospectively examine whether volunteering was associated with a greater use of preventive health care services, but fewer doctor visits and nights spent in the hospital. Methods Participants (n = 7168) were drawn from the 2006 wave of the Health and Retirement Study, a nationally representative panel study of American adults over the age of 51, and tracked for one wave (2 years). Logistic regression and generalized linear models were used for analyses. Results In analyses that adjusted for sociodemographic factors and baseline health, volunteers were 30 more likely to receive flu shots (OR = 1.30, 95 CI = 1.16 1.47), 47 more likely to receive cholesterol tests (OR = 1.47, 95 CI = 1.24 1.74); female volunteers were 53 more likely to receive mammograms/x-rays (OR = 1.53, 95 CI = 1.28 1.83) and 21 more likely to receive Pap smears (OR = 1.21, 95 CI = 1.03 1.41); male volunteers were 59 more likely to receive prostate exams (OR = 1.59, 95 CI = 1.29 1.95). In a model that adjusted for sociodemographic factors, volunteers spent 38 fewer nights in the hospital (RR = 0.62, 95 CI = 0.52 0.76), however volunteering was not associated with frequency of doctor visits (RR = 0.94, 95 CI = 0.87 1.02). The association between volunteering and number of nights spent in the hospital was minimally affected after adjusting for potential confounding (baseline health) and explanatory variables (health behaviors, social integration, stress, positive psychological factors, personality). Conclusion This is the first known study to examine the association between volunteering and health care use. If future studies replicate these findings, the results may be used to inform the development of new strategies for increasing preventive health screenings, lowering health care use and costs, and enhancing the health of older adults. PB - 149 VL - 149 UR - http://www.sciencedirect.com/science/article/pii/S0277953615302495 U4 - Volunteering/Volunteer/Health care use/Physician visits/Physician visits/Preventive health screening/Psychological/Aging ER - TY - JOUR T1 - Adult Child Caregiver Health Trajectories and the Impact of Multiple Roles Over Time JF - Research on Aging Y1 - 2015 A1 - Barnett, Amanda E. KW - Adult children KW - Employment and Labor Force KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Guided by stress process and life course theory, the purpose of this study was to examine adult child caregivers psychological and physical health trajectories and how their multiple family (caregiving, marital, and parenting) and nonfamily (employment) roles contributed to these health outcomes over time. Seven waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers using latent growth curve models. Adult child caregivers have distinct psychological and physical health trajectories that are related to their roles over time. The importance of any given role varies by the type of health outcome and timing in the life course. Caregiving alone does not contribute to adult child caregivers psychological and physical health; marital and employment roles also contribute significantly to caregivers life courses. PB - 37 VL - 37 UR - http://roa.sagepub.com/content/early/2014/03/27/0164027514527834.abstract IS - 3 U4 - caregiving/marital status/employment status/Stress/latent growth model/life course ER - TY - JOUR T1 - Age at Migration and Self-Rated Health Trajectories After Age 50: Understanding the Older Immigrant Health Paradox JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2015 A1 - Gubernskaya, Zoya KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Objectives. This research contributes to the immigrant health paradox debate by testing the hypothesis that older age at migration is associated with the increased risk of poor health in later life.Method. Using the 1992 2008 Health and Retirement Study, I construct linear random-intercept models to estimate self-rated health (SRH) trajectories after age 50 for the native and foreign born by age at migration.Results. At age 50, both Hispanic and non-Hispanic foreign born report better SRH compared with their native-born counterparts, net of race, gender, and education. Non-Hispanic foreign born who migrated after age 35 and Hispanic foreign born who migrated after age 18, however, experience steeper decline in SRH after age 50, which results in a health disadvantage vis- -vis the native born in old age. Education has a smaller protective effect on SRH for the foreign born, especially those who migrated as adults.Discussion. Age at migration is an important factor for understanding health status of older immigrants. Steeper health decline in later life of the foreign born who migrated in advanced ages may be related to longer exposure to unfavorable conditions in home countries and limited opportunities for incorporation in the United States. PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/05/22/geronb.gbu049.abstract IS - 2 U4 - Aging/Demography/Education/Health disparities/Health trajectories/Health trajectories/Immigrant health/Older immigrants/Self-rated health ER - TY - THES T1 - Assessing the burden of worsening self-reported vision in older Americans using the Health and Retirement Study T2 - Pharmacy Y1 - 2015 A1 - Shih, Vanessa KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction AB - Background Visual disorders are estimated to affect about 3.6% of Americans by 2020. Vision impairment has a substantial impact on individuals functionally. Vision impairment is associated with many comorbidities, functional limitations, as well as higher caregiving needs. This study aims to assess the transition to self-reported vision impairment and the effect on an individual's functionality and ability to live independently. Methods The Health and Retirement Study is an ongoing, biennial survey of older Americans that collects an abundance of data on an individual's family, health, and financial circumstances. The explanatory variable of interest was a dichotomous variable of vision impaired or not vision impaired as defined by their self-reported vision status. Outcomes studied were functional limitations defined as difficulty performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), likelihood of move to nursing home, and both informal and formal caregiving needs. Descriptive univariate and bivariate statistics were performed to describe the demographics of the sample over the ten waves of data used, from 1995-2012. Multivariable logistic regressions controlling for sociodemographic characteristics, were performed to test the association between vision status and outcomes of interest for specific representative waves. Panel data methods of logistic regression were used to measure the association between a transition to impaired vision and the effect on functional limitations and nursing home residence while controlling for potential confounders and within-patient correlation. Specifically, mixed-effects logistic regressions with subject-level random-effects were conducted for the binary outcomes of nursing home residence, difficulty in performing at least one ADL, and difficulty in performing at least one IADL. Results The prevalence of overall vision impairment was, on average, about 6%. On average, about 5% and 7% of respondents had near and distal vision impairment, respectively. The overall prevalence of nursing home residence in our sample was approximately 2%. Prevalence of ADL and IADL limitations was stable across waves but ranged from 1%-20% for each of the six ADL and five IADL limitations. More respondents reported receiving informal caregiving versus formal caregiving; however the hours of caregiving received was similar for both formal and informal caregiving recipients. Multivariable logistic regression for three representative waves found numerically higher odds of a nursing home residence for vision impaired individuals compared to individuals with no vision impairment, though the difference was not significant. The odds ratios for 1998, 2006, and 2012 were 1.08 (95% CI: 0.64, 1.84), 1.09 (95% CI: 0.64, 1.86), and 1.22 (95% CI: 0.76, 1.97), respectively. Significant associations were found between vision impairment and functional limitations. Using a similar approach, the odds ratio for difficulty performing at least one ADL was 2.57 (95% CI: 2.16, 3.05), 2.37 (95% CI: 1.97, 2.84), and 2.31 (95% CI: 1.92, 2.77) in 1998, 2006, and 2012, respectively. The odds ratios for difficulty performing at least one IADL was 3.78 (95% CI: 3.15, 4.53), 3.94 (95% CI: 3.26, 4.76), and 3.49 (95% CI: 2.89, 4.22) in 1998, 2006, and 2012, respectively. In the mixed-effects logistic regression of the total study panel, a transition from no vision impairment to vision impairment was significantly associated with 1.37 times higher odds of a nursing home residence (95% CI: 1.05, 1.78), a 2.96 times higher odds of difficulty performing at least one ADL (95% CI: 2.71, 3.24), and a 4.02 times higher odds of difficulty performing at least one IADL (95% CI: 3.70, 4.37), after controlling for confounders. Discussion We found the estimated prevalence of visual impairment and functional limitations within our sample, and the association between the two, to remain relatively stable over time. Additionally, we found an age-adjusted transition to self-reported vision impairment within n in ividual to have significant detrimental effects on the ability to live independently and perform ADLs and IADLs without difficulty. Thus, prevention of this transition can substantially impact an individual's quality of life, and benefits derived from early detection and improved treatment of medical conditions that contribute to vision loss can have extensive value beyond simply improving vision. JF - Pharmacy PB - University of Washington VL - Master's U4 - Public health JO - Assessing the burden of worsening self-reported vision in older Americans using the Health and Retirement Study ER - TY - JOUR T1 - Assessing the Need for a New Household Panel Study: Health Insurance and Health Care. JF - Journal of Economic and Social Measurement Y1 - 2015 A1 - Helen G Levy KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Meta-analyses KW - Panel studies AB -

This paper considers the availability of data for addressing questions related to health insurance and health care and the potential contribution of a new household panel study. The paper begins by outlining some of the major questions related to policy and concludes that survey data on health insurance, access to care, health spending, and overall economic well-being will likely be needed to answer them. The paper considers the strengths and weaknesses of existing sources of survey data for answering these questions. The paper concludes that either a new national panel study, an expansion in the age range of subjects in existing panel studies, or a set of smaller changes to existing panel and cross-sectional surveys, would significantly enhance our understanding of the dynamics of health insurance, access to health care, and economic well-being.

VL - 40 IS - 1-4 ER - TY - JOUR T1 - Asymptotically exact inference in conditional moment inequality models JF - Journal of Econometrics Y1 - 2015 A1 - Armstrong, Timothy B. KW - Healthcare KW - Methodology AB - This paper derives the rate of convergence and asymptotic distribution for a class of Kolmogorov-Smirnov style test statistics for conditional moment inequality models for parameters on the boundary of the identified set under general conditions. Using these results, I propose tests that are more powerful than existing approaches for choosing critical values for this test statistic. I quantify the power improvement by showing that the new tests can detect alternatives that converge to points on the identified set at a faster rate than those detected by existing approaches. A Monte Carlo study confirms that the tests and the asymptotic approximations they use perform well in finite samples. In an application to a regression of prescription drug expenditures on income with interval data from the Health and Retirement Study, confidence regions based on the new tests are substantially tighter than those based on existing methods. (C) 2015 Elsevier B.V. All rights reserved. PB - 186 VL - 186 IS - 1 N1 - Times Cited: 1 0 1 U4 - Prescription drug costs/Statistical analysis/Methodology ER - TY - JOUR T1 - Bargaining Power, Parental Caregiving, and Intergenerational Coresidence JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2015 A1 - Liliana E Pezzin A1 - Robert A. Pollak A1 - Barbara Steinberg Schone KW - Adult children KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Objective. To examine the effect of changes in parent child coresidence on caregiving decisions of non-resident siblings over a 5-year period while controlling for characteristics of the elderly parent and adult children in the family network.Method. We use difference-in-difference models applied to Health and Retirement Study-Assets and Health Dynamics of the Elderly data to test the hypothesis that the formation of a joint household between a parent and one of her children raises the bargaining power of non-resident siblings, who then reduce their care to the parent. Similarly, the dissolution of a parent child household is expected to increase the bargaining power of the child who no longer coresides with the parent relative to her siblings.Results. We find that children whose parent and sibling begin coresiding during the study period are less likely to provide care and provide fewer hours of care than children whose parents never coresided with a child. Adult children whose parent cease coresiding with a sibling, on the other hand, have a higher likelihood of providing care and provide significantly more hours of care relative to children whose parents either coresided with a sibling in both time periods or never coresided with a child.Discussion. Meeting the needs of the growing elderly population while maintaining them in the community is a particular focus of long-term care policy. To the extent that shared living is an important component of such care, the observed sensitivity of non-resident children s caregiving efforts has implications for the well-being of both disabled parents and their coresiding adult children. PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/07/03/geronb.gbu079.abstract IS - 6 U4 - Caregiving/Family bargaining/Intergenerational coresidence/Long Term Care/Public Policy/Disabilities/intergenerational transfer ER - TY - JOUR T1 - Debt literacy, financial experiences, and overindebtedness JF - Journal of Pension Economics and Finance Y1 - 2015 A1 - Annamaria Lusardi A1 - Peter Tufano KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Other AB - We analyze a national sample of Americans with respect to their debt literacy, financial experiences, and their judgments about the extent of their indebtedness. Debt literacy is a component of broader financial understanding that measures knowledge about debt and self-assessed financial knowledge. Financial experiences are the participants' reported experiences with traditional borrowing, alternative borrowing, and investing. Overindebtedness is a self-reported measure. Debt literacy is low, with only about one-third of the population grasping the basics of interest compounding. Even after controlling for demographics, we find a relationship between debt literacy and both financial experiences and debt loads. Individuals with lower levels of debt literacy tend to transact in high-cost manners, incurring higher fees and using high-cost borrowing. We provide a rough estimate of the national implications of debt ignorance on credit card costs by consumers. Less knowledgeable individuals also report that their debt loads are excessive or that they are unable to judge their debt position. PB - 14 VL - 14 IS - 4 U4 - debt loads/credit card borrowing/BEHAVIOR/numeracy/BUSINESS, FINANCE/DEFAULT/ECONOMICS/HOUSEHOLD FINANCE/Financial knowledge ER - TY - THES T1 - Demand for Long-Term Care and Long-Term Care Insurance -- A Human Capital Perspective Y1 - 2015 A1 - Dey, Sanjoy KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Net Worth and Assets AB - The dissertation examines several aspects of the demand for long-term care and long-term care insurance. It develops and applies a comprehensive "full insurance" model analytically in order to empirically estimate the pattern of relationship between private long-term care insurance and other non-marketable alternatives: self-insurance, self-protection, family insurance and safety-net insurance. It therefore allows us to estimate the degree to which demand for private long-term care insurance is substituted or complemented by its non-marketable alternatives. We explicitly explore the crowding out of private long-term care insurance by Medicaid. The role of education and health in the demand for long-term care and long-term care insurance is the primary focus of this study. Individuals with better education and health expect to live longer; they can purchase this insurance product in better health during their late middle age and get rewarded by insurance companies in the form of lower premiums. Medicaid turns out to be an expensive insurance option for them as it carries a high deductible for people with high income and wealth, and an educated person is aware of the potential financial risk associated with future utilization of long-term care services. While conventional wisdom would suggest that the primary effect of education on demand for long-term care insurance operates through an income effect, the paper carefully shows, both theoretically and empirically that it is the knowledge effect and an independent health effect that have the most influence. The spectrum of knowledge effect goes beyond its immediate relevance for the labor market. The paper tries to provide a complex analysis of interactions of different forms of insurances from a broader human capital perspective. The dissertation carefully explores the primary statistically significant determinants of demand for long-term care with the specific focus on the role of private LTCI coverage in determining the choice of mode of care. The dissertation also delves into an empirical investigation to understand the relationship between private insurance coverage and ultimate utilization of long-term care services in different specific caregiving institutional frameworks. The thesis pays explicit attention to different arguments of demand function of private LTCI and future utilization of long-term care. We explore the decision taken by an individual to purchase private long-term care insurance in different strata of wealth distribution. Our comprehensive analysis provides a useful instrument to develop business strategies regarding forecasting future demand for private long-term care insurance for the firms operating in long-term care insurance industry. Our analysis can also be utilized to evaluate implications of any changes in public policies. PB - State University of New York at Buffalo CY - Buffalo, NY VL - 3714584 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1700219388?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-27 First page - n/a U4 - 0501:Economics JO - Demand for Long-Term Care and Long-Term Care Insurance -- A Human Capital Perspective ER - TY - JOUR T1 - Depression and onset of cardiovascular disease in the US middle-aged and older adults JF - Aging and Mental Health Y1 - 2015 A1 - Xiang, Xiaoling A1 - An, Ruopeng KW - Health Conditions and Status KW - Healthcare KW - Risk Taking AB - Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults. Methods: The study sample came from 1992-2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51-61 years old in 1992 with no CVD history. A score of 3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity. Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27 (hazard ratio HR = 1.27, 95 confidence interval = 1.17-1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose-response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant. Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population. PB - 19 VL - 19 IS - 12 U4 - depression/cardiovascular disease/Depressive Symptoms/CES Depression Scale/CES Depression Scale/cardiovascular disease/MENTAL HEALTH/DEPRESSION/risk factors/PSYCHIATRY ER - TY - JOUR T1 - Disparity in dental coverage among older adult populations: a comparative analysis across selected European countries and the USA JF - International Dental Journal Y1 - 2015 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Widstrom, Eeva A1 - Jinkook Lee A1 - Listl, Stefan KW - Cross-National KW - Healthcare KW - Insurance KW - Public Policy AB - Background Insurance against the cost of preventing and treating oral diseases can reduce inequities in dental-care use and oral health. The purpose of this study was to examine the extent of variation in dental insurance coverage for older adult populations within and between the USA and various European countries. Method The analyses relied on 2006 2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and on 2004 2006 data from the Health and Retirement Study (HRS) in the USA for respondents 51 years of age and older. A series of logistic regression models was estimated to identify disparities in dental coverage. Results The highest extent of significant insurance differences between various population subgroups was found for the USA. In comparison with southern and eastern European countries, a lower number of significant differences in coverage was found for Scandinavian countries. Countries categorised as having comprehensive public insurance coverage showed a tendency towards less insurance variation within their populations than did countries categorised as not having comprehensive public coverage. The exceptions were Poland and Switzerland. Conclusions The findings of the present study suggest that significant variations in dental coverage exist within all elderly populations examined and that the extent of inequalities also differs between countries. By and large, the observed variations corroborate the perception that population dental coverage is more equally distributed under public subsidy. This could be relevant information for decision makers who seek to improve policies in order to provide more equitable dental coverage. VL - 65 UR - http://dx.doi.org/10.1111/idj.12139 IS - 2 U4 - SHARE/cross-national comparison/Dental insurance coverage/dental Care/Public Policy/Oral health ER - TY - JOUR T1 - Do Grandchildren Influence How Old You Feel? JF - Journal of Aging and Health Y1 - 2015 A1 - Valeria Bordone A1 - Bruno Arpino KW - Adult children KW - Expectations KW - Healthcare AB - Objectives: Guided by the acknowledged importance of measures of aging alternative to chronological age, we explored the association between subjective age, on the one hand, and having grandchildren and provision of grandchild care, on the other, by gender and age groups. Method: Data from the Health and Retirement Study (HRS; N = 1,701 men and 2,395 women aged 50-85) and linear regression models were used to test two hypotheses. Results: Grandparents feel older than their grandchildless counterparts at younger ages, but such association is reversed in later life if they look after their grandchildren. A cumulative negative association between subjective age and both having grandchildren and providing grandchild care holds for older women. Discussion: This study extends prior research by examining age and gender differences in factors associated with subjective age. The findings suggest that grandparenthood is central in shaping the personal experience of aging. Future studies should address the causality of the factors analyzed. UR - http://jah.sagepub.com/content/early/2015/12/08/0898264315618920.abstract U4 - subjective age/grandparents/grandchild care/intergenerational relationships/family Structure ER - TY - JOUR T1 - Do Physical Activity, Smoking, Drinking, or Depression Modify Transitions from Cognitive Impairment to Functional Disability? JF - Journal of Alzheimer's Disease Y1 - 2015 A1 - Pamela M. Rist A1 - Jessica R Marden A1 - Benjamin D Capistrant A1 - Bei Wu A1 - M. Maria Glymour KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - Background: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. Objectives: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. Methods: Health and Retirement Study participants aged 65 without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. Results: Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95 CI: 0.28 0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95 CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. Conclusion: Physical activity may protect against IADL limitations while smoking, alcohol consumption, and depression do not afford substantial protection among the cognitively impaired. Results highlight the need for extra support for IADLs among individuals with cognitive losses. VL - 44 UR - http://dx.doi.org/10.3233/JAD-141866 IS - 4 U4 - Cognition/disability/disability/epidemiology/dementia/IADLs/Smoking/alcohol use/physical Activity ER - TY - JOUR T1 - Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey JF - Journal of the American Geriatrics Society Y1 - 2015 A1 - Alan R Teo A1 - Choi, Hwajung A1 - Sarah B. Andrea A1 - Marcia A. Valenstein A1 - Jason T Newsom A1 - Dobscha, Steven K. A1 - Zivin, Kara KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - ObjectivesTo determine associations between use of three different modes of social contact (in person, telephone, written or e-mail), contact with different types of people, and risk of depressive symptoms in a nationally representative, longitudinal sample of older adults. DesignPopulation-based observational cohort. SettingUrban and suburban communities throughout the contiguous United States. ParticipantsIndividuals aged 50 and older who participated in the Health and Retirement Survey between 2004 and 2010 (N = 11,065). MeasurementsFrequency of participant use of the three modes of social contact with children, other family members, and friends at baseline were used to predict depressive symptoms (measured using the eight-item Center for Epidemiologic Studies Depression Scale) 2 years later using multivariable logistic regression models. ResultsProbability of having depressive symptoms steadily increased as frequency of in-personbut not telephone or written or e-mail contactdecreased. After controlling for demographic, clinical, and social variables, individuals with in-person social contact every few months or less with children, other family, and friends had a significantly higher probability of clinically significant depressive symptoms 2 years later (11.5 ) than those having in-person contact once or twice per month (8.1 ; P .001) or once or twice per week (7.3 ; P .001). Older age, interpersonal conflict, and depression at baseline moderated some of the effects of social contact on depressive symptoms. ConclusionFrequency of in-person social contact with friends and family independently predicts risk of subsequent depression in older adults. Clinicians should consider encouraging face-to-face social interactions as a preventive strategy for depression. PB - 63 VL - 63 IS - 10 U4 - social isolation/in-person/telephone/face-to-face/e-mail/written/in person/face to face/e mail/GERIATRICS/GERONTOLOGY/TRIAL/RETIREMENT/THERAPY/HEALTH/LONELINESS/NETWORKS/OUTCOMES/GERONTOLOGY/Surveys/Social aspects/Depression, Mental/Older people/Social interaction/Geriatric psychology/Mental depression ER - TY - JOUR T1 - Does prescription drug coverage improve mental health? Evidence from Medicare Part D JF - Journal of Health Economics Y1 - 2015 A1 - Padmaja Ayyagari A1 - Dan M. Shane KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - The introduction of the Medicare Prescription Drug program (Part D) in 2006 resulted in a significant increase in access to coverage for older adults in the U.S. Several studies have documented the impact of this program on prescription drug utilization, expenditures and medication adherence among older adults. However, few studies have evaluated the extent to which these changes have affected the health of seniors. In this study we use data from the Health and Retirement Study to identify the impact of the Medicare Part D program on mental health. Using a difference-in-difference approach, we find that the program significantly reduced depressive symptoms among older adults. We explore the mechanisms through which this effect operates and evaluate heterogeneity in impact. (C) 2015 Elsevier B.V. All rights reserved. PB - 41 VL - 41 N1 - Times Cited: 0 0 U4 - Medicare Part D/prescription drug costs/medication adherence/depression ER - TY - RPRT T1 - Does Retirement Impact Health Care Utilization? Y1 - 2015 A1 - Norma B Coe A1 - Gema Zamarro KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - The objective of this paper is to estimate the causal effect of retirement on health care utilization. To do so, we use data from the 1992-2008 waves of the Health and Retirement Study (HRS) and the 2004-2006 waves of the Survey of Health, Aging, and Retirement in Europe (SHARE).In particular, we estimate the causal impact of retirement on health care utilization as measured by: doctor visits, visits to a general practitioner, nights in the hospital, and preventative care use. This paper uses panel data and instrumental variable methods, exploiting variation in statutory retirement ages across countries, to estimate the causal effects. Cross-country comparisons allow us to examine the role of a health care system s use of the general practitioner as a gate keeper to specialists in this relationship. We find that while retirement is associated with increased health care use, our causal estimates show that retirement leads to fewer doctor visits in both the US and continental Europe. Nights in the hospital are unaffected by retirement status. Further we find that health care systems with primary care physicians who act as gatekeepers are particularly effective at decreasing doctor visits at retirement. Therefore, we conclude that increasing the statutory retirement age to help the solvency of the retirement systems will also increase doctor visits as individuals continue to work longer. In the US, the burden of this increased utilization will likely be borne by private insurance companies and public insurance to the extent it covers working individuals in their 60 s. European evidence suggests that this increase in doctor visits due to delayed retirement will be particularly evident in health systems without strong gatekeeper roles for general practitioners. PB - Los Angeles, CA, Center for Economic and Social Research, University of Southern California U4 - health/retirement/health care utilization/preventive care ER - TY - CHAP T1 - The Economic Security of Latino Baby Boomers: Implications for Future Retirees and for Healthcare Funding in the U.S. T2 - Challenges of Latino Aging in the Americas Y1 - 2015 A1 - Zachary Gassoumis A1 - Kathleen H. Wilber A1 - Torres-Gil, Fernando M. ED - William A. Vega ED - Kyriakos S Markides ED - Jacqueline L. Angel ED - Torres-Gil, Fernando M. KW - Consumption and Savings KW - Healthcare KW - Net Worth and Assets KW - Public Policy KW - Women and Minorities JF - Challenges of Latino Aging in the Americas PB - Springer CY - New York U4 - health Care Costs/Latinos/economic security/Public Policy/economic disparity JO - The Economic Security of Latino Baby Boomers: Implications for Future Retirees and for Healthcare Funding in the U.S. ER - TY - THES T1 - The effects of housing wealth on education and other essays in empirical microeconomics Y1 - 2015 A1 - Ruddy, Ryan KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Public Policy KW - Women and Minorities AB - This dissertation is composed of three essays. The first essay, Family Resources and Secondary Education Investment: Evidence From the Housing Boom uses plausibly exogenous home price increases during the housing boom in the late 1990's and early 2000's to identify the effect of family resources on investment in secondary education. Exploiting the large spatial and timing variation of home price changes during this period, I find the average home price increase lowered the probability of dropping out of high school by age 19 by 1 percentage point, a 10% reduction. Consistent with an increased expectation of ability to pay for college, home price increases also raised the probability of completing a college preparatory curriculum and attending college. Students who reported low grades in eighth grade respond the strongest to home price increases suggesting that merit-based scholarship programs might be less beneficial than scholarship programs which are not contingent on ability. Black students of all ability levels are more likely to remain in high school in response to a home price increase. A mean change in home price decreased the probability of black students dropping out by 20%. The second chapter, The Effect of Housing Wealth on Labor Market Outcomes and Behavior , expands on the findings of Chapter 1 and previous literature that found a link between housing wealth and education by examining the impact of home wealth on adult labor market outcomes and behavior. Using the NLSY97, I measure the effect of a change in home price while in high school on income at age 26, job industry, criminal behavior, and community participation. I find evidence that home wealth shocks increase the probability of holding white collar jobs, increase wages, and positively impact behavior outcomes. These effects are likely manifesting through the increased education found in previous work. The final chapter examines the effect of the introduction of Sildenafil (Viagra) on marriage rates for elderly men in the United States. I exploit the sudden introduction and rise of Viagra use along with the difficulty in obtaining Viagra prescriptions for men with heart problems or history of stroke in a difference in difference framework to find the effect of Viagra on marriage rates. I find that men physically able to take Viagra which married prior to the introduction of Viagra were more likely to remain in their current marriage or enter a new marriage after Viagra's introduction. Furthermore, I find no evidence that the marital behavior of women was altered by health conditions at the time of Viagra's introduction. PB - University of Houston CY - Houston VL - 3663742 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1705295501?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-21 First page - n/a U4 - 0501:Economics JO - The effects of housing wealth on education and other essays in empirical microeconomics ER - TY - THES T1 - Engagement in activities and cognitive functioning among older adults in the health and retirement study T2 - Psychology Y1 - 2015 A1 - May, Pamela E. KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - The goal of this dissertation is to examine the effect of cognitive and social activities on cognitive performance and health conditions in a national sample of older adults from the Health and Retirement Study (HRS). This dissertation first aimed to identify longitudinal relations between activity frequency and cognitive functioning. Two hypotheses were tested, baseline activity frequency predicts change in cognitive functioning over time, and baseline cognitive performance predicts change in activity frequency over time. The dissertation's second aim was to identify links between activity frequency and cognitive trajectories. The third aim was to identify longitudinal relations between activity frequency and overall health. Changes in cognitive functioning and health were also compared simultaneously over three time points, to identify causal relations. The sample included 3,397 respondents aged ? 60 years old from the Health and Retirement Study's 2008, 2010, and 2012 waves. Respondents completed brief cognitive tests and items regarding their health during each wave, as well as items ranking frequency of engagement in cognitive and social activities in 2008 and 2012. A series of structural equation models were implemented to test the aforementioned aims. A paucity of significant findings precluded a comparison between the two hypothesized models on activity frequency and cognitive functioning, as well as between the two contrasting models for activity frequency and overall health. Activity frequency did not significantly predict rate of change in cognitive performance or health conditions over time. Activity frequency also did not significantly change over time. However, frequency of baseline cognitive activity was associated with initial level of episodic memory. Further, a lower frequency of cognitive activities was associated with a higher number of health conditions at baseline, when education was not included in the model. Relations between health and cognition were not consistently indicated over time, suggesting that health conditions may not have strong causal effects on age-related changes in cognitive functioning. Significant associations between baseline activity engagement and initial level of episodic memory and health conditions does not allow one to rule out the protective effect of activity engagement on cognition and overall health. JF - Psychology PB - Wayne State University VL - Ph.D. U4 - Social sciences JO - Engagement in activities and cognitive functioning among older adults in the health and retirement study 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 in industrial organization Y1 - 2015 A1 - Bayot, Denrick Go KW - Consumption and Savings KW - Employment and Labor Force KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Other KW - Risk Taking AB - Chapter 1 considers markets where there are gains to committing to a contract but the contract is not enforceable. Contracts in these markets typically contain some feature that locks the noncommittal agent, such as a penalty for defaulting on a contract. I argue that these lock-in mechanisms might lead to inefficient contract provisions when there is some uncertainty in the agent's valuation of the contract, and such uncertainty cannot be contracted. I then apply this argument when examining the extent to which life insurance contracts drafted today exhibit this form of ex-post inefficiency. There are a few reasons why one would suspect the existence of excessive insurance provisions in the life insurance industry. First, premiums in life insurance contracts are heavily front-loaded to subsidize subsequent premiums. The front-loading of premiums in these contracts and reduction of future premiums, as nicely pointed out by Hendel and Lizzeri (2003), allows firms to insure against rising premiums (insurance against reclassification risk) by reducing the policyholder's incentive to drop a contract and shop for a possibly less expensive policy. Indeed, I find that the level at which these contracts are front-loaded eliminates any future incentive for policyholders to repurchase a contract. I also provide evidence that a policyholder's preference for insuring against mortality risks changes stochastically over time. Despite heavy premium front-loading, almost 40% of policyholders allow their insurance to lapse within the first 10 years. Considering that premiums are lower than the cost of supplying mortality risk insurance and that preferences for such insurance changes over time, one would suspect excessive ex-post life insurance provisions. The core analysis of Chapter 1 discusses why the market for term life insurance contracts fail to fully protect policyholders from reclassification risk. Hendel and Lizzeri (2003) argue that such failure arises from the policyholder's limited-commitment and credit constraints. In particular, they surmise that a policyholder's credit constraint prevents the level of front-loading necessary to prevent all healthy policyholders from eventually walking out. The anticipated default of healthy policyholders then leads to a partial break-down in reclassification risk insurance. I investigate this premise and find that limited commitment alone fails to explain the break-down in full reclassification risk insurance observed in the life-insurance industry. I find that efforts to mitigate ex-post inefficient insurance provisions led to the breakdown of full reclassification risk insurance in this market. Chapter 2 is a joint work with Juliette Caminade and explains why prices of champagne fall during the holiday season. In this chapter, we document countercyclical prices in the sparkling wine market during the holiday season. While quantity demand doubles, prices uniformly decrease and decreases by 16% on average. We examine the role of changes in aggregate elasticity during high demand periods. Using Nielsen retail data, we find that price elasticity for sparkling wine increases by 50% during the holidays. We then use household-level data to document how the change in demand is driven by the entry of a large share of new consumers. These consumers are responsible for a quarter of sales during the holidays and are more price elastic. For instance, they spend less on other alcoholic beverages, and they are more likely to use coupons for their purchases or buy generic products. These suggestive facts are confirmed by the results of our household level demand estimation, where we find that changes to aggregate elasticity is driven by the entry of a more elastic segment. PB - The University of Chicago CY - Chicago VL - 3712084 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1707673975?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 - 2015-09-08 First page - n/a U4 - 0501:Economics JO - Essays in industrial organization ER - TY - THES T1 - Essays on Health Economics Y1 - 2015 A1 - Ippolito, Benedic N. KW - Employment and Labor Force KW - Healthcare KW - Income KW - Insurance KW - Methodology KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - The first chapter, co-authored with Michael Batty, investigates how financial constraints influence hospital care. Specifically we study the impacts of recently enacted state "Fair Pricing" laws, which explicitly limit how much hospitals can collect from uninsured patients. Using the Nationwide Inpatient Sample, we find that the introduction of a fair pricing law leads to reductions in the amount of care delivered to uninsured patients, but find no evidence of deterioration of short-term quality of care. Overall, our results provide strong evidence that hospitals actively alter their behavior in response to financial incentives, and are consistent with the laws promoting a shift towards more efficient care delivery. In the second chapter I investigate how retirement incentives embedded in health insurance contracts influence labor market decisions of older workers. Employers typically offer one of two types of health plans: tied contracts (coverage ends at retirement) or retiree contracts (coverage continues in retirement). In comparison to a retiree plan, a tied contract provides an obvious incentive to delay retirement, but which workers stay? Particularly, what are the health characteristics of workers who respond to the incentives of the tied contract? I show that, contrary to suggestions in the literature, tied contracts produce advantageous selection. Additionally, I investigate the fact that tied contracts are consistently found to delay retirement even after age 65 - at which point workers are eligible for Medicare coverage. I show that this "excess retention" effect is entirely driven by workers with younger spouses who do not have their own insurance. The final chapter is joint work with Michael Batty and Joseph Levy, and examines how physician behavior responds to the introduction of a "panel-based" compensation structure - where a large portion of compensation is based on the number of patients a provider is responsible for, rather than the amount of work actually done. Taking advantage of a natural experiment at a large academic health system, we show that physician behavior is surprisingly unresponsive to changes in incentives - particularly for those who experienced a clear reduction in production incentives. PB - The University of Wisconsin - Madison CY - Madison, WI VL - 3714612 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1700219263?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 - 2015-08-26 First page - n/a U4 - 0769:Health care management JO - Essays on Health Economics ER - TY - THES T1 - Essays on Health Economics and Consumer Finance Y1 - 2015 A1 - Batty, Michael M. KW - Consumption and Savings KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - Chapter 1: Recently enacted state laws that limit how much hospitals can charge uninsured patients provide a unique opportunity to study how financial incentives of healthcare providers affect the care they deliver. Using an event study framework, we find that these fair pricing laws lead to a seven to nine percent reduction in the average length of hospital stay for uninsured patients. Although the longer-term effects of these care reductions are uncertain, they are not accompanied by worsening of short-term measures of quality of care. Overall, our results provide strong evidence that hospitals actively alter their behavior in response to financial incentives, and are consistent with the laws promoting a shift towards more efficient care delivery. Chapter 2: The list price for an average unit of care is more than three times what a hospital will be paid for treating a typical patient, and different hospitals charge widely different prices for the same service. These facts may seem innocuous, but many uninsured and out-of-network patients do pay list price. This paper uncovers patterns in hospital list prices, and explores several potential explanations. We find that markups vary much more across hospitals than within, but geography and quality of care explain little of the overall variation. Further, large, urban, well-equipped, for-profit hospitals have the highest list prices. A quirk in the Medicare Outlier Payment formula appears to have contributed to rapid price increases prior to 2004. Overall, our findings are consistent with more financially-sophisticated and profit-motivated hospitals more aggressively pursuing revenue from uninsured and out-of-network patients. Chapter 3: Many researchers and policy makers worry that Americans are not saving adequately for retirement. However, it is difficult to agree upon what constitutes adequate savings. This paper compares wealth accumulation patterns of different cohorts of Americans born in the first half of the 20th century. This comparative standard frames the retirement prospects of future and recent retirees in terms of the documented retirement experiences of older generations. Contrary to common perception, I find that the wealth accumulation of Americans nearing and entering retirement today is very similar to that of older generations. PB - The University of Wisconsin - Madison CY - Madison, WI VL - 3708721 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1697328358?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 - 2015-08-26 First page - n/a U4 - 0501:Economics JO - Essays on Health Economics and Consumer Finance ER - TY - THES T1 - Essays on Intergenerational Transfers Y1 - 2015 A1 - Sean Fahle KW - Adult children KW - Healthcare KW - Methodology KW - Public Policy AB - The chapters of this dissertation examine transfers between generations across three distinct contexts: a potential role for informal care in U.S. long-term care policy (Chapter 1), the effect of caregiving on bequests (Chapter 2), and making inferences about intra-household allocations using data on intergenerational transfers (Chapter 3). The first chapter poses the question: how can government policy leverage family caregiving to make Medicaid financing of long-term care more sustainable without compromising the well-being of elderly beneficiaries and their families? This question is addressed using a partial equilibrium life-cycle model augmented with a repeated game played between an elderly parent and her adult child over long-term care and living arrangements. The results indicate that policies which either expand access to consumer-directed home care or provide direct financial compensation to caregivers can result in a substantial reduction in the use of institutional care, an increase in informal caregiving, and a decrease in government expenditures. The second chapter is one of the first studies to examine bequest patterns and their determinants using data on actual bequests from a large and approximately representative, longitudinal survey of the U.S. population over age 50. The results indicate that caregiving from and co-residence with adult children are important predictors of the division of assets among children, with child caregivers receiving larger bequests than non-caregivers. The effects are strongest for bequests of housing assets. The salience of housing assets is further supported by evidence of a relationship between ownership of housing assets and the receipt of informal care from children near the end-of-life. The third chapter utilizes a novel source of variation, intergenerational financial transfers from parents to children, to recover the intra-household allocation of resources (the "sharing rule") in a collective model of household behavior. The identifying assumption is that financial transfers from a household to, for instance, the wife's own children (the stepchildren of her husband) can be regarded as the private consumption (an "assignable" good) of the wife. The results indicate that married women receive roughly half of household resources and that an increase in a wife's wage increases her share of household income. PB - University of California, Los Angeles CY - Los Angeles VL - 3704330 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1685959877?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-21 First page - n/a U4 - 0501:Economics JO - Essays on Intergenerational Transfers ER - TY - THES T1 - Essays on Intergenerational Transfers and Living Arrangements T2 - Economics Y1 - 2015 A1 - Fu, Chien-Hao KW - Adult children KW - Event History/Life Cycle KW - Healthcare KW - Methodology KW - Public Policy AB - Intergenerational relationships are playing an increasingly important role in today's family life. In this study, I utilize the data from the Health and Retirement Study (HRS) to explore the linkage between children's residences and their relationships with their parents. I first show that children in closer proximity to their parents are more likely to receive financial transfers from parents, and the differences of the proximity's effect suggest that parents' financial transfers are at least in part to compensate for children's future care provisions. I then present a theoretical framework to analyze adult children's residential decisions in relation to the distance of parents' residences. The model highlights the tradeoff for the children of being closer to the parents for the lower cost of providing care and having easier access to assist parents versus being closer to his or her desired location of residence that provides better amenities or services. The empirical analysis supports the prediction from the theoretical model: children with lower income, who are less educated, or are not working full-time, tend to live closer to the parents, whether comparing children across families or within a family. The results also demonstrate that living arrangements are closely linked to family caregiving arrangements as gender, sibship size, and sibling's residence all play a role in a child's residential decision. Lastly, I examine the Great Recession's impacts on living arrangements and care access for elderly parents and find that for average families, little has changed in terms of their proximity to their children or the gender disparity of care assignment. However, families whose mother was living under the poverty line saw increases in the number of children living in close proximity. Further analysis shows that the changes in living arrangements during the recession are strongly associated with the changes of children's financial situations, but its relationship with parent's conditions are mixed. By presenting the theoretical framework and empirical results about family living and caregiving arrangements, this study helps bridge the gap between the two lines of literature and provides a more integrated view of the intergenerational relationships for the elderly parents. JF - Economics PB - University of Washington VL - Ph.D. IS - 3723990 U4 - Individual and family studies JO - Essays on Intergenerational Transfers and Living Arrangements 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 - Estimating health demand for an aging population: A flexible and robust bayesian joint model JF - Journal of Applied Econometrics Y1 - 2015 A1 - Arnab Mukherji A1 - Satrajit Roychoudhury A1 - Pulak Ghosh A1 - Sarah Brown KW - Healthcare KW - Public Policy AB - We analyse two frequently used measures of the demand for health-hospital visits and out-of-pocket health care expenditure-which have been analysed separately in the existing literature. Given that these two measures of health demand are highly likely to be closely correlated, we propose a framework to jointly model hospital visits and out-of-pocket medical expenditure, which allows for the presence of nonlinear effects of covariates using splines to capture the effects of aging on health demand. The findings from our empirical analysis of the US Health and Retirement Survey indicate that the demand for health varies with age. UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84927935252andpartnerID=40andmd5=a897b45b1f3b7e3f81211af451723deb U4 - health Care Utilization/public policy/hospitalization ER - TY - THES T1 - Familial Caregiving and Timing of Retirement: A Gendered Cohort Analysis Y1 - 2015 A1 - Rachel R Stoiko KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Retirement Planning and Satisfaction AB - Retirement timing has been linked to a host of outcomes for individuals, families, and communities. Well-known predictors of retirement timing include health, wealth, and cognitive capacity; a few studies have also linked gender and family caregiving to retirement timing. In the present study, data from the Health and Retirement Study were used to create profiles of pre-retirement family caregiving (operationalized as time and financial transfers to participants' aging parents and adult children). These profiles, as well as participant gender and cohort, were used to predict later retirement timing. All profiles retired, on average, earlier than their full eligibility for Social Security benefits. The Eldercare profile, which was characterized by high levels of time and financial transfers to aging parents, retired the earliest. On average, women retired earlier than men. Members of the War Babies cohort (b. 1941-1947) retired earlier than members of the HRS cohort (b. 1931-1941). There was not a significant interaction between caregiving profile and gender, revealing that when men enacted female-typical caregiving roles, their retirement timing resembled women's. Implications for individual retirement decision-making and policy are discussed. PB - West Virginia University CY - Morgantown, WV VL - 3718575 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1708653547?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-09-02 First page - n/a U4 - 0620:Developmental psychology JO - Familial Caregiving and Timing of Retirement: A Gendered Cohort Analysis ER - TY - THES T1 - Go Gentle into That Good Night The Past, Present, and Future of End-of-Life Care Y1 - 2015 A1 - Adam E Singer KW - Gerontology KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Policy KW - Public Policy KW - Retirement Planning and Satisfaction AB - End-of-life care has received increasing attention in recent years as the baby boomers age and health care costs continue to rise. This attention has brought with it remarkable growth in the field and improvement in care, but there remains work to be done in order to more consistently deliver high quality, compassionate, and patient- and family-centered end-of-life care. In this dissertation, I examine the past, present, and future of end-of-life care in order to shed light on the most effective ways to organize and deliver it. In the first analysis, I describe changes in symptom prevalence in the last year of life from 1998 to 2010. I find that the many important and troubling end-of-life symptoms, including pain and depression, became more common over that time frame, and that no symptom became less common. These changes occurred at the same time national efforts were underway to improve end-of-life care, which calls into question the nature of these changes and highlights the need to reexamine aspects of the delivery of end-of-life care. In the second analysis, I review the current evidence for palliative health services interventions to identify the populations that are appropriate for palliative care and the interventions that are effective in improving patient and family quality of life and reducing health care use and costs. I find that there are a broad range of currently available interventions that span a variety of goals, settings, and providers; that certain types of interventions are more or less effective for certain quality of life outcomes; and that health care use and cost outcomes are poorly studied overall. Some of these results enhance the existing understanding of what makes for effective end-of-life care. This information can be used in designing end-of-life care programs and in organizing research priorities for the field. In the third analysis, I simulate how cost and quality of life outcomes could fare through 2040 if three of the most effective palliative health services interventions identified in the second analysis were implemented today. I find that all three interventions lower health care costs, reduce mortality, improve quality-adjusted life years, and reduce pain, depression, and activities of daily living dependencies. These results highlight the benefit to individuals and to society of implementing evidence-based approaches to end-of-life care. PB - The Pardee RAND Graduate School CY - Santa Monica, CA VL - 3663332 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1695319615?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-28 First page - n/a U4 - 0351:Gerontology JO - Go Gentle into That Good Night The Past, Present, and Future of End-of-Life Care ER - TY - JOUR T1 - Grandchild care, intergenerational transfers, and grandparents labor supply JF - Review of Economics of the Household Y1 - 2015 A1 - Ho, Christine KW - Adult children KW - Healthcare AB - One-fifth of children aged below five with employed mothers benefit from grandparent provided child care as their main source of daycare in the US. Using data from the health and retirement study, we investigate how grandchild care needs relate to intergenerational transfers of time and money and grandparents labor supply behavior. We find that grandparents with a new born grandchild are more likely to provide grandchild care while married grandparents are also more likely to be employed and provide financial help. Grandparents with grandchildren living close by provided higher time transfers while married grandmothers with resident grandchildren also worked longer hours. PB - 13 VL - 13 UR - http://dx.doi.org/10.1007/s11150-013-9221-x U4 - Grandchild care/Intergenerational transfers/Grandparents ER - TY - JOUR T1 - Grip Strength Values Stratified by Age, Gender, and Chronic Disease Status in Adults Aged 50 Years and Older JF - Journal of Geriatric Physical Therapy Y1 - 2015 A1 - Amy M Yorke A1 - Amy B. Curtis A1 - Shoemaker, Michael A1 - Vangsnes, Eric KW - Disabilities KW - Health Conditions and Status KW - Healthcare KW - Other AB - Background and Purpose: Grip strength is a measure of overall muscle strength and has been found to be a predictor of disability and mortality. Almost 3 in 4 adults aged 65 years and older have multiple chronic conditions, known as multimorbidity. Normative data for grip strength have commonly been reported on healthy convenience samples that may not accurately represent the population of interest. Grip strength values of US adults, utilizing a nationally representative data set based on the number of chronic diseases, would be beneficial to health care providers who serve adults with multimorbidity. The purpose of this study was to describe grip strength values of adults in the United States, based on gender, age, and the number of chronic diseases. Methods: A cross-sectional analysis was conducted using data collected from adults aged 50 years or older (n = 5877) from the Health and Retirement Study survey administered in 2008. Grip strength values (in kilograms) were determined and stratified on the basis of the number of self-reported chronic diseases (0, 1, 2, = 3) and stratified by age (decades) and gender. Results: Consistent with previously published values, males demonstrated higher mean hand grip strength than females and grip strength values decreased with age. Adults with multimorbidity demonstrated decreased grip strength as compared with those without chronic conditions (males/females with 0 chronic diseases right grip strength GRAPHICS = 44.2/26.8 kg as compared with males/females with 3 or more chronic disease right grip strength GRAPHICS = 36.1/21.7 kg). Conclusions: The grip strength values presented can serve as a standard of comparison for the large proportion of adults who have multimorbidity. Clinicians should consider grip strength as a component of a comprehensive physical assessment to identify decreased grip strength and recommend increased physical activity as an appropriate intervention. PB - 38 VL - 38 IS - 3 N1 - Times Cited: 1 0 1 U4 - Grip strength/muscle Weakness/disability/disability/mortality/Physical Activity/Assessment ER - TY - THES T1 - Health Changes after Diabetes Diagnosed in Middle and Old Age: Physical, Mental and Cognitive Health Trajectories and Social Stratification Y1 - 2015 A1 - Ndao-Brumblay, Sokhna Khady KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - The current study focuses exclusively on middle-aged and old-aged adults with incident diabetes, and describes the course of diabetes in late adulthood in terms of physical, mental, and cognitive health change. To do this, it utilizes time-varying diabetes duration as the measure of time to define health trajectories after diabetes diagnosis. The study consists of three empirical analyses of the Health and Retirement Study, an ongoing representative biennial panel survey of Americans age 50 and older. Each study covers a different domain of health, and together they provide a comprehensive and dynamic view of people's experiences with diabetes. Hierarchical linear models of health change with longer diabetes duration (used as the measure of time), reveals that the course of diabetes is characterized by a quadratic acceleration in physical disability and a linear decline in mental and cognitive health. People who are older at the time of diagnosis, younger cohorts, women (due to lower socioeconomic status), blacks and Hispanics (partly due to socioeconomic disadvantage and health disparities before diagnosis) are generally at increased risk of a poor course of diabetes, when compared to their counterparts. Cumulative or persistent socioeconomic disadvantages were found for all outcomes, with worse health trajectories among older adults whose socioeconomic status was lower, with the exception of those in the top two income quartiles, who experienced a faster decline in mental health despite better scores at diagnosis. The study results confirm that diabetes cannot be viewed as a time-constant individual characteristic. Rather, the clinical course of diabetes in terms of physical, mental, and cognitive health changes with longer diabetes duration. Social variations in these changes need to be better understood so that effective healthcare and policy interventions can be devised to ensure successful and equitable aging with late-onset diabetes. PB - University of Michigan CY - Ann Arbor U4 - Sociocultural Factors JO - Health Changes after Diabetes Diagnosed in Middle and Old Age: Physical, Mental and Cognitive Health Trajectories and Social Stratification ER - TY - THES T1 - How socioeconomic status shapes health: Essays on the biological and social determinants of human welfare at older ages Y1 - 2015 A1 - Lauren L Schmitz KW - Demographics KW - Employment and Labor Force KW - Genetics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - Economic and epidemiological research has long established that socioeconomic status (SES) and the core characteristics that define it--education, earnings, and occupation--are strongly associated with health and mortality. However, the actual pathway these interventions and life circumstances take to affect health is not well known, and more research is needed to identify how socioeconomic-related health disparities develop and "get underneath the skin." This dissertation considers the influence of early- and late-life occupational stressors in tandem with genetic inheritances and other elements of SES to better understand how biological and social determinants cumulate over the life span and affect the health of greying populations. The first chapter explores whether characteristics of the physical and psychosocial work environment shape the health gradient in the years leading up to retirement. Dynamic panel and instrumental variable (IV) methods are used in combination with a rich data set that combines demographic information from the Health and Retirement Study (HRS), expert ratings on job characteristics from the Occupational Information Network (O*NET), and W-2 earnings records to draw more robust connections between workplace demands and health at older ages. Results indicate physical demands, environmental hazards, and conditions of the psychosocial work environment are all associated with health outcomes after age 50. In particular, there is a strong relationship between the degree of control and influence exercised on the job and improved self-reported health status, blood pressure, musculoskeletal conditions, cognitive function, and depression. The second two chapters use IV methods that exploit an exogenous shock to occupation at a young age--the Vietnam-era draft lotteries--to investigate genotype-by-environment interactions. Instrumented veteran status is interacted with polygenic scores for smoking initiation and educational attainment to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on health behaviors, educational attainment, earnings, and labor force participation at older ages. Results reveal conscription both amplified polygenic risk for smoking and moderated the socioeconomic attainment of veterans, indicating genetic inheritances further mediate the gestation of health disparities across the life course. PB - The New School CY - New York VL - 3707744 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1696935312?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-28 First page - n/a U4 - 0501:Economics JO - How socioeconomic status shapes health: Essays on the biological and social determinants of human welfare at older ages ER - TY - JOUR T1 - The Impact of Cognitive Impairment and Comorbid Depression on Disability, Health Care Utilization, and Costs JF - Psychiatric Services Y1 - 2015 A1 - Xiang, Xiaoling A1 - An, Ruopeng KW - Health Conditions and Status KW - Healthcare AB - Objectives: This study examined the impact of co-occurring cognitive impairment and depression on functional limitations, hospital and nursing home admissions, and out-of-pocket expenditures (OOPEs) among older adults. Methods: Individual mixed-effects regressions were performed to examine the relationship between cognitive impairment and depression and selected outcomes among 18,315 community-dwelling adults ages 50 and over from the Health and Retirement Study from 1998 to 2010. Results: Cognitive impairment and depression were independently associated with the outcomes of interest, and the estimated effects were largest among individuals with both conditions. Cognitive impairment with comorbid depression predicted limitations in activities of daily living (odds ratio OR =3.02) and instrumental activities of daily living (OR=4.18), hospitalizations (OR=1.53), nursing home admissions (OR=3.34), and an increase of 1,150 in annual OOPEs. Conclusions: Compared with cognitive impairment or depression alone, cognitive impairment plus depression was associated with substantial functional limitations, health services utilization, and costs. PB - 66 VL - 66 UR - http://dx.doi.org/10.1176/appi.ps.201400511 IS - 11 U4 - Patient admissions/Patient admissions/depression/Cognitive impairment/Health services utilization/Mental depression/Health care expenditures/Out of pocket costs ER - TY - THES T1 - Individual personality differences in adjustment to retirement T2 - Psychology Y1 - 2015 A1 - Eby, Rachel E. KW - Health Conditions and Status KW - Healthcare KW - Other KW - Retirement Planning and Satisfaction AB - Retirement is an important life event to study at present, because more people are entering their retirement years and are spending more time in retirement than ever before in our nation's history. Historically, research has shown mixed results on effects of retirement that are not accurately explained by any one theory. These mixed results suggest the possibility of individual differences in retirement adjustment that may not be accounted for with aggregated data. Wang, Henkens, and Shultz (2011) proposed a comprehensive framework of retirement adjustment: the resource-based dynamic perspective, which reasons that adjustment is influenced by antecedent variables, via level of resources possessed by the individual at a given time. The current study seeks to assess the relation between personality as an antecedent variable and retirement adjustment in a longitudinal analysis of participants from the nationally representative Health and Retirement Study. Resources are also modeled as covariates in the analysis. Results should be interpreted with caution due to limitations in model fit. Results from the Growth Mixture Model (GMM) revealed two classes of retirement trajectories and certain personality traits were significant as predictors for these trajectories. Implications for both research and practice are discussed. JF - Psychology PB - Colorado State University VL - M.S. U4 - Psychology JO - Individual personality differences in adjustment to retirement 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 - Longitudinal analyses of obesity determinants and associated health outcomes in the U.S. middle-aged and older adults Y1 - 2015 A1 - Chen, Cheng-Chia KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Other KW - Public Policy AB - This dissertation consists of two sub-studies. Sub-study 1 attempted to examine the longitudinal effects of individual demographics, state-level socioeconomic status (SES), density of fast food restaurants, and proportion of people who walk to work on body mass index (BMI) among adults aged 50 years and older from 2000 to 2010. Data were drawn from the 2000-2010 Health and Retirement Study (HRS) and the 2010 U.S. Census. Respondents who lived at the same census tract during 2000-2010 (N=6,156) were included. A three-level growth model was fit to model BMI trajectories. BMI significantly increased over time showing both a linear and quadratic decelerating trajectory (p<.001). Women living in states with a lower state-level SES had higher BMI level while men living in states with higher state-level SES had a higher BMI (b=-0.242, p=.013). For people living in states with a higher proportion of people who walk to work, Hispanics had higher BMI level at the baseline and lower BMI growth rate, compared with non-Hispanic whites (b=-0.033, p<.001). Evidence suggests that we should provide sex responsive interventions and better walking environments to tackle obesity epidemic. Sub-study 2 investigated the effects of Part D implementation on health outcomes among the U.S. older adults. Data from the 2004-2008 HRS respondents who further participated in the HRS 2005-2007 Prescription Drug Study and consented to share their Medicare claims were analyzed (N=746). A panel ordered logistic regression with a difference-in-differences approach was used to examine the Part D effect on patients' health outcomes before and after Part D implementation. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (OR=0.48; p <.05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activity daily living impairment (ORs=1.12, 1.17, and 1.36, respectively; all ps <.001). The Part D implementation appeared to have a positive effect on older adults' overall health status. Reducing healthcare cost would likely encourage older adults to utilize more needed medications and help maintain better health. PB - Indiana University CY - Bloomington, IN VL - 3712177 U4 - Public health JO - Longitudinal analyses of obesity determinants and associated health outcomes in the U.S. middle-aged and older adults ER - TY - CHAP T1 - Long-Term Care in the United States T2 - Financial Capability and Asset Holding in Later Life: A Life Course Perspective Y1 - 2015 A1 - Jennifer C. Greenfield ED - Morrow-Howell, Nancy ED - Sherraden, Margaret S. KW - Healthcare KW - Public Policy JF - Financial Capability and Asset Holding in Later Life: A Life Course Perspective PB - Oxford University Press CY - New York U4 - Long Term Care/Public Policy JO - Long-Term Care in the United States ER - TY - JOUR T1 - The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers JF - Social Science and Medicine Y1 - 2015 A1 - Erika L. Sabbath A1 - Mejía-Guevara, Iván A1 - Noelke, Clemens A1 - Lisa F Berkman KW - Adult children KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Risk Taking AB - Background: Work stress and family composition have been separately linked with later-life mortality among working women, but it is not known how combinations of these exposures impact mortality, particularly when exposure is assessed cumulatively over the life course. We tested whether, among US women, lifelong work stress and lifelong family circumstances would jointly predict mortality risk. Procedures: We studied formerly working mothers in the US Health and Retirement Study (HRS) born 1924-1957 (n = 7352). We used sequence analysis to determine five prototypical trajectories of marriage and parenthood in our sample. Using detailed information on occupation and industry of each woman's longest-held job, we assigned each respondent a score for job control and job demands. We calculated age-standardized mortality rates by combined job demands, job control, and family status, then modeled hazard ratios for death based on family constellation, job control tertiles, and their combination. Results: Married women who had children later in life had the lowest mortality risks (93/1000). The highest-risk family clusters were characterized by spells of single motherhood (132/1000). Generally, we observed linear relationships between job control and mortality hazard within each family trajectory. But while mortality risk was high for all long-term single mothers, we did not observe a job control-mortality gradient in this group. The highest-mortality subgroup was previously married women who became single mothers later in life and had low job control (HR 1.91, 95 CI 1.38,2.63). Practical implications: Studies of associations between psychosocial work characteristics and health might consider heterogeneity of effects by family circumstances. Worksite interventions simultaneously considering both work and family characteristics may be most effective in reducing health risks. (C) 2015 Elsevier Ltd. All rights reserved. PB - 146 VL - 146 U4 - Social determinants of health/sequence analysis/Single motherhood/Job control/Work family conflict/Job stress/Job strain/mental health/risk factors/cardiovascular disease/public Policy/Working women/Health risk assessment/Occupational stress/Working mothers ER - TY - THES T1 - The Mechanism of Ageism: The Relationship Between Perceived Ageism and Depressive Symptoms in Later Life Y1 - 2015 A1 - Kim, Hyejin KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - Extending the human life span has long been a desire of human beings. It seems the wish has been actualized. However, simply living a long life does not always seem to be a blessing. Older adults report a lower level of psychological well-being and quality of life and even have a higher rate of suicide, compared to the general population. Furthermore, as older adults are likely to experience the death of a loved one, deteriorating health, retirement, and changing relationships with others, older adults have a high risk of depression. Social work has a long history of providing social services to older adults. In particular, social work has provided older adults with a variety of services to enhance their quality of life and mental health status. Because ageism is one form of discrimination that social work has long been concerned with, this study focuses on the relationship between perceived ageism and depressive symptoms among older adults. Therefore, the purpose of this study is to examine the relationship between perceived ageism and depressive symptoms among older adults and to investigate the mechanism linking perceived ageism to late-life depression. Three primary effects were examined: the direct effect of perceived ageism on depressive symptoms in later life, the mediating effects of self-perception of aging and purpose in life on the relationship between perceived ageism and late-life depression, and the moderating effect of perceived ageism on the association between religiosity and depression among older adults. The stress process model was used to provide an overall idea to explain the three types of the effects related to the mechanism of ageism. Cooley's looking-glass self, Beck's cognitive theory of depression, and Levy's stress embodiment theory were used to explain the mediating effect of self-perception of aging, and Beck's cognitive theory of depression was applied again to clarify the mediating effect of purpose in life. The stress buffer theory and the life-span theory of control indicated the moderating effect of perceived ageism on the relationship between religiosity and depression. Secondary analysis of existing data was conducted using the Health and Retirement Study (HRS) datasets, a longitudinal panel study of the U.S. population ages 50 and over. The sample of this study was 3,991 participants, who were older adults ages 65 and over and whose answers were available for the study analyses. Descriptive and preliminary analyses were performed to roughly examine the relationships between variables. With regard to the direct effect of perceived ageism on depressive symptoms, multiple regression analyses were performed controlling for significant variables. With regard to the mediating effects of self-perception of aging and purpose in life, structural equation modeling (SEM) analyses using structural regression models were conducted. In respect to the moderating effect of perceived ageism on the relationship between religiosity and depression, SEM analyses with multiple groups were performed. Based on the results of the several different analyses, a direct relationship between perceived ageism and late-life depression was found. That is, older adults who perceive ageism are likely to have a higher level of depressive symptoms than their counterparts. This direct relationship between perceived ageism and late depressive symptoms among older adults, however, was not detected after controlling for self-perception of aging and purpose in life, indicating the full mediation effects of self-perception of aging and purpose in life. That is, older adults who perceive ageism are likely to have negative self-perception of aging, and this negative view of their own aging is likely to increase depressive symptoms. Additionally, older adults who have a negative view of their aging are likely to have a negative view of their future, and this lower purpose in life also increases depressive symptoms. The strength of the effect of religiosity on depression did not differ between the perceived age sm and the not perceived ageism groups, indicating no moderating effect of perceived ageism on the relationship between religiosity and depression. This study contributes to the existing body of knowledge by providing the information about the relationship between perceived ageism and depression and the mechanism of this relationship. Also, this study re-examined and supported established theories in the context of perceived ageism. Additionally, the current study suggests the necessity of anti-ageism policies and social work services and describes possible ways of providing such social policies and social work services at the micro, mezzo, and macro levels. The results of this study imply that more efforts and resources are necessary to reduce ageism and its negative effect on depression among older adults, and these efforts will eventually contribute to making a more just, better society. PB - The Florida State University VL - Ph. D. UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1729637475?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: N1 -

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Last updated - 2016-01-07

U4 - Depressive Symptoms JO - The Mechanism of Ageism: The Relationship Between Perceived Ageism and Depressive Symptoms in Later Life ER - TY - JOUR T1 - More Caregiving, Less Working: Caregiving Roles and Gender Difference JF - Journal of Applied Gerontology Y1 - 2015 A1 - Lee, Yeonjung A1 - Tang, Fengyan KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Healthcare AB - This study examined the relationship of caregiving roles to labor force participation using the nationally representative data from the Health and Retirement Study. The sample was composed of men and women aged 50 to 61 years (N = 5,119). Caregiving roles included caregiving for spouse, parents, and grandchildren; a summary of three caregiving roles was used to indicate multiple caregiving roles. Bivariate analysis using chi-square and t tests and binary logistic regression models were applied. Results show that women caregivers for parents and/or grandchildren were less likely to be in the labor force than non-caregivers and that caregiving responsibility was not related to labor force participation for the sample of men. Findings have implication for supporting family caregivers, especially women, to balance work and caregiving commitments. PB - 34 VL - 34 UR - http://jag.sagepub.com/content/early/2013/10/29/0733464813508649.abstract IS - 4 U4 - Caregiving Role/Labor Force Participation/Spouse Caregiving/Parent Caregiving/Grandchild Caregiving/Gender Difference ER - TY - THES T1 - No Place Like Home? Disability and Living Arrangements in Later Life T2 - Health Services Research, Policy and Administration Y1 - 2015 A1 - Carrie Elizabeth Henning-Smith KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy KW - Retirement Planning and Satisfaction AB - Current literature on the relationships between disability and both the physical and social environments of one's living arrangement is scarce. The relationship between disability and living arrangements in later life is inherently complex, yet it has the potential to impact older adults' lives in significant ways. With this dissertation, I sought to address this gap in the literature and add to our understanding of how older adults' environments and functional statuses interact. My specific aims were to: 1.) Describe the living arrangements of older adults with disabilities; 2.) Estimate the risk of developing disability by type of living arrangement (both housing type and household composition) for older adults; and, 3.) Estimate the risk of having a change in living arrangement by disability status for older adults. For all three aims, I also examined how the relationships between living arrangements and disability differed by age and socio-economic status. Data came from the American Community Survey (2012; n=504,371 adults age 65 and older) and the Health and Retirement Study (1998-2012; n=43,182 observations.) In Aim 1, I found that disability was most prevalent for older adults living in situations other than with a spouse only and that the odds of disability was highest for older adults living with children (without a spouse.) Compared with living in a single-family home, the odds of disability were higher for older adults living in mobile homes and large apartment buildings. In Aim 2, I found that living in a nursing home or with others was associated with an increased risk of disability, but that living alone was associated with a decreased risk of disabilities related to Instrumental Activities of Daily Living (IADLs.) This latter finding only held true for more affluent older adults, however; the poorest older adults faced an increased risk of disability if they lived alone. Finally, in Aim 3, I found that having IADL and ADL (Activities of Daily Living) disabilities together was predictive of moving, long nursing home stays, and death. ADL and IADL disabilities separately were predictive of long nursing home stays and death, while prior living arrangements were more predictive of moving than individual ADL or IADL disability status. For all of my findings, disability rates were highest among the poorest and oldest older adults. Older adults with the lowest socioeconomic status were also more likely to live alone, with non-spousal others, in rented homes, and in mobile homes or apartment buildings. This population may need additional resources to foster supportive living arrangements and to mitigate disability risk. These findings can be used to identify where older adults with disabilities live and where to target interventions to prevent worsening disability. JF - Health Services Research, Policy and Administration PB - University of Minnesota VL - Ph.D. IS - 3728265 U4 - Aging JO - No Place Like Home? Disability and Living Arrangements in Later Life 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 - Older Adults Reporting More Diabetes Mellitus Care Have Greater 9 Year Survival JF - Journal of the American Geriatrics Society Y1 - 2015 A1 - Benjamin H Han A1 - Caroline S Blaum A1 - Rosie Ferris A1 - Lillian C. Min A1 - Pearl G. Lee KW - Health Conditions and Status KW - Healthcare AB - To determine whether receiving more recommended diabetes mellitus (DM) care processes (tests and screenings) would translate into better 9-year survival for middle-aged and older adults. Longitudinal mortality analysis using the Health and Retirement Study Diabetes Mailout Survey. Health and Retirement Study (HRS). Individuals aged 51 and older (n = 1,879; mean age 68.8 or - 8.7, 26.5 aged a yen 75) with self-reported DM who completed the Diabetes Mailout Survey and the core 2002 HRS survey. A composite measure of five self-reported diabetes mellitus care process measures were dichotomized as greater (3-5 processes) versus fewer (0-2 processes) care processes provided. Cox proportional hazards models were used to test relationships between reported measures and mortality, controlling for sociodemographic characteristics, function, comorbidities, geriatric conditions, and insulin use. Prevalence of self-reported care processes was 80.1 for glycosylated hemoglobin test, 75.9 for urine test, 67.5 for eye examination, 67.7 for aspirin counseling, and 48.2 for diabetes education. In 9 years, 32.1 respondents died. Greater care correlated with 24 lower risk of dying (adjusted hazard ratio = 0.76, 95 confidence interval = 0.64-0.91) at 9-year follow up. When respondents were age-stratified (a yen 75 vs 75) longer survival was statistically significant only in the older age group. Although it is not possible to account for differences in adherence to care that may also affect survival, this study demonstrates that monitoring of and counseling about types of DM care processes are associated with long-term survival benefit even in individuals aged 75 and older with DM. PB - 63 VL - 63 IS - 12 U4 - diabetes mellitus/process of care measures/quality of care/Hemoglobin/Diabetes therapy/Diabetes ER - TY - JOUR T1 - Patient Characteristics and Differences in Hospital Readmission Rates JF - JAMA internal medicine Y1 - 2015 A1 - Barnett, M. L. A1 - John Hsu A1 - J. Michael McWilliams KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Public Policy AB - IMPORTANCE Medicare penalizes hospitals with higher than expected readmission rates by up to 3 of annual inpatient payments. Expected rates are adjusted only for patients' age, sex, discharge diagnosis, and recent diagnoses. OBJECTIVE To assess the extent to which a comprehensive set of patient characteristics accounts for differences in hospital readmission rates. DESIGN, SETTING, AND PARTICIPANTS Using survey data from the nationally representative Health and Retirement Study (HRS) and linked Medicare claims for HRS participants enrolled in Medicare who were hospitalized from 2009 to 2012 (n = 8067 admissions), we assessed 29 patient characteristics from survey data and claims as potential predictors of 30-day readmission when added to standard Medicare adjustments of hospital readmission rates. We then compared the distribution of these characteristics between participants admitted to hospitals with higher vs lower hospital-wide readmission rates reported by Medicare. Finally, we estimated differences in the probability of readmission between these groups of participants before vs after adjusting for the additional patient characteristics. MAIN OUTCOMES AND MEASURES All-cause readmission within 30 days of discharge. RESULTS Of the additional 29 patient characteristics assessed, 22 significantly predicted readmission beyond standard adjustments, and 17 of these were distributed differently between hospitals in the highest vs lowest quintiles of publicly reported hospital-wide readmission rates (P = .04 for all comparisons). Almost all of these differences (16 of 17) indicated that participants admitted to hospitals in the highest quintile of readmission rates were more likely to have characteristics that were associated with a higher probability of readmission. The difference in the probability of readmission between participants admitted to hospitals in the highest vs lowest quintile of hospital-wide readmission rates was reduced by 48 from 4.41 percentage points with standard adjustments used by Medicare to 2.29 percentage points after adjustment for all patient characteristics assessed (reduction in difference: -2.12; 95 CI, -3.33 to -0.67; P = .003). CONCLUSIONS AND RELEVANCE Patient characteristics not included in Medicare's current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher vs lower readmission rates. Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve. PB - 175 VL - 175 IS - 11 U4 - medicare/ADMINISTRATIVE DATA/hospital readmission/Public Policy/health care ER - TY - THES T1 - Perceived Control, Chronic Stress, and Geriatric Frailty: Explicating Frailty's Psychosocial Etiology Y1 - 2015 A1 - Christopher J Mooney KW - Demographics KW - Gerontology KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - Frailty in older adults is a highly prevalent syndrome that is characterized by increased vulnerability to stressors and is more generally thought to result from dysregulation across multiple physiologic systems. Although research has long recognized that psychosocial factors including chronic stress and perceived control influence geriatric health outcomes, relatively little research has explored their etiologic role in the development of frailty. Thus, the primary purpose of this study was to close key knowledge and methodological gaps that exist within the extant literature and to develop empirically based insights into the psychosocial etiology of geriatric or phenotypic frailty, using the allostatic load model of stress and a model of perceived control as guiding theoretical frameworks. Using a population-based sample of older adults from the Health and Retirement Study, the present study found a frailty prevalence of 7-8% in study subsamples. In structural equations modeling, the present study found that perceived control fully mediated the chronic stress and baseline phenotypic frailty and change in phenotypic frailty relationship, as well partially mediated the relationship linking socioeconomic status and baseline phenotypic frailty and change in phenotypic frailty. Multiple group analyses supported hypotheses that the mediating role of control was equivalent across gender and racial subgroups. Contrary to hypotheses, the present study found no evidence to support a stress-buffering or moderating effect of perceived control on baseline or change in phenotypic frailty status. Findings from the study advance the understanding of frailty's psychosocial etiology and underscore the importance of psychosocial factors in senescence and older adult health more generally. PB - University of Rochester CY - Rochester, NY VL - 3745430 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1756721437?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 2015 Last updated - 2016-02-11 U4 - 0451:Social psychology JO - Perceived Control, Chronic Stress, and Geriatric Frailty: Explicating Frailty's Psychosocial Etiology ER - TY - JOUR T1 - Predictors of functional limitation trajectories after injury in a nationally representative U.S. older adult population JF - Annals of Epidemiology Y1 - 2015 A1 - Teresa M. Bell A1 - Wang, Junling A1 - Nolly, Robert A1 - Ozdenerol, Esra A1 - Relyea, George A1 - Ben L. Zarzaur KW - Demographics KW - Disabilities KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare AB - Studies examining postinjury functional status have demonstrated that individuals with severe injuries often do not return to baseline levels of physical functioning. We sought to investigate the impact injuries have on changes in physical functioning across the life course of older adults. The study's objectives were to (1) identify trajectories of long-term functional limitations after injury in the older adult population to better characterize the recovery process and (2) predict which individuals are most at risk for poor functional trajectories after injury. A retrospective cohort study was conducted using six waves of data from the Health and Retirement Study, which surveys Americans older than 50 years every two years. A group-based trajectory model was used to identify trajectories of functional limitations in injured participants. Using multivariate regression, we identified significant predictors of each trajectory. Five distinct trajectories were identified: Trajectory 1-consistently low functional limitations scores (18.9 ), Trajectory 2-increase in functional limitations after injury followed by a gradual, incomplete recovery (46.3 ), Trajectory 3-increase in functional limitations followed by further decline in functioning (10.5 ), Trajectory 4-increase in functional limitations after injury followed by a gradual, complete recovery (13.4 ), and Trajectory 5-consistently high functional limitations scores (10.8 ). Gender, multiple health conditions, and insurance status predicted trajectory membership. Functional limitations after injury follow distinct trajectories that can be predicted by baseline individual characteristics. PB - 25 VL - 25 IS - 12 U4 - Disability/Disability/Life course epidemiology/Quality of Life/Aging/Trauma/Functional Assessment/Functional limitations/Trajectories ER - TY - THES T1 - Purpose in Life and Cardiovascular Health Y1 - 2015 A1 - Eric S Kim KW - Health Conditions and Status KW - Healthcare KW - Other AB - A growing body of research suggests that purpose in life may provide a point of intervention to improve the health behaviors and health of the large segment of adults throughout the world who are progressing into old age. Researchers have recently documented robust associations between purpose and enhanced health behaviors and outcomes. Preliminary studies also indicate that purpose can be systematically enhanced. Further research examining the connection between purpose, health behaviors, and outcomes is needed to guide the design of novel and low-cost prevention and intervention programs. To date, little research has investigated purpose in life's association with cardiovascular health or the possible mechanisms behind this link. In four distinct but linked papers, I use data from the Health and Retirement Study, a nationally representative sample of U.S. adults over the age of 51 to examine this research gap. The first and second studies examined the connection between purpose and cardiovascular health. Each unit increase in purpose (on a 6-point scale) was longitudinally associated with a decreased risk of stroke (OR = 0.78, 95% CI = 0.67-0.91) and myocardial infarction (OR = 0.73, 95% CI = 0.57-0.93), even after adjusting for an array of covariates. The third study examined a potential mechanism behind the purpose and health connection and tested whether higher baseline purpose predicted increased use of six preventive health care services over time. Results showed that higher purpose predicted higher use of cholesterol tests, mammograms, pap smears, prostate exams, and colonoscopies, but not flu shots. The fourth study used structural equation modeling to longitudinally examine if four health behaviors mediated the association between purpose and myocardial infarction. Results showed that only physical activity (β = -.026; 95% CI = -.042, -.009) and smoking (β = -.016; 95% CI = -.035, .004) mediated the association between purpose and myocardial infarction, while sleep quality and cholesterol tests did not. Taken together, these studies expand the literature by enhancing our knowledge about the association between purpose and cardiovascular health. These results are also the first to illuminate how health behaviors mediate the association between purpose and cardiovascular disease. PB - University of Michigan CY - Ann Arbor, MI U4 - intervention JO - Purpose in Life and Cardiovascular Health ER - TY - JOUR T1 - Racial/Ethnic Differences in Cost-Related Nonadherence and Medicare Part D: A Longitudinal Comparison JF - Journal of Health Care for the Poor and Underserved Y1 - 2015 A1 - Bakk, Louanne KW - Demographics KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Public Policy KW - Women and Minorities AB - Little is known about whether racial and ethnic disparities in cost-related medication nonadherence (CRN) have changed since the implementation of Medicare Part D. This longitudinal study examined the impact of Part D on CRN among racial and ethnic minority Medicare beneficiaries, age 65 and older. Nationally representative data were obtained from the Prescription Drug Study and Health and Retirement Study. A differences-in-differences approach was used to compare CRN among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites. The results indicate CRN was higher among the two minority groups than among non-Hispanic Whites before and after Medicare Part D. Mixed-effects logistic regression analyses show that CRN did not significantly change between pre- and post-Medicare Part D for any of these three groups. However, older non-Hispanic Blacks and Hispanics had a larger reduction in CRN than non-Hispanic Whites. These findings suggest that despite Medicare Part D, racial and ethnic disparities in CRN persist. PB - 26 VL - 26 IS - 4 N1 - Times Cited: 0 0 U4 - cost-related nonadherence/adherence interventions/adherence interventions/sociodemographic differences/sociodemographic differences/Minority and ethnic groups/PRESCRIPTION DRUG COVERAGE/HEALTH INSURANCE/public policy/ethnicity/Medicare Part D/Prescription drugs ER - TY - JOUR T1 - The Relationship between Psychosocial Factors and Breast Cancer Screening Behaviors of Older Hispanic Women JF - Social Work in Public Health Y1 - 2015 A1 - Tamara J. Cadet KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Guided by the theory of planned behavior, this study utilized data from the 2008 wave of the Health and Retirement Study to investigate psychosocial factors associated with older Hispanic women's participation in breast cancer screening services. Hierarchical logistic regression models were used to assess the odds of breast cancer screening participation. Findings indicate that satisfaction with aging and constraints were associated with a reduced likelihood of participating in breast cancer screening. These findings suggest the continued importance to assess older women's attitudes when discussing preventive services. PB - 30 VL - 30 IS - 2 N1 - Times Cited: 0 0 U4 - Planned behavior/psychosocial factors/psychosocial factors/hispanics/women/breast cancer/health screening ER - TY - JOUR T1 - Retirement Timing of Women and the Role of Care Responsibilities for Grandchildren JF - Demography Y1 - 2015 A1 - Lumsdaine, Robin L. A1 - Stephanie J. C. Vermeer KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Retirement Planning and Satisfaction AB - This article considers the potential relationship between providing care for grandchildren and retirement, among women nearing retirement age. Using 47,444 person-wave observations from the Health and Retirement Study (HRS), we find that the arrival of a new grandchild is associated with more than an 8 increase in the retirement hazard despite little overall evidence of a care/retirement interaction. We document that although family characteristics seem to be the most important factors driving the care decision, they are also important determinants of retirement. In contrast, although financial incentives such as pensions and retiree health insurance have the largest influence on retirement, the opportunity cost associated with outside income seems to have little effect on whether a grandmother provides care. There is little evidence of substitution between caring for grandchildren versus providing care for elderly parents or engaging in volunteer activities; grandchild care is instead taken on as an additional responsibility. Our findings suggest that policies aimed at prolonging work life may need to consider grandchild care responsibilities as a countervailing factor, while those policies focused on grandchild care may also affect elderly labor force participation. PB - 52 VL - 52 IS - 2 N1 - Times Cited: 0 0 U4 - retirement planning/child Care/family Characteristics/caregiver burden/grandchild care/labor Force Participation ER - TY - THES T1 - Risk, functional outcomes, and the utilization of rehabilitation services among survivors of cerebrovascular accident: A pooled, cross-sectional population-based study Y1 - 2015 A1 - Keptner, Karen M KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Risk Taking AB - Many studies conducted on risk factors for cerebrovascular accident (CVA) rely on homogeneous populations from small geographic areas and lack information about relevant personal and clinical features. Very few studies have looked at long-term functional ability following CVA. CVA clinical guidelines for recommend on-going use of rehabilitation by CVA survivors, but little is known about the extent to which this occurs. The Health and Retirement Study, a nationally, representative sample from the US, and linked Medicare claims data were used to study incidence and effects of first CVA, functional ability of CVA survivors, and the utilization of rehabilitation by survivors. The data were pooled cross-sectionally and Generalized Estimating Equations were utilized as the primary analysis method. Results confirm previous findings that age, gender, and smoking status increase CVA risk. The study also found that: 1) Individuals who were disabled had increased risk for CVA. 2) Age, education, and overweight BMI had a significant effect on the odds of dying in those sustaining a CVA. 3) Of those who survived CVA more than 2 years, age and type of CVA were predictive of worse functional ability. 4) Age, race, co-morbidity, current use of rehabilitation, and depressive symptoms were all associated with worse post-CVA functional ability. 5) Employment status and physical activity behaviors at baseline, better cognition, social support, and mild initial severity of CVA were all predictive of better post-CVA functional ability. 6) Age, type of CVA, and recurrent CVA were the primary predictors of rehabilitation use. 7) Those who were employed at baseline used less rehabilitation services overall. Study findings suggest that 1) the role of employment and BMI in CVA risk and severity should be further studied; 2).attention by healthcare providers to post-CVA depression, cognition, and social support might improve CVA survivors' functional ability; and 3) health system factors, such as medical provider knowledge and attitudes about rehabilitation services, may need to be studied to understand variation in CVA clinical guideline implementation. Overall, this study demonstrates the value of using large databases to study utilization of rehabilitation services. PB - Case Western Reserve University CY - Cleveland, OH U4 - clinical decision-making JO - Risk, functional outcomes, and the utilization of rehabilitation services among survivors of cerebrovascular accident: A pooled, cross-sectional population-based study ER - TY - JOUR T1 - Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study JF - Journal of Geriatric Psychiatry and Neurology Y1 - 2015 A1 - Pertl, Maria M. A1 - Lawlor, Brian A. A1 - Robertson, Ian H. A1 - Walsh, Cathal A1 - Brennan, Sabina KW - Health Conditions and Status KW - Healthcare AB - Caring for a spouse with dementia is a chronic stressor that may compromise caregivers own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments. PB - 28 VL - 28 UR - http://jgp.sagepub.com/content/early/2015/06/10/0891988715588834.abstract IS - 4 U4 - caregiver burden/dementia/cognitive impairment/stress/activities of daily living/depression ER - TY - THES T1 - Risk Predictors, Outcomes, and Costs of Falls among Older Adults Living in the Community Y1 - 2015 A1 - Geoffrey J Hoffman KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy KW - Risk Taking AB - Background: Non-injurious falls (NIFs) and fall-related injuries (FRI) among older adults are common and impose substantial health burdens. Risks include health and health behavior factors, medications, and environmental hazards. Non-injurious falls (NIFs) and fall-related injuries (FRIs) may particularly compromise older adults' ability to engage in social and recreational activities and activities of daily living and can generate chronic stress, resulting in depressive symptoms. Previous studies have used depression to predict falls, but are potentially subject to endogeneity bias by not controlling for other temporal associations between falls and depression. With 2.5 million and .75 million FRIs treated in emergency departments and hospitals, respectively, FRIs also have important Medicare cost implications. However, existing FRI cost estimates are inconsistent, ranging from $2,000 to $26,000, and traditional FRI identification methods likely undercount FRIs. Three studies were conducted to assess relationships between (1) falls and caregiving, (2) falls and depressive symptoms, and (3) FRIs and Medicare costs. Methods: First, 10 survey waves of pooled data from the 2000-2010 Health and Retirement Study (HRS) were used to compare risks of NIFs and FRIs among respondents receiving and not receiving formal and/or informal caregiving assistance in the past two years. Stratified models were used to assess whether cognitive impairment modified the relationship between caregiving receipt and fall risk. Next, using 2006-10 HRS data, "cross-lagged panel" analyses using structural equation modeling were conducted to evaluate temporal associations between falls and depressive symptoms. Structural coefficients of pathways between falls and depressive symptoms (in 2006[arrow right]2008 and 2008[arrow right]2010) were estimated, controlling for baseline (2006) latent factors: poor physical health status (indicated by vision, hearing, cognitive status, activities of daily living, chronic disease, and functional limitations), perceived social support, and social cohesion. Finally, 2007-9 Inpatient, Outpatient, Carrier, Skilled Nursing Facility, Home Health, Durable Medical Equipment, and Hospice Medicare claims and linked 2008 HRS survey data were used to estimate the difference in predicted medical cost change scores (12-month post-index minus 12-month pre-index costs) for an FRI compared to a non-FRI cohort. For this analysis, linear regression models adjusted for sociodemographic characteristics, indicators of health status (sensory impairments, cognitive status, and indices for functional limitations and chronic health conditions), and geographic factors were used. Four different methods--using (1) external cause-of-injury codes (e-codes) and a select set of inpatient ICD-9 diagnostic codes, (2) e-codes, inpatient diagnostic and outpatient diagnostic and procedure codes, (3) e-codes and a broad set of diagnostic codes, and (4) e-codes only--were used to identify FRIs in the claims data. Population: Community-dwelling older adults (ages 65 and older). For the first study, 17,420 unique individuals (172 with cognitive impairment), with a total of 63,542 pooled person-wave observations; for the second study, 13,439 individuals; and for the third study, 5,548 individuals (103 FRI and 5,445 non-FRI) with continuous Medicare Parts A/B coverage and alive during the 24-month study period. Results: For the first study, adjusting for sociodemographic and health characteristics, relative to no care received, older adults receiving low levels of informal care had a 3 percentage-point increase in NIF risk and 2 percentage-point increase in FRI risk while those receiving high levels of informal care had a 4 percentage-point increase in FRI risk. However, those receiving both formal and informal care had a 4 percentage-point (or 20%) decrease in NIF risk. Wald tests showed that those receiving formal care only or formal care and informal care had lower NIF and FRI risks than those receivin informal care only. Among those with cognitive impairment, older adults receiving informal and formal care generally had reduced NIF and FRI risks compared to those receiving no care. For the second study, both the NIF (χ 2 (dfs = 266) = 2,646.39, p <0.001, Comparative Fit Index (CFI) = 0.944, Root Mean Square Error of Approximation (RMSEA) = 0.026) and FRI (χ2 (dfs = 267) = 2,511.52, p <0.001, CFI = 0.945, RMSEA = 0.025) models had acceptable fit. Depressive symptoms predicted future NIFs (unstandardized structural probit coefficients = 0.85 for 2006[arrow right]2008 and 0.83 for 2008[arrow right]2010, p <0.001), a relationship potentially mediated by psychotropic drug use; however, NIFs did not predict future depressive symptoms. Depressive symptoms predicted future FRIs (unstandardized structural probit coefficients = 1.00, p <0.001 for 2006[arrow right]2008 and 0.95, p <0.001 for 2008[arrow right]2010). For the third study, average, unadjusted medical costs during the 12-month follow-up period were $23,429 and $9,818 for FRI and non-FRI cohort individuals, respectively. The estimated change score difference between the FRI and non-FRI cohort was $14,879 (p<0.001) using the first FRI identification method using e-codes and a select set of inpatient ICD-9 diagnostic codes. Change score differences were $6,587 for inpatient, $2,476 for outpatient, $4,595 for SNF, and $1,141 for HH. Overall change score differences were $11,678 (p<0.001), $8,963 (p<0.001), and $12,757 (p<0.001) using the second, third, and fourth FRI identification methods (using varying sets of e-codes and inpatient and outpatient diagnostic and procedural codes), respectively. An FRI increased the risk of persistently high costs using all identification methods. Findings were robust to the inclusion of pre-index costs as a predictor and respondents who died during the study. Conclusion: For the first study, caregiving receipt significantly predicted falls, but was not uniformly negatively associated with NIF and FRI risk. The 20% risk reduction among those receiving formal and informal care was comparable to common falls prevention interventions. While informal care may encourage more activity and risk-taking, formal caregivers may prevent risky behaviors associated with falls and cognitively impaired individuals may particularly benefit from caregiving in preventing falls. For the second study, compared to latent indicators of poor physical health status and social factors, depressive symptoms are strong predictors of older adult NIFs and FRIs. Controlling for these confounders, a one standard deviation increase in depressive symptom levels was associated with a 22% and 28% increase in the risk of future NIFs and FRIs, respectively. However, NIFs and FRIs were not associated with greater odds of future increased depressive symptoms. For the third study, FRIs were associated with substantial and sustained increases in Medicare spending. Substantial increases in medical costs associated with FRIs were driven by inpatient (44%), SNF (31%), outpatient/carrier (17%), and home health (8%) costs and FRIs increased the probability of having high cost in the four quarters following an index FRI from 11.6% to 19.5%, reflecting a 67% increase. The findings suggest a wide range of per-FRI as well as total FRI-related Medicare costs, depending upon the method used to identify FRIs in the claims data; per-FRI costs ranged from approximately $9,000 to $15,000 while total FRI-related Medicare costs ranged from $5 to $49 billion due to differing proportions of beneficiaries experiencing FRIs depending on the FRI identification method used. Implications: These findings suggest a potential opportunity for population health management of falls. To scale up falls prevention for falls costing Medicare billions of dollars per year, policymakers and providers should consider offering assistance to informal caregivers through educational outreach. Falls assessments should also include caregiving as an essential component. Prevention effo ts should include depressive symptomatology as a main falls risk factor and geriatric evaluations should emphasize the depressive symptoms--falls relationship. Current approaches to claims-based FRI identification and current FRI surveillance techniques may be inadequate. Given substantial, sustained costs of FRIs and known effectiveness of falls prevention efforts, Medicare should consider reimbursement for geriatric FRI risk prevention. PB - University of California, Los Angeles CY - Los Angeles VL - 3689159 U4 - Public health policy JO - Risk Predictors, Outcomes, and Costs of Falls among Older Adults Living in the Community 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 - Role of Place in Explaining Racial Heterogeneity in Cognitive Outcomes among Older Adults JF - Journal of the International Neuropsychological Society Y1 - 2015 A1 - Sze Y Liu A1 - M. Maria Glymour A1 - Laura B Zahodne A1 - Weiss, Christopher A1 - Jennifer J Manly KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Racially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We summarized the proportion of variation in outcomes attributable to state of school attendance and compared the magnitude of racial disparities across states. Among WHICAP African Americans, state of school attendance accounted for 9 of the variance in years of schooling, 6 of memory, and 12 of language. Among HRS African Americans, state of school attendance accounted for 13 of the variance in years of schooling and also contributed to variance in cognitive function (7 ), memory (2 ), and vocabulary (12 ). Random slope models indicated state-level African American and white disparities in every Census region, with the largest racial differences in the South. State of school attendance may contribute to racial disparities in cognitive outcomes among older Americans. Despite tremendous within-state heterogeneity, state of school attendance also accounted for some variability in cognitive outcomes. Racial disparities in older Americans may reflect historical patterns of segregation and differential access to resources such as education. PB - 21 VL - 21 IS - 9 N1 - Times Cited: 0 Si 0 U4 - Cognitive functioning/Geographical variation/Memory/AFRICAN-AMERICANS/DEMENTIA/CLINICAL NEUROLOGY/PSYCHIATRY/NEUROSCIENCES/MORTALITY/Sociocultural Factors ER - TY - THES T1 - Self-Rated Health, Social Engagement, and "Older Places" T2 - Sociology - LS Y1 - 2015 A1 - Eric M Vogelsang KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This dissertation consists of three essays that are motivated by an aging world. Its primary goals are to (a) identify how older adult health and its correlates--with a particular focus on social engagement--systematically differ by residential context; and (b) consider the implications of subjective health changes across older ages. The first chapter explores how the type and intensity of older-adult social participation varies by county-level population density. Using the 2003 and 2011 waves of the Wisconsin Longitudinal Study (n=3,006), I find that older adults living in rural counties with relatively low population densities are less socially active than their counterparts in higher-density counties. I also find that just five (of twelve) social activities are related to better health; while only three are associated with health change. Chapter two examines relationships between older adult health and living in relatively older and younger municipalities. Using a national sample of almost 5,000 Japanese older adults over two decades, I employ growth curve models to estimate how self-rated health and self-rated health trajectories differs by local area age structure. I find older adults living in the "oldest places" of Japan are more likely to report less than good health, when compared to those living in younger areas. In addition, relatively high levels of social engagement among older adults living in oldest areas help mitigate even greater odds of reporting worse health in these places. Chapter three explores how two measures of self-rated health (SRH) change are related to mortality. Data come from the Asset and Health Dynamics survey--the "oldest-old" portion of the Health and Retirement Study--and follow 6,233 individuals over thirteen years. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death; when compared to those with no change. These findings suggest that the well-established associations between SRH status and mortality may understate the risk of death for oldest-old individuals with recent subjective health improvements. JF - Sociology - LS PB - The University of Wisconsin - Madison VL - Ph.D IS - 3721759 U4 - Social sciences JO - Self-Rated Health, Social Engagement, and "Older Places" ER - TY - JOUR T1 - Sicker and Poorer: The Consequences of Being Uninsured for People With Disability During the Medicare Waiting Period JF - Health Services Research and Managerial Epidemiology Y1 - 2015 A1 - Yin, Na KW - Disabilities KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology AB - Purpose: Disabled individuals younger than 65 years are entitled to Medicare coverage through the Social Security Disability Insurance (DI) program, but only if they have completed a 2-year waiting period. This is the first study that uses longitudinal panel data, the Health and Retirement Study, and examines whether and to what extent the health and economic status are affected among disability beneficiaries who are uninsured during the Medicare waiting period.Methods: In a quasiexperiment research design, using a difference-in-difference (diff-in-diff) estimator, we compare changes in health and economic outcomes pre-/postentering the DI program for disability beneficiaries with alternative public health insurance and those without.Results: The adjusted diff-in-diff estimates suggest that disability beneficiaries who are uninsured during the waiting period, compared to those who are insured, are 13.6 percentage point more likely to report poor health, 6.3 percentage point less likely to be in excellent health, declare more difficulties in activities of daily living, and 30 higher medical expenditures from out of pocket.Conclusions: The findings highlight punitive health and economic effects of the Medicare waiting period for uninsured disability beneficiaries. We also discuss the implications of the findings for the Affordable Care Act reform. PB - 2 VL - 2 UR - http://hme.sagepub.com/content/2/2333392815571583.abstract U4 - Disability Insurance (DI) beneficiaries/Medicare waiting period/difference-in-difference/Affordable Care Act ER - TY - THES T1 - Social relationships, positivity, and personality in older adulthood Y1 - 2015 A1 - Iveniuk, James KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - In this dissertation, I examine the implications of personality traits for social relationships in older adulthood. My work brings together insights from mid-20th century sociological theory, recent work by social network scholars, and personality psychologists. I build upon these insights in order to examine not only if personality traits are important for social relationships, but also under what social and relational circumstances. The personality characteristic that I focus on in this dissertation is Positivity, which I conceptualize as a person's overall positive (i.e. upbeat and socially desirable) characteristic patterns of thought and behavior. I measure Positivity using structural equation modeling techniques, applied to a Big Five personality battery in the National Social Life, Health, and Aging Project (NSHAP), a nationally representative, longitudinal survey of older adults. I then employ Positivity scores in three empirical studies. In the first study, I examine older adults' social networks, and I find that Positivity is associated with feeling closer to one's confidants, and being more likely to open up to them about one's health. I also find that Neuroticism (emotional instability) is associated with being more likely to talk to one's friends about one's health. In the second study I use dyadic data from NSHAP to examine the implications of traits for marital conflict, with a focus on gender. I find that the Positivity of a husband is associated with reduced marital conflict according to the reports of his wife, but that a wife's Positivity is not associated with conflict according to her husband. In the final study I examine the implications of Positivity for the diagnosis of chronic conditions, using a combination of biomeasures and self-reports. I find that individuals who are more positive are more likely to be undiagnosed for their hyperglycemia, but not hypertension. I relate this finding to theories of doctor-patient interaction, as well as differences in medical procedures for diagnosing these two chronic conditions. I conclude by offering possibilities for sociological research on personality, arguing that issues related to personality cut across existing subfields of the discipline, and that these issues relate to key questions in sociological theory. PB - The University of Chicago CY - Chicago VL - 3687148 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1667702261?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 - 2015-04-14 First page - n/a U4 - NSHAP JO - Social relationships, positivity, and personality in older adulthood ER - TY - THES T1 - Social Resource Factors that Influence Cognitive Functioning of Aging Black Adults Y1 - 2015 A1 - Swett, Laura KW - Demographics KW - Event History/Life Cycle KW - Gerontology KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Women and Minorities AB - Social workers have found that aging adults are often challenged by reduced cognitive functioning, which impacts their health and mental health. Recent advances in knowledge indicate that social resources such as quality of emotional support and social integration can slow cognitive decline. Aging Black persons are twice more likely to have cognitive impairment than aging White persons. However, the majority of studies investigating associations or predictors of cognitive health are comprised of primarily White samples, and little is known regarding the effect of social resource factors on cognition in aging Black adults. Data for the study came from the 2010 wave of the Health and Retirement Study (HRS), an ongoing, longitudinal, population-based cohort study of adults ages 50 to 98. The analyzed sample was comprised of 338 men and 699 women who self-identified as African American/Black. Controlling for factors known to influence cognitive functioning, a multiple regression analysis of four categories of social resources was conducted, by gender, to determine their effect on global cognitive functioning: quality of social supports, social networks, social integration, and social influence. For Black men, emotional support from family and frequency of contact with their children were predictive of global cognition. For Black women, emotional support from friends was positively predictive of global cognition. Further, locus of control perceived constraints was inversely related with global cognition in men, while education was positively predictive of global cognition across gender. The findings demonstrate that the evaluative aspects of social relationships (perceptions of support) are important in predicting cognitive functioning for both genders, and the structural components (types of relationships or frequency of contacts) are important in predicting cognitive functioning for men. Additionally, this study validated the role of gender as a moderator between quality of social supports and global cognition, and as a moderator between social networks and global cognition in aging Black persons. Research grounded in intersectionality theory yielded unique information for Black men and women that is applicable for evidence-based practice interventions. Practices targeting the reduction of constraints and strengthening family, friend, and children networks in men, and practices assisting women in strengthening their friendship networks, may mitigate their cognitive decline and increase their global cognition as they age. PB - The Catholic University of America CY - Washington, DC VL - 3705749 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1705880418?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-08-28 First page - n/a U4 - 0296:African American Studies JO - Social Resource Factors that Influence Cognitive Functioning of Aging Black Adults 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 econometrics and health economics Y1 - 2015 A1 - Parish, William James KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology AB - This dissertation makes contributions to the field of health econometrics as well as the field of health economics. Chapter II presents a review of the "Cake Debates" literature. I also describe a generic econometric framework, which I use to clarify some points of controversy in the literature. Extant approaches to endogeneity in two-part models have failed to consider "separability." Chapter III presents a novel estimator that accounts for endogeneity without imposing "separability." Chapter IV presents a mediation analysis that explores whether improvements in beneficiary health can explain the negative relationship between Medicare Part D and the use of hospital care. PB - The University of North Carolina at Greensboro CY - Greensboro, NC VL - 3722547 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1722227114?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 - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works. Last updated - 2016-03-07 U4 - 0511:Economic theory JO - Three essays in health econometrics and health economics 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 - THES T1 - Three essays on public economics and policy Y1 - 2015 A1 - Li, Xiaoxue KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - This dissertation studies the effects of public programs that target at disadvantaged population. In particular, I examine the effects of these programs on individual well-being and whether these programs lead to behavior distortions. The dissertation consists of three essays that focus on different policy contexts and different populations. In the first essay, I examine the effects of an active labor market program on the labor market outcomes of veterans. In the 1990s, the US Department of Defense implemented the Transition Assistance Program (TAP) to help military personnel transition to the civilian labor market. The program provides career counseling, employment workshops, and information briefing on educational and medical benefits through the Department of Veterans Affairs. The goal of this study is to measure the long-run effects of TAP on the labor market outcomes of veterans. To identify these effects, I exploit variation in program accessibility generated by its initial rollout process. Using data from the veterans supplement to the Current Population Survey, survey years 2001, 2003 and 2005, I find that TAP improves the labor market outcomes of veterans, measured approximately ten years after their separation from the military. The effects of TAP on labor market outcomes vary across veterans with different lengths of military experience, and these effects attenuate over time. One possible mechanism is that TAP encourages use of the GI Bill, a program that provides tuition reimbursement and a monthly allowance to attend institutions of higher education. Moreover, the effect of TAP is concentrated among participants who, based on self-reports, find TAP most helpful in career related services. In the second essay, I examine linkages between Medicaid availability, insurance coverage for pregnant women, use of prenatal care and the health outcomes of newborns. Medicaid coverage for pregnant women would potentially improve health outcomes of newborns by providing medical services at no cost. At the same time, Medicaid provides an incentive for eligible individuals to drop private insurance coverage. I exploit variation from two federal Medicaid expansions in mid-1980s, which eliminated the eligibility discontinuity across age groups. The main data come from the National Hospital Discharge Survey and the Vital Statistics Birth Records. I employ a difference-in-differences method. Findings suggest that the expansions led to a relative increase in Medicaid coverage for women from the immediately affected age group by a significant 6.5 percentage points. However, up to 60% of new beneficiaries would have been covered by private insurance, absent of the expansions. Findings do not reveal significant improvement in birth outcomes, or increase in prenatal care utilization. In the third essay, I examine the effect of Medicaid on the asset holding behavior of the elderly. Medicaid provides coverage for nursing home care to elderly with limited resources. The eligibility rule potentially creates an incentive for the elderly to reduce their asset by making transfers to children. This study provides empirical evidence for the effect of Medicaid nursing home care policy on elderly's asset allocation. I exploit a policy change in 2006, the Deficit Reduction Act 2005, which imposed stricter penalty to asset transfer behavior when determining Medicaid eligibility. Using data from the Health and Retirement Survey, I employ a difference-in-differences method. I find that the elderly who anticipated nursing home entry significantly reduced asset transfer behavior by 3.2 to 4 percentage points, in response to the policy change. The result is robust across demographic groups and more pronounced for the elderly with the highest nursing home entry risk. The findings provide evidence of moral hazard in the public insurance market: the elderly would game with the system in anticipation of nursing home needs. PB - Syracuse University CY - Syracuse, NY VL - 3702323 U4 - Military studies JO - Three essays on public economics and policy ER - TY - THES T1 - Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S Y1 - 2015 A1 - Arora, Kanika KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Net Worth and Assets KW - Public Policy AB - Situated in the context of a rapidly aging population, this dissertation examines the implications of supplying long-term care (LTC) services to the elderly in the United States. The first two essays investigate private costs of LTC assistance borne by adult children of elderly parents. In contrast, the third essay focuses on the cost of publicly-provided, formal LTC services. The first essay analyzes whether adult children devote less time to exercise as time allocation in parental caregiving increases. The empirical model is a system of four correlated equations, where the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. I use pooled cross-sectional data from the Health and Retirement Study (HRS) for this analysis. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, nor in hours of work, among either men or women. The second essay goes beyond time resources and examines whether dementia onset in parents leads to a reduction in adult children's household wealth. Towards this, I construct a longitudinal dataset from seven waves of HRS. Estimates from unconditional quantile regressions indicate that parental dementia substantially reduces household wealth of an unmarried adult child in the upper quantiles of the wealth change distribution in the first two years after parental diagnosis. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent time period as well. An examination of mechanisms suggests that both, losses in labor income and nursing home expenditures, may play a role in leading to wealth declines. This paper makes two contributions: first, it focuses on a broader outcome of private cost, and second, unlike previous studies, it does not limit the analysis to adult children who are informal caregivers. The final essay examines the cost implications of publicly provided formal care services. Medicaid's Personal Care Services (PCS) State Plan benefit is a key mechanism through which states provide personal assistance services to eligible beneficiaries. But, it is widely claimed that states are reluctant to adopt the program over fears of runaway spending. Surprisingly, there has been very little empirical work on examining the effect of the PCS State Plan benefit on Medicaid expenditures. Using aggregate state-level data from 1975 through 2009, this study finds that PCS State Plan adoption had no overall effect on Medicaid expenditures, except briefly during the early-growth years in 1980s. Further, findings suggest that states make decisions to adopt the program based on financial experiences of other adopting states. This study provides evidence consistent with the interpretation that when faced with the dilemma of balancing increased access and uncontrolled expenditures, state officials adapt the design of an entitlement benefit in an effort to make it less expensive. In its entirety, the dissertation provides new thinking on two dominant themes in conventional long-term care research: "caregiver burden" and "woodwork effect". In particular, the results of the first and third essay question the presence of "caregiver burden" and "woodwork effect" respectively, while the third essay challenges the pervasiveness of "caregiver burden" among unmarried adult children. These findings, which in some aspect are unexpected in the context of existing literature, have important implications for policy intervention and the direction of future research efforts in this area. PB - Syracuse University CY - Syracuse, NY VL - 3713670 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1708672813?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-09-02 First page - n/a U4 - 0630:Public policy JO - Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S ER - TY - JOUR T1 - Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia JF - Journal of the American Geriatrics Society Y1 - 2015 A1 - Christopher M. Callahan A1 - Tu, Wanzhu A1 - Kathleen T. Unroe A1 - LaMantia, Michael A. A1 - Timothy E. Stump A1 - Daniel O. Clark KW - Health Conditions and Status KW - Healthcare AB - Objectives: To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. Design: Longitudinal cohort study. Setting: Health and Retirement Study (HRS). Participants: HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N=16,186). Measurements: Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. Results: The 3,447 (21.3 ) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2 returned home without home care services, and 33.8 transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2 transitioned to the hospital, and 25.3 returned home without services. There were 2,139 transitions to death, and 58.7 of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. Conclusion: In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition. PB - 63 VL - 63 IS - 8 N1 - Times Cited: 0 0 U4 - care transitions/cognitive Impairment/functional impairment/dementia/health services/cognitive function/Activities Of Daily Living ER - TY - JOUR T1 - Treatment Type and Demographic Characteristics as Predictors for Cancer Adjustment: Prospective Trajectories of Depressive Symptoms in a Population Sample JF - Health Psychology Y1 - 2015 A1 - Burton, C. L. A1 - Isaac R Galatzer-Levy A1 - George A. Bonanno KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - Objective: Prospectively identifying individuals at heightened risk for depression can alleviate the disease burden of distal physical and mental health consequences after cancer onset. Our objective was to identify heterogeneous trajectories of adjustment in cancer patients, using treatment-type as a predictor. Methods: Participants were followed for 6 years within the Health and Retirement Study (HRS), a prospective population-based cohort study. The sample consisted of 1,294 middle-aged participants who were assessed once before and 3 time points after their report of an initial cancer diagnosis. In addition to self-reported depressive symptoms, subjects indicated receipt of surgical, radiological, or chemical interventions as part of their usual oncological care. Results: Four symptom trajectories were identified with Latent Growth Mixture Modeling: an increasing depression (10.5 ), chronic depression (8.0 ), depressed-improved (7.8 ), and stable-low depression (73.7 ). A conditional model using participants with available predictor data (n = 545) showed individuals in the emerging depression class were significantly more likely to have received chemo/medication therapy when compared with the remitting depression, stable-low, and chronic depression classes. Participants in the chronic and depressed-improved classes generally had worse baseline health, and the depressed-improved were also younger in age. Conclusion: Patients who exhibited increasing depressive symptoms had a greater probability of receiving chemo/medication therapy than any other adjustment trajectory group, although the majority of chemotherapy patients did not exhibit depressive symptom changes. These data underscore the diversity of ways that patients adjust to cancer, and suggest cancer treatment, baseline health, and age may influence long-term patterns of psychological adjustment. VL - 34 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84905632394andpartnerID=40andmd5=50975e20c6acc9448c575b737f6424e8 IS - 6 N1 - Cited By :1 Export Date: 20 January 2015 Article in Press U4 - adjustment/cancer/chemotherapy/heterogeneity/Depressive Symptoms/Treatment effect/disease burden/psychological aspects ER - TY - RPRT T1 - Unequal Bequests Y1 - 2015 A1 - Francesconi, Marco A1 - Robert A. Pollak A1 - Tabasso, Domenico KW - Adult children KW - Healthcare KW - Other AB - Using data from the Health and Retirement Study (HRS), we make two contributions to the literature on end-of-life transfers. First, we show that unequal bequests are much more common than generally recognized, with one-third of parents with wills planning to divide their estates unequally among their children. These plans for unequal division are particularly concentrated in complex families, which are of two types: families with stepchildren and families with genetic children with whom the parent has had no contact, e.g., children from previous marriages. We find that in complex families past and current contact between parents and children reduces or eliminates unequal bequests. Second, although the literature focuses on the bequest intentions of parents who have made wills, we find that many older Americans have not made wills. Although the probability of having a will increases with age, 30 percent of HRS respondents aged 70 and over have no wills. Of HRS respondents who died between 1995 and 2010, 38 percent died without wills. Thus, focusing exclusively on the bequest intentions of parents who have made wills may provide an incomplete and misleading picture of end-of-life transfers. PB - Cambridge, United States, National Bureau of Economic Research, Inc. UR - http://search.proquest.com/docview/1728706877/1B5FA0446C27487FPQ/27 U4 - altruism/bequests/evolutionary motives/exchange/family structure/intergenerational transfers ER - TY - THES T1 - Using mixed methods to identify the characteristics of older fraud victims Y1 - 2015 A1 - DeLiema, Marguerite KW - Consumption and Savings KW - Employment and Labor Force KW - Gerontology KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - In 2011, 7.3% of U.S. adults ages 65-74 and 6.5% of adults ages 75 and older were victims of financial fraud (Anderson, 2013). In addition to the billions of dollars lost annually to scams, indirect societal costs include paying for the care and support of elders who lost their life savings, and the expense of investigating cases and prosecuting offenders. One of the first steps in stopping fraud is determining who is most vulnerable, yet the research literature on risk factors presents a conflicting narrative. Some research studies and consumer protection agencies report that older adults are the most vulnerable age group due to greater social isolation and impairments in financial decision-making however, national prevalence studies have found that elders are the least likely to experience fraud. According to the Financial Fraud Research Center (2012), research identifying the specific risk factors that make elders susceptible to fraud is important to inform policies and where to target resources. After describing the prevalence, cost, and mechanisms of fraud, this dissertation discusses multiple theoretical explanations for why older adults are vulnerable. Chapter I presents a temporospatial framework for fraud based on the routine activity theory (Cohen & Felson, 1979) and an ecological theory of elder financial exploitation (Rabiner, O'Keefe, & Brown, 2004). The adapted model proposes that targets and scam artists are nested within the broader social and political macrostructure comprised of public policy and legislation on consumer protection, prevention/education efforts to reduce fraud, fraud reporting mechanisms, and society's values, beliefs and attitudes about older adults. In the following three empirical chapters, a mixed methods approach is used to identify the demographic, socioeconomic, psychological and cognitive characteristics of older fraud victims using the nationally-representative Health and Retirement Study (HRS) and a sample of victims in Los Angeles County. Researchers have observed that different types of fraud target different socio-demographic groups (Pak & Shadel, 2011). To identify heterogeneity among the respondents who reported fraud in the HRS, Chapter III employs latent class analysis (LCA) to test the hypothesis that older victims of fraud vary in terms of their socioeconomic and demographic characteristics. Two distinct victim classes (i.e., typologies, profiles) emerged from the analysis. Based on the distribution of socioeconomic and demographic characteristics within each group, Class 1 was descriptively labeled " high-SES middle-age married adults, " and Class 2 was labeled " low-SES older widowed females ." The high-SES middle-aged married adult group was larger than the low-SES older widowed female group, suggesting that the former group of victims is more prominent in the U.S. population over age 50. High-SES middle-aged married adults had higher average levels of cognitive functioning and also experienced a higher average number of stressful life events in the past five years compared to low-SES older widowed females . Using a national sample, this analysis provides comparable results to earlier studies that identified two victim typologies using a smaller sample of older victims identified by law enforcement: "bogus prize promotion" and "investment fraud" victim (Pak & Shadel, 2011; Financial Industry Regulatory Authority; 2006). The main finding of Chapter IV is that although fraud and financial abuse victims share many of the same physiological, environmental, demographic, and psychosocial characteristics, they differ in that fraud victims have significantly higher Mini Mental State Exam scores, better mobility, and are more likely to be childless. A proposed explanation for the similarities is that exploitation has less to do with the characteristics and risk factors associated with the victim, and more to do with the people surrounding the victim (or lack thereof). In othe words, the structure of the victim's social network determines whether he or she is more likely t be a victim of fraud by strangers or financial abuse by family and friends. This analysis illuminates areas where intervention and prevention strategies may differ between each type of exploitation. This dissertation contributes to the literature in several important ways. First, it helps clarify the relationship between fraud susceptibility, age, and socioeconomic status among adults ages 50 and older in the U.S. Second, it uses prospective (pre-fraud) data on individuals to determine whether the purported risk factors for fraud--loneliness, poor cognitive functioning, stressful life events--actually do increase like likelihood of victimization later on. Third, findings from the latent class analysis support previous research using victim complaint data to categorize victims based on their SES and demographic characteristics. And fourth, the qualitative findings in this study reveal the tremendous financial cost of fraud, and also the importance of friends and family members in protecting older adults from predatory strangers. (Abstract shortened by UMI.) PB - University of Southern California CY - Los Angeles, CA VL - 3704229 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1705799725?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-08-27 First page - n/a U4 - 0493:Aging JO - Using mixed methods to identify the characteristics of older fraud victims ER - TY - RPRT T1 - Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees Y1 - 2015 A1 - Sudipto Banerjee KW - Healthcare AB - This paper separates the more predictable health care expenses in retirement for older Americans (ages 65 and above) from the less predictable ones. Based on utilization patterns and expenses, doctor visits, dentist visits and usage of prescription drugs are categorized as recurring health care services. Overnight hospital stays, overnight nursing-home stays, outpatient surgery, home health care and usage of special facilities are categorized as non-recurring health care services. The data show that recurring health care costs remain stable throughout retirement. The average annual expenditure for recurring health care expenses among the Medicare-eligible population was 1,885. Assuming a 2 percent rate of inflation and 3 percent rate of return, a person with a life expectancy of 90 would require 40,798 at age 65 to fund his or her recurring health care expenses. This does not include recurring expenses like insurance premiums or over-the-counter medications. Usage and expenses of non-recurring health care services go up with age. Nursing-home stays in particular can be very expensive. For people ages 85 and above, the average and the 90th percentile of nursing-home expenses were 24,185 and 66,600 during a two-year period, respectively. Nursing-home stays, home health care usage, and overnight hospital stays are much higher in the period preceding death. More than 50 percent in every age group above age 65 received in-home health care from a medically trained person before death. For those ages 85 and above, 62.3 percent had overnight nursing-home stays before death and 51.6 percent were living in a nursing home prior to death. Some recurring and non-recurring expenses were also much higher before death. Usage of recurring health care services generally goes up with income and usage of non-recurring health care services -- except outpatient surgery and special facilities -- goes down with income. The top income quartile spent significantly more on nursing-home and home health care expenses than the rest. This could be a result of Medicaid coverage for the lower-income, lower-asset groups. Women above 85 have significantly higher nursing-home usage than men. The rest of the differences between men and women are small. The data for this study come from the Health and Retirement Study (HRS), a study of a nationally representative sample of U.S. households with individuals over age 50. PB - Washington, DC, Employee Benefit Research Institute U4 - Health care costs/Health care utilization/Health care services/Home health care costs/Hospital costs/Nursing home costs/Prescription drug costs ER - TY - JOUR T1 - The Vicious Cycle of Parental Caregiving and Financial Well-being: A Longitudinal Study of Women JF - Journals of Gerontology Series B-Psychological Sciences and Social Sciences Y1 - 2015 A1 - Lee, Yeonjung A1 - Tang, Fengyan A1 - Kim, Kevin H. A1 - Steven M. Albert KW - Adult children KW - Healthcare KW - Net Worth and Assets KW - Women and Minorities AB - Objectives. This study examines the relationship between caring for older parents and the financial well-being of caregivers by investigating whether a reciprocal association, or vicious cycle, exists between female caregiver's lower household incomes and caring for elderly parents. Method. Data for women aged 51 or older with at least 1 living parent or parent-in-law were drawn from the Health and Retirement Survey 2006, 2008, and 2010 (N = 2,093). A cross-lagged panel design was applied with structural equation modeling. Results. We found support for the reciprocal relationship between parental caregiving and lower household income. Female caregivers were more likely than noncaregivers to be in lower household income at later observation points. Also, women with lower household income were more likely than women with higher household income to assume caregiving at later observation points. Discussion. This study suggests that there exists a vicious cycle of parental care and lower household income among women. A key concern for policy is female caregivers' financial status when care of older parents is assumed and care burden when women's financial status declines. PB - 70 VL - 70 IS - 3 N1 - Times Cited: 0 0 U4 - older parents/caregiver burden/household income/women/parental care/financial status ER - TY - JOUR T1 - Welfare-to-Work Reform and Intergenerational Support: Grandmothers' Response to the 1996 PRWORA JF - Journal of Marriage and Family Y1 - 2015 A1 - Ho, Christine KW - Adult children KW - Healthcare KW - Public Policy AB - The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA; Pub. L. 104-193) in the United States aimed at encouraging work among low-income mothers with children below age 18. In this study, the author used a sample of 2,843 intergenerational family observations from the Health and Retirement Study to estimate the effects of the reform on single grandmothers who are related to those mothers. The results suggest that the reform decreased time transfers but increased money transfers from grandmothers. The results are consistent with an intergenerational family support network where higher child care subsidies motivated the family to shift away from grandmother provided child care and where grandmothers increased money transfers to either help cover the remaining cost of formal care or to partly compensate for the loss in benefits of welfare leavers. PB - 77 VL - 77 IS - 2 N1 - Times Cited: 0 0 U4 - caregiving/intergenerational family support/child care/welfare/grandchild care/PRWORA ER - TY - RPRT T1 - What Causes Workers to Retire Before They Plan? Y1 - 2015 A1 - Alicia H. Munnell A1 - Geoffrey T. Sanzenbacher A1 - Matthew S. Rutledge KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - This paper explores the extent to which health, employment, family, or finances are associated with earlier-than-planned retirement using the Health and Retirement Study (HRS). The importance of any shock that drives early retirement depends both on its effect on those experiencing it and its prevalence in the population; therefore, the analysis proceeds in two steps. First, a probit regression is used to determine the strength of the relationship between the shocks and earlier-than-planned retirement, controlling for individual characteristics. Second, to incorporate the prevalence of the shock, counterfactual experiments are run to determine how much early retirement would be reduced in the population if these shocks did not occur. PB - Boston, Boston College UR - http://crr.bc.edu/working-papers/what-causes-workers-to-retire-before-they-plan/ U4 - retirement planning/health Shocks/early retirement/Affordable care act/Involuntary retirement/Involuntary retirement ER - TY - THES T1 - What impacts life satisfaction of aging adults following stressful life events?: An examination of the buffering effect of personal resources Y1 - 2015 A1 - Barragan, Cassandra KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Other KW - Retirement Planning and Satisfaction KW - Women and Minorities AB - Purpose: Existing research has shown that elders experience changes in their life satisfaction following stressful life events. There is an abundance of literature supporting the predictive nature of not only stressful life events on life satisfaction, but social support, autonomy, and financial security. What the literature is lacking, is examination of the buffering effect of social support, autonomy, and financial security on the relationship between stressful life events and life satisfaction. This study hypothesizes that increases in social support, autonomy, and financial security will buffer the impact of SLEs for elders and thus, they will experience increases in their life satisfaction over time. It is also expected that social support and financial security will buffer differently among Black and White elders. Methods: The public use files of the Health and Retirement Study (HRS) between the years 2006 and 2012 are used to explore the interaction between social support, autonomy, and financial security with stressful life events and the impact on life satisfaction. Linear regression are conducted to explore each buffering impact on life satisfaction over time. Results: The research findings in this dissertation demonstrate that the changes in personal resources; social support, autonomy, and financial security; play an important role in changes in life satisfaction. Additionally, Black and White elders are impacted differently by changes in financial security. In general, the results from this study demonstrate that individuals who have declines in their personal resources following stressful life events also experience declines in their life satisfaction. PB - Wayne State University CY - Detroit VL - 3700590 U4 - Aging JO - What impacts life satisfaction of aging adults following stressful life events?: An examination of the buffering effect of personal resources ER - TY - JOUR T1 - Younger subjective age is associated with lower C-reactive protein among older adults JF - Brain, behavior, and immunity Y1 - 2015 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Antonio Terracciano KW - Expectations KW - Health Conditions and Status KW - Healthcare AB - Subjective age, or how young or old individuals experience themselves to be, is related to a range of health-related outcomes in old age, including mortality risk. Little is known, however, about its association with markers of systemic inflammation. Using data from the Health and Retirement Study (HRS), the present study examined the relation between subjective age and C-reactive protein (CRP). Participants were 4120 older adults from the 2008 wave of the HRS who provided measures of subjective age, CRP, demographic variables, Body Mass Index (BMI), depression, smoking, physical activity and disease burden. Regression analyses revealed that a younger subjective age was related to lower CRP, controlling for demographic factors. This association was reduced by half but remained significant when health and behavioral covariates were adjusted for, suggesting that BMI, physical activity and disease burden may partially account for lower inflammation in individuals with a younger subjective age. Furthermore, a logistic regression revealed that feeling younger than one's age was associated with reduced risk of exceeding the clinical threshold of CRP, controlling for covariates. The present study provides the first evidence of an association between subjective age and systemic inflammation among older adults. It suggests that individuals' ratings of their subjective age may help identify individuals at greater risk for immune dysfunction related to morbidity and mortality. PB - 43 VL - 43 N1 - Times Cited: 0 0 U4 - Aging/C-reactive protein/Inflammation/Subjective age/systemic inflammation ER - TY - JOUR T1 - Around a quarter of all older people have disability during the last 2 years of life, with prevalence higher among women and those aged over 80 years JF - Evidence Based Nursing Y1 - 2014 A1 - Hirsch, Calvin H KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - Context The rapidly growing number of disabled elderly is expected to tax health delivery systems, whose focus has been the management of disease rather than the prevention and management of disability. The burden of caring for the disabled rests largely with family caregivers, who commonly experience physical and emotional strain. The network of community services designed to assist caregivers is fragmented, variable and costly. The activity of daily living (ADL) disability may be especially high among individuals near the end of life. Methods To determine the prevalence of disability in the 2 years preceding death, the authors used data from the Health and Retirement Study (HRS), a longitudinal study of health and wealth in a nationally representative sample of US adults aged 50 and over. The HRS surveyed participants every 2 years and determined the date of death in 99 of those involved. From a sample of 8232 decedents between 1995 and 2010, the authors estimated the national prevalence of disability in the last 24 months of life using restricted cubic spline models. The final spline model was entered into a multivariate regression to estimate the probability of disability in various subgroups. Findings At 24 months before death, the predicted prevalence of disability ranged from 15 for those aged 50 69 to 50 among those aged 90. Regardless of the starting prevalence of disability, the four age groups (50 69, 70 79, 80 89 and 90 ) showed similar linear rates of increase from 24 months to around 9 months before death, after which the prevalence of disability rose sharply. At all points in time women were more disabled than men. PB - 17 VL - 17 UR - http://ebn.bmj.com/content/early/2014/01/30/eb-2013-101629.short U4 - Disability/Disability/Health delivery systems/Activities of daily living/MORTALITY/Prevalence/Gender ER - TY - RPRT T1 - Bequests and Informal Long-Term Care: Evidence from the HRS Exit Interviews Y1 - 2014 A1 - Groneck, Max A1 - Krehl, Frederic KW - Adult children KW - Healthcare KW - Retirement Planning and Satisfaction AB - Informal care of children for their frail elderly parents may induce parents to compensate their children for their help. To test this hypothesis, we use the Exit Interview from the Health and Retirement Study. Our results show that caregiving has a significant positive impact on the incidence and the amount of received bequests both at the extensive and intensive margin of help. Three pieces of evidence suggest exchange motives rather than altruism to be the main source for this outcome. First, financially more well off children are more likely to receive an inheritance. Second, we find that a positive impact of help on bequest requires a written will as a contract between the parent and the helping child. Third, our results are even more pronounced when employing a fixed effects model to control for family altruism. PB - Cologne, Germany, University of Cologne U4 - Intergenerational Transfers/Strategic Bequest Motive/Informal Long term care/Altruism/Inheritance/wills 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 - Chronic obstructive pulmonary disease, cognitive impairment, and development of disability: the health and retirement study JF - Annals of the American Thoracic Society Y1 - 2014 A1 - Martinez, Carlos H. A1 - Richardson, Caroline R. A1 - Han, MeiLan K. A1 - Christine T Cigolle KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - RATIONALE: The relationship between chronic obstructive pulmonary disease (COPD) and cognitive impairment in leading to disability has not been characterized. OBJECTIVES: We aimed to investigate the prevalence and cumulative incidence of disability among adults with and without COPD and the association of COPD and cognitive impairment with disability. METHODS: We analyzed 2006-2008 waves of the Health and Retirement Study, a nationally representative longitudinal health survey. COPD was self-reported. Prevalent disability was defined as baseline dependency in one or more activities of daily living (ADLs) and incident disability as one or more additional ADL dependencies. We used a validated performance-based measure of cognition to identify dementia and mild cognitive impairment. Covariates included seven chronic diseases, four geriatric syndromes, and sociodemographics. We used logistic regression to test associations between COPD, cognitive status, and prevalent/incident disability. MEASUREMENTS AND MAIN RESULTS: Of 17,535 participants at least 53 years of age in wave 2006 (representing 77.7 million Americans), 9.5 reported COPD and 13.5 mild cognitive impairment; 17.5 of those with COPD had mild cognitive impairment. Prevalent disability for COPD was 12.8 (5.2 for no-COPD, P 0.001). An additional 9.2 with COPD developed incident disability at 2 years (4.0 for no-COPD, P 0.001). In adjusted models, COPD was associated with baseline (odds ratio, 2.0) and incident disability (odds ratio, 2.1; adjusted for baseline disability). Cognitive impairment had an additive effect to COPD. The COPD-disability association, prevalent/incident, was of similar or greater magnitude than that of other chronic diseases (e.g., stroke, diabetes). The associations were maintained in sensitivity analyses using alternative definitions of disability (dependency in two or more ADLs, dependency in instrumental ADLs), and in analysis excluding respondents with dementia. CONCLUSIONS: Both COPD and mild cognitive impairment increase the risk of disability. The risk conferred by COPD is significant and similar or higher than other chronic diseases. PB - 11 VL - 11 IS - 9 N1 - Times Cited: 0 0 U4 - chronic obstructive pulmonary disease/cognitive impairment/multimorbidity/disability/disability/geriatrics 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 - Dental Care Coverage and Use: Modeling Limitations and Opportunities JF - American Journal of Public Health Y1 - 2014 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen KW - Healthcare KW - Insurance KW - Public Policy AB - Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage. Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use. PB - 104 VL - 104 UR - http://dx.doi.org/10.2105/AJPH.2013.301693 IS - 2 U4 - dental insurance/dental care/public policy ER - TY - THES T1 - Depression and older, community-dwelling, African American women Y1 - 2014 A1 - Tamika C. Baldwin KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Women and Minorities AB - Using data from the Health and Retirement Study (HRS) 2010 wave, this research examined depression among community-dwelling, African American women, age 50 and over. Depression among this population was examined in relation to age, social support, religion, caregiving, and physical health. Intersectionality and social construction were used as theoretical frameworks for the study. Drawn from an original sample of 22,034 individuals, the sample for this research consisted of 2,249 respondents. Multiple logistic regression was used to predict depression among community-dwelling African American women. Findings indicated significant relationships between depression and age, social support, and physical health. However, religion and caregiving were not found to be significant predictors of depression among this population. Implications for future research, practice and policy are also discussed. PB - Morgan State University CY - Baltimore, MD VL - 3626229 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-09-09 First page - n/a U4 - Womens studies JO - Depression and older, community-dwelling, African American women ER - TY - THES T1 - Determinants of spouse/partner informal caregiving and its impacts on informal caregivers' physical, psychological health and economic well-being: evidence from the health and retirement study Y1 - 2014 A1 - Wang, Ming Sheng KW - Healthcare KW - Methodology KW - Public Policy AB - State policies have recently trended towards encouraging home and community-based services (HCBS) over institutionalized care because of the relative higher costs and lower quality in institutions. Studies suggest, however, that this cost-saving strategy has hidden individual and societal costs that may only surface when the informal caregivers grow older themselves. For example, intense caregiving can negatively impact the caregivers' long-term physical, mental/psychological, and economic well-being. However, the determinants of caregiving duration and their impacts on caregivers' later physical health and psychological health and economic well-being have never been examined holistically. Prior studies touching on these issues have narrowly emphasized the influence of either the elderly recipients' or caregivers' characteristics on informal caregiving and caregivers' outcomes. To address these limitations, this study examined the following questions: Q1) What are the determinants of informal caregivers' time spent on caregiving? Q2) How do caregiving hours impact informal caregivers' later physical health, psychological health, and economic well-being? Furthermore, this study examined the associations between predisposing, enabling, and need factors from the viewpoints of both care recipients and caregivers. It also examines differing lengths of caregiver commitments and how they impact the caregivers' outcomes (physical health, psychological health, and economic well-being) in the future across various caregiver characteristics. Using longitudinal, nationally representative data of the Health and Retirement Study from two waves (2008 and 2010), I looked at 496 dyad units (including care recipients and couples/partners as caregivers) of community-dwelling elderly to evaluate the impact of relative factors on the length of informal caregiving hours and whether providing more caregiving hours cause greater negative impacts on caregivers' later physical health, psychological health, and economic well-being. To answer Q1, I used a hierarchical ordinal logistic regression model to identify predisposing, enabling, and need factors from both care recipients and care recipients' and their impacts on caregiving hours. For Q2, multivariate ordinal logistic regression or ordinal least square (OLS) regression models were separately used to examine the impact of three durations of caregiving hours (providing fewer, medium, and longer caregiving hours) at Time 1 on caregivers' physical, psychological, and economic well-being at Time 2. Findings indicate that recipients with higher functional impairment (activities of daily living (ADL) and instrument activities of daily living (IADL)) and usage of home care service by caregivers have a significant, negative impact on caregivers' length of caregiving hours. In addition, caregivers who are older and employed are more likely to provide a greater number of hours. Furthermore, caregivers who provide more hours are more likely to have a higher level of chronic illness (objective physical health). On the other hand, I found no significant associations between caregiving intensity and self-rated health (subjective physical health), psychological health, or household wealth (including assets and income). The analysis considering predisposing, enabling, and need factors from both care recipients and caregivers to unravel the complicated caregiving phenomena are presented. Implications for research, practice, and policy are drawn based on the results. PB - University of Illinois at Urbana-Champaign CY - Champaign, IL U4 - methodology JO - Determinants of spouse/partner informal caregiving and its impacts on informal caregivers' physical, psychological health and economic well-being: evidence from the health and retirement study ER - TY - JOUR T1 - Diabetes associated with early labor-force exit: A comparison of sixteen high-income countries JF - Health Affairs Y1 - 2014 A1 - Juliet Rumball-Smith A1 - Douglas Barthold A1 - Nandi, Arijit A1 - Jody Heymann KW - Employment and Labor Force KW - Healthcare AB - The economic burden of diabetes and the effects of the disease on the labor force are of substantial importance to policy makers. We examined the impact of diabetes on leaving the labor force across sixteen countries, using data about 66,542 participants in the Survey of Health, Ageing and Retirement in Europe; the US Health and Retirement Survey; or the English Longitudinal Study of Ageing. After matching people with diabetes to those without the disease in terms of age, sex, and years of education, we used Cox proportional hazards analyses to estimate the effect of diabetes on time of leaving the labor force. Across the sixteen countries, people diagnosed with diabetes had a 30 percent increase in the rate of labor-force exit, compared to people without the disease. The costs associated with earlier labor-force exit are likely to be substantial. These findings further support the value of greater public- and privatesector investment in preventing and managing diabetes. 2014 Project HOPE- The People-to-People Health Foundation, Inc. A. PB - 33 VL - 33 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84891794055andpartnerID=40andmd5=6065e630ae9199c709499cf87070f6fa IS - 1 N1 - Export Date: 29 January 2014 Source: Scopus U4 - Epidemiology/Workforce Issues ER - TY - JOUR T1 - Diabetes diagnosis and exercise initiation among older Americans JF - Preventive Medicine Y1 - 2014 A1 - Leigh Ann Leung A1 - Shailender Swaminathan A1 - Amal Trivedi KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Objective: To determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. Methods: We used data from the 2004-2010 Health and Retirement Study in a pre-post study design. Individuals newly-diagnosed with diabetes (N. = 635) were propensity score matched to a comparison group with no diabetes. Results: In the year following a reported diagnosis, 35.7 (95 confidence interval 32.0 to 39.5) of those newly diagnosed with diabetes initiated exercise as compared with 31.4 (95 confidence interval 27.9 to 35.1) for the matched cohort with no diabetes, with a between-group difference of 4.3 percentage points (95 confidence interval -0.9 to 9.4). Among individuals with fewer health risk factors at baseline, the between-group difference was 15.6 percentage points (95 confidence interval 1.58 to 29.5). Conclusion: Over 35 of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis. Among individuals with fewer health risk factors at baseline, those newly-diagnosed with diabetes were more likely to begin exercise than those without diabetes. 2014 Elsevier Inc. PB - 65 VL - 65 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84901829825andpartnerID=40andmd5=4961de60a077ce36676e9d5c53632ed9 N1 - Export Date: 6 August 2014 U4 - Diagnosis/Exercise/Health behavior/Physician counseling/Tertiary prevention/Type 2 diabetes/diabetes mellitus/low risk population ER - TY - JOUR T1 - Does Becoming an ADL Spousal Caregiver Increase the Caregiver's Depressive Symptoms? JF - Research on Aging Y1 - 2014 A1 - Ruth E Dunkle A1 - Sheila Feld A1 - Amanda J Lehning A1 - Kim, Hyunjee A1 - Shen, Huei-Wern A1 - Kim, Min Hee KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents depressive symptoms at follow-up, controlling for other factors identified in Pearlin s stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers. Furthermore, wives continuing as caregivers have more follow-up depressive symptoms than wives who do not provide care. Finally, the physical health of the spousal caregiver is related to depressive symptoms at follow-up. We conclude with policy and practice implications of these three main findings. VL - 36 UR - http://roa.sagepub.com/content/early/2013/12/22/0164027513516152.abstract IS - 6 U4 - Depressive Symptoms/ADL/IADL/caregiver burden/stress/spousal caregiving/Public Policy ER - TY - THES T1 - Dyadic analyses of chronic conditions and distress within marriage : a gendered perspective Y1 - 2014 A1 - Thomeer, Mieke Beth KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Chronic conditions negatively impact well-being, and the negative impact of a chronic condition can extend beyond the diagnosed person to his or her spouse. This association may be further influenced by gender, as gender can shape how individuals experience their own chronic conditions-- including what conditions they develop-- and how they react to the conditions and distress of their spouses. In my dissertation, I examine how one spouse's chronic conditions are related to the other spouse's psychological distress over time. I address this using quantitative analysis of the Health and Retirement Study and qualitative analysis of in-depth interviews. In my quantitative analysis, I find that the association between one spouse's chronic conditions and the other spouse's distress differs by gender, number of conditions, whether one or both spouses have chronic conditions, and type of condition. Regarding number of conditions, a husband's number of chronic conditions increases his wife's distress more so than a wife's number of chronic conditions increases her husband's. These associations are mitigated by the chronically ill spouse's own distress and functional limitations. Additionally, this gender difference is more pronounced if both spouses have chronic conditions compared to if only one has chronic conditions. Regarding type of condition, lung disease and stroke are the most negatively impactful for spouses' distress, whereas high blood pressure, cancer, and arthritis are not related to spouses' distress. All conditions, except for stroke, relate to husbands' and wives' distress similarly, but a husband's stroke increases a wife's distress initially whereas the wife's stroke increases the husband's distress over time. In my qualitative analysis, I find that when women are chronically ill, they continue to emotionally care for their husbands, which likely protects their husbands from psychological distress but exacerbates women's own distress. My results point to the importance of promoting the psychological well-being of both spouses during periods of chronic conditions. This is especially critical for spouses of people with more than one condition, chronically ill women whose husbands are also chronically ill, and spouses of people experiencing stroke and lung disease. PB - University of Texas, Austin CY - Austin, TX U4 - psychological well-being JO - Dyadic analyses of chronic conditions and distress within marriage : a gendered perspective ER - TY - BOOK T1 - Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life Y1 - 2014 KW - End of life decisions KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction PB - National Academies Press CY - Washington, DC U4 - end of life/Public Policy/Quality of Life/Health care policy/counseling/advance care planning 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 - The Effect of Community-Based Services on Functional Limitations of American Older Adults in Retirement Community JF - Korea Social Welfare Research Y1 - 2014 A1 - So Jung Park A1 - Kim, Min Hee KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - Being discussed among the various environmental factors for the year, with an independent discourse on successful aging, we examine the relationship between health and community services for the elderly using American study. The review is limited in most cases to be vulnerable older people to explore the relationship between the two previous studies, which focused on the effectiveness of many individual services. The present study was derived using the Health and Retirement Study (1998 2008) panel data, and the use of the service pattern of the individual review of the relevant health service use patterns and trends. In addition, the effect of the use of service resources and informal health services were analyzed with the factors that affect the relationship between health map. Was limited to senior living senior housing community with information about the service analysis, we used the daily living skills scores about healthy level and trend are (instrumental). Configured to use the pattern for the official services (housework, care, care, transportation, meals) in the community through the cluster analysis results did not use all the services a large number of elderly (group 1), in addition to using all of the services that the elderly could be classified as elderly (groups 3 and 4), although the nature (group 2), most of the details to use the service. Analysis of the relation of the health services through a growth curve model (Growth Curve Model) results, in the group compared to the group with all of the services that are not used at all, the service tends to be deteriorated health. But if you take advantage of the informal resources around them showed that mitigation is steep trend deteriorating health. The significance of that is then used to present the major reasons for this study is that no magazine to help in maintaining the health community service use, its extent. Suggests that informal, to study the effect of an integrated formal resources and medical necessity of the service area to review the impact of community service than what it. PB - 40 VL - 40 U4 - Community-based services/senior health/cluster analysis/Informal caregiving/Informal caregiving/community based services/functional limitations/health care policy ER - TY - THES T1 - The Effect of Sleep Medication Use and Poor Sleep Quality on Risk of Falls in Community-Dwelling Older Adults Y1 - 2014 A1 - Min, Yaena KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - The work presented in this dissertation focuses on the association between sleep medication use, poor sleep, and falls in community-dwelling adults 65 years or older. Sleep complaints and the consumption of medications to aid sleep are common in older adults. Psychotropic medications, such as sedative hypnotics, are associated with risk of falls in older adults. However, very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls in community-dwelling older adults. In the first project, a cross-sectional analysis of the Health and Retirement Study (HRS) 2010 data was conducted to determine the prevalence of sleep problems, sleep medication use and falls; and to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. A multiple logistic model adjusted for covariates was used. In the sample of community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the older adults. Older adults who had sleep problems and took sleep medications had a significantly higher risk of falls compared with older adults who did not have sleep problems and did not take sleep medications. The other two groups, older adults who had sleep problems and did not take sleep medications, and those who did not have sleep problems and took sleep medications also had a significantly greater risk for falls. The second project was a prospective cohort study of independently-living older adults from senior congregate housing. The effect of combined poor sleep quality and sleep medication use on risk of falls was assessed using logistic regression modeling. In this study of 113 community-dwelling older adults, 46.9% had at least one fall, and 62.8% had poor sleep quality. Sleep medication use was reported by 44.2% of the older adults. Older adults with poor sleep quality and sleep medication use had a significantly increased risk of falls compared with older adults with good sleep quality and no sleep medication use. Older adults with good sleep quality and sleep medication use, and those with poor sleep quality and no sleep medication use did not have a significantly greater risk for falls. In conclusion, poor sleep added to sleep medication use significantly increased the risk of falls in community-dwelling older adults. The research undertaken in this dissertation was the first to evaluate the associations between poor sleep, use of sleep medications, and falls in community-dwelling older adults. PB - Virginia Commonwealth University CY - Richmond, VA U4 - adult communities JO - The Effect of Sleep Medication Use and Poor Sleep Quality on Risk of Falls in Community-Dwelling 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 - THES T1 - The effects of loneliness and social isolation on hypertension in later life: Including risk, diagnosis and management of the chronic condition Y1 - 2014 A1 - Caitlin E. Coyle KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Social relationships play a vital role in maintaining health and functioning in later life; however, much less is known about the consequences of lacking those social relationships. This research examines the independent effects of social isolation and loneliness on the risk of hypertension as well as on the diagnosis and management of this chronic condition, with particular attention paid to gender differences. Using the Health and Retirement Study (HRS), a series of binary logistic regression analyses are used to estimate the direct effect of isolation and loneliness on hypertension in Wave 9 (2008) and over a two year-period ending in Wave 10 (2010). In addition, the interactive effects of health behavior and depression are explored. A series of multinomial logistic regression analyses are used to estimate the effects of social isolation and loneliness on the likelihood of having undiagnosed or uncontrolled hypertension. Results indicate that even controlling for loneliness, social isolation increases the odds of having hypertension among both men and women. These results also support the idea that social isolation is associated with increased odds of having undiagnosed or uncontrolled hypertension, specifically among women. Results from this study provide no consistent support for the notion that loneliness negatively effects hypertension. In terms of social determinants of health, these results highlight the need for existing chronic disease management to be targeted to include socially isolated older adults. Health professionals may need to focus their efforts on detecting social isolation among their patients, and adjusting treatment plans to be most effective for this vulnerable population of older adults. PB - University of Massachusetts Boston CY - Boston VL - 3622188 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1548983081?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 2014 Last updated - 2014-07-31 First page - n/a U4 - Chronic illness JO - The effects of loneliness and social isolation on hypertension in later life: Including risk, diagnosis and management of the chronic condition ER - TY - JOUR T1 - The Effects of Total Knee Arthroplasty on Physical Functioning and Health among the Under Age 65 Population JF - Value in Health Y1 - 2014 A1 - Linda K George A1 - Hu, L. A1 - Frank A Sloan KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare AB - Objectives: This study examined the effects of total knee arthroplasty on six measures of physical functioning, self-rated health, pain, earnings, and employment status among US adults aged 51 to 63 years at baseline. Methods: Data came from the Health and Retirement Study, a nationally representative longitudinal study conducted biannually. The analysis sample consisted of individuals aged 51 to 63 years at baseline with arthritis who were resurveyed at 2-year intervals from 1996 to 2010. Propensity score matching was used to compare outcomes of persons receiving total knee arthroplasty (TKA) with those of matched controls. Six measures of physical functioning were examined: lower-body mobility problems, instrumental activities of daily living limitations, activities of daily living limitations, and large muscle, fine motor, and gross motor limitations. Self-rated health and pain were also examined. The two employment-related outcomes were earnings and employment status. Results: Receipt of TKA was associated with better outcomes for several measures of physical functioning, especially mobility limitations, pain, and self-rated health. Receipt of TKA was not associated with increased earnings or employment. Conclusions: Receipt of TKA yields important improvements in physical function among persons with an arthritis diagnosis who received the procedure before reaching the age of 65 years. This study contributes to knowledge about the benefits of TKA in a community setting among nonelderly recipients of TKA. 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). PB - 17 VL - 17 IS - 5 N1 - Export Date: 6 August 2014 Article in Press U4 - physical functioning/quality of life/total knee arthroplasty/self assessed health/mobility Limitation/employment status ER - TY - THES T1 - End-of-life care planning and its implementation Y1 - 2014 A1 - Inoue, Megumi KW - End of life decisions KW - Expectations KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets KW - Public Policy KW - Retirement Planning and Satisfaction AB - End-of-life care planning is an opportunity for people to express how they want to spend the final stage of their lives by directing what type of medical treatment they wish or do not wish to receive. The completion of such planning is a way to exercise their autonomy, which is one of the fundamental ethical principles in medicine in the United States. Many older adults in the U.S., however, do not have such a plan or even discuss the topic with anyone. In order to understand the circumstances in which end-of-life planning is enacted, this study investigated two important research questions: (1) What are the sociodemographic and psychosocial factors that enhance or impede the completion of end-of-life planning? (2) How consistent is the content of a living will with the person's actual dying experience? These research questions were developed and examined as an application of expectancy theory, which explains the concepts of motivation and action. A series of logistic regression analyses were conducted. This study analyzed data from the Health and Retirement Study (HRS), which is a nationally representative sample of Americans over the age of 50. The analytic subsample included those who died between 2000 and 2010 ( N = 6,668). The study found that persons who were older, who identified themselves as White, who had higher levels of income and education, and who were widowed or separated were more likely to be motivated to complete end-of-life planning. A higher level of sense of mastery was specifically relevant to documentation of living wills. On the other hand, a lower level of religiosity was specifically associated with having a durable power of attorney for health care. In addition, there was a clear connection between a request for palliative care and less troubling pain. Implications include conducting a community- or workplace-based public educational campaign, incorporating a culturally tailored approach for racial/ethnic minorities (e.g. faith-based interventions), using advance directives written in easy to understand language (e.g. Five Wishes), and funding Medicare provision for end-of-life care consultations between doctors and patients during annual physical exams. PB - Boston College CY - Boston VL - 3629596 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1562496003?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 - 2014-10-14 First page - n/a U4 - public policy JO - End-of-life care planning and its implementation ER - TY - THES T1 - Essays in applied economics Y1 - 2014 A1 - Sacks, Daniel W. KW - Health Conditions and Status KW - Healthcare KW - Income KW - Net Worth and Assets KW - Public Policy KW - Social Security AB - Essay 1 studies physician agency problems, which arise whenever physicians fail to maximize their patients' preferences, given available information. These agency problems are well documented, but the magnitude of their welfare consequences for patients---the losses from suboptimal treatment choice induced by agency---are unclear. I infer patient drug preference from their compliance decisions. I begin by showing that initial prescriptions respond to physician financial incentives to control costs and to pharmaceutical detailing, but compliance does not, pointing to agency problems. I then develop and estimate a model of physician-patient interactions where physician write initial prescriptions, but patients choose whether to comply. Fully eliminating agency problems increases compliance by 6.5 percentage points, and raises patient welfare by 22\% of drug spending. Contracts that better align doctor and patient preferences can improve patient welfare, but attain only half the gains from eliminating agency completely. Although physician agency problems reduce patient welfare, eliminating them is thus likely difficult. Essay 2, co-authored with Alexander M. Gelber and Damon Jones, studies frictions in adjusting earnings to changes in the Social Security Annual Earnings Test (AET) using a panel of Social Security Administration microdata on one percent of the U.S. population from 1961 to 2006. Individuals continue to "bunch" at the convex kink the AET creates even when they are no longer subject to the AET, consistent with the existence of earnings adjustment frictions in the U.S. We develop a novel estimation framework and estimate in a baseline case that the earnings elasticity with respect to the implicit net-of-tax share is 0.23, and the fixed cost of adjustment is $152.08. Essay 3 studies the impact of health expenditure risk on annuitization. Theoretical research suggests that such risk can have an ambiguous influence on the annuitization decisions of the elderly. I provide empirical evidence on this linkage, by estimating the impact of supplemental Medicare insurance (Medigap) coverage on the annuity demand of older Americans. Medigap coverage has a strong impact on annuitization: the extensive margin elasticity is 0.39, the overall elasticity of private annuity income with respect to Medigap coverage is 0.56. These results are robust to controls for health, wealth, and preferences, as well as other robustness tests. They suggest that medical expenditure risk has a large impact on underannuitization. PB - University of Pennsylvania CY - Philadelphia, PA VL - 3622123 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-07-22 First page - n/a U4 - Annuitization JO - Essays in applied economics ER - TY - JOUR T1 - Exploring differences in prevalence of diagnosed, measured and undiagnosed hypertension: the case of Ireland and the United States of America JF - International Journal of Public Health Y1 - 2014 A1 - Mosca, I. A1 - Kenny, R. A. KW - Cross-National KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - TILDA AB - OBJECTIVES: To: (1) compare prevalence of diagnosed, measured, total and undiagnosed hypertension among late middle-aged adults in the United States of America and Ireland; (2) identify the most important predictors of hypertension and compare them across the two countries; (3) investigate whether cross-national differences in prevalence rates are explained by country differences in behavioural risk factors. METHODS: We use data from the 2008 and 2010 waves of the Health and Retirement Study (n = 1,938) and the first wave (2009/2011) of The Irish Longitudinal Study on Ageing (n = 1,455). We employ probit models to determine whether individual attributes, socioeconomic characteristics and behavioural health factors, including smoking, alcohol consumption and obesity, are associated with hypertension. We do not consider whether respondents are on antihypertensive medication. RESULTS: Prevalence of diagnosed hypertension is higher in the United States of America (48.6 versus 32.4 ). Prevalence of undiagnosed hypertension is higher in Ireland (41.2 versus 19.7 ). Little of the difference in prevalence rates is explained by country differences in behavioural risk factors. CONCLUSIONS: A greater focus on prevention of high blood pressure is necessary in Ireland. PB - 59 VL - 59 UR - http://www.ncbi.nlm.nih.gov/pubmed/24942996 IS - 5 N1 - Mosca, Irene Kenny, Rose Anne eng Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Switzerland 2014/06/20 06:00 Int J Public Health. 2014 Oct;59(5):759-67. doi: 10.1007/s00038-014-0573-7. Epub 2014 Jun 19. U4 - hypertension/diagnosed hypertension/behavioral risk factors/socioeconomic Differences/cross-national comparison/TILDA ER - TY - RPRT T1 - Fact Sheet: Cohort Differences in Parental Survival Y1 - 2014 A1 - Maximiliane E Szinovacz KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - Increases in longevity and especially increased survival into very old age have implications not only for individuals own life course but also for that of their families. For example, if parents survive into very old age they will have more opportunities not only to become grandparents but also great-grandparents and to experience these family roles for a longer time period (the so-called beanpole family ). From their adult children s perspective, longer survival of parents also can mean that needs for companionship arising from one parent s widow(er)hood will be postponed into their adult children s later years, possibly after the child s retirement. Similarly, because spouses typically function as primary caregivers for their partners, primary caregiving roles on the part of adult children may be postponed into children s later years if both parents survive into very old age. Despite considerable evidence documenting increases in longevity, little research has been devoted to parental survival among adult children from the World War II babies and baby boom cohorts. We present data comparing parental survival across four cohorts of adult children using data from Health and Retirement Study (HRS). PB - Boston, ScholarWorks, University of Massachusetts Boston U4 - Longevity/caregiver burden/caregiving/adult Children/parental care/parental survival ER - TY - RPRT T1 - Fact Sheet: Cohort Differences in Parents Illness and Nursing Home Use Y1 - 2014 A1 - Maximiliane E Szinovacz KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Surviving parents of the war baby and baby boom cohorts are now reaching very old age. Given their increased longevity and postponement of morbidity into very old age (see Fact Sheets on parental mortality and care needs), it is essential to estimate whether and to what extent these parents will require informal or formal care. Such care is typically most burdensome and costly if it involves long-lasting illness prior to death. Furthermore, Medicare and especially Medicaid expenditures will depend on whether or not these parents require nursing home care. To obtain some estimates of the prevalence of long-lasting illness and nursing home care among these groups of parents, we investigated reports of parental illness preceding death and nursing home placement from four cohorts of adult children, using data from the Health and Retirement Study. PB - Boston, ScholarWorks, University of Massachusetts Boston U4 - caregiver burden/caregiving/Medicaid/medicare/nursing home/Long Term Care/long-lasting illness ER - TY - JOUR T1 - Fundamental resource dis/advantages, youth health and adult educational outcomes JF - Social Science Research Y1 - 2014 A1 - Elman, Cheryl A1 - Linda A. Wray A1 - Xi, Juan KW - Adult children KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Recent studies find lasting effects of poor youth health on educational attainment but use young samples and narrow life course windows of observation to explore outcomes. We apply a life course framework to three sets of Health and Retirement Study birth cohorts to examine early health status effects on education and skills attainment measured late in life. The older cohorts that we study were the earliest recipients of U.S. policies promoting continuing education through the GI Bill, community college expansions and new credentials such as the GED. We examine a wide range of outcomes but focus on GEDs, postsecondary school entry and adult human capital as job-related training. We find that older U.S. cohorts had considerable exposure to these forms of attainment and that the effects of youth health on them vary by outcome: health selection and ascription group effects are weak or fade, respectively, in outcomes associated with delayed or adult attainment. However, poorer health and social disadvantage in youth and barriers associated with ascription carry forward to limit attainment of key credentials such as diplomas and college degrees. We find that the human capital - health gradient is dynamic and that narrow windows of observation in existing studies miss much of it. National context also matters for studying health-education linkages over the life course. PB - 43 VL - 43 UR - http://www.ncbi.nlm.nih.gov/pubmed/24267756 N1 - Times Cited: 0 U4 - Life Course/Health Disparities/Adult Education/Low-Birth-Weight/Childhood Health/Cumulative Disadvantage/Socioeconomic-Status/Gender-Gap ER - TY - JOUR T1 - Gaps in Receipt of Regular Eye Examinations among Medicare Beneficiaries Diagnosed with Diabetes or Chronic Eye Diseases JF - Ophthalmology Y1 - 2014 A1 - Frank A Sloan A1 - Arseniy P Yashkin A1 - Chen, Yiqun KW - Health Conditions and Status KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance AB - Objective: To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM). Design: Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS). Participants: The sample consisted of 2151 Medicare beneficiaries who responded to the HRS. Methods: Medicare beneficiaries with = 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination. Main Outcome Measures: The primary outcome measure was the number of 15-month periods with an eye examination. Results: One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 followup periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations. Conclusions: Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use. PB - 121 VL - 121 IS - 12 N1 - Times Cited: 0 0 U4 - health Care Utilization/macular degeneration/medicare/Diabetes/VISION IMPAIRMENT/MANAGED CARE/INSURANCE/GLAUCOMA ER - TY - THES T1 - A holistic approach to understanding retirement preparedness Y1 - 2014 A1 - Yook, Miyoung KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction KW - Social Security AB - There has been increased interest in understanding the significant disparity in U.S. households' retirement preparedness due to concern about the stability of Social Security benefits, the shift from defined benefit plans to defined contribution plans, and the decreased rate of saving. This dissertation explores a model that can be utilized to understand and enhance retirement preparedness by individuals, educators, practitioners, and policy makers. Retirement preparedness was measured in two different ways--using the income replacement rate and the capital accumulation ratio--for two separate empirical models. The general conceptualization of the framework is based on the retirement planning work of Hershey (2004). This study utilized the 2008 Rand version (Version L) of the Health and Retirement Study (HRS) and 2006, 2008, and 2010 psychosocial and lifestyle questionnaire. The Rand HRS data file is a user-friendly version of the HRS data and contains cleaned data. The two hierarchical regressions were used to analyze the association between retirement preparedness and the theoretical concepts of cultural influence, environmental influence, task components, and psychological influence. Entering the conceptual components as four separate blocks allows for observation of changes in R 2 based on the addition of the conceptual components. This research investigates the following research questions: (a) How strongly are cultural influences associated with retirement preparedness?, (b) How strongly are environmental influences associated with retirement preparedness?, (c) How strongly are task components associated with retirement preparedness?, and (d) How strongly are psychological influences associated with retirement preparedness? Current retirement planning practices are often based on structural profiles such as financial resources, financial needs, and goals. The holistic approach used for this dissertation is based on the awareness of the influence of psychological and personal factors on financial decision making. The results showed that the variables positively associated with the retirement income replacement rate were self-perception of aging, homeownership, stock ownership, household pension ownership, IRA/Keogh ownership, and business ownership. Pre-retirement income log had a highly negative association with the retirement income replacement ratio. Big Five personality and perceived mastery were not significant. However, when asset ownership (excluding homeownership) was not controlled, conscientiousness and low emotional stability became significant and showed a positive association for conscientiousness and a negative association for low emotional stability. Self-perception of aging was a significant psychological variable in both models. The significant variables from the second model measured by the capital accumulation ratio were asset ownerships including homeownership, stock ownership, IRA ownership, real estate ownership, and business ownership. None of the psychological variables were significant, except for agreeableness, which was related negatively to the capital accumulation ratio when the asset ownerships (excluding home ownership) were not controlled. Other significant variables, when asset ownership was not controlled, were home ownership, pre-retirement income log, being non-White. PB - Kansas State University CY - Manhattan, KS VL - 3639324 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1621575221?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 - 2014-11-24 First page - n/a U4 - individual and family studies JO - A holistic approach to understanding retirement preparedness ER - TY - JOUR T1 - Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death JF - Health Affairs Y1 - 2014 A1 - Feng, Zhanlian A1 - Coots, Laura A. A1 - Kaganova, Yevgeniya A1 - Joshua M Wiener KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Hospitalizations and emergency department (ED) visits for people with Alzheimer s disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly. Using data from the Health and Retirement Study linked with Medicare claims from the period 2000 08, we found that among community-dwelling elderly fee-for-service Medicare beneficiaries, those who had dementia were significantly more likely than those who did not to have a hospitalization (26.7 percent versus 18.7 percent) and an ED visit (34.5 percent versus 25.4 percent) in each year. Comparing nursing home residents who had dementia with those who did not, we found only small differences in hospitalizations (45.8 percent versus 41.9 percent, respectively) and ED use (55.3 percent versus 52.7 percent). As death neared, however, utilization rose sharply across settings and by whether or not beneficiaries had dementia: Nearly 80 percent of community-dwelling decedents were hospitalized, and an equal proportion had at least one ED visit during the last year of life, regardless of dementia. Our research suggests that substantial portions of hospitalizations and ED visits both before and during the last year of life were potentially avoidable. PB - 33 VL - 33 UR - http://content.healthaffairs.org/content/33/4/683.abstract IS - 4 U4 - Hospitalization/Emergency department/Alzheimers dementia/Long-Term Care/Medicare/Medicaid/Chronic Care ER - TY - JOUR T1 - How Does Household Expenditure Change With Age for Older Americans? JF - EBRI Notes Y1 - 2014 A1 - Sudipto Banerjee KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Retirement saving involves a lot of unknowns, the most important being not knowing how much money will be needed in retirement. Although it is impossible to predict the retirement expenses of any particular household, the average amounts spent by current retirees can serve as important benchmarks for individual savers as well as for industry experts and policymakers. This paper examines the expenditure pattern of the older segment of the U.S. population. The majority of the households studied here have either reached retirement age or are on the cusp of retirement. The data come from the Health and Retirement Study (HRS) and the Consumption and Activities Mail Survey (CAMS), which is a supplement of the HRS. CAMS contains detailed spending information on 26 nondurable and six durable categories, and it follows the same group of people over time. Using this information coupled with the income information available in the HRS, this study summarizes the consumption behavior of the American elderly. The primary goal is to examine how overall spending and spending in different categories change with age. Home and home-related expenses is the largest spending category for every age group. Health expenses increase steadily with age. In 2011, households with at least one member between ages 50 and 64 spent 8 percent of their total budget on health items, compared with 19 percent for those age 85 or over. Health-related expenses occupy the second-largest share of total expenditure for those ages 75 or older. The two components of household expenditures that show a declining pattern across age groups are transportation expenses and entertainment expenses. Food and clothing expenses (as a share of total expenditure) remain more or less flat across the different age groups. There is a large increase in spending at the 95th percentile for those ages 90 or older, which can be attributed to very high health care expenses. PB - 35 VL - 35 IS - 9 U4 - Consumption/Health care costs/Household expenditure/Household income/Retirement planning/Spending ER - TY - THES T1 - Human, Social and Cultural Capital Predictors of Early Baby Boomer Productivity in Mid- to Late Life: An Examination of Formal Volunteering Behavior Y1 - 2014 A1 - Nowell, William Benjamin KW - Adult children KW - Demographics KW - Healthcare KW - Net Worth and Assets KW - Other KW - Public Policy AB - Productive activity supports successful aging by helping to maintain older adults' cognitive and physical functioning and active engagement in life. This study examines the human, social and cultural resources that contribute to productive activity, specifically formal volunteering, among Early Baby Boomers (EBB) during the transition from mid-life to late life. Four time points across 6 years from a sample of 2,684 EBBs aged 51 and older from the Health and Retirement Study (2004-2010) were analyzed using logistic regression and generalized estimating equations. Baseline and longitudinal human, social and cultural capital factors and demographic variables functioned as predictors of formal volunteer engagement and its intensity. High levels of cultural capital, defined as religiosity, significantly increased the likelihood of both formal volunteer engagement and high intensity volunteering. Greater human capital and some forms of social capital also boosted the probability of volunteer engagement, but higher levels of one component of social capital (paid employment) significantly reduced the likelihood of high intensity volunteering. Volunteer engagement and intensity were stable during the observed period, in spite of the Great Recession during the latter waves of data. Gender appeared to have no effect on the likelihood of volunteer engagement or intensity. The distribution of human, social and cultural resources was associated with differences in mid- to late life productivity among EBBs, and productive activities of formal volunteering and paid employment appear to compete for their time. Exploring the unique contributions of aspects of education and religion to volunteerism in future research may lead to more inclusive public policy and programs that facilitate the participation of individuals from a wider array of backgrounds. Such efforts can increase opportunities for formal volunteering among persons transitioning from mid- to late life. PB - Columbia University CY - New York VL - 3617751 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1527486354?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 2014 Last updated - 2014-06-15 First page - n/a U4 - Social work JO - Human, Social and Cultural Capital Predictors of Early Baby Boomer Productivity in Mid- to Late Life: An Examination of Formal Volunteering Behavior ER - TY - JOUR T1 - Lee and Schwarz Respond to Kawada, Question Context, Ethnic Difference, and Self-Rated Health JF - American Journal of Public Health Y1 - 2014 A1 - Lee, Sunghee A1 - Schwarz, Norbert KW - Health Conditions and Status KW - Healthcare AB - We agree with Kawada that the ideal data set for our study would include a confounder-free experiment that asks the self-rated health (SRH) question in different contexts (or order) and follows study subjects over time to assess subsequent morbidity and mortality. This data set does not exist. As an approximation with minimal methodological non-comparability, we used the National Health Interview Survey linked with the National Death Index and the Health and Retirement Study (HRS) to examine SRH context effects on health outcome predictions. PB - 104 VL - 104 UR - http://dx.doi.org/10.2105/AJPH.2013.301712 IS - 1 U4 - COMORBIDITY/mortality/health outcomes ER - TY - CHAP T1 - The Lifetime Risk of Nursing Home Use T2 - Discoveries in the Economics of Aging Y1 - 2014 A1 - Michael D Hurd A1 - Pierre-Carl Michaud A1 - Susann Rohwedder ED - David A Wise KW - Health Conditions and Status KW - Healthcare AB - This paper estimates the lifetime risk and distribution of stays in nursing homes using 10 waves of data from the Health and Retirement Study covering the population over the age of 50. Using both non-parametric and parametric approaches which account for censoring, we estimate that a 50 year old has a 53 to 59 chance of ever entering a nursing home before he dies and that, conditional on any stay, the average duration is just over a year. We show that stays at the end of life which are typically not captured in core interviews are very important for assessing lifetime exposure. The HRS performs exit interviews with proxies for those who died. Excluding exit interviews yields lifetime risk under 40 . Being female, white and a non-smoker are associated with higher lifetime risk due to lower (competing) mortality risk and higher nursing home risk at older ages. JF - Discoveries in the Economics of Aging PB - University of Chicago Press CY - Chicago U4 - nursing home rist/nursing homes/mortality JO - The Lifetime Risk of Nursing Home Use ER - TY - RPRT T1 - The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality Y1 - 2014 A1 - Black, Bernard A1 - José-Antonio Espín-Sánchez A1 - Eric French A1 - Litvak, Kate KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology AB - We use the best available longitudinal dataset, the Health and Retirement Survey, and a battery of causal inference methods to provide both central estimates and bounds on the effect of health insurance on health and mortality among the near elderly (initial age 50-61) over an 18-year period. Those uninsured in 1992 consume fewer healthcare services, but are not less healthy and, in our central estimates, do not die sooner than their insured counterparts. We discuss why a zero average effect of uninsurance on mortality and health is plausible, some selection effects that might explain our full results, and methodological concerns with prior studies. PB - Evanston, IL, Northwestern University Law Schoo U4 - health insurance/Medicare/healthcare utilization/Mortality/Methodology ER - TY - THES T1 - Mechanisms of Health Disparities in Inflammation: A Test of the Differential Stress Exposure and Differential Stress Vulnerability Hypotheses Y1 - 2014 A1 - Uchechi A Mitchell KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - The current study sheds light on the mechanisms through which group differences in exposure to and the impact of discrimination generate disparities in cardiovascular diseases. The study specifically looks at its effects on C-reactive protein (i.e., CRP), a protein produced in response to exposure to stressors. It is a marker of systemic inflammation that is positively associated with cardiovascular diseases such as stroke, atherosclerosis, and myocardial infarction. The current study goes beyond a basic description of the population-level distribution of CRP by focusing on psychosocial factors that mediate and/or moderate these relationships. The specific aims of the dissertation are to investigate: (1) racial/ethnic and gender differences in CRP levels; (2) differential exposure to discrimination as an explanation for the social patterning of CRP; (3) differential vulnerability to discrimination; and (4) the extent to which coping resources dampens these effects. The dissertation uses data from the Health and Retirement Study (HRS), a multi-cohort longitudinal survey of a large and nationally representative sample of adults age 51 years and older. The HRS aims to identify and better understand the social, economic, psychosocial, and physical factors that influence and result from retirement. Since its inception in 1992, data have been collected every two years on the original HRS cohort and on subsequent cohorts added to the study. The "core" HRS interview is conducted face-to-face at baseline and collects data on demographic characteristics; housing and family structure; employment, income, assets, and insurance; health care, health status, cognition, and disability; and life expectations. Beginning in 2004, HRS respondents were asked to complete a psychosocial questionnaire that included measures of everyday and lifetime discrimination, among other factors, and in 2006 biomarkers--including CRP--were collected from one half of the study sample; biomarkers were collected from the other half in 2008. To maintain sufficient statistical power to detect differences in CRP, multivariate analyses are conducted with data from a hybrid 2006/2008 sample. The analysis involves statistical methods needed to appropriately adjust for the complex sampling design of HRS and to test the intricate causal pathways leading to race differences in CRP. In line with our hypotheses, African Americans have higher levels of CRP than non-Hispanic whites and reported greater exposure to everyday and lifetime discrimination. Hispanics do not significantly differ from non-Hispanic whites in CRP levels or in their reports or everyday and lifetime discrimination. In unadjusted models, everyday and major lifetime discrimination are positively associated with CRP. This association remains for lifetime discrimination in fully adjusted models but not for everyday discrimination. Both everyday and lifetime discrimination mediate racial/ethnic and gender differences in inflammation. Lifetime discrimination mediates these differences in and of itself, and in conjunction with other factors, particularly waist circumference. Everyday discrimination also mediates group differences in inflammation in conjunction with waist circumference. Vulnerability to discrimination does not differ by race/ethnicity or by gender, and the coping resources evaluated in this study do not buffer the effects of discrimination on inflammation. This study supports the presence of racial differences in CRP--an indicator of systemic inflammation and a clinical risk factor for cardiovascular diseases--on a population-level. The findings also suggest that exposure to discrimination, a chronic stressor that disproportionately affects racial minorities, is associated with higher levels of CRP and partially explains racial and gender differences in inflammation. In all, these findings provides further support for the significant contributions of the social environment on health and health disparities. (Abstract shortened by UMI.) PB - University of California, Los Angeles CY - Los Angeles VL - 3623220 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1550352556?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-08-08 First page - n/a U4 - Public health JO - Mechanisms of Health Disparities in Inflammation: A Test of the Differential Stress Exposure and Differential Stress Vulnerability Hypotheses ER - TY - THES T1 - Medical Underwriting: A Factor in Long-Term Care Insurance Market Demand Y1 - 2014 A1 - Morgan, Joyce W. KW - Event History/Life Cycle KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - Medical underwriting policies are designed to prevent individuals from purchasing long-term care insurance (LTCI) at a time they are most likely to require these services. There is little agreement among researchers regarding the best way to increase the market demand for private LTCI, which would reduce the number of individuals at risk for high out-of-pocket costs. Researchers do tend to agree that Medicaid, premium cost, lack of awareness, and product complexities lower the demand for LTCI. The purpose of this quantitative study was to investigate the prevalence of health and lifestyle risk factors associated with medical underwriting, and the relationship of these factors to limiting the potential size of the private insurance market. The theoretical foundation for this study was both Andersen's model of health services utilization and Akerlof's asymmetric information theory. Data were gathered from Wave 10 of the Health and Retirement Study (HRS), a nationally representative dataset, using purposeful sampling to select 12,666 respondents and spouses, ages 51 and older, without LTCI. Descriptive analysis and a nonparametric 1-way chi-square test indicated the presence of at least 1 risk factor in 95.76% of the sample, 2.72 risk factors per participant in the age group of 51-54, and 4.23 risk factors for participants in the age group of 74-84. Quantitative findings indicated that risk factors associated with medical underwriting affect a sizable proportion of US adults, ages 51 and older. The implications for social change include informing policymakers of the impact of medical underwriting on older adults seeking LTCI for financial security. PB - Walden University CY - Minneapolis VL - 3646205 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1639141262?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-12-30 First page - n/a U4 - Health care management JO - Medical Underwriting: A Factor in Long-Term Care Insurance Market Demand ER - TY - JOUR T1 - Medicare spending, managed care and pre-Medicare insurance coverage and associated risks of mortality, deterioration of self-rated health and mental health after four years of Medicare coverage JF - Journal of Hospital Administration Y1 - 2014 A1 - Yi-Sheng Chao KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - National spending on Medicare keeps growing and managed care is reimbursed differently in the United States. Health returns from Medicare spending are not certain. This study aims to quantify the effects of Medicare spending in the first two years of Medicare coverage, managed care and insurance coverage before Medicare (pre-Medicare) on mortality, mental health and self-rated health status after first four years of Medicare coverage. Individuals, who were interviewed from age 65 to 68 years, without Medicare coverage before age 65 years, were included. Health spending (out-of-pocket, OOP) in the first two years of Medicare coverage, their pre-Medicare characteristics and Medicare managed care were used to predict associated risks of mortality, self-rated health status and mental health (Center for Epidemiologic Studies-Depression, CESD scale). Eligible Medicare enrollees (N = 3,503) in the Health and Retirement Study from 1992 to 2011 were chosen. Total health spending was associated with higher likelihood of worse mental health and self-rated health, but OOP spending was associated with risks of health deterioration (p .05 for all). More OOP health spending in the first two years of Medicare coverage was associated with slightly higher chance of more mental problems, but the magnitude of this association became smaller over time. Medicare managed care did not seem to be beneficial for mortality, mental health or self-rated health status. Expanding pre-Medicare health coverage (through the Affordable Care Act) may not influence health status after first four years of Medicare coverage. Preventing pre-Medicare health conditions may be the priority. PB - 3 VL - 3 IS - 5 U4 - Medicare/Managed care/Health returns/Mortality/Health status/Mental health/CESD scale ER - TY - JOUR T1 - A Multilevel Dyadic Study of the Impact of Retirement on Self-Rated Health: Does Retirement Predict Worse Health in Married Couples? JF - Research on Aging Y1 - 2014 A1 - Angela L Curl A1 - Aloen L. Townsend KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - Objectives: This study examined the effects of retirement on self-rated health for married couples, using interdependence and social stratification theoretical frameworks. Method: Dyadic multilevel modeling of data (N = 2,213 non- Hispanic couples) from 1992 to 2010 of the Health and Retirement Survey. Results: Retirement was associated with worse self-ratings of health (SRH) short term (ST) for both husbands and wives during the first couple of years of retirement. In addition, the longer the husbands (but not wives) were retired, the worse was their SRH. Cross-spouse effects varied by gender: When wives retired, their husbands SRH improved ST, but when husbands retired their wives SRH improved long term. Spouse education moderated the relationship between years since spouses retirement and SRH for wives. Discussion: Practitioners can use this information to help married couples through retirement planning and transitions. Results suggest that models of retirement in couples should pay greater attention to gender and other social stratification factors, spousal interdependence, and length of time since retirement. PB - 36 VL - 36 IS - 3 N1 - Date revised - 2014-12-01 Number of references - 58 U4 - Gerontology/GERIATRICS/retirement planning/married couples/socioeconomic status/self-rated health/longitudinal analysis ER - TY - THES T1 - Patterns of dissaving among U.S. elders Y1 - 2014 A1 - Gray, Deborah KW - Adult children KW - Consumption and Savings KW - Event History/Life Cycle KW - Healthcare KW - Net Worth and Assets KW - Public Policy AB - This paper examined patterns of decumulation and the role that health events and marital disruption play in forming those patterns. Study data were drawn from six biennial waves of the HRS (1998 - 2008), and merged RAND HRS data files for the period 1998-2008. The a priori expectation was that there will be variation in drawdown strategies households employ. Findings suggest that patterns of dissaving are heterogeneous. The five most prevalent patterns were discussed. Households predominantly transitioned between oversaving and overspending. Households are expected to have a goal of on target spending therefore the observed cycle's dissaving will influence the next cycle's draw down rate in an attempt to maintain a sustainable drawdown rate. Markov model results suggest that households do recalibrate their depletion rate as a function of their last depletion rate. This study hypothesized that the onset of a health condition or a spouse's admission to a nursing home would be associated with an excessive decumulation of assets. These hypotheses were unsupported by the research. Marital transitions as predictors of decumulation were only partially borne out by the results. Divorce was also expected to increase the likelihood of overspender however this relationship was not significant. Loss of spouse was associated with an increased likelihood of verspending. One of the major contributions of this study is the identification of patterns of dissaving in retirement. Various life course, demographic and decumulation factor variables were determinants of these patterns. Overall results suggest that elders have a difficult time managing to an on target drawdown. This study concludes with a national decumulation policy directive outline. PB - University of Massachusetts Boston CY - Boston VL - 3622193 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1547725290?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 2014 Last updated - 2014-07-26 First page - n/a U4 - Public policy JO - Patterns of dissaving among U.S. elders 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 - Positive Psychological Attributes and Retirement Satisfaction JF - Journal of Financial Counseling and Planning Y1 - 2014 A1 - Asebedo, Sarah D. A1 - Martin C. Seay KW - Demographics KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - This study investigated the association between positive psychological attributes and retirement satisfaction using a sample of 5,146 retired individuals from the 2006 and 2008 waves of the Health and Retirement Study (HRS). Utilizing Seligman s (2012) well-being theory, positive psychological attributes, as represented by the acronym PERMA, were measured by dispositional optimism (Positive emotion), reading the newspaper daily and having a hobby (Engagement), family support (Positive relationships), purpose in life and religiosity (Meaning), and perceived mastery (Accomplishment). Significant evidence was found supporting the association between positive psychological attributes and retirement satisfaction. Specifically, results of the ordinal logistic model revealed that, holding all else constant, dispositional optimism, family support, purpose in life, and perceived mastery were each positively associated with retirement satisfaction. Relevant implications for financial planners, counselors and educators include learning and developing optimism, cultivating family relationships, fostering purpose in life, discovering accomplishment during retirement, and structuring a phased transition to retirement. PB - 25 VL - 25 IS - 2 U4 - positive psychology/psychological well-being/retirement satisfaction/subjective well-being/dispositional optimism/Religiosity/Perceived mastery/retirement planning ER - TY - JOUR T1 - Potentially traumatic events and serious life stressors are prospectively associated with frequency of doctor visits and overnight hospital visits JF - Journal of Psychosomatic Research Y1 - 2014 A1 - Katerina A B Gawronski A1 - Eric S Kim A1 - Laura E. Miller KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare AB - Objective: Cumulative lifetime exposure to potentially traumatic events and serious life stressors has been linked with both mental and physical health problems; however, less is known about the association between exposure to potentially traumatic events and serious life stressors with health care use. We investigated whether a higher number of potentially traumatic events and serious life stressors were prospectively associated with an increased number of doctor visits and nights spent in the hospital. Methods: Participants were drawn from the Health and Retirement Study, a prospective and nationally representative study of adults aged 50. in the United States (n = 7168). We analyzed the data using a generalized linear model with a gamma distribution and log link. Results: A higher number of potentially traumatic events and serious life stressors were associated with an increased number of doctor visits and nights spent in the hospital. On a 10-point scale, each additional potentially traumatic event or serious life stressor was associated with an 8 increase in doctor visits after controlling for sociodemographic factors (RR = 1.08, 95 CI = 1.06-1.11; p . .001). Each additional potentially traumatic event or serious life stressor was also associated with an 18 increase in the number of nights spent in the hospital after controlling for sociodemographic factors (RR = 1.18, 95 CI = 1.10-1.27; p . .001). Conclusion: Exposure to potentially traumatic events and serious life stressors is associated with increased doctor visits and nights spent in the hospital, which may have important implications for the current standard of care. 2014 Elsevier Inc. PB - 77 VL - 77 IS - 2 N1 - Export Date: 6 August 2014 Article in Press U4 - Doctor visits/Health care utilization/Lifetime trauma/Stressor/Trauma/care standards ER - TY - THES T1 - Predictors and Mediators of Long-term Functional Limitations after Injury in the Older Adult Population Y1 - 2014 A1 - Teresa M. Bell KW - Health Conditions and Status KW - Healthcare KW - Other KW - Public Policy AB - With nearly 40 million Americans being treated for nonfatal injuries in emergency departments annually, the burden of nonfatal injury in the United States is extensive. The long-term functional consequences of these injuries can be enduring and far-reaching, especially for older adults. Although studies have reported that persistent functional deficits exist after injury, less information is known about long-term recovery patterns and the factors that influence functional outcomes. The primary aims of this study are to (1) classify differences in long-term, longitudinal changes in functional limitations within the injured population, (2) identify individual characteristics that predict recovery after injury and (3) assess whether medical care use mediates the relationship between long-term changes in functional limitations and significant predictors of outcomes after injury, specifically insurance status. Longitudinal survey data from the Health and Retirement Study (HRS) was analyzed using group-based trajectory modeling and mediation analysis. The trajectory analysis identified five distinct functional trajectories with the following characteristics: Trajectory 1- consistently low functional limitations scores (18.9%), Trajectory 2- increase in functional limitations after injury followed by a gradual, but not complete recovery (46.3%), Trajectory 3- increase in functional limitations followed by further decline in functioning over time (10.5%), Trajectory 4- increase in functional limitations after injury followed by a gradual, complete recovery (13.4%), and Trajectory 5- consistently high functional limitations scores (10.8%). Regression analyses showed that women, individuals with multiple health conditions, and individuals with no insurance and public insurance were more likely to belong to trajectories with poorer functional outcomes. The mediation analysis found that public insurance was associated with increased functional limitations relative to private insurance. The total effect of public insurance on functional limitations was partially mediated by medical care use. Doctor visits was the only significant medical care use mediator for individuals with public insurance. The relative total and direct effects of being uninsured on functional limitations were not significant. However, the indirect effect of being uninsured on functional limitations was significant, indicating that medical care use may suppress the effect of being uninsured on functional outcomes. Prescription drug use was the only significant mediator of the effect of not having insurance on functional status. These results illustrate that distinct courses of recovery after injury in the older adult population exist. Furthermore, personal characteristics of individuals can be used to predict functional trajectories. This study also demonstrated that insurance status is a significant predictor of both functional outcomes and medical care use after injury. Insurance status was found to exert its effect on health outcomes both directly and indirectly through medical care. Ultimately, the findings from this study can be used to improve the understanding of how individuals' functional outcomes differ after injury and the causal processes that determine these outcomes. This knowledge may lead to tailored policies and treatments that improve quality of life after injury. PB - The University of Tennessee Health Science Center CY - Memphis, TN VL - 3619298 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1536437179?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/fmt:kev:mtx:disse N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-07-01 First page - n/a U4 - Public health JO - Predictors and Mediators of Long-term Functional Limitations after Injury in the Older Adult Population ER - TY - JOUR T1 - Predictors of Long-Term Nursing Home Placement Under Competing Risk: Evidence from the Health and Retirement Study JF - Journal of the American Geriatrics Society Y1 - 2014 A1 - Castora-Binkley, Melissa A1 - Meng, Hongdao A1 - Hyer, Kathryn KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Risk Taking AB - Objectives:To examine predictors of long-term nursing home placement (LTNHP) while controlling for mortality as a competing risk event. Design: Longitudinal. Setting: Health and Retirement Study, 1998-2010. Participants: Nationally representative sample of community-living older adults (N=10,385). Measurements: Longitudinal data were used with a maximum follow-up of 12years. First, a traditional Cox proportional hazards model was estimated treating death as an uninformative censoring event. A joint cause-specific hazards model that accounts for the competing risk of mortality in estimating the risk of LTNHP was then estimated. Results: The effect of adjusting for competing risk of mortality is evident for nearly all predictors of LTNHP. Predictors were over- or underestimated in the traditional Cox model, and several predictors changed in the direction of the association, whereas others changed in magnitude. For example, after controlling for mortality, women aged 85 and older had more than twice the risk (hazard ratio=7.23, 95 confidence interval=5.18-10.10) of LTNHP than evidenced in the traditional Cox model. Conclusion: Whenever possible, the competing risk of mortality should be recognized and adjusted in developing screening tools and predictive risk models for LTNHP. PB - 62 VL - 62 IS - 5 N1 - Times Cited: 0 U4 - censoring/competing risk/mortality/nursing home placement ER - TY - JOUR T1 - Productivity improvements in hip and knee surgery JF - Arthritis Y1 - 2014 A1 - Frank A Sloan A1 - Linda K George A1 - Hu, Linyan KW - Health Conditions and Status KW - Healthcare KW - Other AB - Productivity improvements that occur as technologies become widely used are not well documented. This study measured secular trends over 1998-2010 in productivity of hip and knee procedures gauged in terms of changes in physical function and pain after versus before surgery. We used data from the Health and Retirement Study. Health outcomes from surgery were measured by 6 physical functioning scales and 2 pain indicators. We used propensity score matching to obtain nonsurgery control groups. Not only were there substantial improvements in physical functioning and pain reduction after receipt of these procedures in all years, but also we documented improvements in health outcomes over time. Largest improvements were for reductions in numbers of Activity and Instrumental Activity of Daily Living limitations for knee procedures. PB - 2014 VL - 2014 N1 - Times Cited: 0 U4 - ADL/IADL/health outcomes/productivity/Surgical outcomes/Knee Replacement ER - TY - JOUR T1 - Providing dental care coverage to uninsured older US adults who do not use dental care may not result in usage rates similar to those with prior coverage and use JF - Journal of Evidence Based Dental Practice Y1 - 2014 A1 - Vujicic, Marko KW - Healthcare KW - Insurance AB - Subjects The study included adults in the United States who were age 55 years or older. Study Factor The key factor examined in the study was the influence of dental care coverage on dental care use. Outcome Measures The study investigated the link between dental care coverage, dental care use, and personal characteristics for older Americans. The authors examined why older US adults who lack dental care coverage and do not visit the dentist would still have lower dental care use rates than the current insured population if their dental care coverage rates were to expand. Results The authors used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. Compared with persons with no coverage and no dental care use, they found that users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. Conclusions Providing dental care coverage to uninsured older US adults who currently do not visit the dentist will not necessarily result in use rates similar to those with prior coverage and use. The authors offer a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use. PB - 14 VL - 14 UR - http://www.sciencedirect.com/science/article/pii/S1532338214000864 IS - 2 U4 - dental care/dental insurance ER - TY - JOUR T1 - Racial Variations of Parity Status as a Predictor of Disability Onset Among Old-Old Women JF - Journal of Family Issues Y1 - 2014 A1 - Kenzie Latham A1 - Holcomb, Jeanne KW - Adult children KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - This research investigates whether the capacity of parity status to predict disability onset varies by race among older women. Data from the Health and Retirement Study (1998-2008) were used, and a series of discrete-time event-history models were estimated using multinomial logistic regression. Disability onset was constructed from five common activities of daily living measures (i.e., difficulty dressing, bathing, eating, getting in/out of bed, and walking). The initial risk group was old-old women (i.e., born before 1925) without disability in 1998 (N = 2,229). Nulliparous and high-parity Black women born before 1925 were more likely to develop disability onset compared with White women with the same parity status. The results suggest that parity status among Black older women may be a salient risk factor for disability onset. PB - 35 VL - 35 IS - 3 N1 - Times Cited: 0 U4 - Family Demography/Life Course/Mother-Child Relationship/Long-Term Consequences/disabilities/Fertility History/Childbearing/African American ER - TY - JOUR T1 - Receipt of Care and Depressive Symptoms in Later Life: The Importance of Self-Perceptions of Aging JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2014 A1 - Kwak, Minyoung A1 - Ingersoll-Dayton, Berit A1 - Sarah A. Burgard KW - Health Conditions and Status KW - Healthcare KW - Other AB - Objectives. This study examines the extent to which self-perceptions of aging and perceived loss of control explain the relationship between the receipt of care and depressive symptoms among older adults. Methods. The sample consists of individuals aged 51 and older from the 2006, 2008, and 2010 waves of the Health and Retirement Study (n = 5,938). Structural equation modeling was used to test an analytic model that focused on the mediating effects of self-perceptions of aging and perceived loss of control. The respondents demographic and health characteristics and depressive symptoms at baseline were included as control variables. Results. The results indicated that self-perceptions of aging mediated the relationship between receipt of care and depressive symptoms. That is, older adults who received a greater amount of care perceive their aging more negatively, which, in turn, increased depressive symptoms 2 years later. However, perceived loss of control did not significantly mediate the relationship between the receipt of care and depressive symptoms. Discussion. These findings suggest that the receipt of care may make frail older adults more vulnerable to negative self-perceptions of aging. PB - 69 VL - 69 IS - 2 U4 - Care recipient/Depressive symptoms/Loss of control/Self-perceptions of aging ER - TY - JOUR T1 - Relationship between pain and chronic illness among seriously ill older adults: expanding role for palliative social work JF - Journal of social work in end-of-life and palliative care Y1 - 2014 A1 - Morrissey, Mary Beth A1 - Viola, Deborah A1 - Shi, Qiuhu KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 ). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed. PB - 10 VL - 10 IS - 1 N1 - Times Cited: 0 U4 - chronic illness/palliative social work/public health ER - TY - RPRT T1 - Retirement Timing of Women and the Role of Care Responsibilities for Grandchildren Y1 - 2014 A1 - Lumsdaine, Robin L. A1 - Stephanie J. C. Vermeer KW - Adult children KW - Healthcare KW - Retirement Planning and Satisfaction AB - This paper considers the potential relationship between providing care for grandchildren and retirement, among women nearing retirement age. Using 47,400 person-wave observations from the Health and Retirement Study (HRS), we find the arrival of a new grandchild is associated with a more than eight percent increase in the retirement hazard despite little overall evidence of a care/retirement interaction. We document that while family characteristics seem to be the most important factors driving the care decision, they are also important determinants of retirement. In contrast, while financial incentives such as pensions and retiree health insurance have the largest influence on retirement, the opportunity cost associated with outside income seems to have little effect on whether or not a grandmother provides care. There is little evidence of substitution between caring for grandchildren versus providing care for elderly parents or engaging in volunteer activities; grandchild care is instead taken on as an additional responsibility. Our findings suggest that policies aimed at prolonging worklife may need to consider grandchild care responsibilities as a countervailing factor while those policies focused on grandchild care may also affect elderly labor force composition. PB - Cambridge, MA, National Bureau of Economic Research U4 - family Caregivers/transfers/grandchild care/retirement planning ER - TY - THES T1 - The Role of Spousal Characteristics on the Use of Formal Long-Term Care of Elderly Couples in the United States Y1 - 2014 A1 - Eom, Jinyoung KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - In the United States, the last decades have witnessed a steady increase in the percent of formal long-term care (nursing home care and paid home health care) uses. Specifically, it is shown that the percent of elderly couples, who use formal long-term care is much lower than that of single-living elderly to use formal long-term care. However, it has not been fully understood what factors determine the use of formal long-term care for elderly couples. Different from the previous studies, I scrutinize not only own individual factors but also spousal characteristics in terms of spouses health conditions, which may determine the use of formal long-term care of elderly couples. Detailed health conditions of spouse are considered; spouse's health dynamics and diagnosed illness by doctors. In addition, I carefully consider two different cases, according to the identity of the principal decision-maker regarding uses of formal long-term care: (i) An individual who needs long-term care decides formal long-term care uses himself/herself, and (ii) the spouse of the individual decides the individual's formal long-term care utilization. Models are estimated using multinomial logit specification using data from the Health and Retirement Study. Results suggest that the age, education level, the individual's health conditions and Activities of Daily Living ("ADL") changes are key factors that strongly affect the decision for utilization of formal long-term care for the elderly couples. When the individual has more disabilities in daily living, or has illnesses such as cancer, diabetes, stroke, psychological problem, or memory problem, he/she is more likely to use formal long-term care. I have also found that the spouse's health conditions, such as Instrumental Activities of Daily Living ("IADL"), ADL, diabetes, cancer or psychological problems affect the formal long-term care of the individual. This study shows that the spouse has an important effect on the individual's decision-making, regardless of who is ultimately in charge of that decision. However, when the group is classified according to `decision maker', the role of the spouse in the decisions regarding the individual's utilization of formal long-term care is more clearly understood. PB - State University of New York at Stony Brook CY - Stony Brook, NY VL - 3631750 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1566946454?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 - 2014-10-13 First page - n/a U4 - ADL/IADL JO - The Role of Spousal Characteristics on the Use of Formal Long-Term Care of Elderly Couples in the United States ER - TY - JOUR T1 - The schooling of offspring and the survival of parents JF - Demography Y1 - 2014 A1 - Esther M Friedman A1 - Robert D. Mare KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Contemporary stratification research on developed societies usually views the intergenerational transmission of educational advantage as a one-way effect from parent to child. However, parents' investment in their offspring's schooling may yield significant returns for parents themselves in later life. For instance, well-educated offspring have greater knowledge of health and technology to share with their parents and more financial means to provide for them than do their less-educated counterparts. We use data from the 1992-2006 Health and Retirement Study (HRS) to examine whether adult offspring's educational attainments are associated with parents' survival in the United States. We show that adult offspring's educational attainments have independent effects on their parents' mortality, even after controlling for parents' own socioeconomic resources. This relationship is more pronounced for deaths that are linked to behavioral factors: most notably, chronic lower respiratory disease and lung cancer. Furthermore, at least part of the association between offspring's schooling and parents' survival may be explained by parents' health behaviors, including smoking and physical activity. These findings suggest that one way to influence the health of the elderly is through their offspring. To harness the full value of schooling for health, then, a family and multigenerational perspective is needed. PB - 51 VL - 51 IS - 4 N1 - Times Cited: 0 U4 - educational attainment/mortality/children/Behavior/Generational transfers ER - TY - THES T1 - Subjective Socioeconomic Status in Daily Cognitive Functioning and Cognitive Aging Y1 - 2014 A1 - Zavala, Catalina KW - Demographics KW - Employment and Labor Force KW - Expectations KW - Health Conditions and Status KW - Healthcare AB - The primary purpose of this dissertation is to investigate to what extent objective and subjective socioeconomic status (SES) provide unique information regarding the impact of SES on cognitive aging trajectories, as well as daily individual variability and plasticity in cognitive functioning. For Study 1, two large samples were drawn from publically available data in the Health and Retirement Study (HRS) to examine cross-sectional performance on episodic memory and fluid reasoning tasks, and longitudinal change in general cognitive functioning across 6 years. Analyses of the cross-sectional sample indicated that subjective SES positively predicted performance on episodic memory and fluid reasoning tasks above and beyond the effect of objective SES. For both cognitive tasks, objective SES remained a significant predictor of cognitive performance after controlling for physical and mental health, but subjective SES was no longer a significant predictor. In the longitudinal sample, growth curve analyses suggested a small positive effect of increasing subjective SES to level of overall cognitive functioning beginning at around age 68, though this boost waned by age 90. This effect was maintained even while controlling for objective SES, BMI, self-rated health, and depressive symptoms. For Study 2, cognitive functioning across episodic memory and fluid reasoning domains were examined in a sample of 45 older adults who completed an initial baseline questionnaire including assessment of objective and subjective SES, and a 7-day `burst' repeated-measures design including cognitive tasks self-administered once a day. Overall, findings suggested that intraindividual variance in cognitive functioning across seven days was inversely related to overall mean performance for both episodic memory and fluid reasoning, such that individuals who showed more variability in performance tended to perform lower on cognitive tasks. Additionally, findings suggested that intraindividual variance in cognitive functioning is likely associated with both objective and subjective SES, though a number of the observed associations did not reach statistical significance. Collectively, these results suggest that an individual's perceptions of their SES may have fundamental impacts on later cognitive outcomes or, alternatively, that individuals may be able to provide a unique insight regarding their SES as not fully assessed by commonly used SES indicators. PB - University of California, Riverside CY - Riverside, CA VL - 3644052 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1636527559?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 - 2014-12-20 First page - n/a U4 - Cognitive psychology JO - Subjective Socioeconomic Status in Daily Cognitive Functioning and Cognitive Aging ER - TY - JOUR T1 - Is There a Trade-off Between Parent Care and Self-care? JF - Demography Y1 - 2014 A1 - Arora, Kanika A1 - Douglas A. Wolf KW - Adult children KW - Healthcare AB - Caregiving for family members is often described as a 36-hour day. Previous literature has suggested that family caregivers have little time to attend to their own health needs, such as participating in leisure-time physical activity. Using data from the Health and Retirement Study, we analyze whether time-allocation decisions reflect a conflict between time devoted to informal care and time devoted to self-health promotion through physical activity. The empirical model is a system of four correlated equations, wherein the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, or in hours of work, among either men or women. PB - 51 VL - 51 IS - 4 N1 - Times Cited: 0 U4 - caregiving/family caregivers/parental care ER - TY - THES T1 - Three Essays in Health, Education, and Retirement Y1 - 2014 A1 - Arons, Robert KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - In chapter one I examine the impact of Health Maintenance Organization (HMO) coverage on the provision of preventive medicine procedures and undiagnosed disease. Rates of missed preventive care and undiagnosed conditions are substantially lower for middle-aged HMO enrollees compared to non-HMO enrollees. I control for selection with a novel quasi-experiment: turnover in group health insurance contracts at the firm level creates exogenous variation in plan type. The large age heterogeneity in the effect of HMO contracts is consistent with incentive structures in HMOs playing a role in the quality of patient care. In chapter two I use a regression discontinuity framework to analyze the No Child Left Behind (NCLB) Act's attempt to reduce the achievement gap by requiring sociodemographic groups meet group based proficiency count targets. Using a panel of North Carolina public school students in grades three through eight from 2003-2012, I find when a student's group is added to the set of existing accountable groups, it has a small positive impact on subject matter proficiency and test scores. Variation in the application of these laws comes the fact that groups are only held to academic proficiency standards if there are 40 or more tested students in the group within the school. In chapter three I estimate the potential earnings of retirees. Estimating the earnings structure of those no longer working is complex, because (1) health and cognition decline at older ages and drive workers into retirement, (2) retirement may cause changes in health and cognition, and (3) unobserved wage shocks may also drive workers into retirement and bias estimates depending on the direction of selection. Issue (1) is solved by using health and cognitive measures from the data, the Health and Retirement Study. Issues (2)-simultaneity of retirement with health and cognition, and (3)-selection out of the labor force, are controlled for with four instruments, self-reported probability of retirement at age 62 and 65 reported at age 55 and age dummies for 62 and 65. We find that retirees would earn less than a selection corrected estimator would suggest by about $13,000 per year. PB - University of Rochester CY - Rochester, NY VL - 3644859 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1638212186?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 - 2014-12-27 First page - n/a U4 - health Status JO - Three Essays in Health, Education, and Retirement ER - TY - JOUR T1 - The transition to parent care: Costs, commitments, and caregiver selection among children JF - Journal of Marriage and Family Y1 - 2014 A1 - Thomas Leopold A1 - Marcel Raab A1 - Henriette Engelhardt KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Other AB - This research traced the process of caregiver selection among adult children longitudinally, investigating how transitions to parent care were influenced by previous constellations of caregiving costs and commitments within sibling groups. The authors used data from 6 waves (1998-2008) of the Health and Retirement Study, selecting a sample of families (N=641 parents comprising N=2,452 parent-child dyads) in which they observed at least 1 adult child becoming a caregiver to a previously self-sufficient parent. Among cost-related factors, this transition was predicted primarily by between-sibling differences in previous geographical distances to the parent and, to a lesser extent, competing demands in work and family spheres. The indicators for caregiving commitments showed the importance of reciprocity, path dependency, and parental expectations as motivational forces affecting the process of caregiver selection among adult children. Gender effects revealed the primacy of the mother-daughter tie, as daughters were overrepresented only in transitions to mother care. National Council on Family Relations, 2014. PB - 76 VL - 76 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84895111373andpartnerID=40andmd5=b5d6e1e1085bb9c47de88a8bfa7d1720 IS - 2 N1 - Export Date: 21 April 2014 Source: Scopus U4 - Aging/Caregiving/Intergenerational transfers/Parent-child relationships/Siblings/Transitions ER - TY - JOUR T1 - Utilization of occupational and physical therapy services in postacute care: Findings from the 2006 health and retirement study and linked medicare claims data JF - Physical and Occupational Therapy in Geriatrics Y1 - 2014 A1 - Chiung-Ju Liu A1 - Timothy E. Stump A1 - Ambuehl, Roberta A1 - Daniel O. Clark KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Aims: To describe and determine factors predicting utilization of occupational and physical therapy (PT) services in postacute rehabilitation systems over a 1-year period in Medicare beneficiaries. Methods: Data from 1,667 respondents in the 2006 Health and Retirement Study and linked Medicare claims were analyzed. Results: The average length of inpatient rehabilitation stay ranged between 11 and 17 days. Therapeutic procedures were the most commonly claimed Current Procedural Terminology (CPT) codes in outpatient rehabilitation. Very-high level was the mostly claimed resource utilization group (RUG) in skilled nursing facilities. Additionally, the average number of therapy home visit ranged between 31 and 34. Logistic regression analysis showed that greater age and more comorbidities were associated with using therapy services from two or more postacute care (PAC) systems. Conclusion: The study results increase the understanding of the utilization of rehabilitation therapy services across PAC systems and provide basic information for rehabilitation services planning. 2014 Informa Healthcare USA, Inc. PB - 32 VL - 32 UR - https://www.tandfonline.com/doi/full/10.3109/02703181.2014.883044 IS - 1 N1 - Export Date: 21 April 2014 Source: Scopus U4 - Medicare/Occupational therapy/Physical therapists/Utilization 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 - Anticipatory Socialization for Retirement: A Multilevel Dyadic Model JF - CLINICAL GERONTOLOGIST Y1 - 2013 A1 - Angela L Curl A1 - Ingram, J. G. KW - Adult children KW - Demographics KW - Healthcare KW - Other KW - Retirement Planning and Satisfaction AB - Role theory, widely used to examine human behavior, has often been used to describe the transition from work to retirement. Anticipatory socialization, a role theory concept, describes the process that occurs prior to role transitions and assists in that transition by helping individuals learn the norms for the new role. However, not all workers engage in retirement planning. Lack of retirement planning is of concern because those individuals who do not plan for major life transitions tend to be less successful in adjusting to role changes. Data from the Health and Retirement Study were used; selection criteria required participants to be age 45 or older, working full- or part-time, and have complete data for the study variables. Multilevel modeling results of dyadic data from the Health and Retirement Study (N=1,028 dual-earner couples) indicate that older age, being White, higher income, greater retirement wealth, and looking forward to retirement predicted greater anticipatory socialization (i.e., thinking about and discussing retirement) by both husbands and wives. For wives only, having a health problem limiting work, higher spouse occupational status, and having a spouse who was looking forward to retirement predicted more anticipatory socialization. For husbands only, higher education, higher depressive symptomatology, and lower occupational status predicted more anticipatory socialization. This study found evidence of spousal congruence, with husbands, on average, engaging in more anticipatory socialization than wives. These findings identify couples that could most benefit from targeted efforts to increase anticipatory socialization, which predicts better retirement adjustment and satisfaction. PB - 36 VL - 36 IS - 4 U4 - DUAL-EARNER COUPLES/GERIATRICS/GERONTOLOGY/retirement planning/GENDER/PSYCHIATRY/anticipatory socialization/married couples/disparities/GERONTOLOGY ER - TY - RPRT T1 - Are Gender Differences Emerging in the Retirement Patterns of the Early Boomers? Y1 - 2013 A1 - Kevin E. Cahill A1 - Michael D. Giandrea A1 - Joseph F. Quinn KW - Demographics KW - Employment and Labor Force KW - Healthcare KW - Net Worth and Assets KW - Retirement Planning and Satisfaction KW - Women and Minorities AB - Controlling for career employment later in life, the retirement patterns of men and women in America have resembled one another for much of the past two decades. Is this relationship coming to an end? Recent research suggests that the retirement patterns of the Early Boomers those born between 1948 and 1953 have diverged from those of earlier cohorts. Gender differences appear to be emerging as well in the way that career men and women exit the labor force, after nearly two decades of similarities. This paper explores these gender differences in detail to help determine whether we are witnessing a break in trend or merely a short-term occurrence. We use data on three cohorts of older Americans from the nationally-representative, longitudinal Health and Retirement Study (HRS) that began in 1992. We explore by gender the types of job transitions that occur later in life and explore, in particular, the role of four potentially relevant determinants: the presence of dependent children; a parent in need of caregiving assistance; occupational status on the career job; and self-employment status. We find that, among career men and women, child and parental caregiving are not significant drivers of the retirement transitions of the Early Boomers, all else equal. Gender differences that may exist with respect to these characteristics are therefore unlikely to lead to persistent gender differences in retirement patterns. In contrast, self employment continues to be a statistically significant determinant of bridge job transitions and phased retirement. This finding, combined with the fact that men are much more likely than women to be self employed later in life, could lead to some differences by gender going forward, though the impact is likely to be limited given that the large majority of older workers are in wage-and-salary employment. Older Americans both men and women are responding to their economic environment by working later in life and exiting the labor force gradually. While some determinants of these decisions likely impact men and women differently, gender differences with respect to the retirement patterns of the Early Boomers appear to be the result of broader macroeconomic forces. The evidence to date suggests that gender differences may dissipate as the recovery ensues. PB - Washington, DC, Bureau of Labor Statistics UR - http://www.bls.gov/osmr/pdf/ec130090.pdf U4 - Economics of Aging/Partial Retirement/Gradual Retirement/retirement planning/early boomers/labor Force Participation/gender differences/caregiver Status/WOMEN/working spouses ER - TY - JOUR T1 - The Asset and Income Profiles of Residents in Seniors Housing and Care Communities: What Can Be Learned From Existing Data Sets JF - Research on Aging Y1 - 2013 A1 - Norma B Coe A1 - Melissa A. Boyle KW - Health Conditions and Status KW - Healthcare KW - Housing KW - Retirement Planning and Satisfaction AB - The authors use existing, nationally representative surveys to assess the economic characteristics of individuals in three categories of seniors housing and care facilities: independent living communities (ILCs), assisted living residences (ALRs), and continuing care retirement communities (CCRCs). The findings highlight the strengths and weaknesses of using the Health and Retirement Study, National Long-Term Care Survey, and Medicare Current Beneficiary Survey to describe this segment of the population. The results suggest that residents in ILCs and ALRs have lower average incomes than the average costs of these care communities. Conversely, CCRC residents have higher incomes and more assets than those living in private homes, suggesting that CCRCs attract the wealthiest seniors. However, longitudinal analysis is prohibited by the small sample sizes. PB - 35 VL - 35 IS - 1 N1 - Times Cited: 0 U4 - Aging/Housing/Living arrangements/Long-term care/Assisted Living/retirement planning ER - TY - JOUR T1 - Associations of loneliness in older married men and women JF - Aging and Mental Health Y1 - 2013 A1 - Liat Ayalon A1 - Sharon Shiovitz-Ezra A1 - Yuval Palgi KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - We evaluated the associations between loneliness and subjective appraisals of marital relationship as well as reciprocal associations of loneliness in married men and women. The Health and Retirement Study is a national survey of older adults over the age of 50, residing in the US. This study is based on a paper and pencil questionnaire administered in the year 2006. Overall, 2723 couples completed this questionnaire. Loneliness was evaluated using the three-item version of the Revised University of California Los Angeles Loneliness Scale. A non-recursive path analysis was conducted. The model suggested that subjective appraisals of the relationship with spouse play a major role in one's sense of loneliness. In addition, loneliness in men and women shares reciprocal associations. The model explained 24 and 29 of the variability in loneliness reported by married men and women, respectively. Results indicate that capitalizing and enhancing one's social life might also be beneficial for his or her partner. Any intervention to alleviate loneliness in married couples has to take into consideration their perceived marital relationship as well as the reciprocal associations of loneliness in married men and women. PB - 17 VL - 17 IS - 1 N1 - Times Cited: 0 U4 - Loneliness/Social network/Gender/Epidemiology/Dyads/Marriage ER - TY - JOUR T1 - THE CARE SPAN Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay JF - Health Affairs Y1 - 2013 A1 - Amy Kelley A1 - Deb, Partha A1 - Qingling Du A1 - Carlson, Melissa D. Aldridge A1 - R Sean Morrison KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-08, and individual Medicare claims, and overcoming limitations of previous work, we found 2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: 2,650, 5,040, and 6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit. PB - 32 VL - 32 IS - 3 N1 - Times Cited: 2 U4 - Chronic care/Quality of care/Organization and delivery of care/Determinants of health/Access to care/Medicare/health Care Utilization ER - TY - JOUR T1 - Changes in adult children's participation in parent care JF - Ageing and Society Y1 - 2013 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Adult children KW - Healthcare AB - Care-giving research has focused on primary care-givers and relied on cross-sectional data. This approach neglects the dynamic and systemic character of care-giver networks. Our analyses address changes in care-givers and care networks over a two-year period using pooled data from the US Health and Retirement Study, 1992-2000. Based on a matrix of specific adult-child care-givers across two consecutive time-points, we assess changes in any adult-child care-giver and examine the predictors of change. A change in care-giver occurred in about two-fifths of care-giving networks. Ability to provide care based on geographical proximity, availability of alternative care-givers, and gender play primary roles in the stability of care networks. Results underline the need to shift care-giving research toward a dynamic and systemic perspective. PB - 33 VL - 33 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1321173957?accountid=14667 IS - 4 N1 - Copyright - Copyright Cambridge University Press 2012 Document feature - References Last updated - 2013-04-19 CODEN - AGSOD9 DOI - 2929542811; 76658942; 14190; AGSOD9; PANS; CBVPPANS10.1017/S0144686X12000177 U4 - Older parents/Caregivers/Intergenerational effects/Intergenerational effects/caregiver Status/Transfers ER - TY - JOUR T1 - Chemo brain --is cancer survivorship related to later-life cognition? Findings from the health and retirement study JF - Journal of Aging and Health Y1 - 2013 A1 - Porter, Kristen E. KW - Health Conditions and Status KW - Healthcare AB - OBJECTIVE: Studies have shown a correlation between cancer and cognition referred to as chemo brain. This study investigated the relationship between cancer and later-life cognition using nationally representative data. METHOD: Analysis of the 2006 Health and Retirement Study investigated the (a) effects of cancer survivorship on the total cognition score using linear regression in adults age 65 (n = 9,814) and (b) the effects of cancer treatment on the total recall index using linear regression in adults age 50 (n = 657). RESULTS: Total cognition score is not associated with cancer survivorship. The association between long-term cancer survivorship and cognition score was significant (p .05; b = .276). Total recall index is not associated with chemotherapy. DISCUSSION: These results support other research suggesting that chemo brain may be biased by expectation as well as favored by research that relies upon self-reported cognitive measures versus cognitive testing. The study was limited by the cross-sectional design. PB - 25 VL - 25 IS - 6 N1 - Times Cited: 0 U4 - Cancer/Cognitive function/Cognitive status/Geriatrics/Chemotherapy ER - TY - JOUR T1 - Concordance of Physical Activity Trajectories Among Middle-Aged and Older Married Couples: Impact of Diseases and Functional Difficulties JF - The Journals of Gerontology Y1 - 2013 A1 - Li, Kin-Kit A1 - Cardinal, Bradley J. A1 - Acock, Alan C. KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - This study examined spousal concordance of physical activity trajectories among middle-aged and older married couples and the influences of recent diseases and functional difficulties on individuals' trajectories and those of their spouses'. Participants included 5,074 married couples aged 50 or older in the Health and Retirement Study in 2004-2010. Participants were categorized into 4 physical activity trajectories (i.e., stable active, adopters, relapsers, and stable sedentary) using confirmatory latent class growth analysis. Individuals' trajectory memberships were predicted by their spouses' memberships, together with recent diseases and functional difficulties of both couple members. In the main, corresponding husbands' trajectories predicted wives' trajectories and vice versa. More functional difficulties predicted higher likelihoods of unfavorable trajectories among individuals but not of their spouses'. Among wives, more recent diseases predicted slightly more physical activity in subsequent data waves but not trajectory memberships. Results supported spousal concordance in physical activity trajectories. The negative impact of functional difficulties was considerably contained within individuals. Increases in physical activity after acquiring diseases among wives were small and short lived. More research is needed to understand the underlying processes, which can be used to improve the design of future physical activity interventions directed toward women, men, and couples. PB - 68 VL - 68 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1424402869?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Apqrlandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articleandr IS - 5 N1 - Copyright - Copyright Oxford University Press, UK Sep 2013 Last updated - 2013-08-16 U4 - Medical Sciences--Psychiatry And Neurology/Exercise/Couples/Older people/Gerontology/Middle age/Disease ER - TY - THES T1 - The continuing significance of discrimination: Multiple forms of discrimination and health Y1 - 2013 A1 - Grollman, Eric Anthony KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Other KW - Public Policy AB - Researchers have documented the continuing significance of discrimination as a key mechanism through which social inequality is produced and maintained. While evidence confirms the consistent, wide-reaching impact of discrimination on health, prior research has yielded mixed findings regarding the extent to which these experiences contribute to health disparities. In this dissertation, I advance a multidimensional conceptualization of discrimination and provide a more comprehensive assessment of the health consequences of these experiences in three ways. First, using data from the Health and Retirement Study (HRS), and the National Survey for Midlife Development in the US (MIDUS), I assess whether the prevalence, distribution, and health consequences of differential treatment vary by question wording ("unfair treatment" versus "discrimination"). I find that the language of "unfair treatment" yields greater reports of differential treatment than do reports of "discrimination." This difference, however, is due to increased reports among privileged social groups, particularly whites. In addition, unfair treatment has a larger negative impact on mental (but not physical) health than discrimination - an effect that is limited to whites. I argue that unfair treatment and discrimination likely reflect distinct concepts, as such cannot be used interchangeably in research. Second, I use MIDUS data to assess the links between multiple disadvantaged statuses, multiple dimensions of discrimination, and health. I find that adults who hold multiple stigmatized statuses are at an elevated risk for poor mental and physical health because they face more forms of discrimination (e.g., race and gender) than their more privileged counterparts. Finally, I use data from the Black Youth Culture Survey to investigate the association between multiple forms of discrimination and sexual health among Black, Latina/o, and white heterosexual youth. I find that youth who face more frequent exposure to multiple forms of discrimination are more likely to engage in risky sexual behaviors: early sexual initiation, multiple sex partners, and inconsistent condom and contraceptive use. These practices, in turn, increase their likelihood of teen pregnancy and having an abortion. Taken together, this dissertation offers ways to better conceptualize and measure discrimination and to assess the broad reach of its consequences for victims' health and well-being. PB - Indiana University VL - 3587339 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-09-03 First page - n/a U4 - Epidemiology JO - The continuing significance of discrimination: Multiple forms of discrimination and health ER - TY - CHAP T1 - Disability and Subjective Well-being T2 - Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health Y1 - 2013 A1 - Mary C. Daly A1 - Gardiner, Colin S. ED - Kenneth A. Couch ED - Mary C. Daly ED - Julie M Zissimopoulos KW - Employment and Labor Force KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Income KW - Retirement Planning and Satisfaction AB - The authors examine the relationship between disability, its onset, and subjective well-being in Chapter 15. Individuals with a work-limitating disability self-reported lower levels of life satisfaction. Consistent with previous studies, the authors find a negative relationship between disability status and subjective well-being. Employment status, income, and wealth, mitigates this negative relationship, but disability still emerges as a salient determinant of subjective well-being throughout the analysis. JF - Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health PB - Stanford University Press CY - Stanford, CA U4 - disabilities/prognosis/Subjective well-being/Life satisfaction/Life satisfaction/Employment/income/work limitation JO - Disability and Subjective Well-being ER - TY - RPRT T1 - Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study Y1 - 2013 A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Jung K Kim A1 - Heidi M Guyer A1 - Kenneth M. Langa A1 - Mary Beth Ofstedal A1 - Amanda Sonnega A1 - Robert B Wallace A1 - David R Weir KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions. PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan U4 - Biomarker data/survey Methods/health measures ER - TY - JOUR T1 - The effect of informal care on work and wages JF - Journal of health economics Y1 - 2013 A1 - Courtney Harold Van Houtven A1 - Norma B Coe A1 - Meghan M. Skira KW - Demographics KW - Employment and Labor Force KW - Healthcare KW - Income KW - Medicare/Medicaid/Health Insurance AB - Cross-sectional evidence in the United States finds that informal caregivers have less attachment to the labor force. The causal mechanism is unclear: do children who work less become informal caregivers, or are children who become caregivers working less? Using longitudinal data from the Health and Retirement Study, we identify the relationship between informal care and work in the United States, both on the intensive and extensive margins, and examine wage effects. We control for time-invariant individual heterogeneity; rule out or control for endogeneity; examine effects for men and women separately; and analyze heterogeneous effects by task and intensity. We find modest decreases-2.4 percentage points-in the likelihood of working for male caregivers providing personal care. Female chore caregivers, meanwhile, are more likely to be retired. For female care providers who remain working, we find evidence that they decrease work by 3-10hours per week and face a 3 percent lower wage than non-caregivers. We find little effect of caregiving on working men's hours or wages. These estimates suggest that the opportunity costs to informal care providers are important to consider when making policy recommendations about the design and funding of public long-term care programs. PB - 32 VL - 32 IS - 1 U4 - Informal care/Caregivers/Labor force participation/Labor economics/Labor supply/Compensation and benefits/Working hours/wage rates/Long-term care of the sick/gender Differences ER - TY - THES T1 - The Effects of Race, Socioeconomic Status, and Religion on Formal End-of-Life Planning Y1 - 2013 A1 - Burdsall, Tina Dawn Lillian KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction AB - Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values. PB - Portland State University VL - 3568035 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-08-27 First page - n/a U4 - Individual and family studies JO - The Effects of Race, Socioeconomic Status, and Religion on Formal End-of-Life Planning ER - TY - RPRT T1 - Effects of Social Security Policies on Benefit Claiming, Retirement and Saving Y1 - 2013 A1 - Alan L Gustman A1 - Thomas L. Steinmeier KW - Consumption and Savings KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction KW - Social Security AB - An enhanced version of a structural model jointly explains benefit claiming, wealth and retirement, including reversals from states of lesser to greater work. The model includes stochastic returns on assets. Estimated with Health and Retirement Study data, it does a better job of predicting claiming than previous versions. Alternative beliefs about the future of Social Security affect predicted outcomes. Effects of three potential policies are also examined: increasing the early entitlement age, increasing the full retirement age, and eliminating the payroll tax for seniors. Predicted responses to increasing the full entitlement age are sensitive to beliefs. PB - Cambridge, MA, National Bureau of Economic Research UR - http://www.nber.org/papers/w19071 U4 - Retirement/Saving/Behavior/Social Security claiming rates/retirement planning/Public Policy ER - TY - JOUR T1 - Emergency room and inpatient use after cardiac pacemaker implantation JF - The American journal of cardiology Y1 - 2013 A1 - Frank A Sloan A1 - Linda K George A1 - Hu, Linyan KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Although studies have demonstrated health benefits, there is limited evidence on utilization and cost changes associated with cardiac pacemaker implantation from national community samples. The aim of this study was to quantify changes in emergency room (ER) and hospital inpatient use and in Medicare payments per beneficiary/year after pacemaker implantation. Outcomes for pacemaker recipients after and before implantation and between pacemaker recipients and controls were compared using propensity score matching. Data came from Health and Retirement Study interviews merged with Medicare claims. Sample subjects were aged 68 years with diagnosed conduction disorders or cardiac dysrhythmias in the previous 3 years. Outcome measures were (1) ER visits, inpatient admissions and days, and Medicare payments for ER and inpatient care in the after period for the pacemaker versus control groups, defined per beneficiary/year, (2) difference in differences in the same 5 outcome variables, and (3) binary variables for whether or not utilization or payments were lower in the after versus before periods for the pacemaker versus control groups. In conclusion, most pacemaker recipients improved, as measured by reductions in use and payments in the after versus before period, and there were reductions in ER visits and hospital admissions for conditions commonly leading to pacemaker implantation. PB - 111 VL - 111 IS - 4 U4 - Emergency service/Arrhythmia/Medicare/HOSPITALIZATION/health Status/health outcomes/emergency department service use/emergency department service use/Cardiovascular disease/health Care Utilization ER - TY - THES T1 - Essays on formal and informal long-term health insurance markets Y1 - 2013 A1 - Woldemichael, Andinet D. KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Other AB - This dissertation consists of two essays examining formal and informal long term health insurance markets. The first essay analyzes heterogeneity of Long-Term Care Insurance policyholders in their lapse decision, and how their ex-ante and ex-post subjective beliefs about the probability of needing Long-Term Care affect their lapse decisions. In this essay, I develop a model of lapse decision in a two-period insurance framework with a Bayesian learning process and implement several empirical specifications of the model using longitudinal data from the Health and Retirement Study. The results show that policyholders' ex-ante point predictions of their probabilities and their uncertainties about them have a persistent but declining impact on lapse decisions. Those who believe that their risk is higher are indeed more likely to remain insured. However, as their uncertainties surrounding their ex-ante point predictions increase, their chances of lapsing increase regardless of their initial perception biases. These results are heterogeneous across cohorts and policyholders and, in particular, show that those in the older group near the average age of Nursing Home entry have a precise prediction of their risk levels compared to the younger cohort. Policy simulations show that a more informed initial purchase decision reduces the chance of lapsing down the road. The second essay examines the extent to which informal risk sharing arrangement provides insurance against health shocks. I develop a comprehensive model of informal risk sharing contract with two-sided limited commitment which extends the standard model to a regime with the following features. Information regarding the nature of realized health shocks is imperfect and individuals' health capital stock serves as a storage technology and is a factor of production. The theoretical results show that, in such a regime, Pareto optimal allocations are history dependent even if participation constraints do not bind. I perform numerical analysis to show that risk sharing against health shock is less likely to be sustainable among non-altruistic individuals with different levels of biological survival rates and health capital productivity. The results also show that optimal allocations vary depending on the set of information available to individuals. Using panel data of households from villages in rural Ethiopia, I test the main predictions of the theoretical model. While there is negative history dependence in transfers among non-altruistic partners, history dependence is positive when risk sharing is along bloodline and kinship. However, neither short-term nor long-term health shocks are insured through informal risk sharing arrangements among non-altruistic individuals. PB - Georgia State University CY - Atlanta, GA VL - 3613385 UR - https://scholarworks.gsu.edu/econ_diss/91/ N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2014-04-11 First page - n/a U4 - 0501:Economics JO - Essays on formal and informal long-term health insurance markets ER - TY - THES T1 - An Examination on Un-Retirement: Retirees Returning to Work Y1 - 2013 A1 - Guillermo Ernest Gonzales KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Other KW - Retirement Planning and Satisfaction AB - Research that examines retirees returning to work--defined here as un-retirement--is important, given increases in life expectancy and retirement insecurity. Unfortunately research in this area is nascent, limited in scope, and riddled with mixed findings. The current study is guided by three research questions: (1) how do economic resources, as well as human and social capital, relate to un-retirement?; (2) how do other productive activities, including formal and informal volunteering and caregiving, relate to un-retirement?; and (3) how does the retirement experience, including reasons to retire and retirement satisfaction, relate to un-retirement? The empirical literature on wealth and its association with un-retirement is mixed, and thus, an exploratory approach is taken. It is hypothesized that other economic resources (income, pension presence, and health insurances) are negatively related to un-retirement; for example, people with lower levels of income are more likely to return to work. It is hypothesized that higher levels of human capital and social capital are positively associated with un-retirement. It is also hypothesized that productive activities both compete with, and complement each other, and it depends on intensity and timing of events. Specifically, volunteering is a positively associated with un-retirement; that is volunteering complements going back to work. It is also suggested that caregiving is a barrier to un-retirement; that is, the two activities compete. It is hypothesized that forced retirement is positively associated with un-retirement. And finally, it is hypothesized that retirement satisfaction is negatively associated with un-retirement. Data were drawn from the Health and Retirement Study (HRS) which provided a nationally representative sample of fully retired older adults aged 62 and older in 1998 (n=8,334). This sample was followed to 2008, which offered a 10-year period to observe factors associated with un-retirement. The fully conditional specification imputation method was used to complete all missing values of the study variables. Survival analysis tested the hypotheses and yielded information on the significant factors associated with un-retirement. Findings reveal that total household net worth and income were not significantly related to un-retirement. Retirees who possessed a pension (p <.05, hazard ratio (HR):0.78, confidence limits (CL):0.63-0.97) and employer sponsored retiree health insurance (p <.05, HR:0.77, CL:0.62-0.95) were 22% and 23% less likely to return to work when compared to people who did not possess such economic resources for retirement. Generally, individuals with higher levels of human capital--better health (p <.0001, HR:1.31, CL:1.20-1.44), high-skilled (p <.05, HR:1.82, CL:1.20-2.75) and mid-skilled occupational workers (p <.05, HR:1.57, CL:1.07-2.28)--were more likely to return to work when compared to low-skilled occupational workers. This suggests that the probability of returning to work increased by 31% for every one unit increase in self-rated health; and the probability of returning to work were 82% and 57% higher for high and mid-skilled workers compared to low-skilled workers. Education, however, was negatively related to un-retirement when other productive activities were examined ( p <.05, HR: 0.96, CL:0.93-0.99), which suggests that for every unit increase in education, the probability of returning to work decreased by 4%. Certain dimensions of social capital were also significantly related to un-retirement; where the probability of returning to work increased by 75% for people who were married to an employed spouse/partner ( p <.0001, HR:1.75, CL:1.36-2.23). Formal and informal volunteering were significant predictors to work; where volunteers were between 38% and 58% more likely to return to work when compared to non-volunteers. However, providing care to a spouse was a major barrier to returning to work; where caregivers were approximately 80% less likely to return to work in subsequent waves when ompared to non-caregivers ( p <.01 PB - Washington University in St. Louis CY - St. Louis, MO VL - 3593208 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1438181057?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 - 2014-01-21 First page - n/a U4 - 0452:Social work JO - An Examination on Un-Retirement: Retirees Returning to Work ER - TY - THES T1 - Functional limitations and chronic conditions predict CES-D-8 depression scores Y1 - 2013 A1 - Liu, Ying KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Women and Minorities AB - The role of functional limitations and self-reported chronic disease on CES-D-8 depression scores was investigated in the Health and Retirement Study's 2008 data. The sample included 5835 respondent's ranging in age from 50-83. Multivariate adaptive regression splines (MARS) modeling was employed to identify multiple linear splines. Possible predictors included functional limitations (ADL, IADL), chronic diseases (back pain, stroke, arthritis, cancer, high blood pressure, heart disease, lung disease, & diabetes) and demographic measures (age, education, gender, being white, being Hispanic). The MARS modeling process resulted in selection of the following measures in the final model: ADL limitations, IADL limitations, back pain, stroke, education, being female, and being Hispanic. The results indicated that ADL limitations included two splines with a large increase in depression score from zero to one limitation, and a more shallow increase from one to three limitations. IADL limitations included two splines with a linear increase in depression score from zero to two limitations and a decrease in score from two to three limitations. Reporting back pain or stroke resulted in higher depression scores compared to absence of disease. Two splines were identified for education in which the highest depression scores were associated with zero to 7 years of education; there was a linear decline in depression from seven to 17 years of education. Females and Hispanics were associated with higher depression scores compared to males and non-Hispanics. Results emphasize the importance of functional status and selected chronic health conditions on depression scores and provide more detailed descriptions of change than traditional regression-based models. PB - California State University, Los Angeles VL - 1542832 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-08-30 First page - n/a U4 - women JO - Functional limitations and chronic conditions predict CES-D-8 depression scores ER - TY - JOUR T1 - Gender-stratified models to examine the relationship between financial hardship and self-reported oral health for older US men and women JF - American journal of public health Y1 - 2013 A1 - Chi, Donald L. A1 - Reginald D. Tucker-Seeley KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - OBJECTIVES: We evaluated the relationship between financial hardship and self-reported oral health for older men and women. METHODS: We focused on adults in the 2008 Health and Retirement Study (n=1,359). The predictor variables were 4 financial hardship indicators. We used Poisson regression models to estimate the prevalence ratio of poor self-reported oral health. RESULTS: In the non-gender-stratified model, number of financial hardships was not significantly associated with self-reported oral health. Food insecurity was associated with a 12 greater prevalence of poor self-reported oral health (95 confidence interval CI =1.04, 1.21). In the gender-stratified models, women with 3 or more financial hardships had a 24 greater prevalence of poor self-reported oral health than women with zero (95 CI=1.09, 1.40). Number of hardships was not associated with self-reported oral health for men. For men, skipping medications was associated with 50 lower prevalence of poor self-reported oral health (95 CI=0.32, 0.76). CONCLUSIONS: Number of financial hardships was differentially associated with self-reported oral health for older men and women. Most financial hardship indicators affected both genders similarly. Future interventions to improve vulnerable older adults' oral health should account for gender-based heterogeneity in financial hardship experiences. PB - 103 VL - 103 IS - 8 N1 - Times Cited: 0 U4 - Gender/ORAL-HEALTH/SELF-RATED HEALTH/financial hardships ER - TY - JOUR T1 - The Great Recession and Health: People, Populations, and Disparities JF - Annals of the American Academy of Political and Social Science Y1 - 2013 A1 - Sarah A. Burgard A1 - Jennifer A Ailshire A1 - Lucie Kalousova KW - Consumption and Savings KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction AB - Two research traditions have evolved to assess links between recessions and health, with seemingly divergent findings. Aggregate-level studies generally find that mortality rates decline during recessionary periods. By contrast, individual-level studies generally find that events that frequently occur during recessions, like job loss, unemployment, and material hardship, carry negative health consequences. We comprehensively review evidence from these two bodies of research, illustrate key findings, and show how the different mechanisms can operate in parallel. We also outline some of the limitations of the extant evidence, discuss studies emerging to address these limits and directions for future research, and provide brief empirical examples to illustrate some of these limits and directions using the Health and Retirement Study and the Michigan Recession and Recovery Study. Our review emphasizes the importance of considering both the aggregate- and individual-level associations when evaluating the likely short- and longer-term consequences of the Great Recession for health and health disparities. PB - 650 VL - 650 IS - 1 U4 - material hardship/Morbidity/Retirement/Occupational Safety and Health/Great Recession/Mortality Rates/Recessions/Michigan/health disparities ER - TY - THES T1 - Grip strength, multimorbidity, and disability Y1 - 2013 A1 - Amy M Yorke KW - Health Conditions and Status KW - Healthcare KW - Other AB - The presence of two or more chronic health conditions, also known as multimorbidity, is one of the most prevalent health disorders experienced by adults. Adults with multimorbidity and functional limitations represent clinical and financial challenges to the current health care system. The purpose of this three-paper dissertation is to examine the relationship between grip strength, multimorbidity, and the prediction of disability in adults. Data from the 2008 Health and Retirement Study (HRS), a nationally representative, longitudinal study completed on Americans age 50 years and over, are used for the dissertation. The objective of the first paper is to investigate the relationship between grip strength (measured in kilograms, kg) and chronic disease status. The results of this study indicate that when controlling for age and gender, as the number of chronic diseases increased, grip strength decreases. The findings are statistically significant. Grip strength normative values are computed for the second paper. Grip strength norms are stratified by gender (male, female), age (by decades), and chronic disease status (0, 1, 2, >3). The average grip strength for males ranges from 28.10 kg (80 years and older with three or more chronic diseases) to 46.81 kg (50-59 years with zero chronic diseases). Average right grip strength for females ranges from 16.76 kg (80 years and older with two chronic diseases) to 27.48 kg (50-59 years with zero chronic diseases). The third paper investigates a grip strength cutoff value that can be used to predict upper extremity (UE) or lower extremity (LE) disability in adults with and without multimorbidity. Receiver Operating Characteristic curves are calculated for sample, stratified by gender and chronic disease status. In summary, males without multimorbidity and a grip strength of<41kg and males with multimorbidity and a grip strength of <37 kg are anticipated to develop UE and LE disability. In females without multimorbidity and a grip strength of <25 kg and females with multimorbidity and a grip strength of <23 kg are anticipated to develop UE and LE disability. PB - Western Michigan University CY - Kalamazoo, MI VL - 3579432 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1508268705?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/fmt:kev:mtx:disse N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2014-04-08 First page - n/a U4 - 0766:Epidemiology JO - Grip strength, multimorbidity, and disability ER - TY - THES T1 - Health shocks in patients with cancer: A longitudinal analysis of financial and retirement trends using the Health and Retirement study Y1 - 2013 A1 - Adrienne M. Gilligan KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Other KW - Public Policy KW - Retirement Planning and Satisfaction AB - Objectives: Evaluate the association of cancer on net worth, consumer debt, mortgage debt, home equity and changes in retirement trends. Methods: Data from the Health and Retirement Study from 1998-2010 was used. Persons had to have a diagnosis of cancer. The index date was the corresponding HRS wave of the year of the first diagnosis of cancer. The pre-index date was 2 years and a 2-year and 4-year post index was observed. Primary outcomes of interest were zero/negative net worth and net worth. Multiple logistic regression was used to test for the association between demographic, economic, human capital, and cancer-related variables on outcomes. Generalized linear models were conducted to assess the association of cancer on net worth, consumer debt, mortgage debt, and home equity. Multinomial logistic regression was performed to assess the association of cancer on retirement. Results: A total of 6,055,110 individuals (weighted) qualified. The majority of patients in this sample were male (53.8%), non-Hispanic (95.5%), and white (90.3%). Marital status (p<0.05), alcohol consumption (p=0.046), hypertension (p = 0.034), private insurance (p=0.001), cancer status (p<0.001), and cancer treatment (p=0.022) were significant predictors of zero/negative net worth 4-years after cancer diagnosis. Patients receiving treatment for their cancer were 71% more likely to have consumer debt 4-years post diagnosis (p=0.006). Patients who reported their cancer improving 4-years post diagnosis were significantly less likely (p=0.008) to have consumer debt (OR=0.59; 95%CI: 0.41-0.87). Cancer treatment and cancer status were significant predictors of mortgage debt (p<0.001 and 0.024, respectively). For individuals whose cancer either improved (OR=1.46; 95%CI: 1.04-2.06) or worsened (OR=4.09; 95%CI: 1.38-12.15), both groups were significantly more likely (p=0.030 and 0.011, respectively) to have home equity 4-years post diagnosis. Cancer status was a significant predictor of individuals transitioning from working to retired (p=0.022). Conclusion: This nationally representative investigation of 6.1 million patients over 50 years of age with cancer found that approximately 65% of cancer patients reported zero/negative net worth of cancer and almost 45% of cancer patients reported consumer debt four-years post diagnosis. Cancer-related characteristics explain a significant amount of the change in net worth four-years post diagnosis of cancer. PB - The University of Arizona VL - Ph.D. UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1354473932?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/fmt:kev:mtx:disse N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-05-30 First page - n/a U4 - mortgage debt JO - Health shocks in patients with cancer: A longitudinal analysis of financial and retirement trends using the Health and Retirement study ER - TY - JOUR T1 - Health Shocks in the Family: Gender Differences in Smoking Changes JF - Journal of Aging and Health Y1 - 2013 A1 - Rachel Margolis KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Other KW - Women and Minorities AB - This study estimates the likelihood of starting and stopping smoking when respondents and their partners report new chronic illnesses. Analysis of longitudinal data from the Health and Retirement Study tests whether starting or stopping smoking is more likely when (a) the respondent, (b) their partner, (c) or both report a new chronic condition, and whether these patterns differ by gender. Both men and women are more likely to quit smoking when reporting a new chronic condition, relative to when reporting none. However only women are more likely to quit smoking when their partners fall ill. Women are also more likely than men to start smoking at this time. Among older couples, women's smoking changes are more sensitive to health shocks in the partnership. Interventions aimed at preventing unhealthy behaviors should pay attention to how each partner deals with the stress of health shocks. PB - 25 VL - 25 IS - 5 N1 - Copyright - Copyright SAGE PUBLICATIONS, INC. Aug 2013 Last updated - 2013-09-05 U4 - Chronic illnesses/Smoking/Gender differences/Health behavior/Intervention/Older people/women/Spousal care ER - TY - JOUR T1 - Health spending during Medicare coverage and associated health change JF - Journal of Global Health Care Systems Y1 - 2013 A1 - Yi-Sheng Chao A1 - Chao-Jung Wu KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Introduction: Medicare spending growth is creating financial and fiscal issues in the US, but health returns from the spending under Medicare were not clear. This study aims to quantify the returns to mortality, self-rated health status and mental health, from the spending on health care in the first four years of Medicare coverage. Method: Eligible Medicare enrollees in the Health and Retirement Study (HRS) from 1992 to 2008 were chosen to understand the returns to health after four years of Medicare coverage, while controlling for individual characteristics before Medicare coverage (pre-Medicare characteristics). Ordered logit models were used for 4,099 eligible Medicare enrollees. Results: Health spending was associated with a higher likelihood of mortality in total spending model (n=1752, odds ratio OR =1.0044 per 1,000, p 0.01); out-of-pocket spending was not significant (n=4032, OR=1.0027 per 1,000, p=0.12). For health status, total and out-of-pocket spending were associated with worsening (n=1731, OR=1.0056, p=0.001; n=4029, OR=1.0154, p 0.01), while this association was confirmed for mental health only in total spending model (n=1658, OR=1.0018, p 0.001 and n=3922, OR=1.0029, p=0.06). Conclusion: there is an association between health spending and worsening of three health dimensions after first four years of Medicare coverage, as pre-Medicare characteristics also play a role in these health outcomes. Medicare could be more efficient in improving health outcomes if there are incentives to adopt effective care and a focus on the temporal externality from pre-Medicare health coverage and pre-Medicare characteristics. PB - 13 VL - 13 IS - 2 U4 - Medicare/Health returns/Mortality/Health status/Mental health/health expenditures/CESD scale ER - TY - JOUR T1 - Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay JF - Health Affairs Y1 - 2013 A1 - Amy Kelley A1 - Deb, Partha A1 - Qingling Du A1 - Carlson, Melissa D. Aldridge A1 - R Sean Morrison KW - Consumption and Savings KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-2008, and individual Medicare claims, and overcoming limitations of previous work, we found 2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: 2,650, 5,040, and 6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively.Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit. PB - 32 VL - 32 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1316561537?accountid=14667 IS - 3 N1 - Copyright - Copyright The People to People Health Foundation, Inc., Project HOPE Mar 2013 Document feature - Tables; Graphs; References Last updated - 2013-05-25 DOI - 2915999051; 76250142; 15986; HAF; 23459735; INODHAF0001192568 SubjectsTermNotLitGenreText - United States--US U4 - Experiment/theoretical treatment/Quality of care/Hospice care/Social policy/Health care industry/Medicare/Cost reduction/Public Health And Safety ER - TY - JOUR T1 - How do couples influence each other's physical activity behaviours in retirement? An exploratory qualitative study JF - BMC Public Health Y1 - 2013 A1 - Barnett, Inka A1 - Guell, Cornelia A1 - Ogilvie, David KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Public Policy KW - Retirement Planning and Satisfaction AB - Physical activity patterns have been shown to change significantly across the transition to retirement. As most older adults approach retirement as part of a couple, a better understanding of how spousal pairs influence each other's physical activity behaviour in retirement may help inform more effective interventions to promote physical activity in older age. This qualitative study aimed to explore and describe how couples influence each other's physical activity behaviour in retirement. A qualitative descriptive study that used purposive sampling to recruit seven spousal pairs with at least one partner of each pair recruited from the existing EPIC-Norfolk study cohort in the east of England, aged between 63 and 70 years and recently retired (within 2-6 years). Semi-structured interviews with couples were performed, audio-recorded, transcribed verbatim and analysed using data-driven content analysis. Three themes emerged: spousal attitude towards physical activity, spouses' physical activity behaviour and spousal support. While spouses' attitudes towards an active retirement were concordant, attitudes towards regular exercise diverged, were acquired across the life course and were not altered in the transition to retirement. Shared participation in physical activity was rare and regular exercise was largely an individual and independent habit. Spousal support was perceived as important for initiation and maintenance of regular exercise. Interventions should aim to create supportive spousal environments for physical activity in which spouses encourage each other to pursue their preferred forms of physical activity; should address gender-specific needs and preferences, such as chances for socialising and relaxation for women and opportunities for personal challenges for men; and rather than solely focusing on promoting structured exercise, should also encourage everyday physical activity such as walking for transport. PB - 13 VL - 13 IS - 1 U4 - OLDER-ADULTS/INTERVENTIONS/SPOUSES/INACTIVITY/TRANSITION/Physical activity/COMMUNITY/PARENTHOOD/Social aspects/Exercise/Retirement/Couples/HEALTH BEHAVIOR/MARRIAGE/Behavior/Health aspects/MARITAL-STATUS/PUBLIC, ENVIRONMENTAL/OCCUPATIONAL HEALTH/Qualitative study/Indexing in process ER - TY - RPRT T1 - How Do People Form Longevity Predictions? The Effect of Parents and Parents-in-law s Death on Beliefs about Mortality Risk Y1 - 2013 A1 - Chen, Lizi A1 - Economics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - In this paper, we use data from the Health and Retirement Study (HRS) panel, which surveys a representative sample of US seniors about their longevity prospects to examine whether the Bayesian assumption holds. Specifically, I test for (1) whether people s longevity predictions are responsive to new information, e.g., recent parental death which conveys information about genetic risks, lifestyle-related health risks, etc; (2) whether people s longevity predictions respond more to the arrival of precise information (parental death) than less clear information (parent-in-law s death); (3) whether the magnitudes of these updates are in accordance with theoretical predictions. We find that individuals longevity predictions are responsive to new health-related information, and consistently more responsive to precise information (parental death) than imprecise information (parent-in-law s death). The magnitudes of these updates lie between the predicted lower and upper bounds of rational updates, but do not perfectly coincide with the predicted values and are sensitive to model specifications. We conclude that there is no strong evidence against the Bayesian assumption. We point out that the Bayesian assumption is only one aspect of the rationality hypothesis. From qualitative survey data, We find evidence of inattention to government subsidy of long-term care insurance, mistaken beliefs that long-term care is covered by Medicare and tendency to procrastinate on long-term care insurance purchasing decision. The evidence suggests irrationality may cause individuals to under-insure through these other venues. PB - Wellesley, MA, Wellesley College UR - http://repository.wellesley.edu/thesiscollection/93 U4 - Bayesian Analysis/longevity predictions/Long Term Care/retirement planning/health risk ER - TY - RPRT T1 - If My Blood Pressure Is High, Do I Take It To Heart? Behavioral Impacts of Biomarker Collection in the Health and Retirement Study Y1 - 2013 A1 - Ryan D. Edwards KW - Health Conditions and Status KW - Healthcare AB - Starting in 2006, respondents in the U.S. Health and Retirement Study were asked to submit biomarkers and were notified of certain results. Respondents with very high blood pressure were given a card during the interview; all respondents were notified by mail of their BP, hemoglobin A1c, and total and HDL cholesterol readings alongside recommended thresholds. About 5.8 percent received the high blood pressure card, and 5.4 percent had high A1c levels, an indicator of diabetes. Rates of undiagnosed high BP and diabetes according to these biomarkers were 1.5 and 0.7 percent. Average treatment effects of biomarker collection on the panel overall were effectively zero, but notification of rare and dangerous readings triggered new diagnoses, increased pharmaceutical usage, and altered health behaviors among small subsamples of respondents and their spouses. Very high BP or A1c readings raised new diagnosis and medication usage by 20 to 40 percentage points. Uncontrolled high BP triggered reductions in own smoking and own and spouse s drinking. High A1c was associated with a 2.2 percent drop in weight and an increase in exercise among respondents without a previous diagnosis of diabetes, but with no changes among those already diagnosed, whose self-reported health and disability worsened. PB - Cambridge, MA, National Bureau of Economic Research U4 - biomarkers/HDL cholesterol/Diabetes Mellitus/health Care Utilization/Blood pressure ER - TY - THES T1 - Illness-related diabetes social support and glycemic control among middle aged and older adults Y1 - 2013 A1 - Mondesir, Favel L. KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy KW - Women and Minorities AB - Objective: The objective of this study is to investigate the association between illness-related diabetes social support (IRDSS) and glycemic control (GC) among a racially diverse sample of middle aged and older adults. In gender-stratified models we examine whether the relationship between IRDSS and GC is modified by race/ethnicity. Additionally, we explore the association between eight individual types of IRDSS and GC. Methods: We used the Health and Retirement Study (HRS) 2002 and the 2003 Diabetes Survey. The final analytic sample consisted of 914 study respondents. Gender-stratified multivariable logistic regression models were used to calculate odd ratios (ORs) and 95% confidence intervals (CIs) for the association between IRDSS and GC, test an interaction between race/ethnicity and IRDSS, and investigate the association between individual IRDSS variables and GC. Final models were adjusted for socio-demographic characteristics, lifestyle factors and clinical characteristics. Results: 79.5% and 76.7% of males and females respectively are classified as having adequate glycemic control. Among females, there was a significant association between IRDSS and GC (OR: 2.39; 95% CI: 1.44, 4.00), but no significant association was observed among males. There was a significant interaction between race/ethnicity and IRDSS (p-value < 0.10). Among Hispanic females, there was a higher odds (OR: 5.75; 95% CI: 1.01, 32.63) of adequate glycemic control in those who had high levels of IRDSS. The strongest association was found between high levels of emotional oriented social support and GC among females (OR=2.05; 95% CI: 1.18, 3.54). Conclusion: Our findings suggest that the relationship between IRDSS and GC varied by gender, where we only observed an association among females. Although we found a significant interaction between Hispanic race/ethnicity and IRDSS among females, our results should be interpreted with caution due to small sample sizes for the groups. We found that type of social support for self-care activities may play a role in achieving GC, where emotional support was most important. Further studies should aim at identifying factors which may determine gender differences in the association between IRDSS and GC. Race/ethnicity as an effect modifier of this association also needs further exploration in studies with larger sample sizes. PB - University of South Carolina CY - Columbia, SC VL - 1544617 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1438176454?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 - 2014-01-21 First page - n/a U4 - 0766:Epidemiology JO - Illness-related diabetes social support and glycemic control among middle aged and older adults ER - TY - JOUR T1 - Insomnia and Health Services Utilization in Middle-Aged and Older Adults: Results From the Health and Retirement Study JF - The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Y1 - 2013 A1 - Christopher N Kaufmann A1 - Sarah L. Canham A1 - Ramin Mojtabai A1 - Amber M Gum A1 - Dautovich, Natalie D. A1 - Kohn, Robert A1 - Adam P Spira KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Background. Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults.Methods. We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics.Results. Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio AOR = 1.28, 95 confidence interval CI = 1.15 1.43, p .001), use of home health care services (AOR = 1.29, 95 CI = 1.09 1.52, p = .004), and any health service use (AOR = 1.28, 95 CI = 1.15 1.41, p .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95 CI = 1.50 1.96, p .001), use of home health care services (AOR = 1.64, 95 CI = 1.32 2.04, p .001), nursing home use (AOR = 1.45, 95 CI = 1.10 1.90, p = .009), and any health service use (AOR = 1.72, 95 CI = 1.51 1.95, p .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates.Conclusions. In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population. UR - http://biomedgerontology.oxfordjournals.org/content/early/2013/05/09/gerona.glt050.abstract U4 - Sleep/sleep patterns/insomnia/Health services/Public health/HOSPITALIZATION/nursing home admissions/health Care Utilization ER - TY - JOUR T1 - Intergenerational transfers in long term care JF - Review of Economics of the Household Y1 - 2013 A1 - Lopez-Anuarbe, Monika KW - Adult children KW - Consumption and Savings KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - How are parental inter-vivos transfers to their children and children's informal care of parents influenced by personal characteristics, family conditions and state specific long term care policies? AHEAD data from 1993 and 1995 and a two-party choice model are used to guide the estimation of OLS and binary logit models of the amount and likelihood of inter-vivos transfers to children and informal care of parents. Results suggest that both parents' characteristics and their offspring's characteristics affect parental gifts to children and children's time assistance to their parents, highlighting the interdependent nature of these decisions. Furthermore, though state policies did not consistently affect parental gift giving, the availability of state respite care support -short-term breaks for informal family caregivers- (1 significance level) and adult day care centers (5 significance level) were positively related to the amount and likelihood of children's time assistance to their parents. These findings highlight the importance of some state programs such as respite care support in encouraging intra-family support for the elderly. Support for programs that reduce the caregiving burden may encourage more children to care for their elderly parents. PUBLICATION ABSTRACT PB - 11 VL - 11 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1357220955?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl IS - 2 N1 - Copyright - Springer Science Business Media New York 2013 Document feature - Equations; Tables; References Last updated - 2013-06-07 SubjectsTermNotLitGenreText - United States--US Altonji, J G; Hayashi, F; Kotlikoff, L J. Parental altruism and inter vivos transfers: Theory and evidence. JOURNAL OF POLITICAL ECONOMY, 105. 6 (1997): 1121-1166. UNIV CHICAGO PRESS Becker, Gary Stanley. A treatise on the family. A treatise on the family (1981): xii-288. Harvard University Press Bernheim, H. D., Schleifer, A., and Sommers, L. (1985). The strategic bequest motive. Journal of Political Economy, 57 (5), 1138 1159. Cox, D; Rank, M R. INTER-VIVOS TRANSFERS AND INTERGENERATIONAL EXCHANGE. REVIEW OF ECONOMICS AND STATISTICS, 74. 2 (1992): 305-314. MIT PRESS Cox, D. (1987). Motives for private income transfers. Journal of Political Economy, 95 (3), 508 546. Engers, M., and Stern, S. (2002). Long term care and family bargaining. International Economic Review, 43 (1), 73 114. Gale, W G; Scholz, J K. INTERGENERATIONAL TRANSFERS AND THE ACCUMULATION OF WEALTH. JOURNAL OF ECONOMIC PERSPECTIVES, 8. 4 (1994): 145-160. AMER ECON ASSN Gruber, J., and Grabowski, D. (2007). Moral hazard in nursing home use. Journal of Health Economics , 26 (3), 560 577. Hiedemann, Bridget; Stern, Steven; Hiedemann, Bridget. Strategic Play among Family Members When Making Long-Term Care Decisions. Journal of Economic Behavior and Organization, 40. 1 (1999): 29-57 Joulfaian, D. Gift taxes and lifetime transfers: time series evidence. JOURNAL OF PUBLIC ECONOMICS, 88. 9-10 (2004): 1917-1929. ELSEVIER SCIENCE SA Kohli, Martin; Kunemund, Harald; Kohli, Martin. Intergenerational Transfers in the Family: What Motivates Giving? GLOBAL AGING AND CHALLENGES TO FAMILIES (2003): 123-142. Aldine de Gruyter Lee, J., Kim, H., and Tanenbaum, S. (2006) Medicaid and family wealth transfer. The Gerontologist, 46 (1), 6 13. L pez Anuarbe, M. (2012). Parental inter vivos gifts to their adult children: A longitudinal approach. Working Paper. L pez Anuarbe, M. (2010). Intergenerational transfers in the long term care market . University of Connecticut Doctoral Dissertation. Economics Department, University of Connecticut. McGarry, K. Inter vivos transfers and intended bequests. JOURNAL OF PUBLIC ECONOMICS, 73. 3 (1999): 321-351. ELSEVIER SCIENCE SA McGarry, Kathleen; Schoeni, Robert F. Transfer behavior in the Health and Retirement Study: measurement and the redistribution of resources within the family. Journal of Human Resources, v30. n1 (1995): pS184(43). University of Wisconsin Press McGarry, K., and Schoeni, R. F. (1997). Transfer behavior within the family: Results from the asset and health dynamics survey. Journals of Gerontology, 52B, 82-92. National Alliance for Caregiving and AARP. (2008). Caregiving in the U.S. Bethesda, MD and Washington, DC; AARP Public Policy Institute (2008), Valuing the invaluable: The economic value of family caregiving, 2008 Update; family caregiver alliance (2004, June). Family caregiving and long-term care: A crucial issue for America s families (policy brief). San Francisco, CA. This article was accessed on November 29th, 2009. Norton, E. C., and Van Houtven, C. H. (2006). Inter-vivos transfers and exchange. Southern Economic Journal, 73 (1), 157 172. Pezzin, Liliana E; Schone, Barbara Steinberg. Intergenerational household formation, female labor supply and informal caregiving: A bargaining approach. Journal of Human Resources, 34. 3 (1999): 475-503. University of Wisconsin Press Pezzin, L. E., Pollack, R. A., and Schone, B. S. (2009). Long-term care of the disabled elderly: Do children increase caregiving by spouses? Review of Economics of the Household, 7 , 323 339. Pezzin, Liliana E.; Pollak, Robert A.; Schone, Barbara S. Efficiency in family bargaining: Living arrangements and caregiving decisions of adult children and disabled elderly parents. CESIFO ECONOMIC STUDIES, 53. 1 (2007): 69-96. OXFORD UNIV PRESS Sloan, F., Picone, G., and Hoerger, T. J. (1997). The supply of children s time to disabled elderly parents. Economic Inquiry, 35 (2), 295 308. Soldo, B. J., Hurd, M. D., Rodgers, W. L., and Wallace, R. B. (1997). Asset and health dynamics among the oldest old: An overview of the AHEAD study. The Journals of Gerontology Series B , 52B(Special Issue), 1 20. Soldo, B J; Hill. Family structure and transfer measures in the health and retirement study - Background and overview. JOURNAL OF HUMAN RESOURCES, 30. (1995): S108-S137. UNIV WISCONSIN PRESS U4 - Long term health care/Elder care/Parents and parenting/Gifts/Children and youth/Families and family life/Transfer of funds/inter Vivos Transfers/Health care industry/Public Policy ER - TY - THES T1 - Investigating the relationship between recent dental visits, memory, and dementia risk factors Y1 - 2013 A1 - Carlson, Holly I. KW - Gerontology KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Risk Taking AB - Research has concluded in recent years that oral health status is associated with dementia. However, little has been understood about how dental visits, which are a modifiable lifestyle variable, affect memory. The current study applied generalized estimating equations models to the RAND Health and Retirement Study nationally representative longitudinal database in order to determine whether recent dental visits predicted (a) higher memory scores, (b) subjective memory status, and (c) perceived change in self-rated memory. Results indicated that persons with recent dental visits obtained better episodic memory scores, had better self-rated memory, and reported perceived change in self-rated memory. The findings suggested that visiting the dentist and maintaining oral health are crucial for healthy cognitive aging. It is concluded that older adults should regularly visit the dentist in order to maintain memory capabilities. PB - Fielding Graduate University CY - Santa Barbara, CA VL - 3598460 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1459230336?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 - 2014-01-20 First page - n/a U4 - 0622:Clinical psychology JO - Investigating the relationship between recent dental visits, memory, and dementia risk factors ER - TY - THES T1 - Labor outcomes of health shocks and dependent coverage expansions Y1 - 2013 A1 - Burgdorf, James R., Jr. KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Public Policy AB - The traditional bundling of health insurance with employment in the United States may distort workers' labor market choices by encouraging full-time wage and salary employment relative to part-time work, self-employment, and not working. However, disentangling the effects of employer-provided health insurance on labor market outcomes is a challenging empirical issue. To overcome this issue, I conduct three studies which exploit three sources of variation in individual valuation of employer-provided group health care. The first study considers the differential impact of health shocks on self-employed workers and wage and salary workers using panel data from the Health and Retirement Study. I find that among older workers in perfect health, health shocks have a larger effect on exits from self-employment than on exits from wage and salary work, implying that extending group coverage to small firm owners may reduce the number of health-related firm failures. The second study uses data from the Current Population Survey's Annual Social and Economic Supplement (ASEC), and was originally intended to examine the effect of state-level dependent coverage expansions on employment outcomes for young adults. Instead, I uncover new evidence that these reforms have had a more limited impact on young adults' insurance rates than indicated by previous research. The third study again uses ASEC data, but considers the effects of the Affordable Care Act's federal-level dependent coverage expansion on young adults' labor market outcomes. I find that these reforms did effectively increase the reported holding of non-spousal dependent coverage, and initial results indicate a significant association with reduced labor force participation. However, further investigation reveals that the target population's relative withdrawal from the labor force began prior to the implementation of the insurance reform, and is likely driven by the economic recession. ii PB - The Pardee RAND Graduate School CY - Santa Monica, CA VL - 3572588 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1444630929?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 - 2014-01-21 First page - n/a U4 - 0501:Economics JO - Labor outcomes of health shocks and dependent coverage expansions 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 - Linking Perceived Control, Physical Activity, and Biological Health to Memory Change JF - Psychology and Aging Y1 - 2013 A1 - Frank J Infurna A1 - Denis Gerstorf KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Other AB - Perceived control plays an important role for remaining cognitively fit across adulthood and old age. However, much less is known about the role of perceived control over and above common correlates of cognition, and possible factors that underlie such control-cognition associations. Our study examined whether perceived control was predictive of individual differences in subsequent 4-year changes in episodic memory, and explored the mediating role of physical activity and indicators of physical fitness, cardiovascular, and metabolic health for control-memory associations. To do so, we used longitudinal data from the nationwide Health and Retirement Study (HRS; N = 4,177; ages 30 to 97 years; 59 women). Our results show that perceiving more control over one's life predicted less memory declines, and this protective effect was similar in midlife and old age. We additionally observed that higher levels and maintenance of physical activity over 2 years, better pulmonary function, lower systolic blood pressure (SPB), lower hemoglobin A(1c), and higher high-density lipoprotein cholesterol (HDL-C) also predicted less memory declines. Mediation analyses revealed that levels of, and 2-year changes in, physical activity, as well as levels of pulmonary function and hemoglobin A1c and HDL-C, each uniquely mediated control-memory change associations. Our findings illustrate that perceived control, physical activity, and indicators of physical fitness and cardiovascular and metabolic health moderate changes in memory, and add to the literature on antecedents of cognitive aging by conjointly targeting perceived control and some of its mediating factors. We discuss possible pathways underlying the role of control for memory change and consider future routes of inquiry to further our understanding of control-cognition associations in adulthood and old age. PB - 28 VL - 28 IS - 4 N1 - Times Cited: 0 U4 - Sense Of Control/Cognitive Aging/Adulthood and Old Age/Behavioral and Biological Health/Blood Pressure/Self Efficacy/Self Efficacy/Alzheimers Disease/Life Style ER - TY - JOUR T1 - Longer Term Effects of Total Knee Arthroplasty From a National Longitudinal Study JF - Journal of Aging and Health Y1 - 2013 A1 - Frank A Sloan A1 - Linda K George A1 - Hu, Linyan KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - This study used data for 1996-2010 from a U.S. longitudinal sample of elderly individuals from the Health and Retirement Study (HRS) merged with Medicare claims data to assess changes in several dimensions of physical functioning and general health up to 68 months following total knee arthroplasty (TKA) receipt. Using propensity score matching, we assessed outcomes at follow-up for Medicare beneficiaries receiving TKA and a comparable group of beneficiaries with the same osteoarthritis diagnoses (controls). Receipt of TKA was most often associated with improvements in physical functioning, especially in physical functioning measures most directly related to the knee. General health of TKA recipients only improved relative to controls on 1 of the 3 study general health measures. Improvements in physical functioning of TKA recipients persisted in this longer term analysis of outcome in a nationally representative population study. PB - 25 VL - 25 IS - 6 N1 - Copyright - Copyright SAGE PUBLICATIONS, INC. Sep 2013 Last updated - 2013-09-13 SubjectsTermNotLitGenreText - United States--US U4 - Gerontology And Geriatrics/Joint surgery/Older people/Geriatrics/Surgical outcomes/Motor ability/Gerontology/United States--US ER - TY - THES T1 - The Long-Term Costs of Caring: How Caring for an Aging Parent Impacts Wealth Trajectories of Caregivers Y1 - 2013 A1 - Jennifer C. Greenfield KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets AB - Long-term care in the U.S. is a growing concern as our aging population exerts pressure on formal and informal care systems. Public expenditures on formal care are increasing rapidly, even as reliance on informal caregivers expands. Recent policy innovations are shifting Medicaid and Medicare funding toward home- and community-based services (HCBS) as an alternative to nursing home care. This may help reduce overall LTC care costs to states and the federal government, but it also shifts more responsibility to families and informal care networks. Not only can caregiving have negative impacts on the physical and mental health of caregivers, but it also can be expensive, both in terms of direct costs and in terms of lost wages and work opportunities. However, to date, these financial consequences are not fully understood. This project uses longitudinal, nationally representative data from six waves of the Health and Retirement Study (1998-2008) to evaluate whether caring for aging parents impacts caregivers' assets over time. Latent trajectory analysis was used to identify groups for whom caregiving had a negative impact on wealth trajectories. A four-group model fit best and revealed one group, with 4.3% of respondents, for whom caregiving had a significant, negative relationship. Further, race, education, and caregivers' health were significantly related to these trajectories. Gender and marital status were not related. Lastly, among caregivers, care duration did not significantly impact asset trajectories, and care intensity had mixed effects. Findings indicate that caring for an aging parent has a significant, negative impact for some adults over age 50, but only for a small group. Importantly, those who are negatively impacted are more likely to be in already vulnerable groups. As reliance on informal caregiving increases, special attention should be paid to those caregivers who may be particularly vulnerable to the financial impacts of caregiving; better assessments and more economic supports are needed to offset the potential exacerbating impacts of caregiving. PB - Washington University in St. Louis VL - Ph.D. UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1353672076?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 - 2013-05-28 First page - n/a U4 - Informal care JO - The Long-Term Costs of Caring: How Caring for an Aging Parent Impacts Wealth Trajectories of Caregivers ER - TY - THES T1 - Mechanisms of the effect of involuntary retirement on older adults' health and mental health Y1 - 2013 A1 - Min-Kyoung Rhee KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Public Policy KW - Retirement Planning and Satisfaction AB - The purpose of the present study is to provide in-depth information on older adults' experience of involuntary retirement by examining mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 years or older. Although it is a normative expectation to perceive retirement as a phase of life in which older adults become disengaged from paid work, volunteer, and enjoy leisure time with family, not everyone has the luxury of maintaining control over their retirement decisions. Approximately one third of retirees perceive their retirement as forced rather than voluntary. Involuntary retirees are likely to face greater challenges than voluntary retirees during their postretirement adjustment period because they have multiple burdens of health, mental health, and job displacement issues that may have partially led them to involuntarily retire. The prevalence of involuntary retirement is likely to increase because older adults are expected to work longer due to increased financial responsibility despite the challenge of securing or maintaining employment. Although an expanding body of research has addressed various topics of retirement including preretirement planning and decision making, relatively few studies on retirement have focused on the voluntariness of retirement or its varied contexts. Research that has explored health and mental health outcomes after retirement without accounting for voluntariness has reported mixed findings. Considering the fact that retirement has become a more complex and diverse life transition, it is critical to consider the nature of retirement as well as its contexts. To fill this gap of knowledge in research and practice, this study had two specific aims: (1) to explore the prevalence of involuntary retirement among older adults and the extent to which the characteristics of involuntary retirees are different from voluntary retirees or those who did not retire, and (2) to investigate the mechanisms of the health and mental health effect of involuntary retirement by examining the potential mediating effects of financial control, positive and negative family relationships, and social integration. The research questions and hypotheses were formulated based on the life course perspective and latent deprivation theory. Using two waves of longitudinal data extracted from Health and Retirement Study (2006 and 2010), a final sample of 1,280 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves was selected. Univariate, bivariate, and regression-based path analyses were conducted using SPSS 18.0. This study employed a multiple mediation model that considered four mediators simultaneously and the model was estimated in three phases. Results of the study found that 29.3% (n = 429) of the sample retired between 2006 and 2010, and 37.2% (n = 155) of those individuals reported that they retired involuntarily. Results of Phase 1, a multiple mediator model that did not account for voluntariness of retirement using a binary independent variable (retired or not), indicated that there was no significant direct or indirect effects of retirement on self-rated health and mental health outcomes. In Phase 2, in which the same model was estimated using a multicategorical independent variable (involuntarily retired, voluntarily retired, not retired), involuntary retirement had an direct adverse health effect compared to not retiring, whereas voluntary retirement had an indirect positive health effect via financial control. In terms of mental health outcomes, the positive mental health effect of voluntary retirement was mediated by financial control, whereas involuntary retirement had no significant effect. Results of Phase 3, a model that considered retirees only, revealed direct adverse health effects of involuntary retirement compared to voluntary retirement. Involuntary retirement also had an indirect effect on mental health via financial control. Findings of this stu y indicate the significance of specifying the nature of retirement when conducting retirement research and the need to pay more attention to potential detrimental effects of involuntary retirement. Implications of the findings are discussed with regard to retirement policy, research, and social work. PB - University of Southern California CY - Los Angeles VL - 3609989 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1497284030?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertat N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2014-03-18 First page - n/a U4 - 0452:Social work JO - Mechanisms of the effect of involuntary retirement on older adults' health and mental health ER - TY - RPRT T1 - Medicaid Spend Down: Implications for Long-Term Services and Supports and Aging Policy Y1 - 2013 A1 - Joshua M Wiener A1 - Anderson, Wayne L. A1 - Khatutsky, Galina A1 - Kaganova, Yevgeniya A1 - Janet O'Keeffe KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Other KW - Public Policy AB - Medicaid provides an important safety net for people who are poor or become poor, either because of the high costs of health and long-term services and supports, or for other reasons. The transition from non-Medicaid to Medicaid status can be difficult, especially since it is often associated with illness, disability, and declining income and assets. The high cost of long-term services and supports results in catastrophic out-of-pocket costs for many people needing services, some of whom spend down to Medicaid. For people who have been independent all of their lives, transitioning to Medicaid means depending on a means-tested welfare program for their health and long-term services and supports. Moreover, spending for people transitioning to Medicaid is a substantial portion of state Medicaid expenditures. This study examines transitions to Medicaid eligibility or Medicaid spend down by people age 50 and older over a 12-year period. Data for this study come from the 1996 to 2008 waves of the Health and Retirement Study, which has been merged with Medicare data to help establish Medicaid eligibility. PB - Long Beach, CA, The SCAN Foundation U4 - Medicaid/Long Term Care/eligibility/spend down/Medicare/out of pocket costs/Public Policy ER - TY - JOUR T1 - Medicare HMO coverage selection and its impact on the accumulated health spending over the first four years of Medicare coverage in the US JF - Journal of Global Health Care Systems Y1 - 2013 A1 - Yi-Sheng Chao A1 - Chao-Jung Wu KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology AB - Introduction: this study aims 1) to determine the association between individual characteristics before Medicare coverage (pre-Medicare) and the selection into Medicare HMOs (health maintenance organizations) and 2) to quantify the financial impact of Medicare HMO coverage on total and out-of-pocket (OOP) health spending in the first four years of Medicare coverage. Methods: individuals eligible for Medicare because of age in the Health and Retirement Study from 1992 to 2008 were chosen. Individuals interviewed from age 65 to 68 years were included. Pre-Medicare characteristics were used to predict the propensity of selecting into Medicare HMOs and adjust its effect on health spending as well as to quantify the financial impact of Medicare HMO coverage in the first four years, compared to traditional Medicare from 1992 to 2008. There were 1,841 and 4,126 eligible Medicare enrollees included in total and OOP spending models. Results: The pre-Medicare characteristics that were significantly associated with selection into Medicare HMOs included blacks, Hispanic origin, regions of residence and pre-Medicare health plans. The results showed that the average HMO effect on total spending was insignificant, 2,651.0 less than the traditional Medicare plans (SE = 3,761.2, p = 0.46). The saving on OOP spending was significantly 1,411.5 (SE = 620.8, p = 0.03). Conclusion: the HMOs provide better financial protection in OOP health spending for Medicare enrollees in the first four years of Medicare coverage. However, this effect is not significant for total spending. PB - 3 VL - 3 U4 - Medicare/Biased selection/HMO (health maintenance organization)/Propensity score matching/Out of pocket costs/health maintenance organization (hmo) ER - TY - RPRT T1 - Methods for Analysis of the Financing and Use of Long-Term Services and Supports Y1 - 2013 A1 - United States Congressional Office KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - This document describes the data and methods underlying the 23 exhibits presented in Congressional Budget Office, Rising Demand for Long-Term Services and Supports for Elderly People (June 2013). Most of the statistics presented in Rising Demand for Long-Term Services and Supports for Elderly People are based on tabulations of data from the Health and Retirement Study (HRS, http://hrsonline.isr.umich.edu/) and the Access to Care files of the Medicare Current Beneficiary Survey (MCBS, http://go.usa.gov/b7TP). The statistics are population-weighted averages of measurements taken from the data available in those surveys from 2000 to 2010. PB - Washington, DC UR - http://www.cbo.gov/publication/44363 U4 - Public administration/Public Policy/Functional limitation/functional impairment/health Services/cost Control/cost Control/Oldest old people ER - TY - JOUR T1 - Motives for Care that Adult Children Provide to Parents: Evidence from Point Blank Survey Questions JF - Journal of Comparative Family Studies Y1 - 2013 A1 - Cox, Donald A1 - Beth J Soldo KW - Adult children KW - Healthcare KW - Methodology KW - Other KW - Risk Taking KW - Social Security AB - Adult children who care for aging parents. incur costs along psychic, monetary, emotional, and even physical dimensions. What motivates them? Is it altruism, guilt, obligation, or gratitude? Perhaps the anticipation of a bequest? Familial norms, or desire for recognition? Understanding motivation for care is high on the agenda of both economics and sociology. A primary focus of economics is the prospect that public transfers may supplant or stimulate private transfers, depending on the motivation of the private donor. Motives are usually inferred indirectly, on the basis of observed behavior. In contrast, sociologists focus on how familial bonds and networks might be forged and maintained. We depart from each of these approaches to focus on direct questions from a special module in the Health and Retirement Study, which contains questions on motivations for, and concerns about, the provision of familial assistance. Our (deliberately) simple descriptive work reveals abundant new information about motivation for familial transfers and care. These not always provided free of pressure from relatives, for example, and obligations and traditions appear to matter. Findings suggest that the standard economic considerations like utility interdependence or exchange provide an incomplete account of transfer behavior, and that insights from sociological models are essential. We also find that women are far more likely to provide care and take seriously family obligations. Past experience in the provision of financial help and care matters as well, sometimes in intriguingly anomalous ways. Though self-reported motivations must be interpreted carefully, we nonetheless conclude that point-blank questions provide a worthwhile complement to conventional methods for unraveling motivations for private, intergenerational transfers. PB - 44 VL - 44 IS - 4 N1 - Times Cited: 0 Si U4 - Family responsibilities/Old age risk/Social security financing/Evaluation/Data analysis/Elder care/Informal care ER - TY - JOUR T1 - Moving Considerations: A Longitudinal Analysis of Parent-Child Residential Proximity for Older Americans JF - Research on Aging Y1 - 2013 A1 - Zhang, Yiduo A1 - Michal Engelman A1 - Emily M. Agree KW - Adult children KW - Demographics KW - Event History/Life Cycle KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - Residential proximity is an important indicator of family members' availability to provide assistance to each other. We investigate proximity-enhancing moves by older parents and their children and the reasons for such moves. Using the 2000-2004 waves of the Health and Retirement Study, we fit multinomial logit models examining 2-year residential transitions for parents and children living 10 or more miles apart at baseline. Our results show that family members collectively adjust intergenerational proximity to facilitate mutual support. Despite the common assumption that older parents move closer to their children to receive assistance, more than two thirds of all proximity-enhancing moves are made by adult children. While greater anticipated longevity raises the probability that older parents will move closer to their children, parents' anticipated longevity does not influence children's moving decisions. Including individual variability in anticipated longevity in the life course framework helps account for relocation that precedes declines in health or increases in the need for support. PB - 35 VL - 35 IS - 6 N1 - Times Cited: 0 U4 - Anticipated Longevity/Caregiving/Intergenerational Relations/Life Course Migration/Residential Mobility/Subjective Life Expectancy/Adult Children/Elderly Parents/Living Arrangements/Mobility/Retirement ER - TY - JOUR T1 - Multidimensional Approaches to Examining Gender and Racial/Ethnic Stratification in Health JF - Women, Gender, and Families of Color Y1 - 2013 A1 - Tyson H Brown A1 - Taylor W. Hargrove KW - Demographics KW - Healthcare KW - Women and Minorities AB - Extant research on health disparities has traditionally employed a unidimensional approach to stratification, focusing on gender and racial/ethnic inequality separately. Such studies implicitly assume that gender inequality is monolithic across racial/ethnic lines and that racial/ethnic stratification is similar for women and men. While informative, these traditional, unidimensional approaches artificially decouple gender and racial/ethnic inequality and, consequently, may obscure the gender-race/ethnicity-health relationship, thus limiting our understanding of the unique health experiences of women of color. This study extends prior research by using multidimensional approaches to examine whether gender and racial stratification combine in an additive or multiplicative fashion to shape functional health, consistent with double-jeopardy and intersectionality hypotheses, respectively. In addition, this study investigates the extent to which group differences in socioeconomic status (SES), health behaviors, and medical care explain gender-racial/ethnic disparities in health. We use data from the Health and Retirement Study, a nationally representative sample of older adults, to address these questions among a diverse sample of black, white, and Mexican American men and women. Results reveal that women of color have worse functional health than all other gender-racial/ethnic groups and that the joint impacts of gender and racial/ethnic oppression on functional health are additive among Mexican Americans and multiplicative among blacks. We find that multidimensional approaches namely, double-jeopardy and intersectionality as well as examination of various potential mediators of health disparities provide a better understanding of how health is shaped by multiple social locations. PB - 1 VL - 1 IS - 2 U4 - health disparities/Socioeconomic Differences/socioeconomic Status/Minority/ethnic groups ER - TY - JOUR T1 - Neighborhood racial residential segregation and changes in health or death among older adults JF - Health and place Y1 - 2013 A1 - Joseph J Sudano A1 - Perzynski, Adam A1 - Wong, David W. A1 - Colabianchi, Natalie A1 - Litaker, David KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy KW - Women and Minorities AB - We assessed relationships between neighborhood racial residential segregation (RRS), individual-level health declines and mortality using Health and Retirement Study data. We calculated the census-tract level Location Quotient for Racial Residential Segregation (LQRRS), and estimated adjusted relative risks (ARR) of LQRRS for declines in self-reported health or death 1992-2000, controlling for individual-level characteristics. Of 6653 adults, 3333 lived in minimal, 2242 in low, 562 in moderate, and 516 in high LQRRS tracts in 1992. Major decline/death rates were: 18.6 , 25.2 , 33.8 and 30.4 in minimal, low, moderate and high tracts, respectively. Adjusting for demographic characteristics, residence in low, moderate and high LQRRS census tracts was associated with greater likelihood of major decline/death compared to minimal LQRRS. Controlling for all variables, only moderate LQRRS predicted major decline/death, ARR=1.31 (95 CI 1.07, 1.59; p .05). PB - 19 VL - 19 U4 - Segregation/Residential Segregation/Location Quotient for Racial Residential Segregation/Contextual effects/Health status/Census tracts/Health disparities/Mortality/public Policy/Public health ER - TY - JOUR T1 - Ongoing Cumulative Chronic Stressors as Predictors of Well-Being in the Second Half of Life JF - Journal of Happiness Studies Y1 - 2013 A1 - Yuval Palgi KW - Healthcare AB - The main aim of the present study was to examine the relationship between ongoing cumulative chronic stressors (OCCS) and well-being during the second half of life. The sample comprised 7,268 participants who had completed the Health and Retirement Study 2006 psychosocial questionnaire and the full OCCS questionnaire. OCCS were evaluated as a predictor of Subjective Well-Being and Psychological Well-Being (PWB) using two measures: the number of events and the subjective evaluation attributed to the events by the participant. Additionally, the association between OCCS and well-being was evaluated in midlife (50-64), young-old (65-79), and old-old (80-104) participants. The results showed that the participant's age as well as the number of OCCS perceived as very upsetting were strong predictors of well-being. The relationship between OCCS and PWB was weaker among old-old participants than among midlife and young-old participants. Although well-being is considered a stable trait-like personality dimension in the second half of life, the study's findings suggest that as the number of OCCS was higher, and especially as the subjective evaluations attributed to an event are more upsetting, well-being was lower. Nevertheless, this lower level of well-being is partially moderated in the PWB measures by age. Old-old participants maintain a higher general positive sense of PWB than midlife and young-old participants in what was previously termed the well-being paradox. Implications of the results are discussed. PUBLICATION ABSTRACT PB - 14 VL - 14 IS - 4 N1 - Copyright - Springer Science Business Media Dordrecht 2013 Last updated - 2013-09-20 U4 - Psychology ER - TY - JOUR T1 - Optimism, pessimism and bias in self-reported body weight among older adults JF - Obesity Y1 - 2013 A1 - Angelina R Sutin KW - Health Conditions and Status KW - Healthcare KW - Other AB - Objective: Body mass index (BMI) and obesity (BMI 30) are often derived from self-reported weight and height; psychological dispositions may bias how participants report these physical characteristics. The present research used a large national sample of US adults to examine the correspondence between reported and measured body weight and height and to test whether optimists and pessimists misreport their weight/height in ways that are consistent with their worldviews. Methods: Participants in the Health and Retirement Study (N = 11,207) reported their weight and height and completed a measure of dispositional optimism and pessimism; trained interviewers measured participants weight and height. Results: There was a high correlation between measured and reported weight (r = 0.98) and height (r = 0.92). Consistent with their positive and negative worldviews, respectively, optimists under-reported and pessimists over-reported their weight. There was not a consistent association with misreported height. Optimism and pessimism were also associated with actual BMI and risk of obesity, but the protective/risk effects were amplified when using reported weight to derive BMI. Conclusions: These findings suggested that reported body weight tends to be accurate, but that biases associated with psychological dispositions may inflate the relation between the disposition and obesity. Such biases may extend to associations with other self-reported factors thought to be related to optimism and pessimism. PB - 21 VL - 21 UR - http://dx.doi.org/10.1002/oby.20447 IS - 9 U4 - Ideal body weight/Body mass index/Bias (epidemiology)/Insurance selection bias/Publication bias/Obesity/Optimism/Optimism ER - TY - JOUR T1 - Out-of-Pocket Medical Spending and Charon's Obol JF - Journal of General Internal Medicine Y1 - 2013 A1 - J. Michael McWilliams KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - McWilliams discusses the implications of a study by Kelley et al in which they used nationally representative survey data from the Health and Retirement Study to examine out-of-pocket household spending on medical care for 3,209 Medicare beneficiaries in the last 5 years of life. Reforming Medicare and financing long-term care to fulfill this promise is thorny business, and the stakes are high for getting it right. PB - 28 VL - 28 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1278862739?accountid=14667 IS - 2 N1 - Copyright - Society of General Internal Medicine 2013 Language of summary - English Pages - 169-71 ProQuest ID - 1278862739 Document feature - References Last updated - 2013-02-06 Place of publication - Oxford Corporate institution author - Mcwilliams, J Michael DOI - 2874842341; 74969942; 67145; GNLM; 23129165; SPVLGNLM116062822265 DOI - http://dx.doi.org/10.1007/s11606-012-2265-4 U4 - Medical Sciences/medicare/Public Policy/Out of pocket costs/Long Term Care ER - TY - JOUR T1 - Pain and Use of Alcohol in Later Life: Prospective Evidence from the Health and Retirement Study JF - Journal of Aging and Health Y1 - 2013 A1 - Penny L. Brennan A1 - SooHoo, Sonya KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - To determine whether (a) late-life pain predicts growth in older adults' use of alcohol, and elevated risk of drinking problems; and (b) sociodemographic characteristics moderate these relationships. Five times over an 8-year interval, N = 5,446 Health and Retirement Study (HRS) participants provided information about their pain and alcohol use. Two-part latent growth modeling and logistic regression were used to analyze these data. Participants with more pain at baseline had lower initial levels and a faster rate of decline over the next 8 years in alcohol consumption, but they also were at elevated risk of having drinking problems. Income and African American background interacted with pain to predict 8-year change in alcohol consumption and presence of drinking problems. Late-life pain does not predict growth in older adults' alcohol consumption, but is nonetheless linked to elevated risk of drinking problems, especially among African Americans. PB - 25 VL - 25 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1368998096?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Apqrlandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articleandr IS - 4 N1 - Copyright - Copyright SAGE PUBLICATIONS, INC. Jun 2013 Last updated - 2013-06-18 U4 - Gerontology And Geriatrics/Alcohol use/Retirement/Older people/Personal health ER - TY - JOUR T1 - Parental educational attainment and sense of control in mid- and late-adulthood JF - Developmental Psychology Y1 - 2013 A1 - Ward, Michael M. KW - Adult children KW - Demographics KW - Event History/Life Cycle KW - Healthcare AB - Sense of control is greater among children who grow up in households of higher socioeconomic status. It is unclear if this childhood advantage persists throughout life or if schooling and adulthood experiences override any early childhood advantage. Using data from 2 nationally representative samples of primarily middle-aged (National Survey of Midlife Development in the United States, or MIDUS), and older adults (Health and Retirement Study, or HRS), I tested if personal mastery and perceived constraints in adulthood were associated with the educational attainment of the participant's father or mother, adjusting for participant's education level, income, and other demographic characteristics. In both samples, personal mastery was not associated with either parent's education level, but perceived constraints had a graded inverse association with mother's education level. These results indicate that childhood experiences continue to be associated with perceived constraints, even in later life, and may not be completely overridden by adult experiences. PUBLICATION ABSTRACT PB - 49 VL - 49 IS - 7 U4 - Psychology/Educational attainment/Parent educational background/Parent socioeconomic status/Demographics/Child development ER - TY - JOUR T1 - Pathways of Adult Children Providing Care to Older Parents JF - Journal of Marriage and Family Y1 - 2013 A1 - Barnett, Amanda E. KW - Adult children KW - Event History/Life Cycle KW - Healthcare KW - Methodology AB - Guided by life course and stress process theory, this study investigated pathways of adult child caregivers' family (caregiving, marital, parenting) and nonfamily (employment) roles. Eight waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong evidence for a 4-class model of caregivers' role pathways. The four pathways were (a) Not-Married, Early-Transition to Not-Working Caregivers (34 ), (b) Married, Not-Working Caregivers (26 ), (c) Married, Late-Transition to Not-Working Caregivers (23 ), and (d) Married, Not-Working Caregivers with Coresiding Child (17 ). Caregivers' background characteristics and contexts predicted pathway membership. Adult child caregivers have structurally diverse life pathways that have implications for theory, research, and practice. PB - 75 VL - 75 IS - 1 N1 - This article was edited by Deborah S. Carr. U4 - latent class analysis/caregiving/intergenerational transfers/life-cycle/life course/adult Children ER - TY - JOUR T1 - Perceived neighborhood social cohesion and stroke JF - Social Science and Medicine Y1 - 2013 A1 - Eric S Kim A1 - Nansook Park A1 - Christopher Peterson KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Research in the last three decades has shown that negative neighborhood factors such as neighborhood violence, noise, traffic, litter, low neighborhood socioeconomic status, and poor air quality increase the risk of poor health. Fewer studies have examined the potential protective effect that neighborhood factors can have on health, particularly stroke. We examined whether higher perceived neighborhood social cohesion was associated with lower stroke incidence after adjusting for traditional risk and psychological factors that have been linked with stroke risk. Prospective data from the Health and Retirement Study-a nationally representative panel study of American adults over the age of 50-were used. Analyses were conducted on a subset of 6740 adults who were stroke-free at baseline. Analyses adjusted for chronic illnesses and relevant sociodemographic, behavioral, and psychosocial factors. Over a four-year follow-up, higher perceived neighborhood social cohesion was associated with a lower risk of stroke. Each standard deviation increase in perceived neighborhood social cohesion was associated with a multivariate-adjusted odds ratio (O.R.) of 0.85 for stroke incidence (95 Cl, 0.75-0.97, p 0.05). The effect of perceived neighborhood social cohesion remained significant after adjusting for a comprehensive set of risk factors. Therefore, perceived neighborhood social cohesion plays an important role in protecting against stroke. (C) 2013 Elsevier Ltd. All rights reserved. PB - 97 VL - 97 N1 - Times Cited: 0 Si U4 - Stroke/Epidemiology/Public Health/Neighborhood Social Cohesion/Health Psychology/Positive Psychology/Coronary Artery Disease/Myocardial Infarction/Socioeconomic Status/Heart Disease/Incident Stroke/Ischemic Stroke/Mortality 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 - JOUR T1 - Physical health effects of the housing boom: quasi-experimental evidence from the health and retirement study JF - American Journal of Public Health Y1 - 2013 A1 - Hamoudi, Amar A1 - Jennifer B Dowd KW - Health Conditions and Status KW - Healthcare KW - Housing AB - Objectives. We examined the impact of the dramatic increases in housing prices in the United States in the 1990s and early 2000s on physical health outcomes among a representative sample of middle-aged and older Americans. Methods. Using a quasi-experimental design, we exploited geographic and time variation in housing prices using third-party valuation estimates of median single-family detached houses from 1988 to 2007 in each of 2400 zip codes combined with Health and Retirement Study data from 1992 to 2006 to test the impact of housing appreciation on physical health outcomes. Results. Respondents living in communities in which home values appreciated more rapidly had fewer functional limitations, performed better on interviewer-administered physical tasks, and had smaller waist circumference. Conclusions. Our results indicate that increases in housing wealth were associated with better health outcomes for homeowners in late middle age and older. The recent sharp decline in housing values for this group may likewise be expected to have important implications for health and should be examined as data become available. PB - 103 VL - 103 IS - 6 U4 - health outcomes/housing markets/functional limitation ER - TY - JOUR T1 - Physical symptoms, chronic and life-threatening illness trajectories among minority and aging populations JF - Journal of Health and Human Services Administration Y1 - 2013 A1 - Beverly P. Lyons A1 - Helisse Levine KW - Demographics KW - Healthcare KW - Methodology KW - Other KW - Public Policy KW - Women and Minorities AB - The purpose of this study is to determine the relationship across race/ethnicity relative to reported subjective physical symptoms and clinically assessed medical conditions among the aging minority population using the Health and Retirement Study data for years 1998-2000. Poisson and negative binomial regressions were used to estimate three count dependent variables: physical symptom, chronic, and life-threatening medical conditions. Results indicate that while Black respondents were 18 more likely to report physical symptoms when compared to White respondents (B = .171, p .01, e sup .171 = 1.18) and 1.06 times more likely to report life-threatening medical conditions (B = .058, p .01, e sup .058 = 1.06), when SES variables were added being Black was no longer significantly associated with physical symptoms and chronic conditions. However, being Black did remain statistically significant and positively associated with life-threatening conditions, even after controlling for SES. Results bear statistical and clinical significance, given that we are examining racial and ethnic groups. First, Blacks are at higher risk for premature death for a variety of reasons; this has implications on financial expenditures and on the quality of life. Second, growth among the Hispanic population is outpacing both White and Black populations. Policy initiatives, including geriatric health education, partnerships with community and grass-roots leaders will promote awareness. PUBLICATION ABSTRACT PB - 36 VL - 36 IS - 3 U4 - Minority/ethnic groups/Older people/Studies/Health risk assessment/Correlation analysis/Demographics/Public health ER - TY - JOUR T1 - Precautionary Savings Against Health Risks: Evidence From the Health and Retirement Study JF - Research on Aging Y1 - 2013 A1 - Tansel Yilmazer A1 - Scharff, R. L. KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - The precautionary savings model predicts that households accumulate wealth to self-insure against unexpected declines in future income and unforeseen expenditures. The goals of this study are twofold. First, we investigate whether the near-elderly who face higher health risks save more. Second, we examine the factors that contribute to health risks that the near-elderly face. We use data from the Health and Retirement Study to construct two measures of health risks. Our results do not support the hypothesis that household savings increase with the health risks that they face. Individuals who confront higher health risks in the future are those who are already in fair or poor health status or those who have a health condition such as diabetes or lung disease. Lower earnings and high medical expenditures caused by current poor health status prevent households from accumulating savings for future health adversities. PB - 36 VL - 36 UR - http://roa.sagepub.com/content/early/2013/01/22/0164027512473487 IS - 2 U4 - wealth Accumulation/Precautionary Saving/Health Risk Assessment/Health Care Expenditures/Lung Diseases/Diabetes ER - TY - JOUR T1 - Prevalence and predictors of change in adult-child primary caregivers JF - International journal of aging and human development Y1 - 2013 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Adult children KW - Healthcare KW - Public Policy AB - Family caregiving research is increasingly contextual and dynamic, but few studies have examined prevalence and predictors of change in primary caregivers, those with the most frequent contact with healthcare professionals. We identified prevalence and predictors of 2-year change in primary adult-child caregivers. Data pooled from the 1992-2000 waves of the Health and Retirement Study (HRS) represent 1,068 parent-level care occasions and 3,616 child-level occasions. There is considerable 2-year stability in primary adult-child caregivers. Parents are more prone to experience a change in adult-child primary caregivers if they live by themselves and if they have more sons and daughters. As far as the adult children are concerned, daughters and children living closer to parents are more likely to remain primary caregivers. Results suggest that change in primary caregivers is more strongly associated with available alternatives and gender norms than burden and competing obligations. PB - 76 VL - 76 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84880056874andpartnerID=40andmd5=ad81c47215233f14a9e09dd44972d248 IS - 3 N1 - Export Date: 24 September 2013 Source: Scopus U4 - caregiving/transfers/health care policy/primary caregivers/adult Children ER - TY - JOUR T1 - Purpose in life and reduced incidence of stroke in older adults: 'The Health and Retirement Study' JF - Journal of Psychosomatic Research Y1 - 2013 A1 - Eric S Kim A1 - Jennifer K Sun A1 - Nansook Park A1 - Christopher Peterson KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Objective: To determine whether purpose in life is associated with reduced stroke incidence among older adults after adjusting for relevant sociodemographic, behavioral, biological, and psychosocial factors. Methods: We used prospective data from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. 6739 adults who were stroke-free at baseline were examined. A multiple imputation technique was used to account for missing data. Purpose in life was measured using a validated adaptation of Ryff and Keyes' Scales of Psychological Well-Being. After controlling for a comprehensive list of covariates, we assessed the odds of stroke incidence over a four-year period. We used psychological and covariate data collected in 2006, along with occurrences of stroke reported in 2008, 2010, and during exit interviews. Covariates included sociodemographic factors (age, gender, race/ethnicity, marital status, education level, total wealth, functional status), health behaviors (smoking, exercise, alcohol use), biological factors (hypertension, diabetes, systolic blood pressure, diastolic blood pressure, BMI, heart disease), negative psychological factors (depression, anxiety, cynical hostility, negative affect), and positive psychological factors (optimism, positive affect, and social participation). Results: Greater baseline purpose in life was associated with a reduced likelihood of stroke during the four-year follow-up. In a model that adjusted for age, gender, race/ethnicity, marital status, education level, total wealth, and functional status, each standard deviation increase in purpose was associated with a multivariate-adjusted odds ratio of 0.78 for stroke (95 CI, 0.67-0.91, p =.002). Purpose remained significantly associated with a reduced likelihood of stroke after adjusting for several additional covariates including: health behaviors, biological factors, and psychological factors. Conclusion: Among older American adults, greater purpose in life is linked with a lower risk of stroke. PB - 74 VL - 74 IS - 5 N1 - Times Cited: 0 U4 - Stroke/Purpose in life/Meaning in life/Healthy aging/Positive psychology/sociodemographic differences/sociodemographic differences/Socioeconomic Status ER - TY - JOUR T1 - Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up JF - Journal of Behavioral Medicine Y1 - 2013 A1 - Eric S Kim A1 - Jennifer K Sun A1 - Nansook Park A1 - Laura D Kubzansky A1 - Christopher Peterson KW - Health Conditions and Status KW - Healthcare AB - This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults with coronary heart disease after adjusting for relevant sociodemographic, behavioral, biological, and psychological factors. Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults over the age of 50--were used. Analyses were conducted on the subset of 1,546 individuals who had coronary heart disease at baseline. Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the 2-year follow-up period. On a six-point purpose in life measure, each unit increase was associated with a multivariate-adjusted odds ratio of 0.73 for myocardial infarction (95 CI, 0.57-0.93, P = .01). The association remained significant after controlling for coronary heart disease severity, self-rated health, and a comprehensive set of possible confounds. Higher purpose in life may play an important role in protecting against myocardial infarction among older American adults with coronary heart disease. PB - 36 VL - 36 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1318045524?accountid=14667 IS - 2 N1 - Copyright - Springer Science Business Media New York 2013 Last updated - 2013-04-30 DOI - 2922261641; 76454332; 69709; BVMD; 22359156; SPVLBVMD108653629406 U4 - Psychology/Myocardial Infarction/CORONARY-HEART-DISEASE/Self assessed health/quality of Life ER - TY - THES T1 - Quantifying the Unquantifiable: The Measurement and Meanings of Chronic Pain Y1 - 2013 A1 - Grol-Prokopczyk, Hanna KW - Cross-National KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - Chronic pain is an extremely common, costly, and consequential health problem--and one that defies easy quantification. How do (or could) health researchers define and measure this invisible, subjective, and temporally complex phenomenon? This dissertation addresses this question in three empirical chapters, each using different data sources and methods. The first empirical chapter, based on close analysis of 79 medical studies of low back pain (LBP) and 20 interviews with international pain experts, documents the diversity of pain measures used in contemporary LBP research, and seeks to understand why these measures are poorly standardized. Findings reveal several factors undermining standardization, including the locality and multiplicity of the concepts of "validity" and "comparability," as well as the loose networks of the LBP research community. In addition, some pain researchers, responding to the considerable challenges of treating pain intensity , redefine their work around other, putatively more treatable domains, such as disability or social participation. The diversity of measures of low back pain is thus attributable less to pain's epistemological fragility than to its therapeutic intractability. The next chapter uses 11-country data from the World Health Organization and the Health and Retirement Study (HRS) to test whether a recently developed survey method, anchoring vignettes, can improve intergroup comparability of self-ratings of pain. Results show that, except in rare circumstances, existing anchoring vignettes substantially violate critical measurement assumptions, and thus should not be used. The final empirical chapter highlights the dimension of time in its measurement of chronic pain, using 7 waves of biennial HRS data to identify patterns and socioeconomic disparities in long-term pain trajectories. Latent growth curve models reveal striking disparities in pain experiences by sex, education, wealth, and survival status, but a surprising lack of expected disparities by age and race-ethnicity. These findings do not appear to be artifacts of group differences in reporting styles (though they do appear to result partially from mortality selection). Overall, this dissertation integrates sociological theories, advanced statistical methods, and empirical data to explore the measurement of chronic pain, with a goal of enhancing future research on this important area of health research. PB - The University of Wisconsin - Madison N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-09-13 First page - n/a U4 - cross-national comparison JO - Quantifying the Unquantifiable: The Measurement and Meanings of Chronic Pain ER - TY - THES T1 - The Receipt of Care and Depressive Symptoms in Later Life T2 - Social Work and Sociology Y1 - 2013 A1 - Kwak, Minyoung KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Other AB - Apace with the rapid increase in the aging population and steep reductions in federal funding for long-term care in the U.S., caregiving is emerging as an important issue for many families. Although caregiving relationships include both a caregiver and a care-recipient, existing research has focused heavily on caregivers and the experiences of care-receiving older adults have been less-well documented. This three-essay dissertation explores how the receipt of care influences depressive symptoms among older adults by analyzing nationally representative data from the Health and Retirement Study. Based on identity theory, the first essay examines the extent to which self-perceptions of aging explain the relationships among the receipt of care, perceived loss of control, and depressive symptoms among older adults. Structural equation modeling was used. Results indicated that self-perceptions of aging mediated the relationship between receipt of care and perceived loss of control as well as the relationship between receipt of care and depressive symptoms. That is, older adults who received a greater amount of care were more likely to perceive their aging negatively which, in turn, increased perceived loss of control and depressive symptoms. The second essay investigated whether older adults who receive care from their spouse are more vulnerable to the negative impact of their spouse's physical and mental health than older adults who do not receive care by using a linear mixed model. Results indicated that the receipt of care moderates only the impact of wives' mental health on husbands' depressive symptoms. Husbands who receive care from their wives are more sensitive to their wives' depressive symptoms than husbands who do not receive care. Finally, the third essay assessed to what extent the effects of positive and negative supxi port from spouses are stronger for caregiving couples than for non-caregiving couples. Structural equation modeling demonstrated that positive support from spouses is more important for wives who provide or receive care than for those in non-caregiving relationships. No differences in the effects of negative support from spouses were observed between caregiving and non-caregiving couples. JF - Social Work and Sociology PB - University of Michigan CY - Ann Arbor VL - PhD UR - http://hdl.handle.net/2027.42/97967http://mirlyn.lib.umich.edu/Record/012367084 U4 - identity theory JO - The Receipt of Care and Depressive Symptoms in Later Life ER - TY - JOUR T1 - Reciprocity Between Depressive Symptoms and Physical Limitations Pre- and Postretirement: Exploring Racial Differences JF - Journal of Aging and Health Y1 - 2013 A1 - Gayman, Mathew D. A1 - Pai, Manacy A1 - Ben Lennox Kail A1 - Miles G Taylor KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - This study assesses (a) the reciprocity between mental and physical health pre- and postretirement, and (b) the extent to which these associations vary by race. Data are from the 1994 to 2008 waves of the Health and Retirement Study. Analyses based on structural equation modeling reveal that depression and physical health exert reciprocal effects for Whites pre- and postretirement. For Blacks preretirement, physical limitations predict changes in depression but there is no evidence of the reverse association. Further, the association between physical limitations and changes in depressive symptoms among Blacks is no longer significant after retirement. The transition into retirement alleviates the translation of physical limitations into depressive symptoms for Blacks only. The findings underscore the relevance of retirement for reciprocity between mental and physical health and suggest that the health implications associated with this life course transition vary by race. PB - 25 VL - 25 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1368997953?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Apqrlandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articleandr IS - 4 N1 - Copyright - Copyright SAGE PUBLICATIONS, INC. Jun 2013 Last updated - 2013-06-18 U4 - Gerontology And Geriatrics/Retirement/Racial differences/Mental depression/Personal health ER - TY - JOUR T1 - Relationship Transitions Among Older Cohabitors: The Role of Health, Wealth, and Family Ties JF - Journal of Marriage and Family Y1 - 2013 A1 - Jonathan Vespa KW - Adult children KW - Demographics KW - Healthcare AB - This study explored how health, wealth, and family ties shape older cohabitors' chances of marrying or separating. Drawing on rational choice and exchange theories, the author argues these factors affect women and men differently because the rewards, alternatives, and barriers of later-life union formation differ by gender. The study used panel data from the 1998-2006 Health and Retirement Study and a sample of cohabitors 50 and older (N = 1,136). For older female cohabitors, large families and entitlement income lower the risk of marrying, whereas close social networks raise the risk of separating. Moreover, health and wealth have an interactive relationship in that the risk of marrying is highest for unhealthy male cohabitors when they are very wealthy but is highest for the poorest female cohabitors when they are in excellent health. Older men may be exchanging economic resources for caregiving, and cohabitation may be an adaptive response to the gendered costs and barriers of later-life union formation. PB - 75 VL - 75 IS - 4 N1 - Times Cited: 0 U4 - Cohabitation/Family theory/Gerontology/Marriage/Mate selection ER - TY - JOUR T1 - Religiousness, Physical Activity and Obesity among Older Cancer Survivors: Results from the Health and Retirement Study 2000-2010 JF - International Journal of Religion and Spirituality in Society Y1 - 2013 A1 - Nathenson, Sophia Lyn KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - The health behaviors of cancer survivors are an important research agenda in light of mounting evidence that aspects of health such as diet and exercise have salutary effects both mentally and physically for cancer survivors, a rapidly growing population in the United States and elsewhere. This paper analyzes data from the Health and Retirement Study 2000-2010 to determine if religious salience impacts the likelihood of obesity, changes in body mass index, and weekly vigorous activity. Two theories propose different hypotheses about the relationship. The health belief model would suggest the more religious may have the perception that healthy behaviors are positive and will be more likely to have a healthy body weight and get exercise. Conversely, high religious salience may signify a God locus of health control, leading to lesser likelihood of engagement in preventive health behaviors. Using logistic and regression analysis controlling for health behaviors at baseline (2000), these theories are tested, in addition to the explanatory power of lifestyle as a potential mechanism in the relationship of religiousness to body weight. Results show that high levels of religious salience may correspond to greater likelihood of obesity and lesser likelihood of getting regular exercise. Policy implications may include a greater emphasis on diet and physical activity in religious settings that may instead stress other health behaviors such as abstinence from smoking and alcohol. ABSTRACT FROM AUTHOR PB - 2 VL - 2 UR - http://search.ebscohost.com/login.aspx?direct=trueanddb=ofsandAN=86933799andsite=ehost-liveandscope=site IS - 3 N1 - International Journal of Religion and Spirituality in Society Authors:Nathenson, Sophia Lyn 1; Affiliations: 1: Oregon Institute of Technology, University of Utah, USA Ming Wen, University of Utah, USA; Subject: Cancer -- Patients -- Health; Subject: Human behavior; Subject: Body weight; Subject: Obesity; Subject: Body mass index; Subject: Physical activity; Subject: Logistic regression analysis; Author-Supplied Keyword: Cancer Survivorship; Author-Supplied Keyword: God Locus of Health Control; Author-Supplied Keyword: Health Behavior; Author-Supplied Keyword: Health Belief Model; Author-Supplied Keyword: Medical Sociology; Author-Supplied Keyword: Obesity; Author-Supplied Keyword: Physical Activity; Author-Supplied Keyword: Religion; Number of Pages: 16p; Illustrations: 5 Charts; Record Type: Article U4 - Cancer -- Patients -- Health/Human behavior/Body weight/Obesity/Body mass index/Physical activity/Logistic regression analysis/Cancer Survivorship/God Locus of Health Control/Health Behavior/Health Belief Model/Medical Sociology/Religion ER - TY - RPRT T1 - Rising Demand for Long-Term Services and Supports for Elderly People Y1 - 2013 A1 - United States Congressional Office KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - By 2050, one-fifth of the total U.S. population will be elderly (that is, 65 or older), up from 12 percent in 2000 and 8 percent in 1950. The number of people age 85 or older will grow the fastest over the next few decades, constituting 4 percent of the population by 2050, or 10 times its share in 1950. That growth in the elderly population will bring a corresponding surge in the number of elderly people with functional and cognitive limitations. Functional limitations are physical problems that limit a person s ability to perform routine daily activities, such as eating, bathing, dressing, paying bills, and preparing meals. Cognitive limitations are losses in mental acuity that may also restrict a person s ability to perform such activities. On average, about one-third of people age 65 or older report functional limitations of one kind or another; among people age 85 or older, about two-thirds report functional limitations. One study estimates that more than two-thirds of 65-year-olds will need assistance to deal with a loss in functioning at some point during their remaining years of life.3 If those rates of prevalence continue, the number of elderly people with functional or cognitive limitations, and thus the need for assistance, will increase sharply in coming decades. PB - Washington, DC UR - http://www.cbo.gov/sites/default/files/cbofiles/attachments/44363-LTC.pdf U4 - Public administration/Public Policy/Functional limitation/functional impairment/health Services/cost Control/cost Control/Oldest old people ER - TY - THES T1 - Rural African American grandmothers raising grandchildren: The impact of chronic illness Y1 - 2013 A1 - Woods, Tamara M. KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Women and Minorities AB - The purpose of this qualitative phenomenological study was to explore the experiences of eight African American grandmothers residing in rural North Carolina caring for their grandchildren, while suffering from chronic health issues. The research questions for this study are as follows: (1. What is the perceived impact of chronic health issues on African American grandmothers raising their grandchildren in rural North Carolina? (2. How do grandmothers who reside in rural communities describe how their health issues have impacted their ability to care for their grandchild? (3. Do perceptions of social support and life transitions impact grandmother's health? The research examined the health, physical functioning, well-being, social support, and resources of these grandmothers. Family development theory and Wellness theory formed the theoretical frameworks for understanding the impact of the health issues on these grandmothers. The grandmothers reported challenges and needs which included their own health issues, financial difficulties, limited support, transportation difficulties, and childcare concerns. A major finding was that the grandmother's health did not negatively impact their ability to care for their grandchildren. Developing health education programs and other formal supports which focus on the health of the grandmothers, their financial difficulties, transportation needs, respite, and childcare may help address grandmother's perceptions of their changing health and level of community and social support. PB - Capella University CY - Minneapolis, MN VL - 3605171 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1477862228?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 - 2014-01-28 First page - n/a U4 - 0493:Aging JO - Rural African American grandmothers raising grandchildren: The impact of chronic illness ER - TY - RPRT T1 - Self-employment and Health: Barriers or Benefits? Y1 - 2013 A1 - Cornelius A Rietveld A1 - van Kippersluis, Hans A1 - A. Roy Thurik KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare AB - The self-employed are often reported to be healthier than wage workers; however, the cause of this health difference is largely unknown. The longitudinal nature of the US Health and Retirement Study allows us to gauge the plausibility of two competing explanations for this difference: a contextual, causal effect of self-employment on health (benefit effect), or a health-related selection of individuals into self-employment (barrier effect). Our main finding is that the selection of comparatively healthier individuals into self-employment accounts for the positive cross-sectional difference. The results rule out a positive contextual effect of self-employment on health, and we present tentative evidence that, if anything, engaging in self-employment is bad for one's health. Given the importance of the self-employed in the economy, these findings contribute to our understanding of the vitality of the labor force. PB - Rotterdam, Erasmus School of Economics (ESE), Tinbergen Institute U4 - Health Status/labor Force Participation/health-related selection/Self-employment ER - TY - JOUR T1 - Sense of Control and Self-Reported Health in a Population-Based Sample of Older Americans: Assessment of Potential Confounding by Affect, Personality, and Social Support JF - International Journal of Behavioral Medicine Y1 - 2013 A1 - Ward, Michael M. KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - Sense of control has been linked to improved health outcomes, but it is unclear if this association is independent of other psychosocial factors. The aim of this study is to test the strength of association between sense of control and self-reported health after adjustment for positive and negative affect, Big 5 personality factors, and social support. Data on sense of control (measured by personal mastery, perceived constraints, and a health-specific rating of control), affect, personality, social support, and two measures of self-reported health (global rating of fair or poor health and presence of functional limitations) were obtained on 6,891 participants in the Health and Retirement Study, a population-based survey of older Americans. The cross-sectional association between sense of control measures and each measure of self-reported health was tested in hierarchical logistic regression models, before and after adjustment for affect, personality, and social support. Participants with higher personal mastery were less likely to report fair/poor health (odds ratio 0.76 per 1-point increase) while those with higher perceived constraints were more likely to report fair/poor health (odds ratio 1.37 per 1-point increase). Associations remained after adjustment for affect, but adjustment for affect attenuated the association of personal mastery by 37 and of perceived constraints by 67 . Further adjustment for personality and social support did not alter the strength of association. Findings were similar for the health-specific rating of control, and for associations with functional limitations. Sense of control is associated with self-reported health in older Americans, but this association is partly confounded by affect. PB - 20 VL - 20 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1288990847?accountid=14667 IS - 1 N1 - Copyright - International Society of Behavioral Medicine 2013 Last updated - 2013-04-18 DOI - 2895896591; 75515752; 66285; NJBM; 22282403; SPVLNJBM125292019218 U4 - Social support/Personality traits/Psychology/Self assessed health/methodology/psychosocial/Sense of control ER - TY - JOUR T1 - Social relationships and dental care service utilization among older adults JF - Journal of Aging and Health Y1 - 2013 A1 - Jeffrey A Burr A1 - Lee, Hyo Jung KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This study described the association between dental care service utilization and two domains of social relationships (social integration and social support) among older adults. The study employed data from the 2008 Health and Retirement Study, examining regression models for whether a person visited a dentist in the past 2 years, including adjustments for demographic, socioeconomic, and health characteristics. Social interaction, social participation, neighborhood cohesion, and marital status were related to an increased likelihood of having visited a dentist. Older persons exhibiting loneliness and having received financial aid from network members demonstrated a decreased likelihood of visiting a dentist. The increased likelihood of visiting a dentist when a child lives nearby only occurred after introducing health covariates. The article discusses the implications of the study findings as they relate to social relationships and oral health and recommends some additional research directions to explore the etiology of dental care use. PB - 25 VL - 25 IS - 2 U4 - Personal relationships/dental care service utilization/COGNITIVE FUNCTION/Dental care/Social interaction/social integration/HELP-SEEKING/social relationships/CARDIOVASCULAR-DISEASE/HEALTH POLICY/SERVICES/HEALTH-SERVICES/PERIODONTAL-DISEASE/MEDICAL-CARE/TOOTH LOSS/ORAL-HEALTH/Older people/Regression analysis/UNITED-STATES/social support/BEHAVIORAL-MODEL/Health and Retirement Study/GERONTOLOGY/Dental Care - utilization ER - TY - JOUR T1 - Socioeconomic Status and Health Well-Being during Later Life: Potential Mediating Factors JF - Sociological Spectrum Y1 - 2013 A1 - Hsu, Tze-Li A1 - Cossman, Jeralynn S. KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - This study explores the socioeconomic status (SES)-perceived health association, with special attention on living arrangements. It improves upon existing explanations of causal mechanisms underlying the impact of SES on health among the elderly. Using Health and Retirement Study to run ordered logistic regression, it addresses the importance of living arrangements for self-reported health. Income and education are both important predictors of self-reported health and that after controlling them, living arrangements also affect self-reported health. Future research should highlight nuanced measures of living arrangements and should explore longitudinal analyses to determine the long-term effects of these factors on self-reported health. PB - 33 VL - 33 IS - 2 N1 - Times Cited: 0 U4 - living arrangements/Self-reported health/Socioeconomic factors/Health care/Older people/Regression analysis/Logistic Models ER - TY - RPRT T1 - Spousal Effects in Smoking Cessation: Matching, Learning, or Bargaining? Y1 - 2013 A1 - McGeary, Kerry Anne KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Risk Taking AB - Previous research studying the correlation in smoking behavior between spouses has discounted the role of bargaining or learning. Using the Health and Retirement Study (HRS), which contains information on smoking cessation and spouse s preferences, this paper presents an essential investigation of the importance of spousal bargaining or learning on the decision to cease smoking. We find, regardless of gender, when one member of couple ceases smoking this induces the other member to cease smoking through bargaining. Further, we find females demonstrate either altruistic behavior toward a spouse, who has suffered a health shock, or learning from their spouse s health shock. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - Smoking/Bargaining/Bargaining theory/Spousal care/Smoking cessation/risk tolerance ER - TY - THES T1 - Three Essays in Applied Microeconomics T2 - Economics Y1 - 2013 A1 - Zhang, Xuelian KW - Adult children KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This dissertation contains three chapters in applied microeconomics. All three chapters try to answer one question: what factors determine labor market outcomes like employment probability, occupational choice and earnings? Chapter 1 investigates the effects of multidimensional personality traits on employment status, occupational choice and earnings. Using the United Kingdom National Child Development Study, the analysis deals with the problems of reverse causality and measurement error by instrumental variable methods. The results indicate that personality traits play an important role in explaining the variation in labor market outcomes. The more agreeable and conscientious, and the less imaginative a person is, the more likely he is employed. The more outgoing and the less imaginative a person is, the more likely he works in a managerial occupation, but the less likely in a non-manual occupation. Agreeableness reduces one's probability of being in a professional occupation. Being outgoing and conscientious leads to higher earnings for paid employees. Chapter 2 uses the United States Health and Retirement Study to study the effects of elder care provision on one's job choice with respect to flexibility. Fixed effects panel data models are used to control for time-invariant individual heterogeneity. Compared to non-caregivers, both male and female caregivers are significantly more likely to sort into flexible jobs or occupations, though they realize job flexibility through different channels: caregiving women are more likely to choose jobs with direct flexible work arrangements like flexible schedules, while caregiving men are more likely to realize flexibility indirectly by sorting into flexible occupation categories. Chapter 3 uses the Brazil Living Standards Measurement Study Survey to examine the long-run consequences of child labor on an adult's income, health and educational attainment. The analysis leads to the following conclusions. Early working has a substantial negative impact on earnings for rural residents but no impact on urban residents. For health, child labor has an adverse consequence in the long run. As for the schooling effect, the earlier one enters the labor market, the fewer years of schooling he obtains. I also discover appreciable differences of child labor effects between urban and rural residents. JF - Economics PB - Rutgers, The State University of New Jersey CY - New Brunswick, NJ VL - Ph.D. UR - https://rucore.libraries.rutgers.edu/rutgers-lib/40745/PDF/1/play/ U4 - 0501:Economics ER - TY - THES T1 - Vascular depression: An early indicator of decline T2 - Psychology Y1 - 2013 A1 - Daniel Paulson KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Women over the age of 80 represent a rapidly growing demographic group. While older women live longer than men, they do so with more years of disability and frailty. The emergence of geriatric disorders such as vascular disease, depression, frailty and cognitive decline in the aging US population place additional strain and expense on the already over-burdened public health care system. Meanwhile, integrated models of care are associated with preserved functional independence, reduced medical costs, and greater satisfaction for both health care providers and patients. Implementation of integrated care demands process-models of disease that contextualize symptoms within broader patterns of decline. This dissertation proposes a model representing a hypothesized late-life clinical trajectory following from high cerebrovascular burden. The hypothesized trajectory includes higher rates of depression (of vascular origin), cognitive decline, frailty and shortened remaining lifespan. Different facets of this model are tested in the four studies that comprise this dissertation. The sample was drawn from the Health and Retirement Study; a longitudinal, demographically-representative data sample of older adults in the United States. The sub-sample used in this dissertation included 1,368 stroke-free women over the age of 80 at baseline (1998). This sub-sample was followed for 10 years. The first study tested the hypotheses that high CVB predicts greater depression symptoms, and that brain reserve (i.e.: education) protects elders from developing depression symptoms. A latent growth curve was used to identify differences in depression at baseline and over time based on CVB, cognitive functioning, education and age. Results indicate that at any level of CVB, older women with more education experienced fewer depression symptoms. Results support brain reserve theory and the vascular depression hypothesis. These results suggest that having greater education may postpone development of clinically-significant depressive symptoms resulting from high CVB, thereby preserving mood in late life. The second study tested the hypothesis that variables representing the three domains of Rowe and Kahn's Healthy Aging framework predict longevity in this sample of stroke-free women over the age of 80. The "avoidance of disease" domain was characterized in this paper as CVB - chronic comorbidites that slowly erode adaptive functioning over many years. The "sustained engagement" criteria was conceptualized as depression, and deficits in the "preservation of cognitive and physical functioning" domain were identified as rapid cognitive decline. We found that at most waves (2002, 2004, 2006) mortality was predicted by CVB, depressive symptoms and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8-years. Older women with the greatest longevity had low CVB, robust cognitive functioning and few depression symptoms, supporting successful aging theory and terminal cognitive drop. The third study tested the hypothesis that vascular depression is a prodrome for frailty. At baseline, the prevalence of frailty was 31.5%. Over a 4-years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL functioning, arthritis, pulmonary disorders, cancer, and self-rated health, vascular depression significantly predicted new cases of frailty. These findings suggest that vascular depression is a prodrome for frailty. The fourth study tested the proposed model using structural modeling. The model demonstrated good overall fit and a significant indirect pathway from vascular depression to mortality through frailty was identified. Results support the proposed theoretical framework and suggest that vascular depression symptoms are associated with a clinical trajectory including more frailty symptoms and shorted remaining lifespan. This finding supports integrated care for geriatric p tients and suggests specific targets for intervention with older patients experiencing vascular depressi n symptoms. JF - Psychology PB - Wayne State University CY - Detroit, MI VL - Ph.D. UR - https://digitalcommons.wayne.edu/oa_dissertations/737/ U4 - IADLs 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 - THES T1 - Acculturation and depression in older Mexican American adults: The role of social support Y1 - 2012 A1 - Caballero, Daniela KW - Adult children KW - Demographics KW - Healthcare KW - Women and Minorities AB - Despite socioeconomic disadvantages, less acculturated Mexican Americans tend to exhibit better mental health than their more acculturated counterparts. However, in the case of older Mexican American adults, research has demonstrated the opposite to be true (Gonzalez, Haan, & Hinton, 2001). A variable of interest potentially responsible for this difference is social support. Thus, the current study proposed to investigate the mediation and moderation effects that social support has on the relationship between acculturation and depression in older Mexican American adults age 60 or older. Data from the Health and Retirement Study (HRS) was analyzed. Results showed that the mediating effect of contact with one's children (-.109*) and the moderating effect of total social support and contact with one's children (-.127*; -.103*) were statistically significant in the relationship between acculturation and depression. Although these effects are small they may still hold important implications for better understanding this population. PB - University of North Texas CY - Denton, TX VL - M.S. UR - https://digital.library.unt.edu/ark:/67531/metadc149567/m2/1/high_res_d/thesis.pdf U4 - Socioeconomic Differences ER - TY - CHAP T1 - Comparing Health and Employment in England and the United States T2 - Work, Health and Well-Being: The Challenges of Managing Health at Work Y1 - 2012 A1 - Lain, David ED - Vickerstaff, Sarah ED - Phillipson, Chris ED - Wilkie, Ross KW - Cross-National KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Income AB - This chapter explores how health influences employment past age 65 in the United States and England. This is of policy interest, because England followed the United States by extending age-discrimination legislation above 65 in 2011. Drawing conclusions about the health-related capacity of this age group to work is, however, a challenge. Common health measures are often problematic for use with older workers, particularly when they are used to make comparisons between countries. Nevertheless, the most appropriate health measures are identified from the English Longitudinal Study of Ageing and the US Health and Retirement Study. The survey analysis presented shows that, in both countries, health limitations had the strongest negative impact on employment for the poorest over-65s. This suggests that the financial benefits of working are likely to be limited for the over-65s most in need of additional income. JF - Work, Health and Well-Being: The Challenges of Managing Health at Work PB - Policy Press CY - Bristol, UK UR - http://policypress.universitypressscholarship.com/view/10.1332/policypress/9781847428080.001.0001/upso-9781847428080-chapter-4 U4 - Working past 65/Post-retirement work/Health measures/Additional income/cross-national comparison/ELSA_/health status/labor Force Participation JO - Comparing Health and Employment in England and the United States ER - TY - THES T1 - Consequences of Government Provision and Regulation of Health Insurance Y1 - 2012 A1 - Andersen, Martin Sparre KW - Health Conditions and Status KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance KW - Other KW - Public Policy AB - The first two chapters of this dissertation concern the effect of public catastrophic insurance programs. In the first chapter, I show how these programs, which only protect against large health shocks, induce advantageous selection in private insurance. I use data on older Americans with Medicare insurance from the Health and Retirement Study to test if individuals with supplemental private health insurance are systematically lower-risk in states with public catastrophic insurance programs. I find that these programs decrease the average health risk for the privately insured by $700 and that a one standard deviation increase in an individual's health risk decreases her probability of having private insurance by 4 percentage points. In the second chapter, I show that these programs reduce the incentive to invest in risk-reducing activities. I find large decreases in self-protection after a program is introduced and that individuals for whom the program is less generous are more likely to engage in self-protection. These effects are stronger for women than for men and apply to a variety of investments in health, including decisions about smoking, obesity, and cancer screening. The third chapter considers a different form of government intervention in insurance markets. In this chapter, I study laws mandating that employer-sponsored health insurance provide coverage for mental illness. I show that industries for which mental health coverage became more generous had larger increases in the average mental distress of their insured workforce. Part of the increase in generosity was due to regulations mandating coverage of mental health benefits. I then show that these regulations affected the behavior of individuals in the labor market--individuals who value more generous mental health benefits and switch jobs work longer hours after these regulations take effect, but individuals who do not value mental health benefits decrease their labor supply. These results are consistent with firms cutting back on their demand for labor due to the cost of the mandate, which leads to lower wages and a decrease in labor supply by individuals who do not value mental health benefits, but an increase in labor supply by individuals who do value mental health benefits highly. PB - Harvard University CY - United States -- Massachusetts VL - Ph.D. UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1170965443?accountid=14667 N1 - Government provision 2013-01-09 3542944 0501: Economics 1170965443 0769: Health care management 66569 0630: Public policy n/a Social sciences Insurance English Prevention Moral hazard Andersen, Martin Sparre Copyright ProQuest, UMI Dissertations Publishing 2012 2012 Mental health 70669322 Health and environmental sciences 9781267714404 2819192451 Selection U4 - Medicare JO - Consequences of Government Provision and Regulation of Health Insurance ER - TY - JOUR T1 - Cross-national insights into the relationship between wealth and wellbeing: a comparison between Australia, the United States of America and South Korea JF - Ageing and Society Y1 - 2012 A1 - Kim, Sarang A1 - K. A. Sargent-Cox A1 - D. J. French A1 - Kendig, H. A1 - Kaarin J. Anstey KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - KLoSA KW - Methodology KW - Net Worth and Assets AB - ABSTRACT The positive relationship between wealth and wellbeing has received considerable attention over the last three decades. However, little is known about how the significance of wealth for the health and wellbeing of older adults may vary across societies. Furthermore, researchers tend to focus mainly on income rather than other aspects of financial resources even though older adults often rely on fixed income, particularly after retirement. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey (N=1,431), the Health and Retirement Study (HRS) in the United States of America (USA; N=4,687), and the Korean Longitudinal Study of Ageing (KLoSA; N=5,447), this exploratory cross-national study examined the relationship between wealth satisfaction and objective wealth and wellbeing (measured as self-rated health and life satisfaction) among older Australians, Americans and Koreans (50 years). Regression analyses showed that wealth satisfaction was associated with wellbeing over and above monetary wealth in all three countries. The relationship between monetary wealth and self-rated health was larger for the US than Australian and Korean samples, while the additional contribution of wealth satisfaction to life satisfaction was larger for the Korean than the Australian and US samples. These findings are discussed in terms of the cultural and economic differences between these countries, particularly as they affect older persons. PUBLICATION ABSTRACT PB - 32 VL - 32 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2529607071andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 1 U4 - Wealth/Comparative analysis/Quality of life/Older people/Gerontology ER - TY - THES T1 - Disease as a predictor of depression in aging adults Y1 - 2012 A1 - Gray, Mikea R. KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - The purpose of this study is to examine the effects of self-reported chronic health conditions and functional status on the Center for Epidemiologic Studies depression scale using data from the Health and Retirement Study (HRS). The analysis consisted of fitting multivariate adaptive regression splines (MARS) modes to the extant data. Possible covariates included: age, gender, being white, being Hispanic, high blood pressure, heart disease, arthritis, lung disease, back pain, diabetes, stroke, cancer, ADL and IADL functional limitations. Data included 27,461 respondent's longitudinal data, which was collected on eight test occasions. Four hypotheses were formed. Results indicated that back pain and lung disease predicted depression scores which support the second hypothesis. ADL and IADL functional limitations were the most important predictors of depression score, confirming the third and fourth predictions. While chronic disease can lead to elevated depression scores, it appears that functional limitations may be more strongly related to depression. PB - California State University, Los Angeles CY - Los Angeles, CA VL - M.A. U4 - Mental health ER - TY - RPRT T1 - Dynamic Wage and Employment Effects of Elder Parent Care Y1 - 2012 A1 - Meghan M. Skira A1 - Department of Economics KW - Consumption and Savings KW - Employment and Labor Force KW - Healthcare KW - Methodology KW - Public Policy KW - Time Use KW - Women and Minorities AB - This paper formulates and estimates a dynamic discrete choice model of elder parent care and work to analyze how caregiving affects a woman's current and future labor force participation and wages. Intertemporal tradeoffs, such as decreased future earning capacity due to a current reduction in labor market work, are central to the decision to provide care. The existing literature, however, overlooks such long-term considerations. I depart from the previous literature by modeling caregiving and work decisions in an explicitly intertemporal framework. The model incorporates dynamic elements such as the health of the elderly parent, human capital accumulation and job offer availability. I estimate the model on a sample of women from the Health and Retirement Study by efficient method of moments. The estimates indicate that intertemporal tradeoffs matter considerably. In particular, women face low probabilities of returning to work or increasing work hours after a caregiving spell. Using the estimates, I simulate several government sponsored elder care policy experiments: a longer unpaid leave than currently available under the Family and Medical Leave Act of 1993; a paid work leave; and a caregiver allowance. The leaves encourage more work among intensive care providers since they guarantee a woman can return to her job, while the caregiver allowance discourages work. A comparison of the welfare gains generated by the policies shows that half the value of the paid leave can be achieved with the unpaid leave, and the caregiver allowance generates gains comparable to the unpaid leave. PB - Boston College UR - URL:http://fmwww.bc.edu/EC-P/WP792.pdf URL N1 - Boston College Department of Economics, Boston College Working Papers in Economics: 792, 2012 Working Paper U4 - Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination/Demographic Economics: Public Policy/Time Allocation--Labor Supply/Model Construction and Estimation/Informal care/employment/dynamic discrete choice/structural estimation/Family and Medical Leave Act ER - TY - JOUR T1 - The Effect of Long-Term Care Insurance on Home Care Use Among the Disabled Elders JF - Journal of Family and Economic Issues Y1 - 2012 A1 - Kim, So-Yun A1 - Gong-Soog Hong A1 - Montalto, Catherine P. KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - Using the 1998-2004 Health and Retirement Study, this study uses Cox's model to explore the effects of private long-term care insurance ownership on first home care use among the disabled elderly. Results show that long-term care insurance ownership and Medicaid eligibility did not significantly increase the likelihood of using home care services, while income and homeownership lowered this likelihood. Functional limitation was the key determinant of home care use and those who lived with children were less likely to use home care services. Based on the findings, this study provides foundations for long-term care policies and long-term care planning programs. PUBLICATION ABSTRACT PB - 33 VL - 33 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1030719832?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl IS - 3 N1 - Copyright - Springer Science Business Media, LLC 2012 Language of summary - English Pages - 353-362 ProQuest ID - 1030719832 Last updated - 2012-08-02 Place of publication - New York Corporate institution author - Kim, So-yun; Hong, Gong-soog; Montalto, Catherine P DOI - 2726553411; 70920932; 53465; JFEI; SPVLJFEI108343339280 U4 - Psychology/long term care insurance/functional limitation/home care services/Medicaid/public policy ER - TY - THES T1 - The effect of spatial access on utilization of health care services among the elderly Y1 - 2012 A1 - Lin, Chun-Lin KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Barriers exist between potential health care users and their actual access. Compared to other age groups, the elderly population faces more spatial obstacles to health care because of diminishing mobility. The object of this dissertation is to examine the extent to which spatial factors affect utilization of health care among the elderly. This dissertation investigates the main hypothesis that seniors who live in neighborhoods with high levels of spatial access will have higher levels of health care utilization. Data from the 2008 Texas physician record were applied to construct the indicator of spatial access using the Two-Step Floating Catchment Area method. This dissertation also used the Health and Retirement Study 2008 core and 2005-2009 American Community Survey 5-year data to estimate the average level of health care utilization as a function of spatial access and other individual and contextual characteristics. Results showed that older adults who lived in a Census tract with higher spatial access actually had lower mean values of health care utilization. After adding interaction terms, however, spatial access did have positive effect on health care utilization for seniors with very good or excellent health status compared to their counterparts who had fair or poor health status. The findings suggested that spatial access did influence seniors' health care utilization, but the effects varied by an individual's health status. Future studies should control for beneficial contextual factors that might potentially offset the effect of spatial access on health care utilization. PB - The University of Texas at San Antonio CY - San Antonio, TX VL - Ph.D. U4 - Medical geography ER - TY - THES T1 - Essays on family demography, household finance, and economics of the family Y1 - 2012 A1 - Fenaba R. Addo KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Public Policy KW - Women and Minorities AB - This dissertation examines the intersection of financial resources, family demography and economic well-being of American households at transitional periods in the life course. Changes in union formation, the demographic composition of the population, and family structure since the latter part of the twentieth century have challenged existing theories on household formation, individual decision-making, and economic well-being (Bumpass, 1990). With the increase in woman's labor force participation, the rise of cohabitation, pre-marital childbirth, and single-parent households, conventional models used to explain recent trends in marriage market dynamics, intra-household resource allocation, and wealth inequality are continuously tested, challenged, and revamped to keep pace with a society in a current state of demographic and economic flux. Chapter one focuses on early and young adulthood and the role of consumer and education loan debt in transitioning into coresidential relationships using a sample of youth coming of age at the turn of the twenty-first century and during a period of economic expansion, increased college enrollment and growing socioeconomic divide in marital patterns in the United States. Results suggest total debt amount is associated with cohabitation, increasing the odds of cohabitation over marriage and remaining single for both women and men. First marriage is positively associated with greater educational attainment for this cohort of young adults, but women with education loan debt are more likely to delay marrying and cohabit first. Chapter two (co-authored with Daniel T. Lichter) addresses the racial wealth gap by exploring the relationship between marriage and marital histories on wealth accumulation of older Black and White women. Marital and relationship histories are strongly associated with the wealth accumulation process. Women who marry and stay married accumulated levels of wealth that exceeded those of other women with disrupted family lives. The marriage-wealth nexus is sensitive to a women's position in the wealth distribution, and decomposition analyses highlight the non-trivial role of racial disparities in marital histories in accounting for the racial wealth gap. The third and final chapter uses seven waves of individual-level data from the Health and Retirement Survey from 1998-2008 to analyze whether there is a causal effect of being an informal basic needs or financial caregiver to an aging parent on one's health outcomes (self-assessed health and depression) and health behaviors (exercise and smoking). The results suggest a positive effect on depressive symptoms of basic needs caregiving for unmarried adult children, and that they may be selecting into that role because of their poor health. Manifestations of caregiving in future periods include, basic needs caregiving increasing the probability of smoking for married women and financial caregiving increases depressive symptoms for unmarried men. These findings suggest that the financial costs of caregiving can influence adult children's health outcomes, in particular for those not currently in a marital union. PB - Cornell University CY - Ithaca, NY VL - Ph.D. UR - https://ecommons.cornell.edu/handle/1813/31034 U4 - socioeconomic Differences 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 informal care, labor supply and wages T2 - Graduate School of Arts and Sciences Y1 - 2012 A1 - Meghan M. Skira KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Methodology KW - Public Policy AB - This dissertation examines how caregiving for an elderly parent affects an adult child's labor supply and wages. In the first chapter (co-authored with Courtney H. Van Houtven and Norma B. Coe) we identify the relationship between informal care and labor force participation in the United States, both on the intensive and extensive margins, and examine wage effects. We control for time-invariant individual heterogeneity; rule out or control for endogeneity; examine effects for men and women separately; and analyze heterogeneous effects by task and intensity. We find modest decreases--1.4-2.4 percentage points--in the likelihood of working for caregivers providing personal care. Male and female chore caregivers, meanwhile, are more likely to retire. For female care providers who remain working, we find evidence that they decrease work by 3-10 hours per week and face a 2.3-2.6 percent wage penalty. We find little effect of caregiving on working men's hours or wages except for a wage premium for male intensive caregivers. In the second chapter I formulate and estimate a dynamic discrete choice model of elder parent care and work to analyze how caregiving affects a woman's current and future labor force participation and wages. Intertemporal tradeoffs, such as decreased future earning capacity due to a current reduction in labor market work, are central to the decision to provide care. The existing literature, however, overlooks such long-term considerations. I depart from the previous literature by modeling caregiving and work decisions in an explicitly intertemporal framework. The model incorporates dynamic elements such as the health of the elderly parent, human capital accumulation and job offer availability. I estimate the model on a sample of women from the Health and Retirement Study by efficient method of moments. The estimates indicate that intertemporal tradeoffs matter considerably. In particular, women face low probabilities of returning to work or increasing work hours after a caregiving spell. Using the estimates, I simulate several government sponsored elder care policy experiments: a longer unpaid leave than currently available under the Family and Medical Leave Act of 1993; a paid work leave; and a caregiver allowance. The leaves encourage more work among intensive care providers since they guarantee a woman can return to her job, while the caregiver allowance discourages work. A comparison of the welfare gains generated by the policies shows that half the value of the paid leave can be achieved with the unpaid leave, and the caregiver allowance generates gains comparable to the unpaid leave. JF - Graduate School of Arts and Sciences PB - Boston College CY - Boston, MA VL - Ph.D. UR - https://dlib.bc.edu/islandora/object/bc-ir:101322/datastream/PDF/view U4 - labor force participation ER - TY - THES T1 - Financial and health security in old age: Three essays Y1 - 2012 A1 - Diebold, Jeffrey KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets KW - Public Policy KW - Retirement Planning and Satisfaction AB - This dissertation is composed of three essays that examine issues and policies related to the well-being of the elderly in the United States. Using a randomized control design, I demonstrate the relative strength of incentives structured as a credit as opposed to an economically equivalent deduction within the framework of a retirement-based annuitization decision. Next, I exploit the natural experiment provided by the establishment of Medicare Part D in 2006 to evaluate health-related outcomes affected by this policy change. I provide evidence that Medicare Part D resulted in a number of positive health-related outcomes among those Medicare beneficiaries without prescription drug coverage prior to enrolling in Part D. Finally, I test whether the financially literate are more likely to make decisions that minimize the risks to their financial security. The results from this analysis are decidedly mixed. Financially literate individuals do not, necessarily make better financial and investment related decisions but appear more active in the decision-making process. PB - The University of North Carolina at Chapel Hill CY - Chapel Hill, NC VL - Ph.D. U4 - retirement planning ER - TY - THES T1 - A functional use of response time data in cognitive assessment Y1 - 2012 A1 - John J. Prindle KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - The stimulus for the current body of work comes from the desire of researchers to have concise and accurate cognitive tasks implemented in their surveys. The main purpose of this work was to introduce collateral information as a way of making up for lost or forgone information when adaptive frameworks are adopted. The nature of ongoing surveys and the ubiquity of computers provides ample collateral, or nonintrusive, information which can help improve score accuracy. Information such as how long a respondent spends on certain items, their age, education, and other characteristics can improve score prediction beyond simple item responses. The importance of this work included methods to effectively decrease the number of items given to participants, as well as keep the accuracy high despite the loss in information. In the current study, the Woodcock Johnson - III (WJ-III) Number Series (NS) task was presented with 30 previously unpublished items as stimuli. First, a couple of scoring models were implemented to test for model fit and compare the implications of the fit values. Then methods outlined below systematically adjusted patterns of missingness to mimic reduced and adapted subsets. Once the smaller NS item sets were delineated, several methods of adding predictive accuracy were tested and compared. In scoring respondents a traditional Item Response Theory (IRT) model as proposed by Rasch (1960) was first used to provide evidence for a uni-dimensional scale and obtain baseline statistics for item difficulty and person abilities. The next model was a Conditionally Independent Response Time (CIRT) model. The latter model includes a response model as well as a joint response time model for scoring. It was shown that with the full item set these two models provide identical ability estimates and item parameters. The response time model of the CIRT framework provides ability scores and speededness scores based on response time patterns. Next, focus was placed on effectively decreasing the number of items used in scoring each respondent. Methods included item reduction, test forms in which the same item sets were used to score each respondent, and adaptive tests, where each respondent could receive a different item set. Reduced item sets fared better when item difficulties more closely matched sample ability levels (r=0.72-0.90). Adaptive item sets were more consistent in measuring ability (i.e. half-adaptive, block adaptive, fully adaptive), but accuracy was best for the fully adaptive method used (r=0.79-0.91). The last steps of analysis involved introducing response time and demographic variables as additional predictors of the 30 item scores. Item response, response times, and response/response time interactions provided small improvements in explained variance when used as predictors (1-8%). When CIRT ability and speededness scores were used as predictors, speededness provided limited improvements (<1%) to prediction. The addition of age, education, and gender to response models improved explained variance to a moderate degree (1-5%). In conclusion, we note that sample had a higher than average ability level for the NS task and this should color our findings for the methods outlined. The item sets that did not match respondent abilities as well were improved more so by response time and demographic data. If one can correctly identify the ability ranges of a sample before administration, then a more focused reduced item set would be advantageous. Adaptive item sets seem advantageous in a more general testing situation where ability levels are more variable. The advantage of using collateral information in predicting cognitive scores is the amount of time saved by omitting items, potentially lowering costs, and allowing researchers to move onto more tasks if desired. While the improvement due to response time in these methods was limited with NS, there is a good foundation for other cognitive tasks administered in computer assisted designs. PB - University of Southern California CY - Los Angeles, CA VL - Ph.D. UR - https://search.proquest.com/openview/3300180096d513fb0af4ff5ffc3eebf4/1.pdf?pq-origsite=gscholar&cbl=18750&diss=y U4 - Cognitive psychology 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 - THES T1 - Health services use and health status among people with diabetes mellitus and cardiovascular diseases T2 - Public Health Studies Y1 - 2012 A1 - Li, Chien-Ching KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - In the United States, Diabetes Mellitus (DM) becomes an important public health issue and has a great impact on health care costs. Diabetic patients are at a higher risk of developing cardiovascular diseases (CVD) compared to people without DM. This study adopted the Andersen's Behavioral Model of Health Services Utilization as a framework to examine health services uses and to further identify the association of health services uses and subsequent health outcomes within a representative sample of community-dwelling adults aged 51 years and older through a longitudinal analysis of the Health and Retirement Study data from 1998 through 2008. Results showed that less discretionary health services use (hospitalization and home health care) was more likely to be influenced by need factors. More discretionary health services use (doctor visits) was more likely to be influenced by predisposing factors. Although most health services uses were associated with worse or declined status in activities of daily living (ADL), instrumental activities of daily living (IADL), or self-rated health, certain health services use were found to be associated with less worse or not declined health status. The use of outpatient surgery among people with CVD only and the use of home health care among people with DM and CVD were associated with not declined IADL and self-rated health, respectively. In addition, the association between nursing home care and ADL, prescription drug use and IADL, and home health care and self-rated health was found to be different by health groups. Most health services uses were associated with higher risk of 10-year mortality. People with DM and CVD had the greater hazard to death compared with people with DM only. The association between mortality and doctor visits after baseline, and hospitalizations after baseline was different by health groups. Our study findings can provide health care professionals and health care administrators the insight required for improving the health care practice and the quality of health care in the U.S. JF - Public Health Studies PB - Saint Louis University CY - Saint Louis, MO VL - Ph.D. SN - 9781267642875 U4 - Mortality ER - TY - JOUR T1 - Health Shocks, Out-of-Pocket Medical Expenses and Consumer Debt Among Middle-Aged and Older Americans JF - The Journal of Consumer Affairs Y1 - 2012 A1 - Hyungsoo Kim A1 - Yoon, Wonah A1 - Karen A. Zurlo KW - Consumption and Savings KW - Demographics KW - Healthcare KW - Net Worth and Assets AB - We examine two important issues related to health and financial burden in middle-aged and older Americans: (1) whether or not new health events affect a consumer's unsecured debt, and (2) to what extent the associated out-of-pocket medical expenses (OOP) contribute to unsecured debt. We use six biennial waves (1998, 2000, 2002, 2004, 2006 and 2008) from the Health and Retirement Study (HRS). We estimated fixed effects models and conducted mediation analyses. We find that new health events affect the accumulation of unsecured debt. Our estimates suggest that new health events increase unsecured debt by 6.3 ( 230) to 9.3 ( 339); approximately 20 of the increase in unsecured consumer debt comes from OOP when experiencing new health events. New severe health events increase debt for the 50-64 age group, but do not increase it for the 65 group. PUBLICATION ABSTRACT PB - 46 VL - 46 IS - 3 U4 - Health care expenditures/Consumer credit/Middle age/Older people/Personal finance/Investment analysis and personal finance/Experiment/theoretical treatment/Out of pocket costs ER - TY - RPRT T1 - The Interplay of Wealth, Retirement Decisions, Policy and Economic Shocks Y1 - 2012 A1 - John Karl Scholz A1 - Ananth Seshadri KW - Consumption and Savings KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Retirement Planning and Satisfaction KW - Social Security AB - We develop a model of health investments and consumption over the life cycle where health affects longevity, provides flow utility, and retirement is endogenous. We develop a rich, numerical life-cycle model to study the complex interrelationship between health and wealth and the age of retirement. The decision to retire depends on a number of factors including earnings and health shocks, demographic characteristics, preferences, pensions, and social security. We incorporate these features in a computational model of optimal wealth and retirement decisions, solving the model household-by-household using data from the HRS. We use the model to study how workers would respond to an increase in the early eligibility age of retirement (EEA), and to what extent will the bad economy alter retirement plans. We find that increasing the EEA results in sizeable responses to the age of retirement but does not affect health outcomes very much. A 20 percent reduction in wealth induces households to delay retirement by one year, on average, with poor households being relatively unaffected. PB - Ann Arbor, The University of Michigan UR - http://www.mrrc.isr.umich.edu/publications/publications_download.cfm?pid=860 U4 - life Cycle/health investments/Consumption/retirement planning/health Shocks/wealth/social Security/Demographic aspects ER - TY - THES T1 - Longitudinal changes in self-reported expectations for nursing home use in the health and retirement study Y1 - 2012 A1 - Haley, Philip Parker KW - Expectations KW - Healthcare KW - Public Policy AB - The Behavioral Model of Health Services Use (Andersen, 1968; Andersen & Newman, 1973) is a frequently used framework for examining the factors that bear upon the decision to pursue and utilize health services (Andersen & Newman, 1973; Mui, Choi, & Monk, 1998). According to this model, an individual's predisposing characteristics, their enabling resources, and their degree of need combine to determine whether or not they will pursue health services such as nursing home care. The current study investigated the relations between variables predicted by the Behavioral Model of Health Services Use to influence longitudinal expectations for nursing home use among adults 50 years of age and older. Variables of interest were drawn from the 2002-2008 waves of the Health and Retirement Study (HRS) and included demographics, previous health services use, possession of insurance that pays for nursing home care, social support, cognitive status, emotional health, and functional status. Results suggested that the variables selected based upon the Behavioral Model of Health Services Use exhibited a limited ability to predict changes in nursing home use expectations across time. Limitations of the current study, as well as potential areas for future studies, were discussed. PB - The University of Alabama VL - Ph.D. IS - 3539994 N1 - ISBN 9781267645487 Dissertation/thesis number 3539994 ProQuest document ID 1112070427 U4 - Public Policy JO - Longitudinal changes in self-reported expectations for nursing home use in the health and retirement study ER - TY - THES T1 - Medicare expenditure growth and its health returns across cohorts Y1 - 2012 A1 - Yi-Sheng Chao KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - There are several key findings in the following chapters. In Chapter 2, the individual characteristics associated with higher spending growth over the period 1996 to 2008 were identified based on analyses with pooled cross-sectional data from the Medical Expenditure Panel Survey. The key factors that were associated with the adjusted growth rates higher than the actual Medicare spending growth rate (5.8% annually) from 1996 to 2008 include races other than the whites and blacks, Hispanic origin, high income, residence in the West, and very good health status. Findings from Chapter 3 reveal that enrollment in HMOs under Medicare is not random, but is systematically related to characteristics of Medicare enrollees. Using the longitudinal Health and Retirement Study, there were factors associated with a higher likelihood of becoming enrolled in Medicare Advantage/Part C. Chapter 4 examines the relationship between health care spending and returns to health with regard to five dimensions of health: mortality, hypertension, arthritis, self-assessed health status and mental health status (Center for Epidemiologic Studies Depression scale, CESD scale). The pre-Medicare characteristics were used to predict the change in these five dimensions of health after four years of Medicare coverage. The results reveal that increases in Medicare total and out-of-pocket spending were associated with poor health outcomes. Total spending was associated with a higher likelihood of death, worse self-rated health status (five categories) and mental health status. The increase in out-of-pocket health expenditure was associated with a higher chance of getting a worse category in self-rated health status after controlling for health status and other characteristics before being enrolled in Medicare. The findings of these studies suggest that policies to constrain Medicare spending should recognize and target the multiple factors contributing to Medicare expenditure growth and the dubious returns to health, as well as target integrated care for Medicare enrollees and incentives for individuals to prevent the onset of chronic health conditions. PB - Rutgers, The State University of New Jersey CY - New Brunswick, NJ VL - Ph.D. U4 - Chronic conditions ER - TY - THES T1 - Neighborhood Conditions and Gender Differences in Depressive Symptoms Y1 - 2012 A1 - Clinton, Eliva Atieno KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy KW - Women and Minorities AB - Depression is a major public health challenge affecting millions of people worldwide, particularly women. Intra-individual explanations of gender differences in depression include biology (e.g., neurotransmitters, genes, hormones) and psychological factors (e.g., self-concept and esteem, mastery). Social explanations focusing on exposure to stressors (e.g., low socioeconomic status) and social role occupancy (e.g., marital and employment status) also have been considered. The recognition that environmental factors may influence mental health has given rise to studies examining the relationship between neighborhood conditions and risk for depression and psychological distress, but gender differences in neighborhood effects have yet to receive the needed research attention. This dissertation sought an understanding of: (a) gender differences in neighborhood effects on depressive symptoms, and (b) neighborhood influences on variation in depressive symptoms among women. The research is guided by the neighborhood stress process framework focusing on stressors and psychosocial resources as mediators and moderators of the relationships among neighborhood conditions and depressive symptoms. Individual-level cross-sectional data come from the Health and Retirement Survey (HRS: baseline, 2006/2008 interviews and psychosocial questionnaire supplement). The HRS is a U.S. national probability sample of adults over the age of 50. Analyses are performed within a multilevel framework and urban neighborhood data come from the 2000 U.S. Census. Among eight indicators of neighborhood disadvantage, including neighborhood socioeconomic disadvantage (NSD), and five measures of neighborhood advantage examined for gender differences in their effects on depressive symptoms, two were statistically significant but not in the expected direction. Neighborhood proportion non-family households was associated with fewer depressive symptoms among women and it had no effect among men. Neighborhood proportion married-couple households was not significantly related to depressive symptoms among women, but among men, living in a neighborhood with more married-couple households with children was associated with fewer symptoms. Overall, the impact on depressive symptoms of neighborhood characteristics do not differ for men and women. Gender differences in neighborhood effects on three individual-level stressors and three individual-level psychosocial resources also were examined. Nine interactions were statistically significant. Consistent with expectations, people who reside in neighborhoods with more vacant housing units perceived more disorder and less social cohesion in their neighborhoods, and the effects were larger for women than men. Relative to men, women's perceptions of neighborhood social cohesion and social support are more sensitive to neighborhood economic conditions. In general, with a few notable exceptions, neighborhood effects on stressors and psychosocial resources do not vary by gender. In analyses that only included women, NSD was positive and significantly associated with depressive symptoms and neighborhood proportion adults aged 65 and older was negative and significantly associated with symptoms. Perceived neighborhood social cohesion fully mediated the effect of NSD--and partially mediated the effect of neighborhood proportion older adults--on depressive symptoms. The effect on depressive symptoms of neighborhood disadvantage did not vary significantly by levels of stressors and psychosocial resources except for three significant cross-level interactions. Living in a neighborhood with more vacant housing units was associated with more depressive symptoms, and the effect was greater among women who perceived high levels of disorder in the neighborhood than those who perceived less disorder. Also as hypothesized, NSD had the largest positive effect on depressive symptoms among women with less social support than women with more support. However, mastery did not funct on as a stress-buffer. The effect on depressive symptoms of neighb rhood advantage varied significantly by psychosocial factors. Living in a neighborhood with higher proportions of older adults was associated with fewer depressive symptoms more so for women who report low levels of perceived neighborhood physical disorder than women who report average levels of disorder. Also consistent with expectations, higher neighborhood proportion of affluent households and owner-occupied housing units were associated with fewer depressive symptoms, and the effects were larger for women with high levels of mastery than women with low mastery. However, these neighborhood characteristics were less beneficial to the mental health of women with high than low levels of social support. The findings from this dissertation largely indicate that relationships among components of the neighborhood stress process model do not differ by gender or by levels of stressors and psychosocial resources. However, the significant results that emerged make a valuable contribution to the research literature by identifying urban neighborhood conditions that are consequential to the mental health of middle-aged and older adults and that should be the target of interventions. PB - University of California, Los Angeles CY - Los Angeles VL - Ph.D. UR - https://escholarship.org/uc/item/86f6m7br U4 - WOMEN ER - TY - THES T1 - Retirement Consumption Behavior: Evidence from HRS CAMS 2001-2009 T2 - Human Ecology Y1 - 2012 A1 - Chiang, Mei-Fang KW - Consumption and Savings KW - Demographics KW - Event History/Life Cycle KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Recent studies across a number of countries evidence a substantial decline in household consumption expenditure around the time of retirement. This phenomenon, coined as the retirement consumption puzzle, brings a challenge to the traditional life-cycle model. The life-cycle model implies that household consumption should be continuous over time including the transition to retirement, provided that retirement is a foreseeable event. To address the retirement consumption puzzle, this dissertation brings current evidence by carrying out four studies on U.S. household consumption behavior at retirement. Study 1 is a cross-sectional study using the latest available data wave from 2009 HRS CAMS. The main interest is to compare consumption behavior between non-retired and retired households. Based on the life cycle hypothesis, regardless of employment status, households sharing similar socioeconomic characteristics should exhibit similar consumption behavior. The empirical findings, however, show that the consumption behavior between non-retired and retired households is significantly different, holding all other factors constant. Spending for retired households is 8.5% lower than spending for non-retired households. Study 2 is an aggregate-panel study using data from 2001-2009 HRS CAMS. The difference between Study 1 and Study 2 is that Study 2 tracks household consumption behavior over time and investigates whether there is a significant change in consumption pattern after retirement. Fixed-effects analysis is conducted to appropriately account for the effect of individual heterogeneity. The life cycle hypothesis predicts that when retirement is as planned by the household, there is no significant change in consumption after retirement. The fixed-effects regression indicates that there is an insignificant increase of 3% in household consumption after retirement. The discrepancy in the results from Study 1 and Study 2 regarding the retirement consumption puzzle comes from the lack of control of individual heterogeneity in the cross-sectional analysis. Study 3 is a subsamples-panel study. Within the life-cycle framework, if retirement is voluntary and expected, there should be no significant change in household consumption after retirement. However, if the household head is laid-off or experiencing poor health, this household may be forced to be out of the labor market, resulting in early retirement. Because involuntary early retirement reduces the household's lifetime resources, the household must reduce consumption and re-allocate to a new optimal consumption path. As predicted by the life-cycle model, the findings show that households with voluntary retirement have an insignificant increase in household consumption after retirement by 6%. Involuntary-retirement results in a decrease in consumption after retirement by 6-7%. The percentage difference in the household consumption change between these the two groups of households is 11-12% and statistically significant. Accordingly, these findings suggest that household consumption behavior differs by household type (voluntary versus involuntary retirement). These three studies use log consumption as the dependent variable. Alternatively, Study 4 uses consumption growth as the dependent variable to test the retirement consumption puzzle. The regression results provide no evidence of a retirement consumption puzzle, finding an insignificant 3% increase in consumption after retirement. JF - Human Ecology PB - The Ohio State University CY - Columbus, OH VL - Ph.D. UR - http://rave.ohiolink.edu/etdc/view?acc_num=osu1338247837 U4 - life Cycle ER - TY - JOUR T1 - Sense of control and sociodemographic differences in self-reported health in older adults JF - Quality of Life Research Y1 - 2012 A1 - Ward, Michael M. KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Other AB - Stronger sense of control has been associated with improved health outcomes. This study tested whether the association between sense of control and self-reported health varied among demographic groups and whether sense of control attenuated sociodemographic differences in self-reported health. Data from 6,815 participants in the Health and Retirement Study were used to examine moderation between demographic characteristics and sense of control (measured by the personal mastery and perceived constraints scales of the Midlife Developmental Inventory) in their associations with three self-reported health measures (global rating of fair/poor health, functional limitations, and number of comorbid conditions). Higher personal mastery and lower perceived constraints were associated with better self-reported health. There were no significant interactions between the sense of control measures and age, gender, education level, income, or marital status in their associations with either global self-rated health or functional limitations. Higher levels of mastery were associated with lower likelihood of functional limitations among blacks and whites, but not among those of other races. Perceived constraints were slightly more strongly associated with number of comorbid conditions among older than younger individuals. Sense of control measures were generally similarly associated with self-reported health across demographic groups and did not attenuate demographic differences in health. PUBLICATION ABSTRACT PB - 21 VL - 21 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1112162539?accountid=14667 IS - 9 N1 - Copyright - Springer Science Business Media Dordrecht 2012 Language of summary - English Pages - 1509-18 ProQuest ID - 1112162539 Last updated - 2013-01-02 Place of publication - Oxford Corporate institution author - Ward, Michael M DOI - 2789326681; 73133172; 138140; QLFR; 22120892; SPVLQLFR1113621968 U4 - Medical Sciences/health outcomes/Sense of control/Self assessed health/sociodemographic differences/sociodemographic differences/demographic groups/demographic groups/COMORBIDITY/Functional limitation ER - TY - THES T1 - Spousal support and diabetes management: The role of gender and religion Y1 - 2012 A1 - Estevez, Rosemary KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - One in four adults over the age of 60 suffers from diabetes. Around 85%-90% of individuals who have diabetes suffer from Type II diabetes. The prevalence of individuals with diabetes is expected to increase. This paper addresses the influence spousal support, friend support, and religion all have on diabetes mellitus. Gender difference in relation to spousal support benefits has also received limited attention. The limited amount of studies that have examined gender differences in relation to spousal support and diabetes management indicate that diabetic men benefit the most from spousal support due to their wives active involvement in meal preparation and grocery shopping. The results showed that neither spousal support nor religious salience was significantly related to diabetes management. There were observed gender differences in religious salience (males = 4.84, females = 5.36, p <.001) and positive spousal support (males = 3.19, females = 3.02, p <.001), but none of the major hypotheses were supported. PB - University of North Texas CY - Denton, TX VL - Master of Science UR - https://digital.library.unt.edu/ark:/67531/metadc149589/m1/1/ U4 - religion ER - TY - JOUR T1 - Is There a Hispanic Epidemiologic Paradox in Later Life? A Closer Look at Chronic Morbidity JF - Research on Aging Y1 - 2012 A1 - Zhang, Zhenmei A1 - Mark D Hayward A1 - Lu, Chuntian KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - This study examined the morbidity patterns of foreign-born Hispanics, U.S.-born Hispanics, Blacks, and Whites aged 53 years and older using seven self-reported physician-diagnosed chronic diseases as well as six biomarkers. Drawing on the 2006 Health and Retirement Study and its biomarker data, the authors found that foreign-born Hispanics had comparable or lower rates of high blood pressure, heart disease, cancer, arthritis, chronic lung disease, and stroke, controlling for age and gender. The health advantages were robust when socioeconomic conditions and health behaviors were controlled. Foreign-born Hispanics were not significantly different from U.S.-born Hispanics except for a lower risk for arthritis. In terms of biomarkers, foreign-born Hispanics were not statistically different from Whites except for having higher risks of high systolic blood pressure and blood glucose. Future research should explore multiple factors contributing to the lower rates of major chronic diseases among older Hispanics who have faced social disadvantages over the life course. PUBLICATION ABSTRACT PB - 34 VL - 34 IS - 5 U4 - Gerontology And Geriatrics/morbidity/health indicators/hispanics/foreign-born/socioeconomic Differences/hispanics/african Americans/chronic Diseases ER - TY - THES T1 - Three essays in health economics Y1 - 2012 A1 - Wang, Xu KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction AB - This dissertation consists of three essays. In my first essay, I examine the relationship of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) to breastfeeding. Although WIC promotes breastfeeding among its participants through education, counseling, and the provision of enhanced food packages to breastfeeding women, the program has been criticized for discouraging breastfeeding by providing free infant formula. In order to estimate the extent to which participation in WIC discourages breastfeeding, I employ a methodology that disentangles selection bias associated with WIC participation from the incentives associated with the provision of free infant formula. Findings suggest that postpartum entrants are less likely to breastfed for at least 6 months and have shorter breastfeeding durations than non-participants, and the effects are significantly larger among twin mothers than among singleton mothers. In my second essay, I investigate the association between WIC participation and infant health. How effective WIC is at improving birth outcomes is under debate. Identifying treatment effect is challenged by selection bias and gestational age bias. We use twins to minimize selection bias associated with WIC participation because twin pregnancy increases the probability of adverse birth outcomes significantly but is unlikely related to other risky behaviors. Our focus is on measures of fetal growth as outcomes amenable to nutritional supplementation. Our findings from two national datasets, PNSS and ECLS-B, suggest that prenatal WIC participation has very limited effect on fetal growth. We do not find evidence of causal effect between WIC and better birth outcomes, especially among twin births. In my third essay, I turn my interest to a different research question, the association between retirement and alcohol consumption. Retirement is life transition whose significance may provoke lifestyle and health behavioral alterations such as alcohol consumption. We examine the effect of retirement on subsequent period alcohol consumption within a two period follow up. We use seven waves of the data from Health and Retirement Study (HRS) and found retirement lead to consume 1.3 more alcoholic drinks per day within men. No effect has been found within retired women. PB - City University of New York CY - United States -- New York VL - Ph.D. UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1115316395?accountid=14667 N1 - Wang, Xu Breastfeeding 9781267688194 Alcohol 68148022 Health economics 3541918 0501: Economics 0573: Public health 66569 0630: Public policy n/a Social sciences Retirement English 1115316395 Copyright ProQuest, UMI Dissertations Publishing 2012 Infant health 2012 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 2799357101 2012-11-26 Health and environmental sciences U4 - life-cycle JO - Three essays in health economics ER - TY - THES T1 - Three essays on health care spending Y1 - 2012 A1 - Yoo, Minkyoung KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Other KW - Risk Taking AB - This dissertation is composed of three essays that consider the determinants and persistence of health care spending and how policies that control increasing health care costs affect the distribution of health care spending in the U.S. In the first essay, I study the association between education and health care spending for a set of health conditions amenable to self-management. Empirical findings from estimated health expenditure models reveal strong inverse relationships between education and health care spending among elderly adults with hypertension and/or asthma. Additionally, I find that greater educational attainment is associated with a reduced likelihood of being in the top 5% of health care spenders for elderly adults with hypertension and nonelderly adults with diabetes, and also with less severe conditions. The second essay assesses how the distribution of family out-of-pocket health care spending has been affected by changes in recent cost-sharing to understand the effectiveness of the risk protection function of private health insurance against high medical care expenses. The results suggest that families who rely more on health care because of one or more their member's existing health conditions are most affected by changes in cost sharing during the period 2001-2005 and the increased exposure to out-of-pocket spending occurrs primarily for families at higher percentiles of the out-of-pocket spending distribution, thus reducing the "return" to risk protection from holding private health insurance. The final essay examines the dynamics of out-of-pocket health care spending by looking at the persistence of such spending among Medicare beneficiaries. The findings suggest that having a certain chronic condition or a health shock clearly increases the probability of out-of-pocket health care spending persistence. Additionally, having an existing health insurance that supplements Medicare coverage or the acquisition of a new supplementary health insurance has a significant impact on the probability of persistence. PB - Rutgers The State University of New Jersey CY - New Brunswick, NJ VL - Ph.D. U4 - educational attainment ER - TY - THES T1 - Three Essays on the Labor Supply, Savings and Investment Behavior of Older Workers Y1 - 2012 A1 - Clift, Jack W. KW - Employment and Labor Force KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Pensions KW - Public Policy KW - Retirement Planning and Satisfaction KW - Social Security AB - In this dissertation, I provide three distinct analyses addressing labor supply, saving and investment behavior of (older) workers, in the context of the incentives and constraints they face due to employer and government policies. In the first paper, I examine labor supply flexibility and its effect on the labor supply decisions of older workers. Previous literature suggests that people would like to reduce hours of work gradually over time as they get older, but do not have the flexibility to do so in their job, and consequently may retire early rather than continue to work high hours at older ages. If greater flexibility allows individuals to stay in the labor force longer, this could increase total labor supply, helping to increase both private resources for retirement and tax revenue to support public programs. Following a sample of older Americans for 16 years from 1992 to 2008, I find that there are noticeable differences in labor outcomes between those who had flexibility over their hours in 1992 and those who were not able to adjust their hours: those with flexibility worked fewer hours in their 50s, but tended to stay in the labor force longer; the major difference between groups occurred when individuals were in their early-mid 60s, at which time those who did not have flexibility in 1992 were much more likely to retire than those with flexibility. This work provides support for the theory that people prefer gradual retirement to more abrupt departures from the labor force, and indicates that flexibility around key retirement ages might have an impact on behavior. The overall effect on total labor supply of providing flexibility at all points of the lifecycle is ambiguous. In the second paper, we examine whether labor supply flexibility affects investment behavior. Individuals can receive higher returns (on average) on their investments if they are willing to bear more risk, which allows people to reach retirement with greater resources (on average) than if they had pursued low-risk strategies; but the fear of suffering big losses discourages people from taking risks. Theoretical work has argued that individuals with flexibility over their labor supply over the lifecycle can bear more risk in their portfolio of investments, as they can increase their labor to offset any losses they might suffer. Using a new survey we fielded in the American Life Panel (ALP), we examine how different measures of labor supply flexibility are related to measures of risk-taking in investments: individual participation in the stock market, and the percentage of an individual's financial wealth held in stocks. We find no evidence that flexibility over number of hours worked per week is related to investments in stocks. We find weak evidence that other flexibility measures--an individual's belief that they would be able to continue to work longer to make up for any negative wealth shocks, and the absence of factors that make it difficult to sustain a job into old age--may be related to greater risk-taking in investments. These results may indicate that flexibility at the extensive margin (ability to extend a career) may be more relevant to investment decision-making than flexibility at the intensive margin (ability to adjust hours). In the third paper, I describe the construction and characteristics of a unique dataset with which I lay the foundations for understanding pension system incentives and how they influence work and savings behavior over the lifecycle. Public pension systems across the developed world are in need of reform, but it is important to understand how the incentives in these systems affect behavior if we are to predict the consequences of different possible reforms. Previous literature has argued that public pensions displace private savings, but with elasticity of less than 1; this suggests that possible reductions in pension benefits through reforms would be partially (but not fully) offset by increases in private saving. Using new retrospective earnings history data for five European countries, in conjunction with linked survey data describing household wealth, I construct a dataset that captures the heterogeneous pension system incentives faced, and labor supply decisions made, at each point in the lifecycle for a large group of European men. My exploratory analysis of this dataset is consistent with the hypotheses that more generous income replacement by pension plans leads to lower private wealth accumulation, and greater reward within the pension system for continued work leads to later retirement. However, these statistical associations admit of plausible alternative explanations; the work documented in this paper cannot provide definitive answers on the incentive effects of pension systems, but provides the groundwork for significant extensions of research in this field, and eventually for detailed policy simulation of pension reform. (Abstract shortened by UMI.) PB - The Pardee RAND Graduate School CY - Santa Monica, CA VL - Ph.D. UR - https://www.rand.org/pubs/rgs_dissertations/RGSD305.html U4 - Public policy ER - TY - THES T1 - The Urban Neighborhood, Depressive Symptoms, and Age: Stress and Psychosocial Resources Y1 - 2012 A1 - Harig, Fredrick A. KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Risk Taking AB - Background . Existing research shows that residents exposed to neighborhood socioeconomic disadvantage (NSD) have a relatively high risk of some types of mental illness. This study investigated whether this pattern is present for depressive symptoms among persons in late middle age to extreme old age, and if so why. Investigated factors include: stressors (neighborhood physical disorder and financial strain) and psychosocial resources (mastery, social support, and religious service attendance). Age differences were examined. Methods . This was a secondary analysis of data from the 2006 and 2008 Health and Retirement Study Psychosocial Supplemental Assessment. The analytic sample included 8,623 adults aged 52 to 104, residing in 3216 urban neighborhoods (census tracts). NSD was operationalized with a principal component of Census tract indicators (education, poverty, public assistance, and unemployment). Depressive symptoms were measured by an 8-item version of the Center for Epidemiologic Studies Depression Scale. Hierarchical linear regression estimated multilevel models. Results . NSD was positively associated with depressive symptoms, net of individual-level demographic characteristics used to control for selection. Exposure to stressors partially explained the association; while psychosocial resources suppressed it. A significant, curvilinear cross-level interaction with age was found: NSD is positively associated with symptoms among those under 64, but has little effect among persons 65 to 74 year, and is negative at older ages. Conclusion . The mental health disparity for depressive symptoms in NSD is partially due to greater exposure to stressors and fewer resources to counteract this exposure. The counter-intuitive inverse association among the oldest adults warrants further investigation. PB - University of California, Los Angeles CY - United States -- California VL - M.S. UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2693777921&Fmt=7&clientId=17822&RQT=309&VName=PQD IS - AAT 1512042 N1 - ISBN 9781267388599 U4 - social environment JO - The Urban Neighborhood, Depressive Symptoms, and Age: Stress and Psychosocial Resources ER - TY - JOUR T1 - Use of Direct Versus Indirect Approaches to Measure Loneliness in Later Life JF - Research on Aging Y1 - 2012 A1 - Sharon Shiovitz-Ezra A1 - Liat Ayalon KW - Health Conditions and Status KW - Healthcare AB - The aim of the current investigation was to compare a direct versus an indirect approach for measuring loneliness by comparing the one-item Center for Epidemiologic Studies Depression Scale, representing the direct approach, with the shortened version of the Revised UCLA Loneliness Scale, representing the indirect approach, using approximately 2,000 observations from the 2002 Health and Retirement Study. The authors artificially identified a cut point of 6 on the three-item Revised UCLA Loneliness Scale to potentially yield the most similar results to the single-item scale and demonstrate the best sensitivity and specificity. Nonetheless, a high rate of respondents (57 ) who reported being lonely on the direct item were classified as not lonely on the indirect scale. Inconsistency between the two approaches was also evident with regard to the associations between loneliness and age, as well as with education. These findings indicate that the different measures of loneliness provide a somewhat different picture of both the prevalence of loneliness and the characteristic of the people who suffer from it. PUBLICATION ABSTRACT PB - 34 VL - 34 IS - 5 U4 - Gerontology And Geriatrics/depression/Loneliness/depression Symptoms/CES Depression Scale/CES Depression Scale/UCLA Loneliness Scale ER - TY - JOUR T1 - Use of the Medicare Posthospitalization Skilled Nursing Benefit in the Last 6 Months of Life JF - Archives of Internal Medicine Y1 - 2012 A1 - Aragon, Katherine A1 - Kenneth E Covinsky A1 - Yinghui Miao A1 - W John Boscardin A1 - Flint, Lynn KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - In the last 6 months of life, many older adults will experience a hospitalization, followed by a transfer to a skilled nursing facility (SNF) for additional care. We sought to examine patterns of Medicare posthospitalization SNF use in the last 6 months of life. We used data from the Health and Retirement Study, a longitudinal survey of older adults, linked to Medicare claims (January 1994 through December 2007). We determined the number of individuals 65 years or older at death who had used the SNF benefit in the last 6 months of life. We report demographic, social, and clinical correlates of SNF use. We examined the relationship between place of death and hospice use for those residing in nursing homes and the community before the last 6 months of life. The mean age at death among 5163 individuals was 82.8 years; 54.5 of the cohort were female, and 23.2 had resided in a nursing home. In total, 30.5 had used the SNF benefit in the last 6 months of life, and 9.2 had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon (P .01 for all). Of community dwellers who had used the SNF benefit, 42.5 died in a nursing home, 10.7 died at home, 38.8 died in the hospital, and 8.0 died elsewhere. In contrast, of community dwellers who did not use the SNF benefit, 5.3 died in a nursing home, 40.6 died at home, 44.3 died in the hospital, and 9.8 died elsewhere. Almost one-third of older adults receive care in a SNF in the last 6 months of life under the Medicare posthospitalization benefit, and 1 in 11 elders will die while enrolled in the SNF benefit. Palliative care services should be incorporated into SNF-level care. PB - 172 VL - 172 IS - 20 N1 - Copyright - Copyright American Medical Association Nov 12, 2012 Language of summary - English ProQuest ID - 1152162690 Last updated - 2012-11-16 Place of publication - Chicago Corporate institution author - Aragon, Katherine; Covinsky, Kenneth; Miao, Yinghui; Boscardin, W John, PhD; Flint, Lynn; Smith, Alexander K, MD, MS, MPH DOI - 2817091601; 73733012; 29256; AINM; INODAINM0000634121 U4 - Medical Sciences/Medicare claims/Skilled Nursing Facilities/ economics/Skilled Nursing Facilities/ economics/HOSPITALIZATION/Palliative care/posthospitalization benefit ER - TY - JOUR T1 - The Wage Elasticity of Informal Care Supply: Evidence From the Health and Retirement Study JF - Southern Economic Journal Y1 - 2012 A1 - Nizalova, Olena KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Income AB - This article focuses on the wage elasticity of informal care supply to elderly parents employing an instrumental variable approach to account for the fact that the wage rate is likely to be correlated with omitted variables. Using the 1998 wave of the Health and Retirement Study (HRC 1998), the wage elasticity of informal care supply is estimated to be negative and larger in magnitude than found previously. The lower bound of this elasticity is estimated to be -1.8 for males and -3.6 for females. Additional findings suggest that this wage elasticity differs by the type of care provided to elderly parents and that it is larger in magnitude among individuals with siblings and those with independently living parents. Overall the reductions in the informal care constitute about 18 of the labor supply response for men and about 56 of the labor supply response for women, which are not compensated by monetary transfers. PUBLICATION ABSTRACT PB - 79 VL - 79 IS - 2 U4 - Employee incentives/Health care delivery/Wage rates/Labor supply/Elder care/Compensation and benefits/Informal care/intergenerational Transfers ER - TY - JOUR T1 - Who Among the Elderly Owns Stocks? The Role of Cognitive Ability and Bequest Motive JF - Journal of Family and Economic Issues Y1 - 2012 A1 - Eun Jin Kim A1 - Sherman D. Hanna A1 - Chatterjee, Swarn A1 - Lindamood, Suzanne KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Conventional advice is to reduce risky investments as one ages. Such a generalized focus on risk avoidance may be inappropriate for elderly with longer life spans and those with financial goals that extend beyond their lifetime. To better understand risky asset holdings among the elderly, we investigated the effect of cognitive ability and bequest motive on stock ownership and stock purchase. Using the 2004 wave of the Health and Retirement Study, we found that one-third of elderly households held stocks and 36 of those elderly stockowners had recently acquired stocks. The respondent's cognitive ability and bequest motive were strongly related to stock ownership. Among those who owned stock, a bequest motive was positively related to a recent purchase of stocks. PUBLICATION ABSTRACT PB - 33 VL - 33 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1030719840?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl IS - 3 N1 - Copyright - Springer Science Business Media, LLC 2012 Language of summary - English Pages - 338-352 ProQuest ID - 1030719840 Last updated - 2012-08-02 Place of publication - New York Corporate institution author - Kim, Eun Jin; Hanna, Sherman D; Chatterjee, Swarn; Lindamood, Suzanne DOI - 2726553591; 70920932; 53465; JFEI; SPVLJFEI108343339295 U4 - Psychology/investment decisions/investment decisions/retirement planning/cognitive ability/stock market/assets ER - TY - THES T1 - Children's Schooling and the Social Stratification of Parents in Later Life Y1 - 2011 A1 - Esther M Friedman KW - Adult children KW - Demographics KW - Healthcare KW - Other AB - This dissertation expands upon the sociological and social stratification research on the intergenerational effects of education, by looking upward across the generations to understand the effects of educating one generation on the previous generation's health, wealth, and care. Whereas most research on the intergenerational effects of education looks at the effects of parents on their offspring, this dissertation reverses the causal arrow to look at the "upward" intergenerational effects of children on their parents. In later life, in particular, the socioeconomic resources of children may be an important predictor of how parents fare and why some parents do better than others. Data from the Health and Retirement Study (HRS) and the Panel Study of Income Dynamics (PSID) are used to investigate the costs and benefits to parents of having highly-educated children. The first two chapters investigate the potential benefits to parents that stem from having highly-educated children, specifically regarding health and later life care. The third chapter looks at a possible downside to producing highly-educated children--the toll it takes on parental wealth. More specifically, in Chapter One I ask: Does children's education affect parents' survival, and if so, how? I find that parents with highly-educated children live longer than those with less-educated children, even after controlling for parents' own education, income, and wealth. This effect is most pronounced for more preventable deaths, particularly those linked to health behaviors. In fact, two means through which educated children improve their parents' health include getting parents to smoke less and exercise more. In Chapter Two, I examine the role of children's education on the care and financial help that parents receive in later life. In this chapter I ask two primary questions: (1) Are parents of highly-educated children more likely to receive financial and time help? And (2) Is it having highly-educated children that benefits parents--regardless of how the children came to be educated--or are educated children providing this benefit largely in reciprocation for their parents' earlier investment in their schooling? I use data on adult children's educational attainments and on whether parents helped fund children's schooling to examine these questions. The results of this chapter show that parents of college-educated children are more likely to receive financial help from their children than parents of less-educated children. In addition, these effects are more pronounced for parents who helped fund their children's schooling. The final chapter of my dissertation examines the wealth trajectories of parents over the life course. This chapter investigates the extent to which children's college enrollment is related to parents' wealth trajectories before, during, and after educating their children. This chapter shows that, despite the high cost of college tuition, parents whose children attend college have more (not less) wealth than their counterparts in later life, and over most of their lifetimes. They have both higher levels and a greater rate of wealth accumulation over the life course, starting even before their first child enters college. Debt exhibits a parallel trend, with parents of highly-educated children incurring more debt than their counterparts, particularly in mid-life. After accounting for the timing of children's schooling, we can see why. Although parents' liquid assets drop when the oldest child turns 18, parental debt levels soar when children enter college and drop just after they leave school. For parents whose children do not attend college, levels of liquid assets and debts remain fairly constant over the life course. Taken together, this dissertation shows that having highly-educated children has significant implications for parents: highly-educated children improve their parents' health behaviors, increase their longevity, increase the likelihood that parents will receive financial help in later life and, although highly-educat d children are costly, parents of highly-educated children have more (not less) wealth in later life than do their counterparts. This work not only bears on current stratification and education research, but also has practical implications for policy decisions concerning the costs and benefits of educating one generation of the family for the broader family unit. PB - University of California, Los Angeles CY - United States -- California VL - Ph.D. UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2533989291&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - intergenerational Transfers JO - Children's Schooling and the Social Stratification of Parents in Later Life ER - TY - THES T1 - Conversations on death: Cost implications of end-of-life preparations Y1 - 2011 A1 - Cable, Heather M KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction AB - The end of a person's life is important. Sacred, even. But, more and more the end of life is also expensive--very expensive--for patients and for the taxpayer. According to the Dartmouth Atlas of Health Care, "patients with chronic illness in their last two years of life account for about 32% of total Medicare spending." As a result, there is a critical need to better understand effective solutions for reducing those costs. This paper focuses on the effect of living wills on total medical expenditures and utilization of heroic medical interventions at end-of-life. Using data pooled from the 2002-2008 exit surveys of the Health and Retirement Study, this paper uses logistic, regression and simulation models to evaluate the cost and care effects of three different types of living wills--those that call for comfort care only, those that call for limited care in certain situations, and those that call for receiving all care possible at end of life. The findings of this analysis indicate that patient preferences as expressed through living wills do, in fact, influence end-of-life medical expenditures as well as utilization of certain types of heroic end-of-life care. Of those patients who faced health care decisions in the final days of life, individuals who had living wills to limit care in some way had significantly lower total medical expenditures in the last two years of life, ranging from $2,730 (7%) (limited care or withheld treatments) to $8,285 (21%) (comfort care only) lower than their counterparts who did not have a living will. Conversely, those with living wills to receive all care possible had drastically ($24,171) (60%) higher end-of-life costs, as well as a 37 percent higher probability of utilizing life support, compared with those who had no living will. PB - Georgetown University VL - M.P.P IS - AAT 1491306 N1 - ISBN 9781124597539 U4 - retirement planning JO - Conversations on death: Cost implications of end-of-life preparations ER - TY - THES T1 - The Dynamics of Living Arrangements Among the Elderly Y1 - 2011 A1 - Witvorapong, Nopphol KW - Healthcare KW - Methodology KW - Public Policy AB - Combining care arrangements and whom the elderly live with, I study the mechanisms behind changes in living arrangements. I estimate a dynamic model of living arrangements, savings, intergenerational transfers and health outcomes. I use the nonlinear discrete factor random effects estimation method to control for unobserved heterogeneity. I use the rich data available in the 1995 - 2006 waves of the Health and Retirement Study (HRS) and supplement them with data on Medicaid and costs of care, resulting in a unique data set. I find that living arrangements are strongly influenced by health and savings. In particular, functional health is the strongest predictor of living arrangements. Inter vivos transfers and bequest intent affect living arrangements only to the extent that they impact the distribution of unobserved heterogeneity, indicating the absence of the exchange hypothesis as far as living arrangements are concerned. Public policies have a small but significant effect in the determination of living arrangements. For example, a twofold increase in the probability of receiving nursing home benefits among Medicaid eligibles increases the use of nursing home only by a 0.1 percentage point. The effects of public policies are more pronounced among elderly individuals with poor initial health and low initial wealth. PB - The University of North Carolina at Chapel Hill CY - Chapel Hill, NC VL - Ph.D. U4 - Public health ER - TY - JOUR T1 - Effects of Increasing the Incentive Size in a Longitudinal Study JF - Journal of Official Statistics Y1 - 2011 A1 - Willard L Rodgers KW - Healthcare KW - Methodology AB - To assess the possible impacts of increasing the incentive size on response rate and data quality, at one wave of a longitudinal study sample members were randomly assigned to receive one of three incentives: the same 20 incentive per person they had received in previous waves; 30; or 50. Those offered 50 had a higher response rate than those offered 20, and this positive impact persisted for at least the next four waves of biennial data collections. There is some evidence that higher incentives improve data quality as indicated by probabilities of failing to answer questions and of giving responses that would reduce the interview length. PB - 27 VL - 27 UR - https://www.scb.se/contentassets/ca21efb41fee47d293bbee5bf7be7fb3/effects-of-increasing-the-incentive-size-in-a-longitudinal-study.pdf IS - 2 U4 - Panel attrition/data quality/respondent incentives/nonrandom missing data ER - TY - JOUR T1 - Expectancies and Ownership of Long-Term Care Insurance Policies Among Older Married Couples JF - Journal of Applied Gerontology Y1 - 2011 A1 - Francis G. Caro A1 - Frank Porell A1 - Kwan, Ngai KW - Adult children KW - Demographics KW - Expectations KW - Healthcare KW - Insurance AB - The study was concerned with perceived risk of need for long-term care (LTC) as a factor in decisions among older married couples to purchase or retain LTC insurance policies. The study examined the relationship between expectancies of moving to a nursing home and ownership of private LTC insurance policies among married couples in which both partners were at least aged 65. Data from the 2002 and 2004 Health and Retirement Study were analyzed. Higher subjective probabilities of moving to a nursing home within the next 5 years among both primary respondents and spouses were positively associated with the primary respondent's possession of private LTC insurance. The findings add to evidence that among married older people decisions to purchase and retain LTC insurance policies are made jointly. For public education efforts to encourage planning to address LTC financing, the results underscore the importance of attention to the joint concerns of married couples. PUBLICATION ABSTRACT PB - 30 VL - 30 IS - 5 U4 - Insurance policies/Insurance policies/Older people/Couples/Nursing homes/Life expectancy ER - TY - THES T1 - The gender gap in depressive symptoms among elders in the United States and Japan: Social support, coresidence and somatic health as mediating factors Y1 - 2011 A1 - Andrew D. Tiedt KW - Cross-National KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Cross-national research on gender and aging has discussed a persistent gender gap in depressive symptoms among elders, indicating that women report more frequent symptoms than men. In light of recent attention given to both depression and elder care issues in a global context, this dissertation examined the prevalence of depressive symptoms among elder men and women in the United States and Japan. Both nations are facing complications related to aging populations and have similar economic foundations, educational systems and representative governments. Yet the cultural underpinnings of household arrangements and family support obligations are distinct. The analyses used two waves of the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) and the Health and Retirement Study (HRS) to analyze the conditions resulting in the expression of depressive symptoms. One prominent cultural difference between nations is the persistence of intergenerational coresidence among elders and younger generations in Japan, despite more recent shifts in preference towards independent living. This dissertation posited that changing attitudes concerning filial obligations would result in more frequent depressive symptoms among Japanese women due to increased instances of conflict between coresiding elder women and daughters-in-law. Next, the dissertation posited reductions in the gender gap in depressive symptoms over time due to elder men transitioning to retirement, widowhood and disability. The analyses revealed that household relationships were more prominent as predictors of depressive symptoms in Japan than the United States. This was attributed to the persistence of filial piety. There was also evidence of the increased importance of gender in terms of late life transitions such as marital dissolution in Japan, while there was less variation in the correlates of depressive symptoms by gender in the United States. Coresidence proved to be both a buffer and aggravator of depressive symptoms among Japanese women, while coresidence was likely to buffer male mental health in either nation. However, there was evidence that living with children and receiving instrumental support exacerbated depressive symptoms among American men. These findings suggest the importance of within-gender as well as between-gender analytical approaches in order to interpret the role of culture in influencing contemporary family support relationships. PB - Fordham University CY - New York, NY VL - Ph.D. UR - https://research.library.fordham.edu/dissertations/AAI3474150/ U4 - NUJLSOA JO - The gender gap in depressive symptoms among elders in the United States and Japan: Social support, coresidence and somatic health as mediating factors ER - TY - THES T1 - The Impact of Family and Non-Family Roles on Caregiver Health Over Time T2 - Family Social Science Y1 - 2011 A1 - Matzek, A. KW - Adult children KW - Event History/Life Cycle KW - Healthcare KW - Methodology KW - Other AB - Using stress process and life course theory, this dissertation investigated pathways of adult child caregivers' family (caregiving, marital, parenting) and non-family (employment) roles and their relation to caregiver psychological and physical health over time. Eight waves of data (1992-2006) from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong substantive and statistical evidence for a 4-class model of caregivers' role pathways. The four pathways were (a) Married, Working Caregivers (22.5%), (b) Married, Retired Caregivers with Co-Residing Child (12.5%), (c) Married, Retired Caregivers (30.5%), and (d) Not Married, Retired Caregivers (34.6%). Married, Working Caregivers , who were more likely to be male, White, and younger than most other pathways, had more optimal psychological and subjective physical health, but were more likely to have high blood pressure compared to caregivers in other pathways. Results suggest that (a) adult child caregivers have distinct family and non-family role pathways, (b) caregivers' gender, race/ethnicity, and age predict pathway membership, and (c) caregivers' role pathways are connected to psychological and physical health over time. Future research should explore how adult child caregivers' role pathways structurally differ for male versus female and younger versus older caregivers to further explain the heterogeneity of adult child caregivers' role pathways. Family practitioners may be helpful in identifying practices and policies that help adult child caregivers manage their diverse range of long-term family and non-family roles. JF - Family Social Science PB - University of Minnesota CY - Minneapolis, MN VL - Ph.D. UR - https://hdl.handle.net/11299/109832 U4 - adult children ER - TY - THES T1 - Individual and Additive Effects of Lifestyle Behaviors on Cognition: A Longitudinal Study Y1 - 2011 A1 - Eisenstein, A. KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Decreasing the incidence and prevalence of dementia is a national priority. An intervention with the potential to delay the average age of onset of Alzheimer's disease by just one year would greatly reduce the personal and societal costs associated with the disease. The series of proposed studies for this analysis will determine the extent to which a set of modifiable lifestyle behaviors that include physical, social, and cognitive activity, smoking, and alcohol consumption, are associated with multiple measures of cognition. The overall strategy is to examine the individual, interactive, and combined effects of these behaviors on a variety of cognitive outcome measures at 1-year and 7-years post-baseline, using multiple datasets derived from the health and retirement study. The datasets were derived from a sample of N=2037 respondents who completed surveys in 2000, 2001, 2002, and 2008. Demographic and other health status measures will be controlled for. Findings revealed that demographic characteristics had the most consistent association with cognition across outcome measures and across years. Total mental status score was the most sensitive outcome measure of bivariate relations in both the 1-year and 7-year analyses. Lifestyle behaviors at baseline had more significant associations with cognitive scores in the 7-year than the 1-year analyses. Of all the behaviors analyzed, cognitive activity had a significant association with more cognitive outcomes and in more models than any other behavior, followed by alcohol consumption. When controlling for other behaviors, cognitive activity continued to stand out above the others as being a significant predictor of cognitive outcomes. These findings begin to clarify the associations between behavioral risk factors and subsequent cognitive performance among older adults. The findings suggest that a lifestyle including cognitive activity and moderate alcohol consumption, more than any other behavior or a combination of behaviors, may result in promoting cognitive health for both the short-term and long-term. This work highlights the differing conclusions that can be drawn based on the outcome measure use, the time between measurement of predictors and outcomes, and the extent of covariates accounted for. PB - University of Illinois at Chicago, Health Sciences Center CY - Chicago, IL VL - Ph.D. U4 - Cognition JO - Individual and Additive Effects of Lifestyle Behaviors on Cognition: A Longitudinal Study ER - TY - CHAP T1 - Links Between Biomarkers and Mortality T2 - International Handbook of Adult Mortality Y1 - 2011 A1 - Eileen M. Crimmins A1 - Vasunilashorn, Sarinnapha ED - Rebecca G Rogers ED - Eileen M. Crimmins KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - A biomarker is an objectively measured indicator of a physiological state. Biomarkers include indicators of genotype, normal biological processes, pathogenic processes, and pharmacologic responses to a therapeutic intervention (Biomarkers Definitions Working Group 2001; National Heart Lung and Blood Institute 2007). Biomarkers can serve as objective indicators of health status within a sample, indicators of health change over time, and, with comparable measurement, indicators of differences across populations. They signal disease status, early physiological dysregulation preceding disease, or change in organ reserve or functioning. And they can clarify how the social, psychological, and behavioral factors traditionally examined in social science research get under the skin to influence biology and subsequent health outcomes (Crimmins and Seeman 2001, 2004; Crimmins et al. 2008a; Seeman and Crimmins 2001). JF - International Handbook of Adult Mortality PB - Springer VL - 2 SN - 978-90-481-9995-2 N1 - Times Cited: 2 U4 - biomarkers/health Status/population Dynamics/therapeutic intervention/MORBIDITY JO - Links Between Biomarkers and Mortality ER - TY - THES T1 - Modeling social participation as predictive of life satisfaction and social connectedness: Scale or index? Y1 - 2011 A1 - Zelenka, Anne T. KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - Social participation in late adulthood through activities such as volunteering with charities, playing sports, and joining clubs can increase life satisfaction, directly by providing enjoyable engagement and indirectly by increasing a person's sense of social connectedness. When reported levels of different types of activities are used to measure social participation, conventional measure development procedures based on classical test theory lead to a proliferation of small participation subscales that don't show good reliability, don't have theoretical power, and don't match researchers' conceptions of the dimensions of participation. Based on the poor performance of conventional approaches, some researchers have suggested that social participation should be modeled as an index composed of its indicators rather than as a scale in which indicators reflect an underlying latent factor. Typical approaches in psychosocial research rely on reflective-indicator models, which correspond to scale development, rather than incorporating composite variables with causal indicators. The latter approach, where manifest indicators are specified as causing the unobserved construct, is sometimes known as formative measurement , since the construct of interest is formed by its indicators. This study compared a scale model of social participation based on reflective measurement to an index model based on formative measurement. Using a sample representative of community-dwelling U.S. adults over age 65 from the Health and Retirement Study's 2008 wave of data collection, two alternative measurement models of participation were constructed using sixteen items that recorded frequency of participation in different activities. Because patterns of participation differed for males and females, gender-specific models were developed. The scale models assigned participation items to subscales based on item intercorrelations. The index model assigned items to participation composites based on predictive associations with the outcomes of social connectedness and life satisfaction. The index construction process led to a unidimensional representation of participation, composed of six of the original sixteen participation activity items. The initial attempts to build a scale model led to structures with many small factors and poor predictive validity. Based on the findings of unidimensionality for the index model, a single-factor scale model was explored for female respondents only. Results showed that both index and scale approaches have the potential to produce participation models that are parsimonious, well-fitting, and externally valid even though conventional scale development rules-of-thumb and current conceptions of the domains of participation lead the researcher to non-parsimonious, poorly-fitting solutions lacking predictive capability. Participation measurement instrument developers often theorize the existence of three or more dimensions of participation. Whether they use conventional (reflective indicator) or more radical (formative indicator) models, they are advised, based on this study's results, to evaluate a single-dimensional structure among their candidate models. PB - University of Denver CY - Denver, CO VL - Ph.D. UR - https://digitalcommons.du.edu/cgi/viewcontent.cgi?article=1728&context=etd U4 - life satisfaction ER - TY - JOUR T1 - Nursing Home Stays and the Pace of Severe Disability Onset JF - Research on Aging Y1 - 2011 A1 - Kenzie Latham KW - Disabilities KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Severe disability is an important predictor of nursing home admissions. The purpose of this study is to examine the role of severe disability pacing on risk of short- and long-term nursing home stays. Respondents who developed severe disability were assigned into one of two pacing trajectories: catastrophic or progressive disability. The author analyzed seven waves of data from the Health and Retirement Study and created a series of discrete-time event history models. The analysis showed that the risk associated with severe disability and nursing home stays varied based on severe disability pacing. Progressive and catastrophic disability were associated with increased risk of short- and long-term stays; however, the risk of nursing home stays was much greater for respondents with catastrophic disability for short- and long-term stays. The findings have implications for policy and research. The author suggests that future research focus on interventions aimed at slowing the pace of severe disability. PUBLICATION ABSTRACT PB - 33 VL - 33 IS - 6 U4 - Nursing homes/Patient admissions/Patient admissions/Health care policy/Elder care/Disability/Disability/Aging ER - TY - RPRT T1 - Older Americans Act: More Should Be Done to Measure the Extent of Unmet Need for Services Y1 - 2011 A1 - United States Governmental Office KW - Healthcare KW - Public Policy AB - Question: A number of aging services such as meals and home-based care were funded through Title III of the Older Americans Act. GAO was asked to evaluate the need for such services and the extent of any unmet need. Finding: Using the NIA-funded Health and Retirement Study, GAO found that many examples of unmet needs among those not covered by low-income programs. They estimated that 21 percent of people over age 65 needed transportation assistance. In addition, they found there was not ample data with which to study and evaluate unmet need. Recommendation: DHHS should study the effectiveness of cost-sharing and develop further methods for measuring need. JF - GAO Report PB - U.S. Government Accountability Office CY - Washington, D.C. UR - https://www.gao.gov/products/GAO-11-237 U4 - Public Policy/aging services/Home Care Services/transportation ER - TY - JOUR T1 - Potential Enhancements to Data on Health Insurance, Health Services, and Medicare in the Health and Retirement Study JF - Forum for Health Economics and Policy Y1 - 2011 A1 - John Z. Ayanian A1 - Meara, Ellen A1 - J. Michael McWilliams KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology AB - As a nationally representative cohort of middle-aged and elderly adults with longitudinal data spanning nearly two decades, the Health and Retirement Study (HRS) is an important resource for researchers studying the dynamics of health insurance coverage in the United States and the relation of insurance coverage to the use of health services and to health outcomes. We assessed the strengths and limitations of currently available HRS data for such research, focusing on survey items in these domains and Medicare claims data that have been linked to HRS survey data. The process for researchers to obtain Medicare claims has greatly improved in recent years. The additions of biomarkers (e.g. blood pressure and serum cholesterol) and objective measures of physical functioning for HRS participants have also been notable improvements. We propose changes to the HRS to enhance its value for health services research, particularly regarding the effects of health care reform as the Patient Protection and Affordable Care Act of 2010 is implemented over the next decade. PB - 14 VL - 14 IS - 3 U4 - health Insurance/health Services/Biomarker data/medicare/mid-term review/mid-term review/Methodology ER - TY - THES T1 - Psychosocial determinants of diabetic control and satisfaction with diabetes care Y1 - 2011 A1 - Dzivakwe, V. KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Women and Minorities AB - Diabetes mellitus affects 7.8% of the American population. National health statistic data and other research shows that racial/ethnic disparities exist in terms of prevalence and treatment outcomes. The present study investigated the role of patient health beliefs (i.e., locus of control, self-efficacy) and the doctor-patient relationship (e.g., satisfaction and collaboration with health care provider), as relative predictors of diabetic control (i.e., HbA1c levels) and overall satisfaction with diabetes care, in older adult participants with diabetes. Demographic, psychosocial, and diabetes-related data from the Health and Retirement Study (HRS) 2003 Diabetes Study were analyzed to compare treatment outcomes among non-Hispanic White, non-Hispanic Black, and Hispanic individuals with various types of diabetes. Non-Hispanic White individuals exhibited better diabetic control than their minority counterparts ( F (2, 592) = 7.60, p < .001); however, no significant group differences were noted in terms of psychosocial factors. Diabetic control was best predicted by time since diagnosis (² = -.21, p < .001), satisfaction with diabetes self-care (² = .19, p < .001) and age (² = .12, p < .01). In addition, satisfaction with provider care was best predicted by perceived collaboration with provider (² = .44, p < .001), satisfaction with diabetes self-care (² = .22, p < .001) and diabetes self-efficacy (² = .08, p < .05). Recommendations for future research were discussed. PB - University of North Texas CY - Denton, TX VL - M.S. U4 - health Care JO - Psychosocial determinants of diabetic control and satisfaction with diabetes care ER - TY - THES T1 - The roles of self and society in the relationship between physical health, self-perception of aging, and depressive symptoms in later life Y1 - 2011 A1 - Jina Han KW - Health Conditions and Status KW - Healthcare AB - Possibilities for increased morbidity in physical health in later life have been continuously discussed as important factors that can affect psychological well-being of older people. In addition, perceived emotional support has been widely examined as a protective source against depressive symptoms in later life. However, potential roles of self-perception of aging (one's own age stereotypes) that might be related to physical health, perceived emotional support, and depressive symptoms have been rarely studied. Furthermore, although there has been considerable interest in examining influence of self-perception of aging on physical and cognitive functioning of older individuals, the influence of self-perception of aging on mental health has not been widely studied. Since cognition can influence behavior and emotion, self-perception of aging can be an important cognitive predisposition of depressive symptoms of older individuals. Stereotype embodiment theory and the buffer theory of social support have suggested that age stereotypes and perceived emotional support can affect the construction of self-perception of aging in later life. However, little research has explored in an integrated manner about how self-perception of aging is related to both a discouraging societal impact on the self as constructing age schema and a protective role of the self through perceived emotional support in the aging process. In order to address the gaps in the literature, the current study aimed to achieve three goals: (1) to examine the mediating effect of self-perception of aging between physical health and depressive symptoms; (2) to test the moderating effect of age schema on the relationship between physical health and self-perception of aging; and (3) to estimate the moderating effect of perceived emotional support on the relationship between physical health and self-perception of aging. Physical health status was hypothesized to have an impact on depressive symptoms and to be mediated through self-perception of aging. Older individuals having age schema were expected to have more negative self-perception of aging than those without age schema under similar physical health conditions. Also, perceived emotional support was expected to moderate the relationship between physical health status and self-perception of aging. The study used a sample of 1240 community-dwelling older individuals aged 50 and over who participated in the leave-behind surveys from the 2004 and 2008 surveys of the Health and Retirement Study. Data were analyzed using Structural Equation Modeling. The results provided strong evidence for the mediating effect of self-perception of aging in the relationship between physical health and depressive symptoms. To a lesser extent, the moderating effect of age schema was supported; older individuals who had age schema were more likely to report negative self-perception of aging four years later than older individuals without age schema under the same physical health conditions. Although there was a significant main effect of perceived emotional support on self-perception of aging, no evidence was found for the interaction effect of perceived emotional support with physical health in predicting self-perception of aging. Study limitations and implications for future research and practice were discussed. PB - The Ohio State University CY - Columbus, OH VL - Ph.D. UR - http://rave.ohiolink.edu/etdc/view?acc_num=osu1306851809 U4 - Depression ER - TY - THES T1 - Successful Aging and Obesity: Social and Developmental Heterogeneity in Trajectories of Body Weight from Middle to Older Ages Y1 - 2011 A1 - Anda Botoseneanu KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Obesity is increasingly prevalent among older adults, yet little is known about the distribution of long-term trajectories of body-weight in this age group. The three essays included in this dissertation aim to depict the trajectories of body-mass index (BMI) from middle to old age and to examine social and behavioral variations in these trajectories. Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative cohort of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using alternatively hierarchical linear modeling or semiparametric mixture modeling, with adjustment for time-constant and time-varying covariates. First study finds that over 14 years, respondents followed a linearly increasing BMI trajectory. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Older age-at-baseline predicted lower BMI levels and lower rates of increase. No gender differences were found. The second study shows that smoking and vigorous physical activity (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and physical activity resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased during the study period, while the strength of association between BMI trajectories and PA or alcohol use were constant. In the third study, five distinct BMI trajectories are identified, differing primarily in their intercept: normal BMI trajectory (19.9% of sample), overweight (43.8%), borderline-obese (25.4%), obese (8.9%), and morbidly-obese (2.1%). Each trajectory showed an upward trend over the study period, although the rate-ofincrease varied between trajectories. Compared with Whites, Blacks and Hispanics had greater probabilities of membership in the higher BMI trajectory groups. Females had approximately half the risk of following the overweight and obese BMI trajectories compared with males. In conclusion, significant racial/ethnic, gender and educational heterogeneity in BMI trajectories exists in older adults. Health behaviors provide beneficial modifications in BMI trajectories. Tailoring of public health and clinical interventions to trajectory group characteristics may reduce obesity-related health disparities in aging. PB - University of Michigan CY - Ann Arbor, MI VL - Ph.D. UR - http://hdl.handle.net/2027.42/86419 U4 - Physical Activity ER - TY - NEWS T1 - Toll of Caring for Elderly Increases T2 - Wall Street Journal (Online) Y1 - 2011 A1 - Greene, Kelly KW - Employment and Labor Force KW - Healthcare KW - Other AB - The study "points out the importance of considering what caregiving does to your financial security," says Sandra Timmermann, director of MetLife Mature Market Institute, a research unit of MetLife Inc. that conducted the study with the National Alliance for Caregiving and New York Medical College's Center for Long-Term-Care Research and Policy. [The MetLife study is based on data from the Health and Retirement Study for 1112 people over the age of 50 with at least one living parent.] JF - Wall Street Journal (Online) CY - New York, N.Y SN - 1538-6732 UR - http://online.wsj.com/article/SB10001424052702304665904576383483508416152.html U4 - Caregivers/Wages/salaries/Family leave/Alliances JO - Toll of Caring for Elderly Increases ER - TY - JOUR T1 - Trajectories of alcohol consumption among the elderly widowed population: A semi-parametric, group-based modeling approach JF - Advances in Life Course Research Y1 - 2011 A1 - Hui-Peng Liew KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - Even though research on the use, misuse, and abuse of alcohol among the elderly has burgeoned in recent decades (see reviews by Johnson, 2000 , Kirchner et al., 2007 and Patterson and Jeste, 1999 ), only a few empirical studies have explored the post-bereavement alcohol consumption trajectories among the elderly widowed population. To fill this research gap, this study aims to examine the temporal processes underlying the relationship between widowhood and subsequent drinking behaviors among the elderly widowed population and to examine the potential predictors of these trajectories. The empirical work of this study is based on longitudinal data from the 1992 to 2008 Health and Retirement Study (HRS). A semi-parametric mixture model (SPMM) is used to estimate the distinctive trajectories of post-bereavement alcohol consumption. Results reveal that the type of drinking trajectory that characterize the post-bereavement drinking behavior of an individual is largely dependent upon the characteristics of the individuals (e.g. gender), the health conditions and health behavior of deceased spouse, pre-bereavement alcohol consumption, and depression. Another important finding is that bereaved men seem to have greater difficulty overcoming the transitional burden associated with widowhood. Copyright Elsevier Ltd. PB - 16 VL - 16 N1 - Journal Article U4 - Drinking Behavior/Health Behavior/Alcohol Abuse/Widowhood/Elderly/gender/Elder Abuse/Bereavement ER - TY - THES T1 - Accessibility of the residential environment: Its influence on the depressive symptoms of older adults Y1 - 2010 A1 - Guzzardo, Mariana T. KW - Consumption and Savings KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - As people age, a supportive and accessible environment becomes more salient in the face of declining functional capacity. Whereas past research supports a relationship between residential environment and well-being, few studies have focused on the specific relationship between the accessibility of the home and mental health. The purpose of the present study is to examine the influence of barrier-free/accessible features in the home on elderly individuals' depressive symptoms, when they experience difficulty with activities of daily living. The barrier-free/accessible features that are investigated include: ramps, railings, wheelchair modifications, grab bars, shower seats and call devices. This study uses data products distributed by the RAND Corporation, based on the 2006 wave of the Health and Retirement Study. The analytic procedures are divided into three parts. In the first place, descriptive analyses were conducted, including independent sample t -tests. These analyses served the purpose of examining differences between key groups within the sample (ethnic group comparisons, and comparisons between senior housing residents and non-senior housing residents). In the second place, hierarchical multiple regression analyses were conducted to examine the features of the home as predictors of depressive symptoms, after controlling for difficulty with ADLs, and various socio-demographic variables. In the third place, the main purpose of the present study was to test the influence of the residential environment on depressive symptoms through a structural regression (SR) model, using Structural Equation Modeling. The model contains functional impairment as a mediator, while age, income, education, gender, and living arrangement function as exogenous variables. Overall, results provide support for the hypothesized model. Findings suggest that accessible dimensions of the physical environment can contribute to psychological well-being by playing a compensatory or assistive role and meeting the individuals' functional needs. PB - University of Connecticut CY - Storrs, CT VL - Doctor of Philosophy UR - https://opencommons.uconn.edu/dissertations/AAI3420196/ U4 - methodology 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 - RPRT T1 - Attrition and health in ageing studies: Evidence from ELSA and HRS Y1 - 2010 A1 - James Banks A1 - Muriel, Alistair A1 - James P Smith KW - Cross-National KW - Demographics KW - Healthcare KW - Methodology AB - In this paper we present results of an investigation into observable characteristics associated with attrition in ELSA and the HRS, with a particular focus on whether attrition is systematically related to health outcomes and socioeconomic status (SES). Investigating the links between health and SES is one of the primary goals of the ELSA and HRS, so attrition correlated with these outcomes is a critical concern. We explored some possible reasons for these differences. Survey maturity, mobility, respondent burden, interviewer quality, and differing sampling methods all fail to account for the gap. Differential respondent incentives may play some role, but the impact of respondent incentive is difficult to test. Apparently, cultural differences between the US and Europe population in agreeing to participate and remain in scientific surveys are a more likely explanation. JF - RAND Working Paper PB - RAND Corporation CY - Santa Monica, CA UR - http://www.rand.org/pubs/working_papers/2010/RAND_WR784.pdf U4 - Sample Design/Methodology/attrition/health outcomes/Socioeconomic Differences/ELSA_ ER - TY - RPRT T1 - Cognitive Ability and Retiree Health Care Expenditure Y1 - 2010 A1 - Fang, Hanming A1 - Lauren Hersch Nicholas A1 - Daniel S. Silverman KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Prior research indicates that retirees with less cognitive ability are at greater financial risk because they have lower incomes yet higher medical expenditures. Linking HRS data to administrative records, we evaluate two hypotheses about why this group spends more on health: (1) they are in worse health; (2) they receive more expensive or less effective care for the same conditions. We find that the bulk, but not all, of the cross-sectional relationship can be attributed to the poorer health of those with lower cognitive functioning. Much of this relationship appears to be driven by coincident declines in cognitive ability and health. While, in this respect, the data have important limitations, we find no evidence of substantial differences in care, conditional on observable health. PB - Ann Arbor, The University of Michigan UR - https://deepblue.lib.umich.edu/handle/2027.42/78347?show=full U4 - health outcomes/Medical Expenditures/cognitive Function/cognitive decline/socioeconomic Status ER - TY - JOUR T1 - Dentistry; Research conducted at University of Maryland has provided new information about dentistry JF - Health Insurance Law Weekly Y1 - 2010 A1 - Anonymous KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction AB - 2010 APR 18 - ( http://www.newsrx.com NewsRx.com) -- In this recent study, researchers in the United States conducted a study To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS) (see also http://www.newsrx.com/library/topics/Dentistry.html Dentistry). We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. U4 - health Insurance/dental Care/retirement status ER - TY - THES T1 - Diabetes Health and Disability Pathways: Racial/Ethnic, Socioeconomic, and Gender Disparities T2 - Sociology and Health Services Organization and Policy Y1 - 2010 A1 - Emily J Nicklett KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Other AB - This dissertation examines how race/ethnicity, socioeconomic status, and gender relate to longitudinal health outcomes among older adults with type 2 diabetes. Further, this dissertation analyzes the extent to which certain factors, such as social ties and health and illness behaviors, mediate this relationship. The outcomes examined are self-reported health status, adherence, and functional limitations. The hypotheses tested are that individuals with less social support--as well as individuals from socially disadvantaged backgrounds--will report lower health status and greater functional limitations relative to individuals from socially privileged backgrounds and relative to individuals greater amounts of social support. Longitudinal survey data is examined from the Health and Retirement Study (HRS) along with the 2003 HRS Diabetes Supplement. Further, qualitative and quantitative data were collected and analyzed from a small sample (30) of community-dwelling seniors. Multi-level modeling and mixed-method analysis is used to examine individual-level patterns of change. Throughout this series of analyses, race/ethnicity, socioeconomic status, and gender were independent predictors of subsequent health and disability outcomes. However, additional characteristics, such as social support and health characteristics, are important mediators of this relationship. As discussed in the second chapter, diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health. As discussed in the fourth chapter, however, different forms of social support interact strongly with health behaviors to prevent functional decline As diabetes and other chronic illnesses are increasingly recognized as social and public health priorities, it will become more critical to identify proximal and distal mechanisms by which chronic illness trajectories differ. No previous studies have adequately addressed this aim as proposed in this research. The identification of divergent pathways (and in particular, the relationship to mechanisms that can be altered in interventions) over the life course can enable more effective and efficient prevention practices and interventions. JF - Sociology and Health Services Organization and Policy PB - University of Michigan CY - Ann Arbor VL - Ph.D. UR - http://proquest.umi.com/pqdweb?index=0&did=2259687861&SrchMode=1&sid=1&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1298895294&clientId=17822 U4 - Gender disparities JO - Diabetes Health and Disability Pathways: Racial/Ethnic, Socioeconomic, and Gender Disparities ER - TY - THES T1 - Discrimination and health: A longitudinal study T2 - Sociology Y1 - 2010 A1 - Jun Xu KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Healthcare KW - Net Worth and Assets AB - This study examines several questions about discrimination using a longitudinal survey from the 2006 and 2008 waves of the Health and Retirement Study (HRS). Results show that whites are least likely to experience discrimination as we expected. In addition, the data provides support for the hypothesis that people with higher total household assets and higher household total number of members are less likely to experience discrimination. However, contrary to my hypothesis, females have smaller odds of experiencing discrimination compared to males. People with higher education levels are more likely to report major discrimination events compared to those with lower education levels. There is a negative relationship between everyday discrimination and individuals' change in health, but the relationship between major discrimination events and individuals' change in health is not significant. Therefore, the hypothesis that perceived discrimination is linked to adverse change in health is partially supported. Moreover, the buffering effect of social support in the relationship between perceived discrimination and change in health is not supported, and the hypothesis that detrimental effect of discrimination is stronger to men than women is partially supported. JF - Sociology PB - Clemson University VL - M.S. UR - https://tigerprints.clemson.edu/all_theses/933/ U4 - Wealth JO - Discrimination and health: A longitudinal study ER - TY - RPRT T1 - Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence Y1 - 2010 A1 - Fang, Hanming A1 - Alessandro Gavazza KW - Consumption and Savings KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Other AB - We investigate the effects of the institutional settings of the U.S. health care system on individuals' life-cycle medical expenditures. We argue that health is a form of human capital that affects labor productivity, and that the employment-based health insurance system may lead to inefficient investment in individuals' health care. The reason is that labor turnover and frictions in the labor market prevent an employer-employee pair from capturing the entire surplus from investment in an employee's health. Thus, the pair underinvests in health capital, and this underinvestment increases medical expenditures during retirement. We provide extensive empirical evidence consistent with the comparative statics predictions of our model using two datasets, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). The magnitude of our estimates suggests a significant degree of inefficiency in health investment in the U.S. PB - Duke University N1 - Duke University, Department of Economics, Working Papers: 10-01 U4 - Expectations/Intertemporal Consumer Choice, Life/Life Cycle Models and Saving/Health Production/Health,/Health Expenditure, Turnover, Health Care, Health Insurance, Labor/Productivity ER - TY - CHAP T1 - Education and the Prevalence of Pain T2 - Research Findings in the Economics of Aging Y1 - 2010 A1 - Atlas, Steven J. A1 - Jonathan S Skinner ED - David A Wise KW - Demographics KW - Disabilities KW - Healthcare AB - Many Americans report chronic and disabling pain, even in the absence of identifiable clinical disorders. We first examine the prevalence of pain in the older U.S. population using the Health and Retirement Study (HRS). Among 50-59 year females, for example, pain rates ranged from 26 percent for college graduates to 55 percent for those without a high school degree. Occupation, industry, and marital status attenuated but did not erase these educational gradients. Second, we used a study of patients with lower back pain and sciatica arising from intervertebral disk herniation (IDH). Initially, nearly all patients reported considerable pain and discomfort, with a sizeable fraction undergoing surgery for their IDH. However, baseline severity measures and surgical or medical treatment explained little of the variation in 10-year outcomes. By contrast, education exerted a strong impact on changes over time in pain: just 9 percent of college graduates report leg or back pain always or almost always after 10 years, compared to 34 percent for people without a high school degree. This close association of education with pain is consistent with recent research emphasizing the importance of neurological -- and perhaps economic -- factors in the perception of pain. JF - Research Findings in the Economics of Aging T3 - National Bureau of Economic Research conference report PB - University of Chicago Press CY - Chicago U4 - EDUCATION/DISABILITY/DISABILITY/lower back pain/socioeconomic Status JO - Education and the Prevalence of Pain ER - TY - RPRT T1 - The Effect of the Risk of Out-of-Pocket Spending for Health Care on Economic Preparation for Retirement Y1 - 2010 A1 - Michael D Hurd A1 - Susann Rohwedder KW - Demographics KW - Healthcare KW - Retirement Planning and Satisfaction AB - After retirement, the primary sources of uncertainty with respect to an individual s economic status are longevity, investment outcomes and out-of-pocket spending on health care. In previous work, we estimated economic preparation for retirement, taking into account the risk of living to an advanced old age and the concomitant risk of running out of resources. But while we accounted for the average level out-of-pocket spending for health care, we did not account for the risk of out-of-pocket spending. In this paper we augment our model for this omission. We find that the risk of out-of-pocket health care spending reduces economic preparation for retirement from about 72 of persons in the age range 65-69 to about 63 . However, this relatively modest reduction is quite unequally distributed: about 57 of single persons are adequately prepared when health care spending is not stochastic, but just 44 when it is. Among single women who are not high school graduates the percentage adequately prepared declines from 33 to 15 . PB - The University of Michigan, Michigan Retirement Research Center UR - http://ideas.repec.org/p/mrr/papers/wp232.html U4 - retirement planning/Socioeconomic Status/Out of pocket costs/health care spending ER - TY - THES T1 - The effects of disability on employment patterns among older workers Y1 - 2010 A1 - Hwang, Ju Hee KW - Disabilities KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - Given the substantial number of individuals with disabilities and the sheer rapid growth of U.S. aging population, research on labor transition among older people with disability is vital for improving quality of life for society in general, as well as people with disabilities. Nonetheless, there has been a lack of research on labor transition and older individuals with disabilities in the literature. To reduce and further eliminate labor transition among older people with disabilities, as well as to provide effective interventions and policies for eliminating, it is imperative to investigate the existence of labor transition of older workers and elucidate mechanisms in which labor transition occur. The purpose of this study was to investigate the prevalence of late onset disability among older workers, the consequences for their acquired disability on employment patterns, and the determining factors affecting later-life employment transitions. Given a lack of research employing a national data set for employment and older workers with disabilities, this study examined older people aged 50 and over and used the object measures for define a disability. This study was tested chi-square, ANOVA test, binary and multinomial logistic regression. As an ex post facto design, this study employed the Health and Retirement Study data. Of the total 10,890 age-eligible (age over 50) full time workers who reported thoroughly free of disability (healthy) at the time of baseline interview, the final sampling consisted of 1,096 older workers reported functional or mental disability two years later. 506 male (46.2%) and 590 female (53.8%) reported that they are experiencing disabilities. It is about 10.1% prevalence of an acquired disability among full time older workers. Surprisingly, the prevalence of mental disability was 7.3% and the prevalence of functional disability was 2.7% among older labor force participation. Findings for descriptive results show that about 62.4% workers still kept their full time job even though older workers experienced some types of disabilities. Older workers at older ages were much more likely to change their job to a par-time or quit their job than younger workers. Older workers with mental disability consistently have a better chance of being employed and sustaining their full time job than older workers with functional disability. The findings also confirm that older workers with high levels of education, those who are white, those are female and those in white collar occupations seem to more likely continue their full time job Chi-square tests, independent t-test, and ANOVA found that significant differences existed in age, the level of education, type of disability, self employed status, current occupation, industry, and financial factors (earnings, household net assets, and Social Security Retirement Income) between older individuals who kept their job and who quit their full time job. The binary logistic regression and multinomial logistic results support that gender, high level of education, mental disability, self employed status, white collar occupation and white collar related industry, and not depending on social security retirement pension were independently associated with employed older workers. Implications for rehabilitation counselor practice, education and future research are discussed. PB - Michigan State University CY - East Lansing, Michigan VL - Ph.D. N1 - ISBN: 9781124338187 U4 - Vocational education JO - The effects of disability on employment patterns among older workers ER - TY - JOUR T1 - Effects of Immigration and Age on Health of Older People in the United States JF - Journal of Applied Gerontology Y1 - 2010 A1 - Chizuko Wakabayashi KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Following cumulative advantage/disadvantage theory and drawing longitudinal data from the 1996, 1998, 2000, 2002, 2004, and 2006 Health and Retirement Studies, this article examined the relationship between immigration experience and health transitions in late life among non-Hispanic White, non-Hispanic Black, and Mexicans in the United States. The results revealed that the timing of migration in the life course helped determine the ways in which individual health transitions would be associated with their aging process, and the pathways would be complex and vary based on the health outcomes and gender of the immigrants. For example, among women, the later-life immigrants would face most disadvantageous health trajectories as they aged with respect to activities of daily living limitations. The results suggested that the timing of U.S. immigration would affect the degree to which immigrants could take advantage of economic opportunities to accumulate financial resources that would benefit health later in life. PB - 29 VL - 29 IS - 6 U4 - Health decline/aging/immigrant/socioeconomic status/cumulative disadvantage ER - TY - THES T1 - Essays on race/ethnic variations in the dynamics of chronic diseases among middle and old aged Americans Y1 - 2010 A1 - A. R. Quinones KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Women and Minorities AB - This dissertation is composed of three empirical papers on ethnic disparities in chronic disease morbidity. The first paper analyzes intra- and interpersonal differences in comorbidity burden reported by white, black and Mexican Americans. Data come from Health and Retirement Study (HRS) participants aged 51 and over from 1995-2006. Hierarchical linear models are employed to analyze ethnic variations in temporal changes of reported comorbidities. On average, participants have nearly two chronic diseases at the baseline, which increased to almost three conditions over 11 years. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to whites. In contrast, blacks show an elevated level of comorbidity, although their rate of change decelerated over time relative to whites. The second paper examines ethnic variations in the onset of hypertension diagnosis for white, black and Mexican Americans age 51 and over. Data came from HRS respondents who report being hypertension-free at the baseline for up to five time intervals (1995-2006). Discrete-time survival models are used to analyze ethnic variations in the probability of developing hypertension. We find the risk of newly diagnosed hypertension increased for all participants. Relative to white and Mexican Americans, black Americans had an elevated risk of incident hypertension throughout the 11-year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics were adjusted. The third paper examines the onset of diabetes mellitus diagnosis for HRS participants 51 and over who report being free of diabetes at the baseline. Discrete-time survival models are used to analyze ethnic variations in the probability of developing diabetes in up to five time intervals (1995-2006). We find the risk of newly diagnosed diabetes increased for all study participants. Relative to white and black Americans, Mexican Americans have a significantly elevated risk of diabetes. Increases in diabetes incidence for Mexican Americans persist through adjustment of health behaviors, socioeconomic status, demographic characteristics and changing health status. In contrast, increases in incident risk for black Americans relative to white Americans operate largely through changes in time-varying health status. Our findings of continued racial and ethnic disparities in chronic disease burden as well as hypertension and diabetes mellitus incidence suggest there are still improvements to be made in prevention efforts aimed at middle and older aged minorities. These empirical papers highlight the importance of social and structural factors as critical policy levers for mitigating chronic disease burden as well as reducing the elevated risk of two pervasive chronic diseases for minorities in the U.S. PB - University of Michigan VL - Ph.D. UR - https://deepblue.lib.umich.edu/handle/2027.42/77913 N1 - ISBN 9781124278254 U4 - MORBIDITY JO - Essays on race/ethnic variations in the dynamics of chronic diseases among middle and old aged Americans ER - TY - THES T1 - Essays on Selection in Health Survey Data T2 - Economics Y1 - 2010 A1 - Maksym Obrizan KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Income KW - Methodology KW - Other AB - In this paper I consider the effects of sample selection in a study of stroke occurrence among Medicare-eligible Americans using the survey on Assets and HEAlth Dynamics among the Oldest Old (AHEAD). First of all, I apply the propensity score method based on the assumption of data missing at random and find no substantial effects of the sample selectivity, similar to Wolinsky et al. (2009). Then I employ a weaker assumption of incidental truncation and extend the Heckman's (1979) sample selection model to the case of a discrete outcome variable (whether a stroke occurred after the baseline). This constitutes the main methodological contribution of the current paper, with potential applications in health, labor and applied economics, where the outcome variable is discrete and selection takes place along multiple dimensions. The sample selection model with binary outcome(s) extends the multivariate probit setup in Chib and Greenberg (1998) to allow some of the responses to be missing. I also use Cholesky factorization of the variance matrix to simplify the Gibbs algorithm in Chib and Greenberg (1998). I do not find strong selection effects driven by the data in my application to the stroke equation. The main substantive contribution of the paper is that there is no evidence of selection in the AHEAD data based on either propensity score or sample selection model. Government shares in total output are characterized by significant variation across countries. In this paper I use a neoclassical growth model to show that in equilibrium government shares decline non-linearly in the price of government services relative to private consumption. I calibrate the model to the US economy and show that it generates government shares which closely match those from the Penn World Table. In addition, I provide empirical evidence showing that relative price of government consumption increases in income and that richer countries tend to have smaller governments if measured at international prices. The systematic relationships between factor productivities, output composition and economic development have not been explored in the literature. JF - Economics PB - University of Iowa CY - Iowa City, IA VL - Ph.D. UR - https://ir.uiowa.edu/etd/566/ U4 - Income ER - TY - THES T1 - Evaluating social factors in diabetes management by Mexican American ethnicity Y1 - 2010 A1 - Huerta, Serina KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Differences in Mexican American ethnicity, family and friend social support, and importance of diabetes self-management as related to diabetes management in the older adult population were evaluated with the University of Michigan Health and Retirement Study (HRS) 2003 Diabetes Study. Comparisons were made between Mexican Americans with Type II diabetes and similar non-Hispanic Caucasian and African American individuals with Type II diabetes. Neither family/friend social support nor importance of diabetes self-management were significant predictors of HbA1c levels. Results did not support the idea that perception of receiving support from family/friends or placing importance on diabetes self-management covaried with lower HbAlc level (family/friend: beta = -.13, t = -1.47, p = .143; self management: beta = .08, t = .55, p = .584). PB - University of North Texas VL - M.S. IS - AAT 1492897 N1 - ISBN 9781124582528 U4 - ethnic differences JO - Evaluating social factors in diabetes management by Mexican American ethnicity ER - TY - RPRT T1 - Gain and Loss: Marriage and Wealth Changes Over Time Y1 - 2010 A1 - Julie M Zissimopoulos KW - Adult children KW - Healthcare KW - Income KW - Net Worth and Assets AB - Family composition has changed dramatically over the past 25 years. Divorce rates increased and remarriage rates declined. While considerable research established a link between marriage and earnings, far less is empirically understood about the effect of marriage on wealth although wealth is an important measure for older individuals because it represents resources available for consumption in retirement. This research employs eight waves of panel data from the Health and Retirement Study to study the relationship between wealth changes and marital status among individuals over age 50. It advances understanding of the relationship by first, incorporating measures of current and lifetime earnings, mortality risk and other characteristics that vary by marital status into models of wealth change; second, measuring the magnitude of wealth loss and gain associated with divorce, widowing and remarriage and third, estimating wealth change before and after marital status change so the change in wealth change is not the result of individuals entering or leaving the household and other sources of unobserved differences are removed from estimates of the effect of marriage on wealth. The results suggest no differences in wealth change over time among individuals that remain married, divorced, widowed, never married and partnered over 7 years. In the short-run there are substantial wealth changes associated with marital status changes. Divorce at older ages is costly, remarriage is wealth enhancing and people appear to change their savings in response to changes in marital status. JF - RAND Working Paper PB - RAND Corporation CY - Santa Monica, CA UR - https://www.rand.org/pubs/working_papers/WR724.html U4 - household income/individual income/Wealth/Marriage/divorce/Marital Dissolution/Family Structure/Domestic Abuse ER - TY - RPRT T1 - Geographic Dispersion and the Well-being of the Elderly Y1 - 2010 A1 - Suzanne M. Bianchi A1 - Kathleen McGarry A1 - Judith A Seltzer A1 - Michigan Retirement Research Center KW - Adult children KW - Demographics KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Other AB - Perhaps the largest problem confronting our aging population is the rising cost of health care, particularly the costs borne by Medicare and Medicaid. A chief component of this expense is long-term care. Much of this care for an unmarried (mostly widowed) mother is currently provided by adult children. The provision of family care depends importantly on the geographic dispersion of family members. In this study we provide preliminary evidence on the geographic dispersion of adult children and their older unmarried mother. Coresidence is less likely for married adult children, those who are parents and the highly educated and more likely for those who are not working or only employed part time and for black and Hispanic adult children. Close proximity is more common for married children who are parents but less common for the highly educated. When we look at transitions between one wave of data collection and the next (a two-year interval), about half of adult children live more than 10 miles away at both points, a little less than one quarter live within 10 miles at both points, and 8 percent are coresident at both points in time. Among the 17 percent who make a transition, about half of the changes result in greater distance between the adult child and mother and half bring them into closer proximity. The needs of both generations are likely reflected in these transitions. In fact, a mother s health is not strongly related to most transitions and if anything, distance tends to be greater for older mothers relative to those mothers in their early 50s. JF - MRRC Working Paper PB - Michigan Retirement Research Center, University of Michigan CY - Ann Arbor, MI UR - http://hdl.handle.net/2027.42/78351 U4 - medicare/medicaid/Long Term Care/Transfers/geographic dispersion/coresidence ER - TY - RPRT T1 - Health and Access Effects of New Drugs: Combining Experimental and Non-Experimental Data Y1 - 2010 A1 - Pierre-Carl Michaud A1 - Darius Lakdawalla A1 - Dana P Goldman A1 - Sood, Neeraj A1 - Cong, Ze KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - We propose to combine clinical trial and estimates of behavioral responses in the population to quantify the value of new drug innovations when such values cannot be obtained by randomized experiments alone. New drugs are seen as having two distinct effects on patients. First, they can provide better outcomes for patients currently under treatment, due to better clinical efficacy. Second, they can also provide treatment access to more patients, perhaps by reducing side effects or expanding treatment. We compare these clinical and access effects using claims data, data on the arrival rate of new drugs, and the clinical trials literature on the effectiveness of these drugs. We find that the effect of new drug introductions on the number of patients treated accounts for a substantial majority of the value created by new drugs. UR - https://depot.erudit.org/bitstream/003241dd/1/CIRPEE10-38.pdf U4 - Pharmaceutical innovation/effectiveness/cost-benefit analysis/cancer ER - TY - RPRT T1 - Health and Wealth in a Life-Cycle Model Y1 - 2010 A1 - John Karl Scholz A1 - Ananth Seshadri KW - Consumption and Savings KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets AB - This paper presents a preliminary model of health investments over the life cycle. Health affects both longevity and provides flow utility. We analyze the interplay between consumption choices and investments in health by solving each household s dynamic optimization problem to obtain predictions on health investments and consumption choices over the lifecycle. Our preliminary model does a good job of matching the distribution of medical expenses across households in the sample. We illustrate the scope of future model applications by examining the effects of a stylized Medicare program on patterns of wealth and mortality. PB - The University of Michigan, Michigan Retirement Research Center UR - https://mrdrc.isr.umich.edu/pubs/health-and-wealth-in-a-life-cycle-model/ U4 - life Cycle/consumption/health investments/Medical Expenditures/wealth/mortality ER - TY - JOUR T1 - Home equity commitment and long-term care insurance demand JF - Journal of Public Economics Y1 - 2010 A1 - Davidoff, Thomas KW - Healthcare KW - Housing AB - This paper shows how home equity may substitute for long-term care insurance (LTCI). The elderly commonly hold substantial wealth in the form of home equity that is rarely spent before death, except for after moves to long-term care facilities. Absent strong bequest motives implies that marginal utility fluctuates less across health states than one would predict based on a standard model without wealth tied up in housing. Numerical examples show that this asset commitment may substantially weaken LTCI demand. PB - 94 VL - 94 UR - http://www.sciencedirect.com/science/article/B6V76-4XBG17Y-1/2/7454bb1f43081b6bd02fe86de4c3d416 IS - 1-2 U4 - Health care markets/Housing ER - TY - RPRT T1 - How Much Is Enough? The Distribution of Lifetime Health Care Costs Y1 - 2010 A1 - Anthony Webb A1 - Natalia A. Zhivan KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction AB - Estimates of the expected present value of lifetime out-of-pocket medical costs from age 65 onward are of limited value to households managing wealth decumulation in retirement. Their risk characteristics may differ from the average. They will also care about the whole probability distribution of health cost outcomes, and will want to update that probability distribution during the course of retirement. Using Health and Retirement Study data, we simulate health, mortality, and health cost histories of retired households. We show that the life expectancy and average health costs of our simulated households closely match published life tables and the findings of previous research. Using our simulated data, assuming a 3-percent real interest rate and including Medicare and private insurance premiums, we estimate that a typical household age 65 has a 5-percent risk of the present value of its lifetime health care costs exceeding 311,000, or 570,000 including the cost of long-term care. We find that relatively little resolution of uncertainty occurs with age, even for those who remain free of chronic disease. UR - http://crr.bc.edu/images/stories/Working_Papers/wp_2010-1.pdf U4 - health insurance/health care costs/Medicare/retirement planning ER - TY - THES T1 - The impact of cumulative socioeconomic inequalities on physical functioning, self-rated health, and depression among older adults T2 - Social Work Y1 - 2010 A1 - Kim, Jinhyun KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Other KW - Women and Minorities AB - Socioeconomic inequalities have been viewed as significant contributors to health disparities. However, little is known about the impact of cumulative socioeconomic inequalities on physical functioning, self-rated health, and depression across time, especially in later life. In addition, despite a strong connection between socioeconomic inequalities and the presence of private health insurance, few studies have examined how lack of private health insurance affects individuals' health trajectories. Thus, this study focuses on the impact of socioeconomic inequalities and lack of private health insurance on physical functioning, self-rated health, and depression using longitudinal panel data from the Health and Retirement Study (HRS). The latent growth curve model was conducted in three steps: unconditional model, conditional model, and multiple group analysis. First, the unconditional growth curve model presented that individuals' physical functioning, self-rated health, and depression tend to worsen as people age. However, significant variability in the initial level of health outcomes and their rate of change among individuals were found. Second, the conditional growth curve model was conducted to test potential covariate effects on this variability. Results from the conditional model showed that higher level of income and assets significantly predicted better physical functioning and self-rated health but less depressive symptoms. In particular, increases in income or assets significantly predicted slower worsening in physical functioning, self-rated health, and depression. However, iii higher level of education was a significant predictor for better self-rated health and less depression at baseline but not for physical functioning. In addition, having private health insurance significantly predicted better physical functioning, self-rated health, and less depressive symptoms at baseline. In particular, decline in physical functioning was slower among those who have private health insurance over time. Third, the multiple group analysis was conducted to examine potential moderating effects of gender and race on health trajectories. Results from the multiple group analysis showed that economic status had greater impact on females' declines in physical functioning, self-rated health, and depression than on males'. Despite lower initial level of physical functioning and self-rated health among Blacks than among Whites, they were less likely to suffer rapid declines in physical functioning and self-rated health after controlling for socioeconomic status. These results indicated that Blacks might have resilience factors such as religious activities and social support networks buffer health declines. Specific implications for social policy, practice, and research are discussed. JF - Social Work PB - The Ohio State University VL - Ph.D. N1 - ISBN 9781124254692 U4 - SELF-RATED HEALTH JO - The impact of cumulative socioeconomic inequalities on physical functioning, self-rated health, and depression among older adults 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 - THES T1 - The Influence of Individual Characteristics and Cohort Membership on Preventive Service Use in the Near Elderly Y1 - 2010 A1 - Petigara, Tanaz Kavas KW - Health Conditions and Status KW - Healthcare KW - Other AB - Despite the known benefits of preventive care in reducing morbidity and mortality, many Americans do not receive preventive services. Among the near elderly (50-64 years), the use of preventive services remains below recommended levels. Using the Health and Retirement Study, this dissertation examined the influence of individual characteristics and cohort membership on preventive service use in the near elderly through three separate analyses. The first examined differences in preventive service use between two near elderly birth cohorts. The second examined characteristics associated with different influenza vaccination patterns--no vaccination versus receiving at least one vaccination; and intermittent compared to regular vaccination. The third compared characteristics associated with receiving intermittent or regular mammograms in near elderly women. Results show that improvements in education, income, and access to medical care in the later birth cohort led to increases in their use of preventive services. Other factors such as increases in obesity could adversely affect the preventive service use in future near elderly cohorts. In addition, the characteristics associated with the use of preventive care differ by type of service. There were some differences in the factors associated with the two vaccination patterns. Predisposing characteristics--age, gender, race, marital status, and education were significant predictors of receiving at least one vaccination. However, only race and education were associated with regular vaccination. Insurance, chronic conditions, and physician visits were associated with both vaccination patterns. In comparison, enabling but not predisposing characteristics--insurance, income, and physician visits, were significant predictors of regular mammography. Obese women and those in poor health were also less likely to receive regular mammograms. The health of the near elderly and their use of medical care are increasingly important to policymakers because of their impact on Medicare. Several proposals have been developed to allow the uninsured near elderly to buy-in to Medicare. However, this dissertation shows that in addition to health insurance, other characteristics such as cohort membership also influence preventive service use among near elderly individuals. It may also be useful for policymakers to consider that the characteristics associated with preventive service use differ by type of service. PB - The Johns Hopkins University CY - United States, Maryland U4 - COHORT JO - The Influence of Individual Characteristics and Cohort Membership on Preventive Service Use in the Near Elderly ER - TY - RPRT T1 - Informal Care and Formal Home Care Use in Europe and the United States Y1 - 2010 A1 - Holly, Alberto A1 - Lufkin, Thomas A1 - Edward C Norton A1 - Courtney Harold Van Houtven KW - Adult children KW - Cross-National KW - Healthcare KW - SHARE AB - The provision of informal care by adult children is an important form of long-term care for older individuals and can reduce the use of medical services if they are substitutes. We examine how informal care by all children and formal care interact, which is critically important given demographic trends and the many policies proposed to promote informal care. The purpose of this study is to compare the United States and European countries, by merging data from the U.S. Health and Retirement Study (HRS) with its European counterpart, the Survey of Health, Ageing and Retirement in Europe (SHARE). We argue that the institutional setting is different across the Atlantic, as European home care schemes are predominantly publicly run, whereas the market plays a bigger role in the United States. We use a fexible simultaneous equations approach that allows for a different relationship between informal and formal home care in the two regions, using couples. We find that in Europe it is predominantly the supply of formalhome care that influences decisions by children to provide informal care, while in the United States parents' decisions to use formal home care are based on the amount of informal care received and the amount of informal care provided by children is dependent on the amount of formal care. UR - ftp://cemfi-server.cemfi.es/pdf/papers/wshop/Holly_seminar.pdf U4 - Home Care Services/Informal caregiving/Informal caregiving/SHARE/Families/Transfers ER - TY - THES T1 - Investigating age group differences in depression symptoms among older adults with operational impairments Y1 - 2010 A1 - Kohnke, Kevin J. KW - Health Conditions and Status KW - Healthcare AB - Health and Retirement Study data from 2006 was used to examine whether health has a moderating effect on the relationship between age and depression. The sample consisted of 9,988 respondents in the 2006 data sample. Ages ranged from 41 to 102 with an average age of 69 and a standard deviation (SD) of 11.0 years. Gender, race/ethnicity, marital status, number of years of education, work status, and perceived health status were each analyzed by Ordinary Least Squares to determine the true population relationship between each of these factors and the depression of the participants. The majority (54%) of the sample was female; 50% were married, and 25% were widowed. Only 26% were working full-time. The large majority were Caucasian, with 16.5% being African-American. The mean level of education in years was 12.4 with an SD of 3.3 years. Health, measured by ADL and IADL was allowed to freely vary, rather than restricting its variance by selecting only those with ADL or IADL limitations. The average level of depressive symptomatology, ranging from 0 to 8, was quite low with a mean of 1.6 depressive symptoms and an SD of 2.0. This indicates the average person experienced less than 2 symptoms. DSM-IV, for example, requires 5 or more for a diagnosis of depression. Self-rated health had the largest unique effect on health ( B = - .25), indicating that as health declined, the number of depressive symptomatologies increased. ADL limitations exerted the next largest unique effect ( B = .18), indicating an increase in depressive symptoms with increasing ADL limitations. IADL limitations operated in a similar manner. As hypothesized, age was significantly related to the level of depressive symptoms with the number of symptoms growing with increasing age. With the present data it seems that age does have a significant, independent effect on depression for those suffering from at least one limitation of ADL or IADL. Only one interaction, age by IADL, had a significant unique effect on depressive symptomatology (t(1) =3.4; p<.01). The contribution of the set was trivial, explaining only .004% additional variance in depressive symptomatology. PB - The University of Nebraska - Lincoln CY - Lincoln VL - Doctor of Philosophy UR - https://digitalcommons.unl.edu/dissertations/AAI3411996 U4 - health Status ER - TY - THES T1 - Medicaid Crowd-Out of Long-Term Care Insurance with Endogenous Medicaid Enrollment Y1 - 2010 A1 - Kim, Geena KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Other KW - Public Policy AB - With states facing tightening Medicaid budgets, the high cost of financing long-term care for the elderly through Medicaid has prompted proposals to make private long-term care insurance (LTCI) more affordable through tax incentives. The effectiveness of tax incentives for stimulating LTCI demand depends in part on the availability of Medicaid, since it is considered a substitute for LTCI. This paper examines the impact of tax subsidies and Medicaid financing on the demand for LTCI by developing and estimating a stochastic dynamic model of the decision to purchase private long-term care insurance. A key contribution of this paper is that the model also incorporates and accounts for endogenous decisions on Medicaid enrollment, nursing home use, and asset holdings, which reduces the estimate of the Medicaid crowd-out effect on LTCI demand. State-specific Medicaid enrollment criteria are explicitly accounted for in modeling the Medicaid enrollment decision. The parameters of the model are estimated using individual level data from the Health and Retirement Study for the years 1998 to 2002 by simulated maximum likelihood. Using the estimated parameters, counterfactual policy experiments are performed to investigate the effects of tax policy and Medicaid on LTCI demand. The main finding is that both effects are small. The estimated price elasticity of the LTCI demand is -0.08, implying that tax subsidies are expected to have only a limited effect in reducing the number of uninsured. Eliminating the Medicaid program increases LTCI holding by only 5.3%, implying that the demand for LTCI would remain small even without Medicaid. PB - University of Pennsylvania VL - Ph.D. N1 - ISBN: 9781124318059 U4 - long Term Care JO - Medicaid Crowd-Out of Long-Term Care Insurance with Endogenous Medicaid Enrollment ER - TY - CHAP T1 - Mind the Gap! Consumer Perceptions and Choices of Medicare Part D Prescription Drug Plans T2 - Research Findings in the Economics of Aging Y1 - 2010 A1 - Florian Heiss A1 - Daniel McFadden A1 - Joachim Winter ED - David A Wise KW - End of life decisions KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Medicare Part D provides prescription drug coverage through Medicare approved plans offered by private insurance companies and HMOs. In this paper, we study the role of current prescription drug use and health risks, related expectations, and subjective factors in the demand for prescription drug insurance. To characterize rational behavior in the complex Part D environment, we develop an intertemporal optimization model of enrollment decisions. We generally find that seniors' choices respond to the incentives provided by their own health status and the market environment as predicted by the optimization model. The proportion of individuals who do not attain the optimal choice is small, but the margin for error is also small since enrollment is transparently optimal for most eligible seniors. Further, there is also evidence that seniors over-react to some salient features of the choice situation, do not take full account of the future benefit and cost consequences of their decisions, or the expected net benefits and risk properties of alternative plans. JF - Research Findings in the Economics of Aging T3 - The Economics of Aging PB - University of Chicago Press CY - Chicago SN - 0-226-90306-0 UR - https://www.nber.org/books-and-chapters/research-findings-economics-aging/mind-gap-consumer-perceptions-and-choices-medicare-part-d-prescription-drug-plans U4 - Medicare Part D/prescription drug coverage/health insurance/decision Making ER - TY - THES T1 - Older adults with visual impairments: The role of health dimensions in predicting falls T2 - Gerontology Y1 - 2010 A1 - Bernard A Steinman KW - Health Conditions and Status KW - Healthcare AB - The purpose of this dissertation was to examine relationships between self reported vision impairment, health dimensions, and falls among older people; and to describe an indirect pathway through which vision loss may increase risk for falls by way of poor health outcomes in dimensions of health that are believed to lead to disability. Whereas previous research has tended to focus on direct effects of vision loss on fall risk, the primary goal of this research was to examine integrated effects between systems that might lead to increased fall risk via moderated or mediated relationships. First, in order to establish health disparities by self reported vision status, binary and multinomial logistic regression models were performed using data from the National Health and Nutrition Examination Survey, 1999-2008 (N=6,693) to estimate the probability of negative health outcomes across four dimensions of health, including biological risk, pathological conditions, functional difficulties and disability in daily living activities, by vision status. Results suggest that older adults with poor vision have greater likelihood of experiencing negative health outcomes across the four dimensions. Next, two waves (2004 & 2006) from the Health and Retirement Study (HRS) (N=8,449) were analyzed using binary logistic regression to investigate whether a moderating relationship exists between vision status and upper and lower limb functioning. This relationship was hypothesized to derive, in part, from decreased physical activity that often follows vision loss in late life, to result in poorer functional ability. Little evidence was found for a moderating effect of self-reported vision status on musculoskeletal health and functioning; however, results suggest that declines and/or gains in functioning across short periods of time may supercede self-reported vision as a predictor of falls. Thus, poor self-reported vision status may not be as good an indicator of fall risk in older adults as might otherwise be assumed. In a third study, two waves (2006 & 2008) from HRS (N = 9,143) were used to test whether functional difficulties and disability with daily living activities mediate self-reported vision loss to increase fall risk among older adults. Binary logistic and Poisson regression analyses were conducted to test indirect paths leading from self-reported vision to falls, through declines in indices of functioning and disability. No evidence was found for a mediating effect among women; however, for men, large muscle groups were implicated as partially mediating risk factors for falls among participants with poor vision. Finally, implications of the three studies are discussed, including the need for prioritizing improved muscle strength of older persons with vision impairments as preventive measure against falls. It is acknowledged that the most effective fall prevention interventions are likely multifactorial in structure; therefore, interventions pertaining to education, medical assessment, exercise, and home assessment and modification are discussed with respect to older persons who have vision impairments. JF - Gerontology PB - University of Southern California VL - Ph.D. UR - http://digitallibrary.usc.edu/assetserver/controller/view/etd-Steinman-4125 U4 - Aging JO - Older adults with visual impairments: The role of health dimensions in predicting falls ER - TY - RPRT T1 - Personality, Lifetime Earnings, and Retirement Wealth Y1 - 2010 A1 - Angela Lee Duckworth A1 - David R Weir A1 - Michigan Retirement Research Center KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Social Security AB - Studies of adolescents and young adults have shown that schooling impacts economic outcomes beyond its impact on cognitive ability. Research has also shown that the personality trait of conscientiousness predicts health outcomes, academic outcomes, and divorce. Using the Big Five taxonomy of personality traits, this study examines whether non-cognitive traits are related to economic success over the life course. Examining Health and Retirement Study survey data linked to Social Security records on over 10,000 adults age 50 and over, we investigate the relationship of personality traits to economic outcomes. Controlling for cognitive ability and background variables, do more conscientious and emotionally stable adults have higher lifetime earnings, and is this due to higher annual earnings, longer work lives, or both? Do more conscientious adults save a higher proportion of their earnings for retirement, and does conscientiousness of each partner in a married couple matter? Do conscientiousness and emotional stability interact such that the effects of conscientiousness are greater among less emotionally stable adults? PB - Michigan Retirement Research Center, University of Michigan CY - Ann Arbor, MI UR - https://ideas.repec.org/p/mrr/papers/wp235.html U4 - health outcomes/cognitive ability/economic outcomes/earnings and Benefits File 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 - RPRT T1 - The Risk of Out-of-Pocket Health Care Expenditure at End of Life Y1 - 2010 A1 - Samuel M Marshall A1 - Kathleen McGarry A1 - Jonathan S Skinner KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - There is conflicting evidence on the importance of out-of-pocket medical expenditures as a risk to financial security, particularly at older ages. We revisit this question, focusing on health care spending near the end of life using data from the Health and Retirement Study for the years 1998-2006. We address difficulties with missing values for various categories of expenditures, outliers, and variations across individuals in the length of the reporting period. Spending in the last year of life is estimated to be 11,618 on average, with the 90th percentile equal to 29,335, the 95th percentile 49,907, and the 99th equal to 94,310. These spending measures represent a substantial fraction of liquid wealth for decedents. Total out-of-pocket expenditures are strongly positively related to wealth and weakly related to income. We find evidence for a mechanism by which wealth could plausibly buy health: large expenditures on home modifications, helpers, home health care, and higher-quality nursing homes, which have been shown elsewhere to improve longevity. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - health care costs/demographics/education/wealth/Longevity ER - TY - THES T1 - Three Essays on Cancer Survivorship and Labor Supply T2 - College of Health and Human Development Y1 - 2010 A1 - Markowski, Michael P. KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction AB - These essays examine the effects of cancer on labor supply by cancer survivors in three situations: patients deciding whether to continue working during treatment, spouses deciding whether and how much to work in the years following treatment, and survivors deciding about the timing of retirement. These choices affect individual and societal welfare. Work matters to individual cancer survivors because it is a source of personal fulfillment, a measure of health and vitality, income, and employer-sponsored health insurance benefits. Work matters to society. The National Cancer Institute has estimated that cancer costs over $20 billion annually in work-loss days. Efforts to support and accommodate work by cancer survivors would reduce the indirect economic costs of cancer to society and would potentially improve the well-being of cancer survivors and their families. Although sixty percent of newly diagnosed cancer survivors decide to continue to work during treatment, little is known about the factors that are associated with that decision. Furthermore, spouses share in the cancer survivorship journey, yet the labor supply effect of cancer on spouses in working couples is unknown. With the incidence of cancer increasing with age, the labor supply decision of older cancer survivors increasingly becomes a decision about retirement. The studies use data from the Penn State Cancer Survivor Study (PSCSS) funded by the National Cancer Institute, and supplemented with data from the Health and Retirement Study (HRS), to produce estimates of the effects of cancer on work status and the usual hours of work per week for cancer survivors and spouses at difference stages of survivorship. Logistic regression methods were used to produce estimates of the effects of cancer on working or on complete retirement. Tobit models were used to estimate the effect of cancer on hours of work. The first study finds that the decision to work during treatment is mainly determined by clinical considerations, such as cancer type and stage, although job-related health insurance of survivors and spouses is associated with a greater likelihood of working through treatment. The second study finds that cancer has little long-term effect on the labor supply of the spouses of survivors, at least in older couples or where both partners were working at diagnosis, the situations that were the focus of this research. The third study finds that survivors of both genders who remain cancer-free postpone retirement compared to other adults with no cancer history, but female survivors with recurrences or new cancers retire sooner. JF - College of Health and Human Development PB - Pennsylvania State University CY - State College, PA VL - Doctor of Philosophy U4 - Health policy JO - Three Essays on Cancer Survivorship and Labor Supply ER - TY - THES T1 - Three essays on the economic decisions faced by elderly households T2 - Economics Y1 - 2010 A1 - Wei Sun KW - Healthcare KW - Methodology AB - This dissertation contains three essays. Each considers an economic decision faced by elderly households. The cost of nursing home care represents a substantial financial risk for older households. Yet, only 10 percent purchase long-term care insurance (LTCI), with many relying on Medicaid. The first essay estimates a structural model of the LTCI purchase decision using Health and Retirement Study data. Estimates indicate that this population has a modest preference for higher quality care and thus Medicaid crowds out LTCI. In addition, housing wealth provides self-insurance against the cost of nursing home care, so that individuals who are "house-rich cash-poor" are less likely to purchase LTCI. I also evaluate public policies designed to stimulate the take-up of LTCI and reduce Medicaid spending. I find that a comprehensive 20 percent subsidy would increase take-up by 160 percent, but the resulting Medicaid savings would amount to only 22 percent of the subsidy cost. A targeted subsidy would be more likely to break even, but would have only a small effect on coverage. Full enforcement of Medicaid estate recovery programs would reduce Medicaid expenditure by 31 percent, but would have insignificant effect on LTCI coverage. The second essay investigates the impact of house prices fluctuations on the non-durable goods consumption decision of older households. House prices in the United States fluctuate over time with significant regional variation. Thus, understanding how these price movements affect households' consumption has important policy implications. Existing studies focus mostly on the working population, leaving the effect of older households, who could be either the largest beneficiaries or victims of house price fluctuations, unexamined. Using Health and Retirement Study data, I show that house price fluctuations significantly affect non-durable goods consumption of older households. Estimates indicate that both the wealth effect and a relaxed borrowing constraint increase consumption when house prices appreciate. In addition, I find that only unexpected changes in house prices lead to changes in consumption of non-credit constrained households, which is consistent with economic theory predictions. Finally, I provide evidence that older households usually fund the additional consumption by increasing mortgage debt, rather than by drawing down financial assets. The third essay evaluates the value of the additional longevity insurance acquired by delaying claiming social security benefit. Individuals can claim Social Security at any age from 62 to 70, although most claim at 62 or soon thereafter. Those who delay claiming receive increases that are approximately actuarially fair. I show that expected present value calculations substantially understate both the optimal claim age and the losses resulting from early claiming because they ignore the value of the additional longevity insurance acquired as a result of delay. Using numerical optimization techniques, I illustrate that for plausible preference parameters, the optimal age for non-liquidity constrained single individuals and married men to claim benefit is between 67 and 70. I calculate that Social Security Equivalent Income, the amount by which benefits payable at suboptimal ages must be increased so that a household is indifferent between claiming at those ages and the optimal combination of ages, can be as high as 19 percent. JF - Economics PB - Boston College CY - Boston, MA VL - Doctor of Philosophy UR - http://hdl.handle.net/2345/1187 U4 - Economics ER - TY - RPRT T1 - Trigger Events and Financial Outcomes Among Older Households Y1 - 2010 A1 - Geoffrey L Wallace A1 - Haveman, Robert A1 - Karen C. Holden A1 - Barbara Wolfe KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Social Security AB - Follow a sample of social security beneficiaries drawn from the Health and Retirement Study from their first year of retirement up to 15 years into retirement, we estimate rates at which retirees are subject to family structure change, cognitive decline, health decline, and other events. Then we assess the vulnerability of wealth and wealth-based adequacy measures to adverse events, drawing conclusions about the effect of events on a wealth-based measure and a wealth-based inadequacy measure. Our findings highlight the importance of cognitive and health decline as events with the potential to shape the evolution of wealth post-retirement. JF - Center for Financial Security Working Paper PB - Center for Financial Security, University of Wisconsin-Madison CY - Madison, WI UR - https://cfs.wisc.edu/2010/09/10/trigger-events-and-financial-outcomes-among-older-households/ U4 - social Security/wealth/adverse events/adverse events/Cognitive decline/health decline/Families ER - TY - THES T1 - Understanding Quality of Life in Older Adults T2 - Psychology Y1 - 2010 A1 - Cardona, Laura A KW - Health Conditions and Status KW - Healthcare AB - I analyzed the 2004 and 2006 Health and Retirement Study data to test structural equation models of the quality of life (QOL) construct. The participants ( N =1352) were non-institutionalized individuals aged 42 and older ( M =65.70, SD =10.88), with an average education of 12.73 years ( SD =2.96) and of varied ethnicities. The results indicated that physical functioning, affective experience, life satisfaction and social support could serve as indicators for a second order QOL factor. Furthermore, the developed QOL model explained 96% of the variance of the CASP-19 (Control, Autonomy, Self-realization and Pleasure), a QOL measure that reflects fulfillment of psychological needs. The results also indicated that Depression and Life Satisfaction are related through reciprocal causation and that Physical Functioning is more likely to cause a change in Depression than the reverse. The results suggest that QOL is a complex, multidimensional concept that should be studied at different levels of analysis. JF - Psychology PB - University of North Texas CY - Denton, TX VL - M.S. UR - https://digital.library.unt.edu/ark:/67531/metadc28402/m2/1/high_res_d/thesis.pdf U4 - Clinical psychology ER - TY - THES T1 - Using Developmental Trajectories of Cognitive Performance and Cardiovascular Risk Factors for the Early Prediction of Alzheimer's Disease and Vascular Dementia in Late Adulthood T2 - Psychology Y1 - 2010 A1 - Koontz, Jennifer M. KW - Health Conditions and Status KW - Healthcare AB - The purpose of this thesis is to examine risk factors present before the diagnosis of dementia in the Aging, Demographics and Memory Study (ADAMS), a sample of 856 participants chosen from the Health and Retirement Study (HRS), a nationally representative sample of persons of retiring age and older, to take part in a clinical assessment for cognitive impairment and collection of other health information. A subset of 330 individuals from the ADAMS study diagnosed with either Alzheimer's disease (AD) or vascular dementia (VaD) was considered in the primary analyses. Risk factors examined were age, gender, years of education, APO-[varepsilon] status, and empirical Bayes estimates of latent growth curve trajectory components of longitudinal episodic memory performance, mental status and cardiovascular risk to test whether it was possible to discriminate whether a participant would be later diagnosed with either Alzheimer's disease (AD) or vascular dementia (VaD). Data from the HRS from up to a decade before diagnosis were used in logistic regression analyses to find the best fitting model of prediction into groups of either AD or VaD. Results showed that while age, gender, number of APO-[varepsilon]4alleles, episodic memory and cardiovascular risk factors were predictive of later diagnosis of AD versus VaD subtypes, educational attainment and longitudinal mental status trajectories were not significant predictors. Each APO-[varepsilon]4 allele more than doubled the odds of being classified into the AD group (OR =2.48). Higher levels of performance and maintenance of episodic memory ability across age decreased the odds of being classified in the AD group (OR Intercept = 0.92; OR Slope = 0.79). Every unit of increased cardiovascular risk tended to decrease the odds of being classified into the AD group (OR = 0.77). An attempt was made to examine mixed dementia cases by a re-categorization of participants with vascular pathology into new groups of mixed cases versus a more 'pure' AD group but the percent of cases that were correctly classified decreased from 79.7% in the original analyses to 77.9% once re-organized, indicating more may need to be done to get at underlying risk and cognitive factors involved in mixed dementia. JF - Psychology PB - University of California, Riverside CY - Riverside VL - Doctor of Philosophy UR - https://escholarship.org/uc/item/6gb0020n U4 - Vascular dementia ER - TY - RPRT T1 - Using Matched Survey and Administrative Data to Estimate Eligibility for the Medicare Part D Low Income Subsidy Program Y1 - 2010 A1 - Erik Meijer A1 - Lynn A Karoly A1 - Pierre-Carl Michaud KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology AB - The 2003 Medicare Prescription Drug Improvement and Modernization Act added a new prescription drug benefit to the Medicare program known as Part D (prescription drug coverage), as well as the Low-Income Subsidy (LIS) program to provide extra help with premiums, deductibles, and copayments for Medicare Part D beneficiaries with low income and limited assets. In this paper, the authors report on the use of matched survey and administrative data to estimate the size of the LIS-eligible population as of 2006. In particular, they employ individual-level data from the Survey of Income and Program Participation (SIPP) and the Health and Retirement Study (HRS) to cover the potentially LIS-eligible noninstitutionalized and institutionalized populations of all ages. The survey data are matched to Social Security Administration (SSA) administrative data to improve on potentially error-ridden survey measures of income components (e.g., earnings and beneficiary payments from Supplemental Security Income and Old Age, Survivors, and Disability Insurance) and program participation (e.g., participation in Medicare or a Medicaid/Medicare Savings program). The administrative data include the Master Beneficiary Record/Payment History Update System, the Master Earnings File, and the Supplemental Security Record. The survey data are the source of information on asset components, as well as the income components (e.g., private pensions) and individual characteristics (e.g., health status) not covered in the administrative data. Their baseline estimate, based on the matched data, is that about 12 million individuals were potentially eligible for the LIS as of 2006. A sensitivity analysis indicates that the use of administrative data has a relatively small effect on the estimates but does suggest that measurement error is important to account for. The estimate of the size of the LIS-eligible population is more sensitive to the relative weight they place on the two survey data sources, rather than the choice of methods we apply to either data source. JF - RAND Working Paper PB - RAND Corporation CY - Santa Monica, CA UR - https://www.rand.org/pubs/working_papers/WR743.html U4 - Prescription drug coverage/Medicare/Measurement Error/ADMINISTRATIVE DATA 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 - THES T1 - Women's alternative retirement transition options: Social Security retirement benefits and employment status Y1 - 2010 A1 - Gillen, Martie KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Net Worth and Assets KW - Public Policy KW - Retirement Planning and Satisfaction KW - Social Security KW - Women and Minorities AB - The purpose of this dissertation is to examine two common measures of retirement status: (1) receipt of Social Security retirement benefits and (2) employment status. A three manuscript format was used to report the effects of human capital characteristics (education, marital status, and health status), types of income sources (pension income, IRA/annuity income, investment asset income, and other income), and age on women's timing of Social Security retirement benefit receipt and employment status. Four waves of Health and Retirement Study (FIRS) data (2000, 2002, 2004, and 2006) were used in the analyses. Manuscript 1 used longitudinal data to investigate alternative retirement options based on timing of Social Security benefit receipt and employment status. A majority of women chose early receipt of benefits compared to normal or delayed receipt. A greater percentage of women who did not receive Social Security benefits were employed compared to those who received benefits. Among women employed full-time; a large percentage did not receive Social Security benefits while a large percentage of women employed part-time received benefits. Manuscript 2 used cross-sectional data to focus on timing of receipt of Social Security retirement benefits. Less than excellent health and receiving pension income increased the likelihood of early receipt. Not being married and receiving income from earnings and unspecified income sources reduced the likelihood of early receipt. Manuscript 3 used cross-sectional data to estimate the likelihood of being employed. Having more years of education and being divorced/separated increased the likelihood; while poor/fair health, older age, receipt of Social Security benefits, and pension income reduced the likelihood of being employed. Additionally, manuscript 3 estimated the likelihood of full and part-time employment for women receiving Social Security benefits. Overall, this dissertation updates current knowledge regarding the complex options of timing of receipt of Social Security retirement benefits and employment options. PB - University of Kentucky CY - United States -- Kentucky VL - Ph.D. UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2575907951&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - Human Capital JO - Women's alternative retirement transition options: Social Security retirement benefits and employment status ER - TY - THES T1 - Women's retirement insecurity across U.S. birth cohorts Y1 - 2010 A1 - Isaacs, K. KW - Adult children KW - Demographics KW - Healthcare KW - Other KW - Women and Minorities AB - Older women in the U.S. face greater risks of economic insecurity in comparison with other age groups and with men their own age. Although these risks have been documented in prior research, few studies investigate the life course mechanisms underlying women's retirement insecurity. This dissertation seeks to fill this gap by using a life course perspective and the theory of cumulative disadvantage to examine how women's earlier work and family experiences shape subsequent economic resources in retirement. The three major types of retirement resources in the U.S. - Social Security benefits, occupational pensions, and private retirement wealth - are considered. Analyses use a variety of modeling techniques and panel data from the Health and Retirement Study linked to restricted access Social Security Administration files. In addition, this dissertation specifically investigates retirement insecurity across birth cohorts of older women. The first substantive chapter examines how Social Security benefit eligibility type is influenced by four major life course predictors: marital continuity, family timing, employment commitment, and cohort change. Social Security benefit type is an important indicator of retirement security for women because, despite nearly universal program coverage, benefit type is associated with differential economic security in retirement for women. Multinomial logit models demonstrate the importance of women's own paid employment histories for later benefit type. Receiving own worker Social Security benefits or being dually eligible for Social Security are more likely outcomes with increased employment experience. The second empirical chapter uses discrete-time even history models to examine the timing of women's access to occupation pension income. The timing of pension income receipt is relevant for women's retirement security because delayed access indicates a missing source of economic resources. Results reveal significant cohort differences in the timing of first pension receipt as well as the important roles of marital continuity and family timing for older women's access to occupational pension income. The final empirical chapter employs age-based growth models to examine differential trajectories of private retirement savings in early retirement (ages 51-65) across U.S. birth cohorts of women. This analysis examines both initial retirement wealth and wealth accumulation over time to understand how life course processes advantage some older women, but contribute to ongoing disadvantage for others as part of this third, major source of retirement security. Results from growth models reveal variation across birth cohorts as well as the negative effects of divorce for initial wealth holdings and growth in retirement wealth. Overall, this dissertation illustrates the importance of women's work and family experiences across the life course for the cumulative disadvantages they face in retirement. Moreover, each type of major retirement resource interacts with different aspects of women's prior work and family roles to produce economic outcomes in retirement. PB - Duke University CY - United States -- North Carolina VL - Ph.D. UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2008732861&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - Demography JO - Women's retirement insecurity across U.S. birth cohorts ER - TY - THES T1 - The cumulative influences of socioeconomic status on health outcomes in late adulthood: A latent growth curve analysis Y1 - 2009 A1 - Kyung H. Kwag KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - The objectives of this study were to examine (a) the cumulative influences of demographic variables as well as socioeconomic status on trajectories of physical limitations, chronic diseases, and depressive symptoms, and (b) cross-domain associations of these health problems in late adulthood. This study used the data ( N = 4,374, age > 65 years) from the Health and Retirement Study (HRS), collected biennially during the period from 1998 to 2006. The results of this study indicated that SES was confounded with demographic factors, especially ethnicity/race, because most of the influences of demographic factors and ethnicity/race on health problem trajectories diminished when SES was accounted for. The results of latent growth curve analyses demonstrated long-term influences of socioeconomic status on (a) the levels (severity), and (b) the slopes (rates of change) in health problem trajectories during old adulthood. Graphical analyses revealed that the SES influences on slopes reflect (a) the diverging trajectories in physical limitations reflecting a cumulative influence of SES and (b) the persistent trajectories in depressive symptoms reflecting a parallelism in old age. In addition, the initial level of a health problem influenced the change in another health problem over time, supporting the notion of a stress-manifestation or health proliferation process over late adult years. Overall, the results showed that health problems progress over the later adulthood years as an inter-related dynamic process influenced by SES. By understanding differential influences of SES on different health outcomes in old age and the dynamic health process during this period, better health interventions and prevention programs can effectively be formulated and implemented for older adults. PB - Iowa State University CY - Ames VL - Doctor of Philosophy U4 - aging JO - The cumulative influences of socioeconomic status on health outcomes in late adulthood: A latent growth curve analysis 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 - THES T1 - The Effect of Long-Term Care Insurance on First Nursing Home Entry and Home Care Use: Using duration analysis Y1 - 2009 A1 - Kim, So-Yun KW - Healthcare KW - Insurance AB - The main purpose of this study was to examine whether Long-Term Care Insurance (LTCI) ownership causes moral hazard in the Long-Term Care (LTC) market. By accounting for the endogeneity of LTCI ownership and LTC utilization, this study explored the unbiased effects of LTCI ownership on LTC utilization using duration analysis. In addition, this study presented the determinants of LTCI purchase and those of first LTC use of the elderly. Using the longitudinal data from 1998-2004 HRS (Health and Retirement Study), the first LTC use among the elderly who are 65 and older were analyzed. Two duration models were employed accounting for the endogeneity of LTCI purchase and LTC use: Cox model used lagged LTCI values and the discrete time model used the LTCI values predicted in the two-stage estimation. Findings from the two models were very consistent. Based on the two-period utility model, this study estimated LTCI purchase and first LTC use. As for LTCI purchase, the elderly with higher income and non-housing assets were more likely to buy LTCI. Denying the concern of adverse selection in the LTCI market, those who had poor health conditions were less likely to buy LTCI. And those who had informal caregivers were less likely to purchase LTCI, implying that informal care and formal LTC are substitutes. LTCI ownership increased the use of nursing home care, indicating some moral hazard in the nursing home care. And no moral hazard was found in the home care market. Medicaid eligibility significantly increased LTC use, while income and nonhousing assets had negligible effect on LTC utilization, suggesting that financial resources are not important factors that determine LTC use. In addition, health limitations substantially increased LTC use, and availability of informal caregivers decreased the probability of using LTC. With the findings that LTCI ownership would not generate substantial moral hazard in the LTC market, this study provides evidences to support the policy initiatives to expand LTCI market to reduce public LTC spending. In addition, policy implications to secure LTC market and expand LTCI market were discussed. PB - The Ohio State University CY - Columbus, Ohio VL - Doctor of Philosophy UR - https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=osu1242907491&disposition=attachment U4 - Nursing Homes JO - The Effect of Long-Term Care Insurance on First Nursing Home Entry and Home Care Use: Using duration analysis ER - TY - JOUR T1 - Formal Home Health Care, Informal Care, and Family Decision Making JF - International Economic Review Y1 - 2009 A1 - Byrne, David A1 - Hiedemann, Bridget A1 - Goeree, Michelle S. A1 - Steven N. Stern KW - Healthcare AB - We use the 1993 wave of the Assets and Health Dynamics Among the Oldest Old (AHEAD) data set to estimate a game-theoretic model of families' decisions concerning the provision of informal and formal care for elderly individuals. The outcome is the Nash equilibrium where each family member jointly determines her consumption, transfers for formal care, and allocation of time to informal care, market work, and leisure. We use the estimates to decompose the effects of adult children's opportunity costs, quality of care, and caregiving burden on their propensities to provide informal care. We also simulate the effects of a broad range of policies of current interest. PB - 50 VL - 50 UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2354.2009.00566.x/abstract IS - 4 ER - TY - JOUR T1 - Housing, Health, and Annuities JF - Journal of Risk and Insurance Y1 - 2009 A1 - Davidoff, Thomas KW - Consumption and Savings KW - Demographics KW - Healthcare KW - Net Worth and Assets KW - Other AB - Abstract Annuities, long-term care insurance (LTCI), and reverse mortgages appear to offer important consumption smoothing benefits to the elderly, yet private markets for these products are small. A prominent idea is to combine LTCI and annuities to alleviate both supply (selection) and demand (liquidity) problems in these markets. This article shows that if consumers typically liquidate home equity only in the event of illness or very old age, then LTCI and annuities become less attractive and may become substitutes rather than complements. The reason is that the marginal utility of wealth drops when an otherwise illiquid home is sold, an event correlated with the payouts of both annuities and LTCI. Simulations confirm that demand for LTCI and annuities is highly sensitive to the liquidity and magnitude of home equity. PB - 76 VL - 76 IS - 1 U4 - long Term Care/Annuities/Financial planning/Personal finance/Older people/Home equity loans/Reverse mortgages/Leasebacks ER - TY - CHAP T1 - How Do The Better Educated Do It? Socioeconomic Status And The Ability To Cope With Underlying Impairment T2 - Developments in the economics of aging Y1 - 2009 A1 - David M Cutler A1 - Landrum, Mary Beth A1 - Stewart, Kate A. ED - David A Wise KW - Demographics KW - Disabilities KW - Healthcare AB - Our analysis considers two primary issues. First, we ask how much of this gradient in health is a result of underlying differences in functioning versus the ability to cope with impairments. We show that while the bulk of the difference is a result of underlying functioning—the better off have much less difficulty with these measures even in the absence of help—coping is important as well. The better educated are less likely to have functional disabilities in the first place, and cope with them better when they occur. JF - Developments in the economics of aging T3 - A National Bureau of Economic Research conference report PB - University of Chicago Press CY - Chicago SN - 0-226-90335-4 UR - https://www.nber.org/books-and-chapters/developments-economics-aging/how-do-better-educated-do-it-socioeconomic-status-and-ability-cope-underlying-impairment U4 - socioeconomic Status/DISABILITY/DISABILITY/health outcomes/health gradient ER - TY - RPRT T1 - International Differences in Longevity and Health and Their Economic Consequences Y1 - 2009 A1 - Pierre-Carl Michaud A1 - Dana P Goldman A1 - Darius Lakdawalla A1 - Adam Gailey A1 - Yuhui Zheng KW - Cross-National KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to 1.1 trillion in discounted total health expenditures from 2004 to 2050. JF - NBER Working Paper PB - The National Bureau of Economic Research CY - Cambridge, MA U4 - SHARE/Public Policy/health Care/Medicare/Longevity ER - TY - RPRT T1 - The Long-Term Financial and Health Outcomes of Disability Insurance Applicants Y1 - 2009 A1 - Kathleen McGarry A1 - Jonathan S Skinner KW - Disabilities KW - Healthcare KW - Insurance KW - Net Worth and Assets PB - 11th Annual Joint Conference of the Retirement Research Consortium U4 - DISABILITY/DISABILITY/health outcomes/financial outcomes/financial outcomes/Insurance ER - TY - JOUR T1 - Medicare Spending for Previously Uninsured Adults JF - Annals of Internal Medicine Y1 - 2009 A1 - J. Michael McWilliams A1 - Meara, Ellen A1 - Alan M. Zaslavsky A1 - John Z. Ayanian KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance AB - BACKGROUND: Medicare spending after age 65 years may be higher for previously uninsured adults if suboptimal care before this age leads to irreversible complications, persistently elevated clinical risks, or delay of costly elective procedures. OBJECTIVE: To compare Medicare spending for previously uninsured and insured adults by using Medicare claims data. DESIGN: Longitudinal survey data and linked Medicare claims data were used to compare Medicare spending for beneficiaries age 65 to 74 years who were previously insured or previously uninsured before age 65 years. An inverse-probability-of-treatment weighting technique was used to adjust for fixed and time-varying sociodemographic and health characteristics before age 65 years. Condition-specific hospitalizations were compared, and their contribution to differences in Medicare spending was estimated. SETTING: Nationally representative Health and Retirement Study, 1992 to 2006. PARTICIPANTS: 2951 continuously insured adults and 1616 adults who were continuously or intermittently uninsured before age 65 years. MEASUREMENTS: Mean adjusted annual Medicare spending (total and by type of service) and annual rates of condition-specific hospitalizations. RESULTS: Adjusted annual total Medicare spending was significantly higher for previously uninsured than previously insured adults ( 5796 vs. 4773; difference, 1023 95 CI, 29 to 2016 ; P = 0.044). Among relevant clinical subgroups, previously uninsured adults had higher adjusted annual hospitalization rates than previously insured adults for complications related to cardiovascular disease or diabetes (9.1 vs. 6.4 ; P = 0.002) and for joint replacements (2.5 vs. 1.3 ; P = 0.006). Differences in these hospitalizations accounted for 65.7 of the 644 difference in annual Medicare inpatient spending between all previously uninsured and insured adults. LIMITATION: Unobserved confounders could have explained spending differences. CONCLUSION: Costs of expanded coverage before age 65 years may be partially offset by subsequent reductions in Medicare spending after age 65 years, particularly for uninsured adults with cardiovascular disease, diabetes, or severe arthritis. PRIMARY FUNDING SOURCE: The Commonwealth Fund. PB - 151 VL - 151 IS - 11 N1 - PMID: 19949141 U3 - 19805758 U4 - Medicare and Medicaid spending/Insurance Coverage/HOSPITALIZATION ER - TY - THES T1 - Poverty Transitions for the Elderly Y1 - 2009 A1 - Lee, Youngae KW - Healthcare KW - Methodology AB - The purpose of this study is to examine the likelihood of poverty transition and the effects of different events on poor elderly. This study is important because the aging population has grown rapidly, and elderly poverty involves many complex relationships across an individual's life span. The contributions of this study are to improve the understanding of elderly poverty and to provide considerable policy implications for elderly demographic changes in the future. The data for this study are from the years 1992-2006 of the Health and Retirement Study (HRS) and the sample consists of 30,405 elderly individuals from eight waves. To examine the incidence and dynamics of elderly poverty, poverty-rate decomposition and the poverty exit (re-entry) hazard rate based on Kaplan-Meier product-limit estimates are used. Entry into and exit from elderly poverty models are separately used to estimate the conditional relationship between poverty transition and multiple trigger events as well as various covariates using the discrete-time hazard model. These multivariate techniques show a more realistic picture of elderly poverty transition in terms of providing a preliminary explanation of the unobserved heterogeneity of the elderly poverty. The major findings are: (1) the poverty rates for the HRS data fluctuated considerably during the 1990s, but the rates have had little turnover and have been relatively stable over time during the 2000s; (2) in terms of poverty entry and exit rates, the exit rate was decreased during the 1990s, but the rate was increased during the 2000s while the entry rate fell somewhat during the 1990s and rose somewhat during the 2000s; (3) the poverty rate for the HRS cohort individuals in a given year by cross-sectional data is relatively low, and the duration of the poverty spell is also relatively short (a fifth of the HRS cohort individuals had at least one poverty spell); (4) as the length of the poverty spell increased, the probability of poverty exit decreased; (5) as the non-poverty duration increases, the poverty re-entry rates are constant at around 10 percent; (6) retirement and a negative change in health condition both have significant effects on elderly poverty entry, while retirement, increase in total wealth, and becoming insured from any government health program all have significant effects on elderly poverty exit; and (7) life history variables, such as total years of work and length of marriage have significant effects on both elderly poverty entry and exit. Results from the hazard rates (exit and re-entry rate) imply that a person who falls into poverty during his or her elderly years is highly likely to remain poor because the exit probabilities fall as the length of the poverty spell increases. In addition, the results of constant re-entry rates infer that the elderly population is exposed to the risk of falling to an income that puts them below the poverty line. Results from multivariate analysis suggest that retirement has an important role in elderly poverty transition and a negative change in health condition also has positive impact on elderly poverty entry. Thus, effective income support programs and social policies for the elderly help to prevent elderly individuals from becoming poor. PB - The Ohio State University CY - United States -- Ohio U4 - Sociology JO - Poverty Transitions for the Elderly ER - TY - CHAP T1 - The SES Health Gradient On Both Sides Of The Atlantic T2 - Developments in the economics of aging Y1 - 2009 A1 - James Banks A1 - Michael Marmot A1 - Oldfield, Zoë A1 - James P Smith ED - David A Wise KW - Cross-National KW - Healthcare KW - Risk Taking AB - Looking across many diseases, average health among mature men is much worse in America compared to England. Second, there exists a steep negative health gradient for men in both countries where men at the bottom of the economic hierarchy are in much worse health than those at the top. This health gradient exists whether education, income, or financial wealth is used as the marker of one's SES status. These conclusions are maintained even after controlling for a standard set of behavioral risk factors such as smoking, drinking, and obesity and are equally true using either biological measures of disease or individual self-reports. In contrast to these disease based measures, health of American men appears to be superior to the health of English men when self-reported general health status is used. The contradiction most likely stems instead from different thresholds used by Americans and English when evaluating health status on subjective scales. For the same objective health status, Americans are much more likely to say that their health is good than are the English. Finally, feedbacks from new health events to household income are one of the reasons that underlie the strength of the income gradient with health in England. JF - Developments in the economics of aging T3 - A National Bureau of Economic Research conference report PB - University of Chicago Press CY - Chicago UR - https://ssrn.com/abstract=942969 U4 - health outcomes/cross-national comparison/risk Factors/ELSA_ JO - The SES Health Gradient On Both Sides Of The Atlantic ER - TY - THES T1 - Socioeconomic status and health redux: New evidence from England in a comparative context Y1 - 2009 A1 - Caswell, Kyle J. KW - Cross-National KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Other KW - Public Policy AB - People with higher socioeconomic status (SES) enjoy superior health. For the US, it is especially difficult to identify pathways underpinning this relationship, as it likely reflects differences in access to health care in addition to other factors correlated with SES. In England, however, access to care is universal, so that if SES is positively correlated with health, its main effects must come via alternative pathways other than access to care. This dissertation investigates the effects of SES on health outcomes, and vice versa, using the English Longitudinal Study of Ageing (ELSA). As the ELSA is similar to the US Health and Retirement Study, I compare the SES-health relation between countries. I find that the effect of SES on health is significant in England, with wealth the most important in guarding against negative health outcomes. However, for lower SES individuals, there are important differences between countries, suggesting that access to care has its largest effect among the least advantaged. Furthermore, new health events affect the economic resources of English individuals less than their US counterparts. Finally, there is evidence among married couples that wives respond to their husbands' new health conditions by increasing market labor hours--i.e., an 'added worker effect.' PB - The American University CY - Washington, D.C. VL - Ph.D U4 - cross-national comparison JO - Socioeconomic status and health redux: New evidence from England in a comparative context ER - TY - RPRT T1 - Take-Up of Medicare Part D and the SSA Subsidy: Early Results from the Health and Retirement Study Y1 - 2009 A1 - Helen G Levy A1 - David R Weir KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - We analyze newly available data from the Health and Retirement Study on senior citizens take-up of Medicare Part D and the associated SSA Low-Income Subsidy. We find that economic factors specifically, demand for prescription drugs - drove the decision to enroll in Part D. For the most part, individuals with employer-sponsored coverage in 2004 kept that coverage, as they should have. Individuals with no prescription drug coverage in 2004 mostly enrolled in Part D or obtained other coverage; many of those who remained without coverage reported that they do not use prescribed medicines. Take-up of the SSA Extra Help subsidy seems to have been more problematic, with many Part D beneficiaries unaware of the subsidy program or unsure about their eligibility. There is apparent under-reporting in the HRS of participation in the subsidy program, suggesting that some who profess to be unaware of the program may actually be participating in it. In terms of respondents subjective experiences of decision-making, the majority report having had little or no difficulty with the Part D enrollment decision and being confident that they made the right decision. Thus, for the most part, despite the complexity of the program, Medicare beneficiaries seem to have been able to make economically rational decisions in which they had confidence, although additional intervention for low-income beneficiaries may be desirable. PB - Cambridge, MA, National Bureau of Economic Research, Working Paper 14692 UR - http://www.nber.org/papers/w14692 N1 - http://www.nber.org/papers/w14692 U4 - Medicare/Prescription Fees ER - TY - THES T1 - Three Empirical Papers on Medicaid, Medicare, and Long-Term Care Insurance Y1 - 2009 A1 - Nadia Greenhalgh-Stanley KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - This dissertation consists of three empirical essays investigating the relationship between the government provision of long-term care services through Medicaid and Medicare and the housing and portfolio decisions of the elderly. In the first essay, I exploit state-by-time variation in Medicaid's treatment of owner-occupied housing assets through the adoption of estate recovery programs to measure the impact of these law changes on elderly housing and asset decisions. In the second essay, I provide empirical evidence on the extent to which long-term care insurance affects the housing and living arrangements of the elderly by examining plausibly exogenous changes in the supply of long-term care insurance through the Medicare program that occurred in the late 1990's. In the third essay, I examine the relationship between the 1988 increases in the asset and income spousal protections and the wealth holdings of widows. The first essay examines the impact of state adoption of estate recovery programs on housing and asset decisions among the elderly. Adoption of estate recovery programs changed the owner-occupied housing safety net by making the house eligible for recovery by the government, which increased the implicit tax of holding owner-occupied housing. Using data from 1993-2004 in the Health and Retirement Study on elderly individuals, I find that state adoption of estate recovery programs makes the elderly decrease homeownership at death by 20 percentage points off a base homeownership rate of 60%, making them 33% less likely to own their homes at death and has a small impact on homeownership rates while the recipients are alive. Also, there is evidence that trusts are treated as a substitute to housing in order to preserve assets and carry out bequest motives at death. Adoption of these programs decreased the housing share of the elderly wealth portfolio. The second essay provides estimates on the extent to which the supply of long-term care insurance affects the housing and living arrangements of the elderly. My estimates indicate that living arrangements are quite responsive to home health care benefits. The estimated elasticity of shared living to benefits is -0.7 over all elderly and -1 for widowed elderly. However, these benefits have little impact on household headship among the elderly. This suggests that the bulk of the shared-living response occurred through co-residents living in elderly households. There is some weak evidence that increases in benefits raised elderly homeownership. The final essay estimates the impact of increases in the spousal impoverishment protections from the Medicare Catastrophic Coverage Act of 1988. I find that widows after 1988 held 29% more total wealth and 14% more financial wealth than those widowed before1988. I also find that widows after 1988 are more likely to own their homes and are less likely to live in a home owned by a relative compared to those widowed prior to the 1988 law change. PB - Syracuse University CY - United States, New York U4 - Insurance, Long Term Care JO - Three Empirical Papers on Medicaid, Medicare, and Long-Term Care Insurance ER - TY - THES T1 - Three Essays on Long-Term Care and Life Insurance Y1 - 2009 A1 - Daifeng He KW - Healthcare KW - Insurance AB - This dissertation consists of three essays on long-term care and life insurance. Essay 1 examines the impact of the tax incentive prescribed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on individuals' long-term care (LTC) insurance purchasing behavior. 1 Using data from the Health and Retirement Study, we find that the tax incentive in HIPAA increased the take-up rate of private LTC insurance by 3.3 percentage points, or 25%, for those eligible. Despite this seemingly strong response, our results imply that even an above-the-line tax deduction would not increase the coverage rate of seniors beyond 13%, indicating that tax incentives alone are unlikely to expand the market substantially. We also present, to our knowledge, the first estimate of the price elasticity of demand for LTC insurance of around -3.9, suggesting that demand is highly elastic at the current low ownership rate. Finally, we evaluate the net fiscal impact of the tax incentive and find that the tax deductibility of LTC insurance premiums leads to a net revenue loss for the government, as the reduced tax revenue from granting the tax incentive exceeds the savings in Medicaid's LTC expenditures. Essay 2 finds evidence for the presence of adverse selection in the life insurance market, a conclusion contrasting with the existing literature. In particular, I find a significant and positive correlation between the decision to purchase life insurance and subsequent mortality, conditional on risk classification. Individuals who died within a 12-year time window after a base year were 19 percent more likely to have taken up life insurance in that base year than were those who survived the time window. Moreover, I find that individuals are most likely to obtain life insurance four to six years before death. Methodologically, I address sample-selection and omitted-variables issues overlooked in the previous literature. In Chapter 3, I examine whether dynamic adverse selection prevails in the life insurance market and finds little evidence of it. In particular, I find that individuals with lower mortality risk do not have a higher lapse rate than do otherwise equivalent individuals with higher mortality risk, nor do they lapse a higher amount conditional on a cancellation. The absence of dynamic selection in life insurance markets appears to imply that adequate premium front-loading may serve as an effective consumer lock-in mechanism in long-term insurance markets. PB - Washington University CY - St. Louis, Missouri U4 - Long-Term Care JO - Three Essays on Long-Term Care and Life Insurance ER - TY - RPRT T1 - Understanding the Economic Consequences of Shifting Trends in Population Health Y1 - 2009 A1 - Dana P Goldman A1 - Darius Lakdawalla A1 - Pierre-Carl Michaud A1 - Yuhui Zheng A1 - Adam Gailey KW - Employment and Labor Force KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy AB - The public economic burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy - with a concomitant decrease in the public-sector's annuity burden - but these savings may be offset by worsening functional status, which increases health care spending, reduces labor supply, and increases public assistance. Using a microsimulation approach, we quantify the competing public-finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures (including Social Security and income assistance). Together, the reduction in smoking and the rise in obesity have increased net public-sector liabilities by $430bn, or approximately 4% of the current debt burden. Larger effects are observed for specific public programs: annual spending is 10% higher in the Medicaid program, and 7% higher for Medicare. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - Cross Cultural Comparison/life Expectancy/Functional Status/health care spending/public assistance/labor Supply/government expenditures ER - TY - JOUR T1 - U.S. Pharmaceutical Policy In A Global Marketplace JF - Health Affairs Y1 - 2009 A1 - Darius Lakdawalla A1 - Dana P Goldman A1 - Pierre-Carl Michaud A1 - Sood, Neeraj A1 - Lempert, Robert A1 - Cong, Ze A1 - de Vries, Han A1 - Italo Gutierrez KW - Healthcare AB - U.S. consumers generate more pharmaceutical revenue per person than Europeans do. This has led some U.S. policymakers to call for limits on U.S. pharmaceutical spending and prices. Using a microsimulation approach, we analyze the welfare impacts of lowering U.S. prices toward European levels, and how these impacts vary with key modeling assumptions. Under the assumptions most favorable to them, price controls generate modest benefits (a few thousand dollars per person). However, for the remainder of plausible assumptions, price controls generate costs that are an order of magnitude higher. In contrast, publicly financing reductions in consumer prices, without affecting manufacturer prices, delivers benefits in virtually all plausible cases. PB - 28 VL - 28 IS - 1 U4 - pharmaceutical spending ER - TY - THES T1 - Childlessness and Psychological Well-Being Across the Life Course as Manifested in Significant Life Events Y1 - 2008 A1 - Chang, Echo Win-Hu KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - The childless population in the United States is growing fast, accounting for approximately one fifth of population aged 65 and older. The combination of longevity, marital status changes, and childlessness has led to the projection that about 25% of the population aged 70 to 85 in 2030 will not have a living spouse or a living child. Surprisingly, there is relatively little documentation about the lives of childless elders. Childless people have been conspicuously ignored in social sciences, even in very pertinent fields such as adult development, aging, the life course, and the family. Among previous studies, two common shortcomings make results on childlessness and old-age well-being inconclusive: (a) treating childlessness as a static status and not considering possible changes in its meaning and impact felt in significant life events, and (b) focusing on negative aspect of childlessness at the exclusion of possible positive rewards. This dissertation added contextual variables and measured both negative and positive affects of psychological well-being. It adopts stress process model as a framework to study the effects of childlessness on psychological well-being in the events of caregiving in middle age, retirement in young-old age, and disability in advanced old age. This dissertation uses data from Health and Retirement Study. The findings indicate that childlessness by itself does not pose a negative threat to psychological well-being. The lack of a negative effect of childlessness on psychological well-being does not mean that children are not beneficial to parents. Rather, it suggests that taking the "deviant" path of childlessness, whether voluntarily or not, does not necessarily render childless persons at a greater disadvantage than parents in old age. However, one natural outcome of childlessness is the lack of biological grandchildren the benefits associated with grandparenthood. In this dissertation, grandchildren are found to have a positive influence on grandparents', and in particular grandfathers', transitions to retirement. The effects of childlessness were teased out from the impact of marital status. Possible interaction of gender, parental status, and marital status were tested. Childlessness and singlehood interacts in some cases. Childlessness poses different implications for men and women. PB - University of Southern California CY - United States -- California VL - Doctoral Dissertation UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1564020811&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - Sociology JO - Childlessness and Psychological Well-Being Across the Life Course as Manifested in Significant Life Events ER - TY - JOUR T1 - Consequences of Parental Divorce for Adult Children's Support of their Frail Parents JF - Journal of Marriage and Family Y1 - 2008 A1 - Lin, I-Fen KW - Adult children KW - Healthcare AB - Using three waves of data from the Health and Retirement Study, I examined the association of parental divorce and remarriage with the odds that biological, adult children give personal care and financial assistance to their frail parents. The analysis included 5,099 adult children in the mother sample and 4,029 children in the father sample. Results indicate that adult children of divorced parents are just as likely as adult children of widowed parents to give care and money to their mothers, but the former are less likely than the latter to care for their fathers. The findings suggest that divorced fathers are prone to be the population most in need of formal support in old age. PB - 70 VL - 70 U4 - Divorce/Caregiving/Adult Children ER - TY - JOUR T1 - Division of Parent Care Between Spouses JF - Ageing and Society Y1 - 2008 A1 - Maximiliane E Szinovacz A1 - Adam Davey KW - Adult children KW - Demographics KW - Healthcare AB - Research on the division of family work has focused on household work and child-care to the exclusion of other domains, whereas studies on care-giving for older people typically ignore spouses support to care-givers. In this paper we apply an approach that is typical of research on spouses division of family work in caring for parents, in that the theoretical model focuses on the cultural mandates that guide spouses division of care, namely gender ideologies about appropriate roles, kinship obligations, and taboos against cross-gender personal care. Other predictors of the spousal division of care drawn from economic and health-care utilisation models are also examined. The analyses use pooled data on 1,449 care occasions from the first five waves of the US Health and Retirement Study. It was found that most couples to some extent share parent care, and that the involvement of husbands depended on a complex interplay of cultural mandates and contexts. Husbands participated most in personal care for parents if the care was mandated by kinship obligations (they cared more for their own than their wife s parents), and by cross-gender care taboos (they cared more for fathers than mothers). Other cultural contexts (such as race), a spouse s other commitments, health-related ability, resources (including support from the parents other children), and care-burden also played a role. The findings demonstrate that decisions to care for parents emerge from complex negotiations among spouses and their children and siblings or, in other words, that parental care is a family endeavour. PB - 28 VL - 28 IS - 4 U4 - Caregiving/Family Characteristics/GENDER-DIFFERENCES/Spouses ER - TY - RPRT T1 - Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study Y1 - 2008 A1 - Eileen M. Crimmins A1 - Heidi M Guyer A1 - Kenneth M. Langa A1 - Mary Beth Ofstedal A1 - Robert B Wallace A1 - David R Weir KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan U4 - health measures/survey Methods/Physical Activity ER - TY - JOUR T1 - The Effects of Retirement on Physical and Mental Health Outcomes JF - Southern Economic Journal Y1 - 2008 A1 - Dhaval, Dave A1 - Rashad, Inas A1 - Spasojevic, Jasmina KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - While numerous studies have examined how health affects retirement, few have analyzed the impact in the reverse direction. Using the Health and Retirement Study (1992-2005), this paper estimates the effects of retirement on indicators of physical and mental health. To account for biases from unobserved selection and endogeneity, panel data methodologies are used, augmented by counterfactual and specification checks. Results indicate that complete retirement leads to a 5-14 increase in difficulties associated with mobility and daily activities, 4-6 increase in illnesses, and 6-9 decline in mental health (evaluated relative to the sample mean). The adverse health effects are mitigated if the individual is married, engages in physical activity, or continues to work part-time post-retirement. Evidence also suggests larger adverse health effects in the event of involuntary retirement. Retiring at a later age may lessen or postpone poor health outcomes for older adults, raise well-being, and reduce health care services utilization. PB - 75 VL - 75 UR - https://www.nber.org/system/files/working_papers/w12123/w12123.pdf IS - 2 U4 - retirement planning/labor Force Participation/health outcomes/Health Care Utilization/Well Being ER - TY - THES T1 - Factors associated with purchase of long-term care insurance Y1 - 2008 A1 - Holve, Erin KW - Healthcare KW - Public Policy AB - Spending on long-term care (LTC) is projected to increase from $194 billion in 2004 (with 49% coming from Medicaid) to $540 billion in 2040. In response, efforts have been made to bolster the market for private long-term care insurance (LTCI) to reduce Medicaid spending. Private insurers want to understand what motivates people who purchase LTCI and how to expand the private market; consumers want to understand whether LTCI is an appropriate strategy for them to cover long-term care costs; and policymakers want to understand what the potential role of private LTCI is in terms of meeting future needs to fund LTC and what can be done to encourage purchase of LTCI. These papers aim to respond to these questions by reviewing sources of LTCI market failure and understanding the extent to which assets, income maintenance savings (savings that may set aside for 3 or more years), taste for insurance, and prior experience with a parent in nursing home care is associated with purchase of LTCI. Analysis of data from the 2004 Health and Retirement Study (HRS) shows that the most likely market of those for whom it might be worth purchasing LTCI is limited to approximately one-quarter of those over 50. Analyses were conducted within a target market of individuals (with $100,000 - $2 million in assets) who have medical insurance other than Medicaid, and are younger than 85. Logistic regression models were conducted with data from the HRS in 2000, 2002, and 2004. Data are weighted to represent the population of adults over 50 in the US as of 2004. Among those in the target market, individuals with a very high level of income maintenance savings (>/$100,000), who could presumably self-insure against all but the greatest risk of LTC; those with life insurance; and those with a parent who lived or lives in a nursing home, are associated with a greater likelihood of purchasing LTCI. However, with the exception of life insurance, none of these factors is independently associated with more than a forty percent higher likelihood of LTCI purchase, demonstrating that factors motivating purchase of LTCI are diffuse. The data presented suggest it important to re-evaluate expectations for the private market for LTCI based on individuals' personal and financial circumstances, taste for insurance, and prior experience. Realistically assessing the factors that influence long-range planning for LTC among those capable of purchasing LTCI illustrates the largely separate roles of the public and private sector in terms of financing LTC. PB - The Johns Hopkins University CY - Baltimore, MD VL - Doctor of Philosophy U4 - Health care management 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 - THES T1 - Gender disparities in trajectories of functional, mental, and self-rated health: An analysis of older adults Y1 - 2008 A1 - Leah Rohlfsen KW - Health Conditions and Status KW - Healthcare AB - Recent research has shown the disadvantage women experience in functional, mental, and self-rated health is not as uniform as once thought. Furthermore, there is a lack of research on gender differences in mental health outcomes that characterize males. Most studies are based on cross-sectional data or data from two time-points and fail to examine trajectories of functional, mental, and self-rated health. This dissertation addresses these limitations to more thoroughly understand gender differences in health. Latent growth curve modeling is used to model trajectories of functional limitations, depressive symptoms, problem drinking, and self-rated health for males and females using longitudinal data from the Health and Retirement Study (HRS) and the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). The differential exposure and differential vulnerability explanations are used to examine the extent to which an extensive set of social structural, childhood background, behavioral, and health status factors explain gender differences in health. Females have higher odds of having functional limitations and depressive symptoms, as well as have more functional limitations and depressive symptoms compared to males. Males have higher odds of problem drinking. Different factors explain gender differences in problem drinking and depressive symptoms, and the factors that cause females to be depressed differ from those that cause males to drink problematically. This suggests depressive symptoms and problem drinking are not gender-comparable outcomes. There are no gender differences in self-rated health at baseline, but females have slightly higher odds of reporting good health over time. This provides evidence of a new health paradox, in which females have the same or better self-rated health compared to males regardless of more physical limitations, acute and non-fatal chronic health conditions, and depressive symptoms. The gender differences in depressive symptoms and self-rated health are fully explained by the factors in the analysis, while the differences in functional limitations and problem drinking are only partially explained. Findings confirm the differential exposure explanation, which suggests differences exist because males and females occupy different positions in society, as well as the differential vulnerability explanation, which suggests males and females react differently to their positions in society. PB - Arizona State University CY - Tempe, AZ VL - Doctor of Philosophy U4 - Health ER - TY - BOOK T1 - Home Modifications: Use, Cost, and Interactions with Functioning Among Near-Elderly and Older Adults T2 - U.S. Department of Health and Human Services Y1 - 2008 A1 - Vicki A Freedman KW - Healthcare KW - Housing AB - Recent studies suggest a potentially large role for assistive home features in the daily lives of older adults. Yet surprisingly little current and generalizable information has been available to policy makers to allow them to investigate who has assistive home features, who has added these features and at what cost, who actually uses such features, and who potentially needs such features but has not put them into place. The 2005 Pilot Study of Technology and Aging was funded by the Assistant Secretary for Planning and Evaluation in cooperation with the National Center for Health Statistics and the National Institute on Aging to develop measures of the home environment and assistive technology use for national health and aging surveys (Freedman, Agree, and Cornman 2005; Freedman, Agree, and Landsberg 2006; Freedman, Agree, and Cornman 2006b). A subset of these items was included in the 2006 Health and Retirement Study (HRS) as an experimental module. In this report we analyze the 2006 HRS Home Modification Module (N=1,512) to describe the range of assistive home features for near-elderly and older adults (born 1953 or earlier; ages 52 and older in 2006). Research Questions. Four questions are addressed: (1) To what extent do near-elderly and older adults live in homes with assistive features and to what extent have they added and do they use such features (alone and in combination with personal care). (2) What is the distribution of out-of-pocket costs for adding assistive features and to what extent do insurance and government programs contribute. (3) How does the existence, addition, and use of assistive home features vary for demographic groups. Are these differences accounted for by differences in economic or health-related factors. (4) To what extent are near-elderly and older adults at risk for home modification sthat is, what percentage of near-elderly and older adults have low functioning, yet do not have relevant assistive home features and what is the demographic and socioeconomic makeup of this group. Data and Methods. Respondents to the 2006 HRS Home Modifications Module were asked about ten assistive home features: ramps at the entrance, handrails at the entrance (asked if the respondent has to step up or down to get into home), an emergency call system, grab bars in the shower or tub area, a seat for the shower or tub, grab bars around the toilet, a raised or modified toilet seat, a stair glide or chair lift to go up or down stairs (asked if the respondent has living space on more than one floor), handrails in the stairways (if the respondent has living space on more than one floor), and handrails in the hallways. JF - U.S. Department of Health and Human Services PB - Office of the Assistant Secretary for Planning and Evaluation CY - Washington, D.C. UR - https://aspe.hhs.gov/basic-report/home-modifications-use-cost-and-interactions-functioning-among-near-elderly-and-older-adults U4 - Assistive home features/Home modifications/Assistive technology ER - TY - THES T1 - Kinship status and life course transitions as determinants of financial assistance to adult children T2 - Sociology Y1 - 2008 A1 - R Corey Remle KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This dissertation contributes to the literature on intergenerational transfers by examining the dynamics of financial assistance provided by midlife parents to their adult children across the life course. This dissertation also examines whether the cumulative advantage hypothesis stretches across generational lines during co-occurring life course experiences so that financial transfers convey additional advantages to adult children. I use panel data from four waves of the Health and Retirement Study (1992, 1994, 1996 and 1998) to provide a broad picture of the process of financial assistance to younger adults within extended families. I constructed within-family trajectories of assistance to demonstrate that financial transfers are more common than previously estimated. Over 60% of all midlife-parent households gave $500 or more at least once and many parents gave multiple transfers and/or gave transfers to several adult children during a seven-year period. In an examination of kinship structures that differentiates between paternal children and maternal children within blended families, I use nonlinear logistic regression models to show that the decreased likelihood that fathers provided financial assistance to children from a previous marriage accounted solely for the reduction in transfers that all stepchildren received compared to biological children. Multilevel regression models demonstrate that transfer amounts are also influenced by kinship structures and parental resources. Additional analyses show adult child life course transitions related to schooling and coresidence were influential for parents' transfer behaviors while other life course transitions related to work, marriage, home ownership and the addition of a grandchild to the family were not influential. The number of life course transitions experienced by adult children during later waves significantly increased the likelihood of transfer receipt. However, the diversification of experiences over time made it difficult to pinpoint specific life course transitions relevant to financial assistance from parents. The strong impact of previous transfers upon the likelihood that adult children would receive transfers at later waves shows that patterns of repeated transfers were common for many intergenerational families. I argue that future research should analyze the impact of parental wealth on transfers and should explicitly examine parents' motives for giving money to adult children. JF - Sociology PB - Duke University CY - United States -- North Carolina UR - https://dukespace.lib.duke.edu/dspace/handle/10161/618 U4 - Sociology JO - Kinship status and life course transitions as determinants of financial assistance to adult children ER - TY - THES T1 - Longitudinal study of loneliness and depression as predictors of health in mid- to later life Y1 - 2008 A1 - Chlipala, M. Linda KW - Health Conditions and Status KW - Healthcare AB - The longitudinal relationship between loneliness and depression as predictors of chronic health conditions in middle-aged to older adults was investigated utilizing data collected by the Health and Retirement Study (HRS), a national representative longitudinal study of health, retirement, and aging, conducted by the Institute for Social Research (ISR) Survey Research Center (SRC) at the University of Michigan, funded by the National Institute on Aging and the Social Security Administration. The correlation between these loneliness and depression was moderate ( r = .32 to r = 51). The single-item subjective self-report of loneliness was found to be an adequate measure of loneliness. A cross-lagged panel correlation and regression design was used to examine the longitudinal relationship between loneliness, depression, and chronic health conditions. A temporal precedence was indicated implying a causal relationship with depression leading to subsequent loneliness. The relationship between recurring loneliness and chronic health conditions was weak ( r = .13). PB - University of North Texas CY - United States -- Texas UR - https://www.semanticscholar.org/paper/Longitudinal-Study-of-Loneliness-and-Depression-as-Chlipala/280b8fe2b9a1def92df6a551d3477754ed13b491 U4 - Physiological psychology JO - Longitudinal study of loneliness and depression as predictors of health in mid- to later life ER - TY - THES T1 - Modeling aging processes: Social activities, partner influence, and individual well-being Y1 - 2008 A1 - Hao, Yanni KW - Healthcare KW - Methodology AB - The past decade has witnessed a growing interest in longitudinal studies of aging. The perspective of cumulative advantage/adversity was employed to explain health disparities in later life. In terms of methodology, recent advances in the statistical theory of growth curve models have enabled important breakthroughs in the study of correlates of change. Moreover, moving beyond single-trajectory growth curve analysis, a combination of the longitudinal model for individual change and the cross-sectional model for matched pairs makes it possible to estimate dual aging trajectories of marital dyads. Hence, this dissertation focuses on effects from social activities and partner influences that affect aging. Using the Health and Retirement Study (HRS) and the Asset and Health Dynamics among the Oldest Old (AHEAD) data, I conduct three studies in this dissertation. In first two studies, I perform growth curve analyses to examine how activities such as volunteering, helping and late-life employment influence aging trajectories for mid-old aged and older adults. In the third study, I extend growth curve models into family and marriage research to estimate dual aging trajectories for marital dyads and to examine cross-partner interactive processes. The results suggest that social activity and marital context do influence aging processes after midlife. Findings also confirm the existence of selection mechanisms that may drive healthy individuals into activity and similar individuals into a marital relationship. In total, causal relations between activities and partner influence and the effects on later aging trajectories are established. Moreover, these studies predict that, to the extent that the changes accumulate, the above mechanisms will keep shaping older adults' health trajectories over time. This suggests a mutually reinforcing cumulative process of selection and causal mechanisms. PB - The University of Chicago CY - United States -- Illinois U4 - Sociology JO - Modeling aging processes: Social activities, partner influence, and individual well-being ER - TY - CHAP T1 - Pathways to Disability: Predicting Health Trajectories T2 - Health at Older Ages: The Causes and Consequences of Declining Disability Y1 - 2008 A1 - Florian Heiss A1 - Axel Borsch-Supan A1 - Michael D Hurd A1 - David A Wise ED - David M Cutler ED - David A Wise KW - Disabilities KW - Healthcare JF - Health at Older Ages: The Causes and Consequences of Declining Disability SN - 0-226-13231-5 UR - https://www.nber.org/books-and-chapters/health-older-ages-causes-and-consequences-declining-disability-among-elderly/pathways-disability-predicting-health-trajectories U4 - DISABILITY/DISABILITY/health trajectories/health trajectories ER - TY - JOUR T1 - Quit Your Job and Get Healthier? The Effect of Retirement on Health JF - Journal of Labor Research Y1 - 2008 A1 - Neuman, Kevin KW - Healthcare KW - Retirement Planning and Satisfaction AB - Although the health effect of retirement has important policy implications, few economists have researched the topic. This paper utilizes longitudinal data from the Health and Retirement Study and instruments retirement status using exogenous variation in public and private pensions. Subjective health change models indicate retirement preserves the health of both men and women, although insignificant results for objective health change models suggest the preservation may be more perceived than real. The same pattern of results is found using continuous measures of annual hours. At the very least, the results give strong evidence against the anecdotal idea that retirement harms health. PB - 29 VL - 29 IS - 2 U4 - Health care/Retirement Policies ER - TY - THES T1 - Tax policy, housing markets, and elderly homeowners T2 - Economics Y1 - 2008 A1 - Shan, Hui KW - Healthcare KW - Methodology KW - Public Policy AB - This dissertation consists of three essays studying the impact of tax policy on housing markets and elderly homeowners. Chapter One examines the potential lock-in effect of capital gains taxation on home sales, using the Taxpayer Relief Act of 1997 (TRA97) as a policy instrument. Before 1997, homeowners were subject to capital gains taxation when they sold their houses unless they purchased replacement homes of equal or greater value. Since 1997, homeowners can exclude $500,000 of capital gains when they sell their houses. Using zip-code level housing price indices and sales data from 1982 to 2006 on single-family houses in 16 affluent towns within the Boston metropolitan area, I find that TRA97 reversed the lock-in effect for houses with low and moderate capital gains. However, the semiannual home sale rate of houses with capital gains above $500,000 declined after TRA97, suggesting that TRA97 generated an unintended lock-in effect for houses with capital gains over the maximum exclusion amount. Chapter Two studies the relationship between property taxes and elderly mobility. This is the first study using an instrumental variable approach to address the endogeneity problem associated with property taxes in analyzing elderly mobility. Using household-level panel data from the Health and Retirement Study (HRS) and a newly-collected dataset on state-provided property tax relief programs, I find evidence suggesting that higher property taxes raise mobility rates among elderly homeowners. Eligibility for relief programs lowers mobility rates, and the impact of these programs appears to vary with program types, program generosity, and implementation strategy. Chapter Three investigates the effect of property taxes on elderly homeowners labor supply decisions, using similar data and empirical strategy employed in Chapter Two. I examine both the extensive margin--whether elderly homeowners' delay retirement or reenter the labor force in the face of rising property taxes, and the intensive margin--whether elderly homeowners work longer hours when property taxes increase. I find little evidence that property taxes have a significant impact on elderly labor supply. (Copies available exclusively from MIT Libraries, Rm. 14-0551, Cambridge, MA 02139-4307. Ph. 617-253-5668; Fax 617-253-1690.) JF - Economics PB - Massachusetts Institute of Technology CY - Cambridge, MA VL - Doctor of Philosophy UR - https://dspace.mit.edu/handle/1721.1/43728 U4 - Finance ER - TY - THES T1 - Topics in the economics of health and aging Y1 - 2008 A1 - Noam Y Kirson KW - Healthcare KW - Methodology KW - Public Policy AB - The following three essays contain examinations of several topics in the economics of health and aging. While the subject matter of each essay is quite distinct, all three share a strong empirical focus, and attempt to shed light on issues at the intersection of family, society, economics and health. The first essay examines the effects of women's labor force participation on health, primarily the health of their employed spouses. A wide array of data sources is used do demonstrate that among married couples, men whose spouses work suffer from a range of adverse health outcomes, compared to men whose spouses are homemakers. The results strongly suggest that dual-earning households are subjected to high levels of chronic stress, leading to poorer health outcomes. Statistical identification constrains the analysis to the health of men alone. The second essay shares some of the data sources used in the first, though shifts the focus to a much broader question. I conduct a cross-country comparison of health outcomes across five developed nations, to examine their performance on a range of chronic conditions. Importantly, this comparison overcomes many challenges in the existing literature by relying primarily on objectively measured health, rather than self-reported data. The comparison yields a surprising result: though considerably more obese, Americans display remarkably low levels of hypertension and total cholesterol. Treatment patterns can account for much of the difference, suggesting that the American healthcare system might be better at screening and treating these conditions, contrary to common belief. Finally, in the third essay I address a topic more closely associated with aging than health per se. In it, I examine whether a strategic bequest motive can account for apparent sub-optimal tax planning of older households with respect to estate taxes. I develop a theoretical model incorporating both strategic exchange and tax considerations among altruistic parents, leading to an outcome consistent with the literature on suboptimal estate tax behavior. I then turn to test the model's predictions using data from the Health and Retirement Study, and find evidence consistent with a strategic bequest motive among households more likely to face the estate tax. PB - Harvard University CY - Cambridge, MA VL - Doctor of Philosophy U4 - Public health ER - TY - THES T1 - Toward a demographic divide? Equity, race, and Social Security Y1 - 2008 A1 - Accius, Jean C., II KW - Healthcare KW - Public Policy KW - Racial/ethnic differences KW - Social Security AB - The retirement system within the United States for millions of Americans revolves around Social Security. Social Security is a policy that was designed to ensure economic security to individuals who contributed into the system while working and now have transitioned into retirement. Yet, the combination of conflicting goals, demographic trends, and inadequate assumptions in the design of the Social Security program has threatened its solvency. With these concerns have come various proposals to reform the system, including increasing the retirement age and privatizing the Social Security program. These proposals have spurred social equity concerns regarding the potential adverse impacts on the ability of minorities and/or low-income individuals to retire. While race is typically proffered as social equity concerns when it comes to Social Security and its accompanying reforms, it is possible that this cleavage is not the most important one for policy makers to anticipate and attempt to cope with in the future. As a result, this study seeks to address the following questions in more rigorous, robust, and sophisticated ways than has prior research: Are there differences by race in retirement decisions, controlling for other factors such as class? If differences do exist, what are their social equity implications for society? How might any social inequities that might exist be best addressed in the United States? To address these questions, this study combines qualitative as well as quantitative research using the Health and Retirement Study (HRS) to examine, from 1992 to 2004, the retirement behaviors of Americans born between 1931 and 1941. Logistic regressions were used to decompose the differences in retirement decisions across racial groups while controlling for demographic, economic, and quality of life factors. The analysis revealed that, controlling for economic and health variables, statistically significant differences among races in retirement decisions did not exist. Overall, this study suggests that the most important focus of policymakers seeking the most cost-effective way to address social inequities related to retirement decisions is to focus proactively on ways to address poverty and poor health, and reactively , to focus social services on attenuating the worst impacts of social inequities. PB - The American University CY - United States -- District of Columbia JO - Toward a demographic divide? Equity, race, and Social Security ER - TY - RPRT T1 - Burnout and the Retirement Decision Y1 - 2007 A1 - Nicole Maestas A1 - Xiaoyan Li KW - Employment and Labor Force KW - Healthcare KW - Retirement Planning and Satisfaction AB - We introduce the process of psychological burnout and recovery as an explanation for the phenomenon known as unretirement. We illustrate theoretically how predictable time variation in burnout could generate retirement and subsequent re-entry in a standard retirement model. We apply this model to the longitudinal Health and Retirement Study, presenting a novel measure of burnout, the Burnout EX3 Index. The index is correlated with different types of work stressors, and its time profile discriminates among different types of retirees. For example, prior to retirement, burnout rises steeply for future unretirees then falls rapidly after retirement; whereas burnout among future partial retirees is low and changes little over time. Using a series of econometric models derived from our theoretical model, we show that as burnout rises, retirement becomes more probable, and as burnout recedes following retirement, re-entry becomes more probable. While access to public and private pension benefits increases the likelihood of retirement for all retirees, pension accruals are least important for those who will later unretire, suggesting that unretirees are more willing to trade future gains in pension wealth for leisure than other retirees. Indeed, for this group, the effect of burnout dominates that of the net return to work. JF - Retirement Research Center PB - Michigan Retirement Research Center, University of Michigan CY - Ann Arbor, MI UR - http://hdl.handle.net/2027.42/57428 U4 - Retirement Behavior/Psychology/labor market behavior ER - TY - CHAP T1 - Commentary: The Future of Intergenerational Relationships--Variability and Vulnerabilities T2 - Social Structures: The impact of demographic changes on the well-being of older persons Y1 - 2007 A1 - Maximiliane E Szinovacz ED - K. Warner Schaie ED - Uhlenberg, Peter KW - Adult children KW - Demographics KW - Healthcare AB - Demographic and family structural changes since the mid-1900s will shape family relationships will into the 21st century. Hagestad and Uhlenberg (chapter 15, this volume) argue that these demographic changes promote age integration and closeness in intergenerational relations while at the same time enhancing age segregation in nonfamily social structures. Their rather rosy depiction of intergenerational relationships contrasts sharply with the more bleak picture of dying family bonds and of intergenerational conflict painted by other scholars (Kornhaber, 1966; Williamson, Watts-Roy and Kingson, 1999). While Hagestad and Uhlenberg's chapter depicts historical trends in intergenerational relationships, this commentary addresses the questions of whether and to what extent future intergenerational relationships will benefit from recent and continuing demographic and family structural changes. Focusing on intergenerational relations in the United States, I will first explore demographic changes other than those noted by Hagestad and Uhlenberg that influence intergenerational relationships, most importantly, trends in divorce and the timing of parenthood. Second, I will address heterogeneity in demographic changes among subpopulations and resulting variability in the future of intergenerational relationships. Third, I will discuss the potential vulnerabilities in intergenerational supports, especially care for the elderly and grandparents' access to and care for grandchildren. JF - Social Structures: The impact of demographic changes on the well-being of older persons PB - Springer CY - New York N1 - ProCite field 6 : In ProCite field 8 : eds U4 - Intergenerational Relations/Family Structure/Caregiving/Demographic Trends and Forecasts JO - Commentary: The Future of Intergenerational Relationships--Variability and Vulnerabilities ER - TY - CHAP T1 - Division of Care Among Adult Children T2 - Caregiving Contexts: Cultural, familial, and societal implications Y1 - 2007 A1 - Adam Davey A1 - Maximiliane E Szinovacz ED - Adam Davey ED - Maximiliane E Szinovacz KW - Adult children KW - Healthcare AB - Adult children play a central role within the family context of care for frail elders. As the preceding chapter by Stoller and Miklowski indicated, older married adults turn first to a spouse for assistance. However, rising divorce rates during the past decades may decrease the availability of spouses as caregivers in the future, and, as the gender gap in longevity closes and more couples age together, both spouses may experience frailty or cognitive decline and thus require support from other family members. After spouses, the next preferred group of potential family caregivers is adult children (Cantor, 1975). Today's cohort of older adults is unique with regard to their high fertility, which produced the baby boom cohorts. As a result, these parents have, on average, more children than generations that precede or follow them. While children of today's older adults tend to have more siblings than older and younger cohorts, they also have more parents who survived into old age than earlier cohorts, and thus more potential occasions to provide care. Both the availability of multiple adult children as potential caregivers and the potential care needs of multiple parents or parents-in-law likely heighten the complexity of care networks and the need to negotiate and navigate multiple relationships, requiring greater coordination of care activities and enhancing opportunities for conflict over the allocation of care responsibilities. JF - Caregiving Contexts: Cultural, familial, and societal implications PB - Springer CY - New York N1 - ProCite field 6 : In ProCite field 8 : eds U4 - Adult Children/Caregiving/Family Structure JO - Division of Care Among Adult Children ER - TY - RPRT T1 - Dynamic Inefficiencies in Employment-Based Health Insurance System: Theory and Evidence Y1 - 2007 A1 - Fang, Hanming A1 - Alessandro Gavazza KW - Employment and Labor Force KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - We investigate how the employment-based health insurance system in the U.S. affects individuals' life-cycle health-care decisions. We take the viewpoint that health is a form of human capital that affects workers' productivities on the job, and derive implications of employees' turnover on the incentives to undertake health investment. Our model suggests that employee turnovers lead to dynamic inefficiencies in health investment, and particularly, it suggests that employment-based health insurance system in the U.S. might lead to an inefficient low level of individual health during individuals' working ages. Moreover, we show that under-investment in health is positively related to the turnover rate of the workers' industry and increases medical expenditure in retirement. We provide empirical evidence for the predictions of the model using two data sets, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). In MEPS, we find that employers in industries with high turnover rates are much less likely to offer health insurance to their workers. When employers offer health insurance, the contracts have higher deductibles and employers' contribution to the insurance premium is lower in high turnover industries. Moreover, workers in high turnover industries have lower medical expenditure and undertake less preventive care. In HRS, instead we find that individuals who were employed in high turnover industries have higher medical expenditure when retired. The magnitude of our estimates suggests significant degree of intertemporal inefficiencies in health investment in the U.S. as a result of the employment-based health insurance system. We also evaluate and cast doubt on alternative explanations. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - Health Insurance/health outcomes/Employer Accommodation/Medical Expenditures ER - TY - THES T1 - Elderly Care and Public Health Insurance Programs Evaluation Y1 - 2007 A1 - Gao, Song KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - This dissertation examines the effects of Medicaid and Medicare on medical services utilization among elderly Americans using panel data from the Health and Retirement Study (HRS). In Medicaid studies, we first identify those elderly who were eligible for Medicaid coverage during 1998-2004 and then focus the analysis on these poorest elderly Americans. Relying on variation in take-up among the homogenous Medicaid eligible elderly, we explore their health care use differences. Estimation addresses the endogeneity of Medicaid participation decisions among Medicaid eligibles in medical utilization regressions. It tests what factors drive Medicaid take-up among the poorest elderly and explores whether Medicaid benefits cause the elderly to participate in the program. State Medicaid policy measures are constructed to indicate policy generosity and used as instruments which might affect people's behavior in Medicaid participation, without directly influencing health care use. We find significant positive program effects of Medicaid benefits on all medical care use, especially on long-term care (LTC). After purging the endogeneity of Medicaid participation, the treatment effects of Medicaid coverage on LTC use are significantly reduced suggesting that the decision to take-up benefits is driven by expected LTC needs. No significant changes are found among the acute care use. Moreover, the study revealed that current Medicaid eligible elderly consist of two groups. Group one consists of the pre-existing poor who are the Medicaid-targeted beneficiaries. The second group consists of non-targeted beneficiaries who have changed their consumption and saving arrangements in order to qualify for Medicaid LTC coverage. We find that some elderly with bad health condition plan in advance to transfer their assets to qualify for Medicaid. They are Medicaid beneficiaries by choice. Such behaviors are significant and the magnitude cannot be ignored which suggests that the Medicaid resources are going to non-target beneficiaries. The Medicare study, co-authored with Partha Bhattacharyya, examines the effectiveness of Medicare policy and general health market access policy over one that might encourage access to health care at younger ages. We focus on adults who are approaching entry into Medicare. We explore the total medical spending and corresponding health status of previously uninsured individuals before and after they enter Medicare compared to their insured counterparts. We examine the effects of the lack of private health insurance before age 65 on medical expenditures and health outcomes after entering into Medicare in a longitudinal framework. We follow individuals for a period of eight years, that is four years before entering Medicare and four years afterward. We identify their private health insurance status prior to entering Medicare, and we observe their expenditures and health status biannually and examine the difference of expenditures and health status between every two years. The major finding of this study is that the lack of private health insurance coverage before coming into Medicare will only temporarily skyrocketed medical expenditures of previously uninsured elderly, compared to previously insured people right after they enter Medicare. At the same time, we observe relatively better health among the uninsured. Effects are more significant for males than females. However, the trend disappears in the long-run. Which as a policy implication, expanding health insurance coverage to the uninsured at younger ages, especially males should result in substantial savings after they enter Medicare and better health in the long run. This has important Medicare policy implications when one considers the solvency issues and an aging baby-boomer population. PB - State University of New York at Stony Brook U4 - Health Care Utilization JO - Elderly Care and Public Health Insurance Programs Evaluation ER - TY - THES T1 - Essays on Supply and Demand side of the Health Care Market Y1 - 2007 A1 - Bhattacharyya, Partha KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - This dissertation addresses empirical issues on both the supply and demand side of the health care market. The first essay of the dissertation focuses on the supply side, namely male physicians and how they respond to labor supply as wage changes. The second part evaluates current Medicare policy, given the general health insurance market and interactions between the two, from an efficiency perspective. On the supply side, we offer a new methodology to test two competing labor supply theories for physicians: the standard intertemporal model and target income model, where individuals have reference or target income which they try to achieve over time. The standard model predicts positive wage elasticities of labor supply, where as target income model exhibits negative wage elasticities. Our findings suggests that male physician' exhibit target income behavior, namely, physician that are at or above their target income have inelastic wage elasticities of labor supply, where as physicians that are below their target income exhibit negative wage elasticities which leads them to work longer hours as reimbursement in lowered. On the demand side we evaluate current Medicare policy. This paper is co-authored with Song Gao. The paper evaluates current Medicare policy, given the general health insurance market and interactions between the two, from an efficiency perspective. Using longitudinal data from the Health and Retirement Study (HRS) we track medical expenditures and health of adults just 4 years before enrollment into Medicare, upon entry, and a four years post entry by prior enrollment insurance status.. Specifically we are interested in differences in cost and benefit outcomes of those who faced barriers to health care services prior to Medicare coverage and those who experienced smoother consumption trajectories. We follow individuals for a period of eight years, that is four years before entering Medicare and four years afterward. We group them by their private health insurance status prior to entering Medicare, and compare their expenditures and health status biannually over the course of the study. We find that lack of private health insurance coverage before coming onto Medicare will result in a temporary greater increase in medical expenditures upon entry compared to those previously insured. At the same time, we observe relatively better self reported health among the uninsured at this time, which may be based on utilization. Effects are more significant for males than females. However, the trend disappears in the long-run so that both expenditures and health status converge after two years of enrollment, even after controlling for mortality. There may be efficiency gains to spreading costs of care over the life cycle rather than a jump at age 65 borne by the already constrained Medicare system - particularly given the growing number of new enrollees as the babyboomers enter the system. PB - State University of New York at Stony Brook U4 - Medicare JO - Essays on Supply and Demand side of the Health Care Market ER - TY - JOUR T1 - Formal and Informal Volunteer Activity and Spousal Caregiving Among Older Adults JF - Research on Aging Y1 - 2007 A1 - Namkee G Choi A1 - Jeffrey A Burr A1 - Jan E Mutchler A1 - Francis G. Caro KW - Adult children KW - Healthcare AB - On the basis of data from the 1998 and 2000 waves of the Health and Retirement Study, this study tested two alternative hypotheses, role overload and role extension, about the relationship between volunteering and spousal caregiving among older married persons. Spousal caregiving was not significantly associated with the likelihood of formal or informal volunteering for men; however, female caregivers were found to be less likely than noncaregivers to have engaged in formal or informal volunteering to a certain extent, thus lending partial support to the role overload hypothesis. Functional health status and other human and cultural capital resources were significant predictors of both formal and informal volunteering for both men and women. Future studies need to examine in more depth the effect of spousal caregiving on volunteering, taking caregiving burden and stress into consideration, to more fully understand these two types of productive activity in later life. PB - 29 VL - 29 IS - 2 U4 - Spouse/Caregiving ER - TY - THES T1 - Job Characteristics and the Psychological Well-being of Older Workers T2 - Sociology Y1 - 2007 A1 - Shattuck, Anne M. KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare AB - Changes in public and private pensions as well as demographic and economic changes will likely lead to higher labor force participation rates for older adults in the future. Little research has examined the impact of work on the well-being of older adults beyond simply comparing those who work with those who do not. Using data from the 2002 and 2004 waves of the Health and Retirement Study, this thesis examined whether specific job characteristics--namely job flexibility, job stress, and the workplace climate's friendliness to older workers--were associated with depressive symptoms among a group of workers aged 62 to 73. Cross-sectional analyses indicated that job stress and workplace climate were associated with depressive symptoms. Longitudinal analysis revealed that workers whose employers would permit older workers to move to less demanding jobs showed decreases in depressive symptoms across survey waves compared with those who could not make such a move. JF - Sociology PB - University of New Hampshire CY - Durham, NH VL - Master of Arts UR - https://scholars.unh.edu/thesis/65/ U4 - Depression ER - TY - THES T1 - Mammography Use among Older Women in the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study Y1 - 2007 A1 - Thomas R Miller KW - Health Conditions and Status KW - Healthcare AB - Mammography is an accepted secondary prevention tool for detecting breast cancer, the second leading cause of cancer deaths among women. Although Medicare began covering screening mammography in 1991, its use among older women is not without controversy and there is a lack of uniform guidelines. Understanding the factors associated with mammography among older women, therefore, is important from a clinical and policy perspective. This dissertation used a comprehensive array of demographic, socioeconomic, and health-related variables to examine mammography among Medicare beneficiaries in the Asset and Health Dynamics Among the Oldest Old study. Progressive model building using multivariable logistic and multinomial regression was performed and several sensitivity analyses were conducted. The research objectives included: to determine the prevalence of mammography based on self-reports and claims information, assess the concordance between self-reported mammography and Medicare claims, identify the characteristics associated with concordance, and determine the risk factors associated with mammography among older women. The prevalence of self-reported mammography (54%) was twice the prevalence of mammography identified from Medicare claims data (27%). The concordance between self-reported and claims-based mammography use was poor; African Americans and women on Medicaid had significantly lower odds of concordance, primarily due to overreporting. Based on claims data, continuity of care was the factor most strongly associated with mammography use and this finding was extensively explored. Women with at least a high school education, with 2 or more children, and women who participated in regular vigorous activity also were more likely to have had a mammogram. The odds of receiving screening mammography decreased with a woman's age and were lower for women with a decline in self-rated health. Although income and wealth were not independently associated with mammography use, self-expectations about future financial position were. The study of mammography among older women will continue to be an essential research agenda because of increases in life expectancy and health-related quality of life improvements, advances in imaging and therapies, controversy regarding the efficacy and cost-effectiveness of mammography, and Medicare policies to subsidize these services. PB - University of Iowa U4 - Health Services for the Aged JO - Mammography Use among Older Women in the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study 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 - RPRT T1 - Medicaid Long-Term Care: Few Transferred Assets before Applying for Nursing Home Coverage; Impact of Deficit Reduction Act on Eligibility is Uncertain Y1 - 2007 A1 - United States Governmental Office KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets KW - Public Policy AB - Question: There is some concern that individuals transfer assets (at less than fair market value) in order to be eligible for Medicaid. Since Medicaid paid nearly one-half of the nation s total long-term care expenditures in 2004, analysis was needed to determine how prevalent this practice was. Finding: Using the NIA-funded Health and Retirement Study, GAO found that few elderly individuals had resources to support even a year s worth of private-pay nursing home care at the time they entered a nursing home. Medicaid-covered nursing home residents were less likely to have reported transferring cash than non-Medicaid-covered residents. JF - GAO Report PB - U.S. Government Accountability Office CY - Ann Arbor, MI UR - https://www.gao.gov/products/GAO-07-280 U4 - Asset transfer/Medicaid/Long Term Care/Public Policy ER - TY - JOUR T1 - Medicaid's Nursing Home Coverage and Asset Transfers JF - Public Finance Review Y1 - 2007 A1 - Bassett, William F. KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets AB - Medicaid covers the costs of a long nursing home stay. This coverage may create an incentive for the elderly to transfer their assets to their children to qualify for Medicaid before entering a nursing home. Previous researchers had found little evidence that such behavior was widespread or that asset transfers were large. However, data from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD) suggest that the self-assessed probability of entering a nursing home is a significant determinant of the likelihood of making an asset transfer. The budgetary implications of these Medicaid-induced asset transfers were probably fairly small at the time of the study, but not insignificant, and are likely to have risen steadily since. PB - 35 VL - 35 UR - http://www.federalreserve.gov/pubs/feds/2004/200415/200415pap.pdf IS - 3 U4 - Medicaid/Nursing Homes/Assets ER - TY - THES T1 - Modifiable factors for disability: Is there potential for reducing racial disparities in disability in older age? T2 - Aging Studies Y1 - 2007 A1 - Mihaela A. Popa KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - White-Black disparities in disability in the older population are consistently reported in the literature, and are usually ascribed to differences in socio-economic, health, and cognitive status. However, the role of modifiable influences on disability, such as health and lifestyle behaviors or health care utilization on these differences is less clear. This dissertation examines: (1) longitudinal White-Black differences in disability and the potential contributions of distinct health behaviors to these differences; (2) White-Black differences in the effects of health care utilization on trajectories of disability; and (3) whether cognition mediates the effects of health behaviors on disability in Whites and in Blacks, independent of established confounders for these relationships. This dissertation uses longitudinal data from the Asset and Health Dynamics among the Oldest Old study (AHEAD). Trajectories of disability in basic (ADL) and instrumental (IADL) activities of daily living are fit using mixed effects models with time-varying predictors. The mediation effect is tested using a multilevel mediation model. Results indicate that health behaviors close the residual White-Black gap in IADL trajectories but not the residual gap in ADL trajectories. Physical activity participation and maintenance of a normal weight or overweight status resulted in lower ADL and IADL disability levels over time among Whites. None of the health behaviors influenced longitudinal trajectories of disability in Blacks. Short-stay nursing home and home health care utilization was associated with lower ADL and IADL disability levels over time among Blacks. Cognition mediated the effect of physical activity participation on ADL and cognitive IADL in Whites but not in Blacks. That is, physical activity participation had positive effects on ADL and IADL disability both directly, and indirectly through beneficial effects on cognition. Modifiable influences on disability, such as health and lifestyle behaviors and health care utilization should be targeted by intervention programs and regulatory policies in order to narrow or eliminate the White-Black disability disparities. Such interventions may represent effective avenues for achieving the goals of Healthy People 2010 . JF - Aging Studies PB - University of South Florida CY - Tampa, FL VL - Doctor of Philosophy UR - https://scholarcommons.usf.edu/etd/2324/ U4 - health behaviors JO - Modifiable factors for disability: Is there potential for reducing racial disparities in disability in older age? ER - TY - THES T1 - Nursing home placement among older adults: A national study of risk perceptions, access and placement outcomes Y1 - 2007 A1 - Adaeze B Akamigbo KW - Demographics KW - Healthcare KW - Nursing homes KW - Older Adults KW - Risk Factors AB - In health services research, race and gender are frequently included as demographic variables along with other relevant predictors. Frequently, however, routine inclusion of race and gender is of a cursory nature, and does not inform researchers of the great differences that can be evident between groups. To address this, particularly in long-term care research, the principle purpose of this dissertation research was to explore the additive and interactive effects of race and gender on several aspects of nursing home use including expectations for placement, the risk for placement, access to nursing home services, and outcomes of nursing home use. Data were drawn from the Health and Retirement Study, specifically, the study on Asset and Health Dynamics among the Oldest Old (AHEAD). 7,447 AHEAD study respondents were 70 years and older at baseline data collection in 1993. The observation period lasted through 2004. Multivariate binary and multinomial logistic regression models, as well as ordinary least squares, and hazard modeling techniques were used. Study results confirmed that risk perceptions as reported by respondents were rational, and that older adults can accurately assess their risk for placement in 5 years. Overwhelmingly, Blacks were at a lower risk for placement in a nursing home in 5 years, or after 11 years. However, the risk for placement was significantly impacted by the growth of assisted living beds over the study period which expanded access for Whites, but limited long-term care options for Blacks to nursing homes. Women experienced higher risk for placements, especially multiple placements over time, suggesting a possible reliance on nursing homes for respite care due to more limited caregiver options in the community. Study results suggest that early identification of individuals at risk informs budget planning for Medicaid and other payers, and directs resources to individuals and communities that are in greatest need. Planning for the anticipated growth in the need for long-term care services are also improved by identifying demographic and other personal and market factors that contribute to temporary, multiple, or terminal use of long-term care services by older adults. PB - University of Iowa JO - Nursing home placement among older adults: A national study of risk perceptions, access and placement outcomes ER - TY - THES T1 - Private Long-term Care Insurance and Patterns of Care Use among Older Adults Y1 - 2007 A1 - Yong Li KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - This dissertation looks at private long-term care insurance (LTCI) and its effects on the use of long-term care (LTC) services among disabled older adults. This study contributes to the literature in three ways. First, in order to provide an integrated picture of care use, I systematically quantify the effects of LTCI on three major types of LTC, namely, nursing home care, formal home care, and informal care. Second, to obtain consistent estimates, I explicitly address the endogeneity of LTCI purchases in all models. Finally, I address these issues with the most recent and nationally representative data from the Health and Retirement Study (HRS). The results from this dissertation suggest that LTCI significantly changes the patterns of care utilization. LTCI decreases the probability of entering a nursing home, and increases the use of formal home care. In the meantime, the level of informal care is maintained rather than reduced. Based on these findings, LTCI allows elders to avoid or at least postpone nursing homes, and encourages the use of formal home care, which is a less costly alternative to institutional care. public policies aimed at promoting LTCI should have the expected effects of correcting the institutional bias and reducing the cost pressure on Medicaid, if they are well targeted at the middle-income population who would otherwise spend down to qualify for Medicaid payments. By directing resources to formal home care without discouraging family care-giving, LTCI helps reduce unnecessary nursing home stays, and more efficiently finance LTC services. PB - Wayne State University U4 - Caregiving JO - Private Long-term Care Insurance and Patterns of Care Use among Older Adults ER - TY - THES T1 - Three Essays on Health Insurance and Health Care Consumption Y1 - 2007 A1 - Liu, Fei KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology AB - The first essay of this dissertation aims to study the decision to enroll in supplementary insurance plans for the Medicare elderly. It also examines the impact of insurance status on several health care utilization measures. The insurance decision and utilization can be influenced by common unobserved attributes, such as attitude toward risks. Therefore, I model medical utilization and insurance choices jointly with a latent factor specification in order to control for unobserved heterogeneity. The estimation method is maximum simulated likelihood. This chapter analyzes a five-wave panel data set derived from the Health and Retirement Study. The empirical results indicate a significant positive relation between supplementary insurance and nights spent in a nursing home, nursing home admission frequency, and hospital admission frequency. The evidence of selection on unobservables is modest. The results also show that supplementary insurance has a negative impact on number of doctor visits in clinics, a measure which excludes doctor contacts made in a hospital or nursing home. In addition, the number of doctor visits exhibits high positive correlation with unobserved heterogeneity. The second essay studies the impact of various supplementary insurance plans on medical expenditures of the Medicare elderly, with a focus on total out-of-pocket expenditure on all kinds of medical services used and out-of-pocket expenditure on prescription drugs. I use quantile regression method and finite mixture models to account for heterogeneity in medical consumption. The empirical results demonstrate the distinct impact of different supplementary insurance plans on health care expenditures. Employer-sponsored supplementary plans have a significant negative impact on total out-of-pocket, and out-of-pocket drug expenditure, relative to individually purchased plans; HMO plans decrease out-of-pocket expenditure significantly relative to other private plans. Quantile regressions show mild variation in the impact of supplementary insurance choices across quantiles. The results from finite mixture models support the hypothesis which assumes the existence of two latent subpopulations. That is, the impact of insurance choice is quite different in the heavy users group and the light users group. The third essay investigates the switching behavior of non-elderly enrollees in U.S. managed care plans. Treatment effect analysis is used to examine the disaggregated expenditures of plan switchers and plan stayers prior to their decision to switch or stay. Propensity score matching methods are used to estimate the average treatment effects on the treated. The results, which are based on a national representative data set from the Medical Expenditure Panel Survey, indicate that switchers (from HMO to non-HMO) spend more on hospitalization. The other type of switchers (from non-HMO to HMO) spends less on prescribed medicine and office-based physician visits. The findings suggest that the non-HMO private managed care plans provide better coverage on hospitalization, office-based physician visits and prescribed medicine than the HMO plans. PB - Indiana University CY - United States -- Indiana U4 - Gerontology JO - Three Essays on Health Insurance and Health Care Consumption ER - TY - THES T1 - Veteran Status, Health Status, and Use of Health Services Y1 - 2007 A1 - Paul R Brezinski KW - Health Conditions and Status KW - Healthcare AB - There are more than seven million veterans aged 70 and older in the United States. Prior research indicates differences in health status and health resource utilization of older veterans, compared with nonveterans of the same age cohort. Improved understanding of these differences can inform fiscal and social policy. One important contributing factor to these differences is the impact of the G.I. Bill. Education is strongly associated with improved health status. Results have implications for health care and education policy, as well as for retirement benefits. This longitudinal research evaluates hypotheses regarding veterans' health status, physician use, and hospital use compared to nonveterans. Education is expected to mediate the veteran effects. The study draws on the Andersen Behavioral Model (1995) for its conceptual framework and is among the most comprehensive applications of the predisposing, enabling, and need paradigm to date. Six waves (1993-2004) of the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD) are analyzed. Primary analyses were conducted using a dichotomous veteran variable (veteran/nonveteran). Separate veteran subgroup analyses (early/late entry, disabled/not disabled, career/noncareer) were also conducted. The study finds evidence of a positive effect of veteran status on both health status and physician utilization, but not hospital utilization. Compared to nonveterans, early entry veterans, non-career veterans and non-disabled veterans have higher health status. Late entry veterans, non-career veterans, and disabled veterans use more physician services relative to nonveterans. The study finds a strong positive effect of education on both health status and physician utilization. Education mediates the veteran status effect on health status and has a direct effect on physician utilization for both veterans and nonveterans. Veteran status also has effects on physician utilization that can not be attributed to education. Further research is warranted to discover specific effects among other veteran cohorts that could be applied to reshape the Veterans' Health Administration and the Military Health delivery systems, as well as to Medicare benefits. PB - University of Iowa U4 - Health Care Utilization JO - Veteran Status, Health Status, and Use of Health Services ER - TY - THES T1 - Caring for Depression and Comorbid Pain: Evidence from HRS and HCC Y1 - 2006 A1 - Tian, Haijun KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - Depression is a common and serious illness, which often occurs together with painful physical symptoms. Though depression and its social and economical impacts have been well documented in the past decades, the role of pain comorbidity is far less understood. Based on two recent national survey datasets, Health and Retirement Study, and Healthcare for Communities, this dissertation investigates the interaction of depression and pain and its impact on labor market, financial, insurance, disability, medication decision, and medication costs outcomes. Chapter 2 examined the relationship between depression and pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65, using wave 3 of Health and Retirement Survey. It found that depression and comorbid pain was associated with worse labor market, financial, insurance and disability outcomes compared to depression alone, and showed the adverse effects were attributed disproportionally to individuals with depression and comorbid pain versus "pure" depression. Chapter 3 examined the relationship between depression and pain, and medication behavior and medication costs outcomes in a nationally representative cross-section of Americans, using first wave of Healthcare for Communities survey. It found that depressed individuals with pain comorbidity were substantially less likely to take antidepressant medications compared to those with depression only, and pain comorbidity was associated with a heavier burden on total medication costs and prescription drug costs. Chapter 4 used Health and Retirement Survey to analyze the effect of depression and comorbid pain on the transition from employment to full retirement for male and female workers. It found that depression and comorbid pain predicted early retirement for female workers, but depression alone did not predict fully retirement for either female workers or male workers. This dissertation not only makes an important contribution to our understanding of depression and pain comorbidity in terms of its prevalence in the general population, and its effect on treatment and access to care, it will also inform health policy makers who want to reduce the burden of depression and pain, and has implications for health care providers and practitioners to improve the quality of care for depression and pain comorbidity. PB - The Pardee RAND Graduate School CY - United States -- California UR - https://search.proquest.com/openview/9dc142c80dfc678ee1e5b7b1e0cc9647/1?pq-origsite=gscholar&cbl=18750&diss=y U4 - Health care JO - Caring for Depression and Comorbid Pain: Evidence from HRS and HCC ER - TY - THES T1 - Change in Depression of Spousal Caregivers of Dementia Patients Y1 - 2006 A1 - Tweedy, Maureen P. KW - Health Conditions and Status KW - Healthcare AB - Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression. PB - University of North Texas CY - United States -- Texas UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1196414461&Fmt=7&clientId=17822&RQT=309&VName=PQD N1 - Masters Thesis U4 - Caregivers JO - Change in Depression of Spousal Caregivers of Dementia Patients ER - TY - THES T1 - The Demography of Community Based Care: The Late Middle-Aged Versus the Elderly Y1 - 2006 A1 - Julie C Lima KW - Health Conditions and Status KW - Healthcare PB - Brown University U4 - Caregiving JO - The Demography of Community Based Care: The Late Middle-Aged Versus the Elderly 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 - JOUR T1 - Development and Validation of a Prognostic Index for 4-year Mortality in Older Adults JF - Journal of the American Medical Association Y1 - 2006 A1 - Sei J. Lee A1 - Lindquist, Karla A1 - Mark Segal A1 - Kenneth E Covinsky KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Context: Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment. . Objective To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report. . Design, Setting, and Participants Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index. Main Outcome Measure Death by December 31, 2002. Results: The overall response rate was 81 . During the 4-year follow-up, there were 1361 deaths (12 ) in the development cohort and 1072 deaths (13 ) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, 85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index 25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4 risk, 6 to 9 points predicting a 15 risk, 10 to 13 points predicting a 42 risk, and 14 or more points predicting a 64 risk. The risk index showed excellent discrimination with a c statistic of 0.84 in the development cohort and 0.82 in the validation cohort. Conclusion: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality. PB - 295 VL - 295 IS - 7 N1 - Article English U4 - CORONARY-HEART-DISEASE/ADMINISTRATIVE DATA/PREDICTIVE MODEL/UNITED-STATES/COMORBIDITY/COMMUNITY/HEALTH/HOSPITALIZATION/PREVENTION ER - TY - JOUR T1 - Development and validation of an index to predict activity of daily living dependence in community-dwelling elders JF - Medical Care Y1 - 2006 A1 - Kenneth E Covinsky A1 - Hilton, Joan A1 - Lindquist, Karla A1 - Dudley, R. A. KW - Health Conditions and Status KW - Healthcare KW - Risk Taking AB - BACKGROUND: Maintaining independence in daily functioning is an important health outcome in older adults. A key measure of functional independence in elders is the ability to do activities of daily living (ADL) without the assistance of another person. However, few prognostic indices have been developed that stratify elders into groups at variable risk for developing ADL dependence. OBJECTIVE: We sought to develop and validate a prognostic index that distinguishes between elders at different risk of ADL dependence. RESEARCH DESIGN, SUBJECTS, AND MEASURES: We studied subjects enrolled in Asset and Health Dynamics Among the Oldest Old (AHEAD), a nationally representative cohort of elders older than the age of 70. We included 5239 subjects (mean age, 77) reporting that they could do each of 5 ADL (bathing, dressing, toileting, transferring, and eating) without the assistance of another person at baseline. Subjects were divided into development (n = 3245) and validation (n = 1994) samples based on region of the United States. Our primary outcome was the need for help (dependence) with at least one ADL at 2 years. We used logistic regression to select among predictor variables encompassing several domains: demographic characteristics, comorbid conditions, functional status, cognitive status, and general health indicators. RESULTS: The 9 independent predictors of 2-year ADL dependence were age older than 80, diabetes, difficulty walking several blocks, difficulty bathing or dressing, need for help with personal finances, difficulty lifting 10 pounds, inability to name the Vice President, history of falling, and low body mass index. We created a risk score by assigning 1 point to each risk factor. In the development sample, rates of 2-year ADL dependence in subjects with 0, 1, 2, 3, 4, and 5 or more risk factors were 1.3 , 2.8 , 3.8 , 10 , 22 , and 33 , respectively (P 0.001, roc area = 0.79). In the validation sample, the rates were 0.7 , 4.3 , 8.7 , 11 , 18 , and 40 (P 0.001, roc area = 0.77). The risk score also discriminated between subjects at variable risk for a combined outcome of either ADL decline or death (4.3 , 7.6 , 15 , 21 , 30 , and 47 ). CONCLUSION: Using data available from patient reports, we validated a simple risk index that distinguished between elders at variable risk of ADL dependence. This index may be useful for identifying elders at high risk of poor outcomes or for risk adjustment. PB - 44 VL - 44 IS - 2 U4 - Activities of Daily Living/risk assessment/risk Factors/health outcomes ER - TY - JOUR T1 - Does Caregiving Increase Poverty among Women in Later Life? Evidence from the Health and Retirement Survey JF - Journal of Health and Social Behavior Y1 - 2006 A1 - Chizuko Wakabayashi A1 - Donato, Katharine M. KW - Healthcare KW - Income KW - Women and Minorities AB - Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being. PB - 47 VL - 47 IS - 3 U4 - Caregiving/WOMEN/Poverty ER - TY - JOUR T1 - Does Religion Influence Patient Satisfaction? JF - American Journal of Health Behavior Y1 - 2006 A1 - Benjamins, Maureen Reindl KW - Demographics KW - Healthcare AB - Objectives: To determine if patient satisfaction varies by level of individual religiosity. Methods: Data from the Health and Retirement Study (HRS), a nationally representative sample of older adults in the United States, were used to assess the relationship between religious salience (importance) and patients satisfaction with their health care encounters. Results: Higher levels of religious salience are significantly related to being very satisfied with one s health care, even after demographic, social, and health variables are taken into account. Conclusions: Researchers, practitioners, and administrators should be aware that religion may significantly influence how patients rate their health care experiences. PB - 30 VL - 30 IS - 1 U4 - Religiosity/Health Care/Patient Satisfaction ER - TY - JOUR T1 - Does Working Longer Make People Healthier and Happier? JF - Center for Retirement Research Issue Brief Y1 - 2006 A1 - Calvo, Esteban KW - Employment and Labor Force KW - Expectations KW - Health Conditions and Status KW - Healthcare AB - Financing retirement is one of the major challenges facing an aging U.S. population. If individuals continue to retire in their early 60s, many will be hard pressed to maintain an adequate standard of living throughout retirement due to the declining role of Social Security, the shift to 401(k) plans, and low personal saving rates. Combine the retirement income crunch with the dramatic increase in life expectancy, and continued employment in later life appears to be an attractive option. While it is clear that working longer would benefit older Americans financially, less attention has focused on the non-monetary effects of work at older ages. This brief addresses the impact of late-life paid work on physical and psychological well-being. The first section reviews the literature on work at older ages and elderly well-being. The second section describes the analysis. The third and fourth sections present the results. The fifth section identifies vulnerable groups. A final section offers concluding thoughts. PB - Series 2 VL - Series 2 IS - Feb U4 - Retirement Expectations/Work Behavior/Social Interaction/health outcomes ER - TY - THES T1 - Essays on Retirement Economics Y1 - 2006 A1 - Eberhardt, Bjorn KW - Employment and Labor Force KW - Expectations KW - Health Conditions and Status KW - Healthcare AB - In the last thirty years, research on the economics of retirement has become increasingly important. Understanding the determinants of the retirement decision is a prerequisite to assessing the impact of public insurance programs or private pension schemes on labor force participation. Given the current uncertainties about Social Security's and Medicare's long-run financial sustainability, increasing labor force participation of the elderly would be a potential way to mitigate these uncertainties. The first chapter of this dissertation reviews the literature on the retirement decision for the last 30 years and summarizes the conclusions reached in this field so far. In the second chapter, the impact of self-rated survival probabilities on the decision to retire is investigated. It is shown that a simple life-cycle model without uncertainty predicts that higher life expectancies should also lead to later retirement. Using data from the Health and Retirement Study, it is found that individual beliefs about the chance of surviving until age 85 can explain part of the variation in retirement ages. Those respondents with below-average beliefs about life expectancies also retire earlier than other respondents, even when controlling for the current health status. The third essay studies the determinants of retiree well-being over time. Previous research has almost exclusively focussed on the economic well-being of retirees. However, non-economic variables may play an important role for the subjective well-being as well. Given that many public policies are aimed at increasing the well-being of individuals, it is important to understand the relative importance of economic and non-economic variables to predict how individual's well-being would respond to such policies. Previous research has mostly relied on cross-sectional data for this analysis, and hence, the contribution of this paper is to increase our understanding in this area by adding a time dimension and study how the well-being of retirees changes over time. The findings confirm the importance of the voluntariness of retirement, as found in earlier studies, and it is also found that on average retiree well-being increases with the length of retirement. PB - The University of Wisconsin - Milwaukee CY - United States -- Wisconsin U4 - Well Being JO - Essays on Retirement Economics ER - TY - THES T1 - Expectations to Move and Residential Mobility in Older Adults: Delineating reactive and proactive decision processes Y1 - 2006 A1 - Julie F. Sergeant KW - Expectations KW - Healthcare AB - Older adults desire to maintain their independence, and most prefer to age in place. In later life, a variety of factors may culminate to challenge these preferences and prompt a residential move to another community-based setting or to a nursing home. The purpose of this study is to gain insight into these residential decision processes. A theoretical model for motivation and self-regulation is helpful for explaining dynamics that occur between goals for independence and to remain at home, the aging context, and expectations to move. This longitudinal research utilizes data from the 2000 and 2002 waves of the Health and Retirement Study to better understand the relationship between expectations to move within two years and actual residential mobility. The sample included adults ages 68 and older who did not live in a nursing home in 2000 and who were able to independently complete the interviews (N =5,020). Results from logistic regression analyses indicated that move expectations were significant predictors of community-based moves within two years, but they did not predict nursing home moves. A significant number of move expectations were interrupted by other life transitions such as marriage. Findings delineated patterns of reactive and proactive residential decision processes. Access to informal support was a critical factor in reactive moves, and fewer health diagnoses, positive perceptions of the physical environment, and use of home- and community-based services were associated with proactive decision patterns. The identification of proactive intervention strategies has implications for improved quality of life for older adults and for policy. This research supports the presentation of residential decision processes as an on-going phenomenon in later life, and the use of subjective probability measures and the motivation and self-regulation research model in gerontological research on ambiguous late-life transitions. PB - The University of Kansas CY - United States -- Kansas U4 - Retirement Expectations JO - Expectations to Move and Residential Mobility in Older Adults: Delineating reactive and proactive decision processes ER - TY - JOUR T1 - Gender Differences across Race/Ethnicity in Use of Health Care among Medicare-Aged Americans JF - Journal of Women's Health Y1 - 2006 A1 - Song, Jing A1 - Chang, Rowland D. A1 - Larry M Manheim A1 - Dorothy D Dunlop KW - Demographics KW - Healthcare AB - Background: Despite Medicare, medical services are not equally used by elderly women and men in the United States. Our purpose is to examine gender differences in healthcare utilization among older Americans, the persistence of gender differences across race/ethnicity, and the roles of sociodemographic, health, and economic factors to explain differences. Methods: Data from the 1998 2000 Health and Retirement Study are used to investigate gender differences in use of hospital, outpatient surgery, home health, and physician services. Analyses are controlled for sociodemographic, health (medical conditions, functional health), and economic (income, wealth, education, health insurance) factors. Results: Women are significantly less likely to use hospital service (odds ratio OR =0.83) and outpatient surgery (OR=0.85) but are more likely to use home health care (OR=1.27) and physician services (OR=1.45), controlling for sociodemographics. Differences in health needs and economic resources partially mediate the gender differences in physician and home healthcare utilization but do not explain the gender differences in hospital service and outpatient surgery. Notably, African American, Hispanic, and white women compared with men show significantly less use of hospital services. Conclusions: Gender differences in medical use vary according to the type of services used and are largely consistent across racial/ethnic groups. As the size of the Medicare population increases, promoting equitable use of healthcare resources by both women and men is an important issue in developing healthcare policy and designing public health strategies. PB - 15 VL - 15 IS - 10 U4 - Health Care Utilization/GENDER-DIFFERENCES/Racial Differences 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 - JOUR T1 - Health Insurance and Health at Age 65: Implications for medical care spending on new Medicare beneficiaries JF - Health Services Research Y1 - 2006 A1 - Hadley, J. A1 - Timothy A Waidmann KW - End of life decisions KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance KW - Other AB - Objectives. To investigate the consequences of endogeneity bias on the estimated effect of having health insurance on health at age 63 or 64, just before most people qualify for Medicare, and to simulate the implications for total and public insurance (Medicare and Medicaid) spending on newly enrolled beneficiaries in their first years of Medicare coverage. . Data. The longitudinal Health and Retirement Survey of people who were 55-61 years old in 1992, followed through biannual surveys to age 63-64 or until 2000 (whichever came first), and those who were 66-70 years olds from the Medicare Current Beneficiary Surveys, 1992-1998. . Study Design. Instrumental variable (IV) estimation of a simultaneous equation model of insurance choice and health at age 63-64 as a function of baseline health and sociodemographic characteristics in 1992 and endogenous insurance coverage over the observation period. . Findings. Continuous insurance coverage is associated with significantly fewer deaths prior to age 65 and, among those who survive, a significant upward shift in the distribution of health states from fair and poor health with disabilities to good to excellent health. Treating insurance coverage as endogenous increases the magnitude of the estimated effect of having insurance on improved health prior to age 65. The medical spending simulations suggest that if the near-elderly had continuous insurance coverage, average annual medical spending per capita for new Medicare beneficiaries in their first few years of coverage would be slightly lower because of the improvement in health status. In addition, total Medicare and Medicaid spending for new beneficiaries over their first few years of coverage would be about the same or slightly lower, even though more people survive to age 65. Conclusions. Extending insurance coverage to all Americans between the ages of 55 and 64 would improve health (increase survival and shift people from good-fair-poor health to excellent-very good health) at age 65, and possibly reduce total short-term spending by Medicare and Medicaid for newly eligible Medicare beneficiaries, even though more people would enter the program because of increased survival. PB - 41 VL - 41 IS - 2 N1 - Article English U4 - insurance/health outcomes/Medicare and Medicaid spending/IV analysis/INSTRUMENTS/SERVICES/COVERAGE/DECLINE ER - TY - JOUR T1 - Health Insurance Coverage and the Risk of Decline in Overall Health and Death Among the Near Elderly, 1992-2002 JF - Medical Care Y1 - 2006 A1 - David W. Baker A1 - Joseph J Sudano A1 - Durazo-Arvizu, Ramon A1 - Joseph Feinglass A1 - Whitney P. Witt A1 - Jason A. Thompson KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Other AB - Background: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time. . Objective: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage. .Methods: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals. . Results: People who were uninsured at baseline had a 35 (95 confidence interval CI 12-62 ) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95 CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95 CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6 ) died; of those who died, only 70 (31.8 ) were still uninsured at the HRS inter-view prior to death. Conclusions: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance. PB - 44 VL - 44 IS - 3 N1 - Article English U4 - health insurance/mortality/health status/outcome studies/SELF-RATED HEALTH/MYOCARDIAL-INFARCTION/REGRESSION-ANALYSIS/LONGITUDINAL DATA/MORTALITY/OUTCOMES/TERMINATION/CANCER/COHORT/SPELLS ER - TY - JOUR T1 - The Impact of Comorbidity on Wealth Changes in Later Life JF - Journals of Gerontology, Series B: Psychological Sciences and Social Sciences Y1 - 2006 A1 - Hyungsoo Kim A1 - Jinkook Lee KW - Demographics KW - Healthcare KW - Net Worth and Assets AB - Despite the high prevalence of comorbidity in later life, scientists do not fully understand its financial impact. The objective of this study was to enhance researchers' understanding of the impact of compounded health problems on the wealth of older people. Using data from the Asset and Health Dynamics Among the Oldest Old study (1995 to 2002 waves), we conducted ordinary least squares regression analysis on wealth changes. We found that comorbidity leads to significant wealth depletion in later life, especially for single elders. Single elders with comorbidity depleted 20 to 22 of their wealth over a 2- to 3-year time period, especially those with the combination of heart disease and diabetes. The impact of comorbidity was disproportionately greater than the estimated impact of a single health problem. However, the impact of comorbidity did not appear to be significant among married people. We found that compounded health problems also create compounded financial problems in later life. For an accurate estimation of the financial consequences of health problems, it is important to consider comorbid health problems, as the effect of comorbidity is not equal to the sum of the effects of single health problems. PB - 61B VL - 61B UR - http://psychsoc.gerontologyjournals.org/ IS - 6 U4 - HEALTH-CARE COSTS/Wealth/Elderly 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 - THES T1 - Labor Market Responses to the Onset of Disabilities or Health Problems for Older Workers: A longitudinal study of race difference Y1 - 2006 A1 - Xu, Judy KW - Demographics KW - Disabilities KW - Employment and Labor Force KW - Healthcare AB - This study assesses dynamic racial differences in the labor market responses of older workers (aged 50-64) to the onset of disabilities and health problems. The study uses the national representative longitudinal data of the Health and Retirement Study (HRS) from 1992 to 2002. Discrete hazard models are developed to study differences across race as far as the risk of older workers exiting the labor market following the occurrence of disabilities or health problems. Additionally, multinomial logit models are developed to study the differences across race with respect to full-time to part-time transitions and changes in employers following the occurrence of disabilities or health problems. The results show that exit risk is significantly higher for older black female workers with reported work limitations or major health events than for their white counterparts. For older males, differences in exit risk across race are evident only where functional limitations exist. The magnitudes of the effects of the onset of disabilities or health problems on employer transitions or on the decision whether or not to choose a part-time job are much less than the effects of those on the hazard of exiting the labor market. Black males are more likely to work part-time as well as exit the labor market than white males following the onset of functional limitations. Black females are less likely to change employers than white females following the onset of functional limitations. The study suggests that as blacks become older, they may suffer relatively greater economic losses following the onset of disabilities or health problems than their white counterparts. It would appear that differences across race more likely result from differences in labor market exit risk than from differences in job transition. It would also appear that racial differences in education and job skills may explain some of the racial gaps among older workers---especially among female older workers---in labor market responses to the onset of disabilities and health problems. Further studies on the issue are important for understanding differences across race with respect to labor decision processes and economic well-being when individuals approach retirement. PB - The Johns Hopkins University U4 - Health Problems (D353100) JO - Labor Market Responses to the Onset of Disabilities or Health Problems for Older Workers: A longitudinal study of race difference ER - TY - JOUR T1 - Parent Care and the Stress Process: Findings from panel data JF - The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences Y1 - 2006 A1 - Amirkhanyan, Anna A. A1 - Douglas A. Wolf KW - Health Conditions and Status KW - Healthcare AB - OBJECTIVE: The purpose of this study was to test with panel data an extended model of the stress process recognizing the separate effects of a parent's need for care and an adult child's caring activities. Methods. Using data from the 1996, 1998, and 2000 waves of the Health and Retirement Study, we estimated nonlinear mixed models of mental health outcomes. We assessed mental health for separate samples of 3,350 men and 3,659 women by using an 8-item scale of depressive symptoms. We also explored the sensitivity of results to alternative measures and model specifications. RESULT: . We found that female, but not male, caregivers whose parents needed care exhibited adverse mental health consequences. However, we found that, generally, both male and female noncaregivers whose parents needed care were more likely to report symptoms of depression than were noncaregivers without disabled parents. Additional findings suggest that the stress process is still more complex among married couples. Discussion. This study distinguishes the outcomes of parental care needs from those attributable to caregiving activities. Adverse psychological outcomes appear to be dispersed throughout the family. To focus narrowly on active caregivers is to underestimate the social burdens of disability at older ages. PB - 61 VL - 61 UR - http://psychsoc.gerontologyjournals.org/contents-by-date.2006.shtml IS - 5 U4 - Caregivers/Stress Psychology 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 - RPRT T1 - The Size and Characteristics of the Residential Care Population: Evidence from Three National Surveys Y1 - 2006 A1 - Brenda C Spillman A1 - Black, Kirsten J. KW - Healthcare KW - Housing AB - This report is the second of two prepared as part of a project to better understand the size and characteristics of the long-term care population in all settings. Identified were three recently federally supported surveys — the 2002 Health and Retirement Survey, the 2002 Medicare Current Beneficiary Survey Cost and Use file, and the National Long-Term Care Survey — as being best suited for the purpose because of their focus on the older population and data elements that allow identification of residential care alternatives by name, services available, or both. In this report, the authors report on their analysis of these surveys and discuss the implications of our findings for improving collection of data on residential settings. PB - U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy CY - Washington, D.C. UR - https://aspe.hhs.gov/pdf-report/size-and-characteristics-residential-care-population-evidence-three-national-surveys U4 - Home Care Services/Home Nursing/Home Modifications ER - TY - THES T1 - A Three-Part Study on the Relationship Between Retirement Planning and Health Y1 - 2006 A1 - Linda Christine Albert KW - Health Conditions and Status KW - Healthcare KW - Public Policy KW - Retirement Planning and Satisfaction AB - Researchers consistently conclude that finances and health are the two most significant factors associated with retirement decision-making and a successful retirement experience. Retirement planning is one mechanism by which individuals prepare for the retirement transition; however, retirement planning routinely emphasizes financial concerns, often to the exclusion of health or other significant aspects of retirement. Retirement planning is an increasingly relevant topic at a time when the population is aging, company-sponsored pensions and retiree benefits have diminished significantly, and reform is being sought for the long-standing social programs that have provided support for generations of older Americans. From a financial perspective, few would question the positive benefits associated with retirement planning; however, preparing for a healthy retirement is equally important. If a relationship between retirement planning and health status were to be established, Americans might find increased public and private support for individual retirement planning efforts, particularly among more vulnerable populations such as minorities and women. This dissertation explores the notion that engagement in retirement planning is associated with health status through three studies. Utilizing data from the Health and Retirement Study (HRS), the first article explores prevalence of plans for retirement among worker and retiree respondents, and compares health and other key characteristics associated with planning among the two sub-samples. The second and third articles focus on time order relationships between health status and retirement planning, with article two addressing the question of whether onset of poor health precedes planning for retirement and article three examining health status of planners versus non-planners, over time, to determine whether those who engage in retirement planning are more likely to realize better health outcomes. A brief review of the health, retirement, and retirement planning literature provides the theoretical framework for these research questions and related hypotheses. This dissertation consists of five chapters. Chapter 1 is an introduction to the retirement planning and health literature, Chapters 2-4 describe the series of three studies conducted, and Chapter 5 discusses the overall conclusions as well as future directions for research. PB - University of South Florida CY - United States -- Florida UR - http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=3436&context=etd JO - A Three-Part Study on the Relationship Between Retirement Planning and Health ER - TY - JOUR T1 - The Aging, Demographics and Memory Study: Study Design and Methods JF - Neuroepidemiology Y1 - 2005 A1 - Kenneth M. Langa A1 - Brenda L Plassman A1 - Robert B Wallace A1 - A. Regula Herzog A1 - Steven G Heeringa A1 - Mary Beth Ofstedal A1 - James F. Burke A1 - Gwenith G Fisher A1 - Fultz, Nancy H. A1 - Michael D Hurd A1 - Guy G Potter A1 - Willard L Rodgers A1 - David C Steffens A1 - David R Weir KW - Health Conditions and Status KW - Healthcare AB - Objective: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and cognitive impairment, not demented (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data. Methods: The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals aged 70 or older who were participants in the on-going HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g., Alzheimer disease, vascular dementia) were assigned to denote the etiology of cognitive impairment. Conclusion: Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally-representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia. PB - 25 VL - 25 U4 - Aging/Dementia/Epidemiology ER - TY - JOUR T1 - Depressive Symptoms of Caregiving Women in Midlife: The role of physical health. JF - Journal of Women and Aging Y1 - 2005 A1 - Timothy S Killian A1 - M Jean Turner A1 - Rebekah Cain KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - This research examined the relationships between providing assistance to aging family members, caregivers' age, caregivers' perceptions of their physical health, and caregivers' depressive symptoms. Several alternative hypotheses were examined. Longitudinal data from 1,898 women from the 1992 and 2000 waves of the Health and Retirement Study (HRS) were used. Results indicate a reciprocal relationship between depression and physical health. These processes were examined using a path analysis. Although the evidence only supported one of the hypotheses, this study clearly demonstrated the importance of physical health for the psychological well-being of women in midlife. PB - 17 VL - 17 IS - 1/2 U4 - Caregivers/Depression/Health Physical/Women ER - TY - JOUR T1 - Differences in Amount of Informal Care Received by Non-Hispanic Whites and Latinos in a Nationally Representative Sample of Older Americans JF - Journal of the American Geriatrics Society Y1 - 2005 A1 - Weiss, Carlos O. A1 - Hector M González A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Healthcare KW - Women and Minorities AB - The objective of this study was to evaluate informal (unpaid) care and its broad determinants for Latinos in a nationally representative sample. A cross-sectional analysis of the 1993 Asset and Health Dynamics Study, a national probability sample of 7,443 older adults aged 70 and older, was performed to determine the independent effect of Latino ethnicity on the receipt of informal care by disabled older individuals. Self-reported race/ethnicity was used to predict the mean daily hours of informal care received for activity of daily living (ADL) or instrumental activity of daily living (IADL) assistance after adjustment for predisposing, need, and enabling variables. There was a significant association between informal home care and ethnic group, with 44.3 of Latinos receiving informal care, compared with 33.9 of African Americans and 24.6 of non-Hispanic whites (Po.001). After adjustment, Latinos received 11.0 weekly hours of informal care, compared with 7.5 hours for non-Hispanic whites and 6.3 hours for African Americans (Po.001). The results from this nationally representative sample indicate that Latinos receive significantly more hours of informal care on average than African Americans or non-Hispanic whites for ADL and IADL disability. Clinicians should be alert to the significant amount of informal care and possible associated strain in caregivers of older Latinos. PB - 53 VL - 53 IS - 1 U4 - Hispanic Americans/Caregiving ER - TY - JOUR T1 - Do Seniors Understand Their Risk of Moving to a Nursing Home? JF - Health Services Research Y1 - 2005 A1 - Donald H. Taylor Jr. A1 - Ostermann, Jan A1 - Acuff, S. Will A1 - Truls Ostbye KW - Health Conditions and Status KW - Healthcare AB - Objective: To determine whether seniors understand their risk of moving to a nursing home. Data Sources: We used longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) database. AHEAD is a nationally representative survey (n=8,203) of community dwellers aged 70 years and their spouses. Study Design: We followed respondents for 5 years from the date of the first interview fielded in 1993. Our primary dependent variable was whether respondents moved to a nursing home within 5 years of baseline; self-assessed probability of moving to a nursing home within 5 years, also assessed at baseline, was the primary explanatory variable. Principal Findings: We found that seniors who believed they were more likely to move to a nursing home within 5 years were indeed more likely to do so, and that most elders overestimated their likelihood of moving to a nursing home. Conclusions: Low rates of private long-term care insurance are not plausibly a result of seniors underestimating their personal risk of moving to a nursing home; such an assumption is inherent in many strategies to plan for the future long-term care needs of the baby boom generation. PB - 40 VL - 40 IS - 3 U4 - Long-Term Care/Nursing Homes/Aging ER - TY - RPRT T1 - Documentation of Chronic Disease Measures in the Health and Retirement Study Y1 - 2005 A1 - Gwenith G Fisher A1 - Jessica Faul A1 - David R Weir A1 - Robert B Wallace KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - The focus of this report is on (1) self-rated overall health status and recent changes in overall health, (2) the presence of common chronic medical conditions and follow-up questions concerning treatments in all waves of the core HRS/AHEAD through 2002. PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan U4 - health Status/chronic Disease/health measures/Survey Methods ER - TY - THES T1 - Does Gendered Labor Force Structure Affect Adult Children's Provision of Transfer to Their Elderly Parents? An Examination of the Late-Middle-Aged Generation Y1 - 2005 A1 - Shieh, Ching-yi KW - Adult children KW - Demographics KW - Healthcare AB - Adult children are key supporters of elderly parents, providing both monetary and time resources. In the existing literature, the most commonly used approach to assess this intergenerational transfer process is the "need versus ability" model. It posits that parents with higher need are more likely to receive support, whereas adult children equipped with better support-giving ability are more likely to give transfers. In addition, adult children's transfer motivation, including altruism, reciprocity, and rational calculations, all provide theoretical insight into the question of transfer differentials. Using the 1992 and 1996 Health and Retirement Study (HRS 92, 96), this dissertation goes beyond the need, ability, and motivation model to examine how adult children ages 51 to 61 satisfy their non-coresident parents' need. This project incorporates gender norms and adult children's labor force participation constraints to assess the gendered division of transfer practices. The effects of spouses' and siblings' roles, resource competition between grandchildren and their grandparents, resource competition between two living parents, and adult children's life course transition, are also considered. Statistical analysis shows that both gender norms and the gendered labor force structure affect adult children's transfer behaviors. Adult sons tend to use monetary transfers to substitute for time contributions because their opportunity costs in the wage market are high. Conversely, because the social norms construe women as primary caregivers, adult daughters' time contributions to parents do not decrease even when they are well-paid. Spouses of adult children may either be transfer supporters or resource competitors to their parents-in-law. While siblings are important in transfer practices, this study finds that sisters are more likely to substitute for adult children's caregiving roles, whereas brothers' contributions supplement adult children's transfer efforts. Finally, adult children's transfer practices are sensitive to their employment transitions. Adult children who stayed in the labor force from 1992 to 1996 are the most likely to increase their amount of monetary transfers. On the other hand, those who retired from their paid jobs in the studied time interval are more likely to increase their time contributions. PB - University of Maryland, College Park UR - http://hdl.handle.net/1903/2463 U4 - Gender JO - Does Gendered Labor Force Structure Affect Adult Children's Provision of Transfer to Their Elderly Parents? An Examination of the Late-Middle-Aged Generation ER - TY - THES T1 - The Effect of Health Insurance on the Health, Health Care, and Labor Market Outcomes of the Near-Elderly: Evidence from the Health and Retirement Study Y1 - 2005 A1 - Jody Schimmel KW - Employment and Labor Force KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - The vast majority of individuals in the United States obtain their health insurance through employer-sponsored plans. Though there are benefits to offering health insurance through the employment setting such as risk pooling, lower administrative costs, and tax advantages, this arrangement may lead to unintended side effects such as a lack of portability of benefits or uninsurance during job transitions. Those who lack health insurance have increased financial risk, diminished access to appropriate medical care, and may suffer from worse health outcomes as a consequence. The three chapters of this dissertation explore various aspects of health insurance: its effects on health care utilization and medical expenditures, on health outcomes, and finally, on the determination of wages in the market equilibrium among those around the age of 65. First, I exploit the exogenous change in health insurance that occurs for most Americans at age 65 due to Medicare enrollment to study the effects of uninsurance on health care utilization and health. I find that those who are uninsured prior to Medicare store-up demand in anticipation of insurance coverage, particularly for services that are more easily delayed and more elective in nature such as doctor's visits and outpatient surgery. I also find that those who obtain insurance coverage at age 65 experience an increased rate of diagnosis of chronic conditions such as heart and lung conditions compared to those who had continuous insurance coverage. The combination of the increased utilization and diagnosis upon obtaining insurance coverage provides evidence that those who lack insurance do not receive timely diagnosis and may have worse health trajectories throughout the rest of their life course as a result. Finally, I attempt to uncover the tradeoff between monetary wages and health insurance in the labor market equilibrium by exploiting variation in the preference for health insurance among married women. Together, these three chapters provide a unique look into the health insurance choices of the near-elderly and the consequences of the lack of health insurance on health and the use of health services. PB - University of Michigan U4 - Wages, Compensation, and Labor Costs: General (J300) JO - The Effect of Health Insurance on the Health, Health Care, and Labor Market Outcomes of the Near-Elderly: Evidence from the Health and Retirement Study ER - TY - JOUR T1 - Epidemiologic studies on disability prevention - Perspectives from the English longitudinal study of ageing (ELSA) and the US health and retirement study JF - The Gerontologist Y1 - 2005 A1 - David Melzer A1 - Jack M. Guralnik A1 - Robert B Wallace KW - Demographics KW - Healthcare AB - An abstract of a study by Benjamin and Matthias examining client outcomes in several areas: service experience, safety, empowerment, unmet needs, service satisfaction, and quality of life is presented. Interpretation of the findings is complex; variations may be due to differences in quality of care or differences in perceptions shaped by cultural lenses. PB - 45 VL - 45 N1 - Meeting Abstract English U4 - clinical outcomes/Home health care/Older people/Racial Differences ER - TY - THES T1 - Essays on Intergenerational Transfers Y1 - 2005 A1 - Wang, Jingshu KW - Adult children KW - Healthcare AB - Intergenerational transfers are an important economic phenomenon, with many aspects still unknown. Using national longitudinal data from the Health Retirement Study, this dissertation expands the issue of transfers into three other economic areas and offers new research angles and techniques. The first study investigates how recent welfare reforms affect childcare provision by grandparents. In general, parents of single mothers are found to spend more time with their grandchildren. Welfare reforms affect grandparents differently: for families who had been depending on grandparents for childcare, welfare reforms increase their reliance on this safety net. However, for families who did not have such a relationship with grandparents, there is no increase in the likelihood that they will start to use grandparents caring for their grandchildren after welfare reforms. As grandparents are usually the primary childcare providers next to center care, the finding that some families did not use grandparents for childcare raise the concern that these school-age children may not be receiving enough adult supervision. The second study estimates the price of time, i.e. the unit value people put on time doing certain activities. It finds that time spent on caregiving did not affect the value of time on leisure, indicating that caregiving was not treated in the same way as labor market work. It thus offers an explanation why previous studies find different relationship between these two decisions. Furthermore, the study provides a framework to simulate policies that compensate caregivers for their care provision. The simulation results show that such policies can increase the amount of caregivers and caregiving, with a low corresponding reduction in labor supply. The third study proposes new tests and evidence of the transfer motive, an important yet inconclusive question in the literature. It examines the key relationship on which the "exchange motive" model is built: whether a donor's behavior is affected by his own expectation of receiving an inheritance or intervivos transfers. The study finds that children's time transfers were positively associated with their expectation of intervivos transfers. They were found not to be affected by the expectation of receiving bequests. PB - Duke University U4 - Bequests JO - Essays on Intergenerational Transfers ER - TY - THES T1 - Essays on Intergenerational Transfers in Older Families Y1 - 2005 A1 - Azuma, Misuzu KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Methodology AB - In a series of three essays, I examine intergenerational transfers between elderly parents and their adult children. In the first chapter, I examine the extent to which informal care from family members substitutes for nursing home care. I build a model of families' care decisions for their elderly relatives. My model predicts that nursing home admission is postponed for elderly persons with greater access to informal care. It also predicts that elderly individuals with greater access to informal care enter nursing homes only after their care needs become more severe. To test the predictions of my model, I use data from the 1993-2000 waves of the Assets and Health Dynamics Among the Oldest Old (AHEAD) study. I find that elderly individuals who are married and have more daughters enter nursing homes significantly later. I also find that elderly individuals who are married and are living with their adult children before nursing home entry face significantly higher mortality risk subsequent to nursing home entry. In the second chapter, I examine whether the generosity of the public transfer program for low-income elderly persons, Supplemental Security Income (SSI), displaces private support from family members in the form of coresidence. I use data from the first wave of the AHEAD study. My findings indicate that a $1,000 increase in SSI annual benefits reduces the probability of coresidence by 0.41 percent, implying a small effect of the SSI program on coresidence for the low-income elderly individuals. In the third chapter, coauthor Professor Meta Brown and I examine the motives for holding a trust, using data from the 1995-2002 waves of the Health and Retirement Study. We argue that among households with living trusts, 83 percent of living trusts are created to avoid a probate. We find that few households that are subject to federal estate tax take advantage of living trusts to minimize the estate tax. We also find that among households with estate trusts, 70 percent of estate trusts are created to restrict consumption pattern of the surviving spouse and to guarantee that assets are transferred to their adult children. PB - The University of Wisconsin - Madison CY - United States -- Wisconsin UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1059994081&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - Economics JO - Essays on Intergenerational Transfers in Older Families ER - TY - THES T1 - Expectations of Nursing Home Use: Patterns, levels, and impact on the purchase of long-term care insurance Y1 - 2005 A1 - Lin, Hung-Tai KW - Expectations KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - A substantial literature examining the factors associated with actual nursing home entry and the lifetime risk of nursing home use is often used to infer who is most at risk of asset depletion and, therefore, for whom nursing home insurance or additional savings is most valuable. Yet insurance purchases or additional savings must be driven by expectations. This dissertation utilizes longitudinal data from the Health and Retirement Study to examine the following research questions: 1) whether the five-year perceived risk of entering a nursing home is different for a specific age cohort over time, 2) whether the factors individuals use to assess their perceived five-year versus lifetime probability and five-year expectations of nursing home entry over time are different, and 3) how individuals incorporate lifetime expectations into their long-term care insurance decision. The results show the average perceived five-year risk of entering a nursing home increases at all ages over time, with female respondents reporting higher average five-year expectations than male respondents from 1994 to 2002. I find that individuals use different factors to assess their risk of nursing home entry over the next five-years versus over their remaining lifetime. I conclude that the first reflects their assessment of the risk of short-term rehabilitative or post-hospitalization stays while the second their assessment of long-term custodial care risks. I conclude these are two very different questions, capturing very different reasons for nursing home entry. I argue that an examination of changes in long-term care insurance decisions is the best way to measure the sensitivity of purchasing long-term care insurance to changes in the environment in which decisions are formulated. In addition to examining the determinants of having long-term care insurance, this dissertation uses an event history analysis to understand the correlates of long-term care insurance purchase. The analysis examines how individuals incorporate new information on risk factors, particularly their perceived lifetime risk of entering a nursing home. Although the price of long-term care insurance rises with age, the results suggest that these respondents, 60-69 in 1996, purchased additional insurance in response in part to new information. PB - The University of Wisconsin - Madison CY - United States -- Wisconsin UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1059992401&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - Life Expectancy JO - Expectations of Nursing Home Use: Patterns, levels, and impact on the purchase of long-term care insurance ER - TY - THES T1 - Impact of Food Insecurity and Food Assistance Programs on Nutrition and Health Outcomes in Elders Y1 - 2005 A1 - Kim, Kirang KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Income AB - This research examined the relationship between need and help-seeking behavior over time in elders, looking at the pattern of food insecurity and program participation, which are a part of need and help-seeking behavior. Then, it assessed how a help-seeking behavior (i.e., participation in food assistance programs) among elders in need (i.e., food insecure elders) affected multiple outcomes such as obesity, depression, and health service utilization. For addressing these research questions, secondary data analysis was done using two longitudinal data sets: Health and Retirement Study (HRS 1996, 2002) and the Asset and Health Dynamics Among the Oldest Old (AHEAD 1995, 2002). The finding on patterns of food insecurity and participation in food assistance programs over time showed that need and help-seeking behavior were changeable but the variation over time was small. The relationship between them was monotonic and increasing. Food insecurity was a useful indicator of need for participation in food assistance programs and previous experience of participation was an important indicator of help-seeking behavior. While food insecurity was a part of need for participation in food assistance programs, for health service utilization it appeared to be a barrier that makes food insecure elders be less likely to use health services. While food insecurity increased overweight and depression, participation in food assistance programs had beneficial impacts on poor health outcomes resulting from food insecurity. Food insecure elders who participated in food assistance programs were less overweight, depressed, and admitted to hospital and nursing home than those who did not participate in the programs. Findings of positive impacts on reducing or preventing obesity, depression, and admission to hospital and nursing home implies other benefits of food assistance programs such as decreased health-care expenditures and increased independence of elders, supporting further development of these programs for elders. PB - Cornell University U4 - Obesity JO - Impact of Food Insecurity and Food Assistance Programs on Nutrition and Health Outcomes in Elders ER - TY - RPRT T1 - Medicaid: Transfers of Assets by Elderly Individuals to Obtain Long-Term Care Coverage Y1 - 2005 A1 - United States Governmental Office KW - Adult children KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets AB - In fiscal year 2004, the Medicaid program financed about $93 billion for long-term care services. To qualify for Medicaid, individuals' assets (income and resources) must be below certain limits. Because long-term care services can be costly, those who pay privately may quickly deplete their assets and become eligible for Medicaid. In some cases, individuals might transfer assets to spouses or other family members to become financially eligible for Medicaid. Those who transfer assets for less than fair market value may be subject to a penalty period that can delay their eligibility for Medicaid. GAO was asked to provide data on transfers of assets. GAO reviewed (1) the level of assets held and transferred by the elderly, (2) methods used to transfer assets that may result in penalties, (3) how states determined financial eligibility for Medicaid long-term care, and (4) guidance the Centers for Medicare & Medicaid Services (CMS) has provided states regarding the treatment of asset transfers. GAO analyzed data on levels of assets and cash transfers made by the elderly from the 2002 Health and Retirement Study (HRS), a national panel survey; analyzed states' Medicaid applications; and interviewed officials from nine states about their eligibility determination processes. In 2002, over 80 percent of the approximately 28 million elderly households (those where at least one person was aged 65 or over) had annual incomes of $50,000 or less, and about one-half had nonhousing resources, which excluded the primary residence, of $50,000 or less. About 6 million elderly households (22 percent) reported transferring cash, with amounts that varied depending on the households' income and resource levels. In general, the higher the household's asset level, the more likely it was to have transferred cash during the 2 years prior to the HRS study. Overall, disabled elderly households--who are at higher risk of needing long-term care--were less likely to transfer cash than nondisabled elderly households. Certain methods to reduce assets, such as spending money to pay off debt or make home modifications, do not result in penalty periods. Other methods, such as giving gifts, transferring property ownership, and using certain financial instruments, could result in penalty periods, depending on state policy and the specific arrangements made. None of the nine states GAO contacted tracked or analyzed data on asset transfers or penalties applied. These states required applicants to provide documentation of assets but varied in the amount of documentation required and the extent to which they verified the assets reported. These states generally relied on applicants' self-reporting of transfers of assets, and officials from these states informed GAO that transfers not reported were difficult to identify. To help states comply with requirements related to asset transfers, CMS has issued guidance primarily through the State Medicaid Manual. CMS released a special study in 2005 to help states address the issue of using annuities as a means of sheltering assets. Additionally, CMS officials provide ongoing technical assistance in response to state questions, but noted the challenge of issuing guidance applicable to all situations given the constantly changing methods used to transfer assets in an attempt to avoid a penalty period. In commenting on a draft of this report, CMS noted the complexity of the current law and commented that data on the precise extent and cost of asset transfers to the Medicaid program have been difficult to gather. JF - GAO Report PB - U.S. Government Accountability Office CY - Washington, DC UR - http://www.gao.gov/cgi-bin/getrpt?GAO-05-968 U4 - Assets/Transfers/Long-Term Care/Medicaid ER - TY - JOUR T1 - Medical Diagnosis Can Induce Depressive Symptoms JF - The American Journal of Nursing Y1 - 2005 A1 - Kayalli, Andrea KW - Health Conditions and Status KW - Healthcare AB - Researchers used the data from the Health and Retirement Study to assess symptoms of depression in those between the age of 51 and 61 who were not depressive at the beginning of the study. The state of each subject's emotions was evaluated periodically with specific attention paid to the connection between their emotions and a recent medical diagnosis. PB - 105 VL - 105 IS - 11 U4 - Depressive Symptoms/Diagnosis/aging ER - TY - JOUR T1 - Socioeconomic Differentials in Mortality and Health at the Older Ages JF - Genus Y1 - 2005 A1 - Eileen M. Crimmins KW - Demographics KW - Health Conditions and Status KW - Healthcare PB - LXI VL - 61 IS - 1 U4 - MORTALITY/socioeconomic Status/health outcomes ER - TY - THES T1 - Three Essays in Labor Economics and the Economics of Aging Y1 - 2005 A1 - Nizalova, Olena KW - Employment and Labor Force KW - Healthcare AB - Essay I. The Wage Elasticity of Informal Care Supply: Evidence from The Health and Retirement Study. This paper analyzes the relationship between wages and the supply of informal care. Unlike most of the previous research estimating wage elasticities of informal care supply, this study recognizes that the wage rate may be measured with error or may be correlated with omitted variables and employs instrumental variables techniques to overcome these problems. Based on the data from the 1998 wave of the Health and Retirement Study, the results show that the wage elasticity of informal care supply is negative and larger in magnitude than has been found previously. Additional findings suggest that informal care supply is more elastic among individuals with siblings and that it differs by the type of care provided to elderly parents (help with basic personal needs vs. help with household chores, transportation, errands, etc.). Essay II. Economic Consequences of the Death of Elderly Parents (In Progress). The death of an elderly parent might have numerous effects on the financial well being of the households of the surviving adult children. On the one hand, there is a possibility of inheritance and/or cessation of a period of caregiving on the part of the surviving children. On the other hand, there may be significant impact of the grieving process on everyday activities that may be translated into economic losses. Economists have done very little to explore these effects. This paper will use 1992-2002 data from the Health and Retirement Study to produce a descriptive account of the financial impact on surviving children of the death of an elderly parent. This data will allow an examination of the time path of earnings and household income both for households that did experience the death of an elderly parent during the panel and for households that did not, an obvious comparison group. The relationship between the impact of the death and the circumstances surrounding the death (i.e. sudden death vs. death after long illness) will also be explored. The descriptive account of this paper will provide evidence that will allow both the formulation and the testing of hypotheses about the impact of the death of an elderly parent. Essay III. Minimum Wages in the Longer Run (with David Neumark). Exposure to minimum wages at young ages may lead to longer-run effects. Among the possible adverse longer-run effects are decreased labor market experience and accumulation of tenure, lower current labor supply because of lower wages, and diminished training and skill acquisition. Beneficial longer-run effects could arise if minimum wages increase skill acquisition, or if short-term wage increases are long-lasting. PB - Michigan State University U4 - Caregiving JO - Three Essays in Labor Economics and the Economics of Aging ER - TY - THES T1 - Three Essays on Retirement Wealth Y1 - 2005 A1 - Walker, Lina KW - Adult children KW - Healthcare KW - Housing KW - Net Worth and Assets AB - One of the central questions in economics is what motivates savings. This question is important for a number of reasons, one of which is it provide a benchmark for evaluating whether households are financially prepared for retirement. This is particularly relevant given the aging of the baby boom cohort, where the anticipated surge in the number of elderly persons could exert considerable pressure on the budgets of existing government programs. My dissertation includes three essays that focus on some of the current themes in the ongoing debate over the motivation for savings. The first essay focuses on the tendency among the elderly to hold onto their homes and examines whether this behavior is consistent with the notion that housing wealth is insurance against out-of-pocket medical expenses in retirement. I find that housing sales for single households is mostly driven by worsening health and it suggests that homeowners are selling because of a change in demand for housing services. Among married households, there are indications that some households are selling in order to access housing equity; however, the magnitude of the effect is very small. Taken together, the evidence does not lend much validity to the insurance story. The second essay examines the effect of uncertain nursing home expenses in retirement on savings behavior. Using differences in differences, I find that households with lower exposure to nursing home expenses accumulate lower retirement wealth. The results suggest that households are responsive to the incentives embedded in the Medicaid program and they are forward-looking in their savings decisions. The third essay focuses on the tendency among parents to leave equal inheritances to all their children. The paper examines the pattern of bequest giving and attempts to draw a picture of what motivates bequests. I find that the larger the differences among children, the more likely the decedent deviates from equal giving. These differences include differences in children's resources and differences in time assistance to parents. Among decedents that choose unequal division, bequests appear to be motivated by exchange. Among decedents that choose equal division, bequests are consistent with altruist preferences. PB - University of Michigan CY - Ann Arbor, MI UR - https://www.proquest.com/docview/305459722 U4 - Bequests JO - Three Essays on Retirement Wealth ER - TY - THES T1 - Black-White Mental and Physical Well-Being Following Divorce Y1 - 2004 A1 - Avellar, Sarah A. KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Despite the consistent link between divorce and deleterious mental and physical health outcomes, racial variations have been relatively neglected. With divergent socioeconomic statuses, rates of divorce, and other stressors, African-Americans and whites are likely to experience divorce in very different contexts. Racial differences in health outcomes after divorce are often the result of particular constraints and resources, and thus reveal the functioning of social arrangements. I address this issue in three separate but related chapters. In Chapter II, I use five waves of the Health and Retirement Study (HRS) to examine racial differences in divorce outcomes among older people. Today's midlife and elderly cohorts are probably the first to contain a substantial number of divorcees. I model self-rated health, limitations in activities of daily living, other physical limitations, and mortality for 1) the overall sample and 2) a transitioners sample, comprised of respondents who divorce or separate between waves. The results indicate that in the overall sample, divorce affects blacks and whites similarly and negatively, though this is largely accounted for by an individual's wealth. In the transitioners sample, divorce is associated with an improvement in health status, though only for white respondents. In Chapter III, I establish whether the health gap between the divorced and married exists for both blacks and whites. I model self-rated health and depressive symptoms with both waves of the National Survey of Families and Households (NSFH), for a nationally representative sample of all ages. In addition to longitudinal data, I improve on past research by employing multiple estimations of the health gap: ordinary least squares, fixed-effects, and matching models. The results suggest that both blacks and whites experience an increase in depressive symptoms after divorce, but the results for self-rated health are inconsistent and weak. The last analytic chapter, Chapter IV, is an examination of whether other factors can account for the heightened depressive symptoms associated with divorce. Again using the NSFH, I include sociodemographic, psychological, social, and relationship variables in OLS models. For both blacks and whites, the heightened distress can be accounted for by employment, worries about income, and having moved. PB - University of Michigan CY - United States -- Michigan UR - https://search.proquest.com/docview/305181892?pq-origsite=gscholar&fromopenview=true U4 - Depressive Symptoms JO - Black-White Mental and Physical Well-Being Following Divorce ER - TY - JOUR T1 - Diabetes Diagnosis and Weight Loss in Middle-Aged Adults JF - Research on Aging Y1 - 2004 A1 - Linda A. Wray A1 - Caroline S Blaum A1 - Mary Beth Ofstedal A1 - A. Regula Herzog KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Using three waves of Health and Retirement Study data, this study investigated whether (a) self-reported physician-diagnosed diabetes prior to 1994 predicted weight loss between 1994 and 1996 in adults who were aged 51 to 61 and relatively healthy but overweight in 1992 (n = 2,642) and (b) socioeconomic status influenced that relationship. The authors found that these overweight middle-aged adults were at least 50 more likely to report that they lost at least 10 pounds of excess body weight if they had been diagnosed with diabetes than if they had not. Furthermore, the authors found that neither education nor net worth predicted weight loss in these adults. Identifying the social, psychological, and physiological mechanisms linking chronic conditions and health behaviors can inform policy makers and health care providers and enhance the development of effective interventions to prevent or reduce health risks in middle-aged and older adults. PB - 26 VL - 26 UR - http://roa.sagepub.com/content/26/1/62.abstract IS - 1 U4 - Diabetes/Diagnosis/Middle Aged Adults ER - TY - JOUR T1 - Disability and Home Care Dynamics Among Unmarried Older Americans JF - The Journals of Gerontology: Social Sciences Y1 - 2004 A1 - Vicki A Freedman A1 - Aykan, Hakan A1 - John E. Marcotte A1 - Douglas A. Wolf KW - Disabilities KW - Healthcare AB - Objectives. We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines. Methods. Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models. Results. Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care. Discussion. Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities. PB - 59B VL - 59B UR - http://psychsoc.gerontologyjournals.org/ IS - 1 U4 - Disability/Disability/Caregiving 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 - Documentation of Physical Functioning Measures in the Health and Retirement Study and the Asset and Health Dynamics Among the Oldest Old Study Y1 - 2004 A1 - Stephanie J. Fonda A1 - A. Regula Herzog KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This document is part of a series of working papers on health-related measures in the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest-Old (AHEAD) study. The series currently contains papers on cognitive function, affective function, and physical function, the latter of which is the focus of this document. The purpose of this document is to aid prospective analysts in the appropriate use of the physical functioning data. To do so, this document provides an inventory of the physical functioning measures included in the survey interviews, describes the formats and origins of these measures, discusses their reliability, validity, and change over time and several options for working with the evolution of the questions, and provides SAS code for recoding the variables and creating simple summary measures. PB - The University of Michigan U4 - Physical Activity/Physical function/health measures/Survey Methods ER - TY - JOUR T1 - Effects of Risk and Time Preference and Expected Longevity on Demand for Medical Tests JF - Journal of Risk and Uncertainty Y1 - 2004 A1 - Gabriel A. Picone A1 - Frank A Sloan A1 - Donald H. Taylor Jr. KW - Expectations KW - Health Conditions and Status KW - Healthcare AB - Despite their conceptual importance, the effects of time preference, expected longevity, uncertainty, and risk aversion on behavior have not been analyzed empirically. We use data from the Health and Retirement Study (HRS) to assess the role of risk and time preference, expected longevity, and education on demand for three measures used for early detection of breast and cervical cancer—regular breast self-exams, mammograms, and Pap smears. We find that individuals with a higher life expectancy and lower time preference are more likely to undergo cancer screening. Less risk averse individuals tend to be more likely to undergo testing. PB - 28 VL - 28 U4 - Subjective expectations/Longevity/Health Care Utilization ER - TY - THES T1 - Elderly Parents' Expectations and Realizations of Informal Care from Adult Children: Economic perspective T2 - Economics Y1 - 2004 A1 - Godwin, Jennifer Woodard KW - Adult children KW - Healthcare AB - Over the next 50 years, the U.S. will see a tremendous growth in the elderly population due to the aging baby boomers and rising life expectancies. Currently, forty-five percent of seniors need assistance with activities of daily living. Medicare and Medicaid provide little coverage for these services, leaving the elderly to rely on informal care. While previous research has examined who provides care and the process by which children and parents arrange care, I use the Study of Assets and Health Dynamics among the Oldest Old (AHEAD) to examine parents' expectations about future care from children and the implications of those predictions after the onset of a disability. Using a probit framework, I examine who anticipates care from children among non-disabled households and who actually receives care among disabled households. The household characteristics correlated with anticipating future care differ from those correlated with the true probability of receiving care. For example, an additional daughter increases the probability that an elderly household expects future care, however an additional daughter is not statistically significantly related to the true probability of receiving care. Conversely, parents' socioeconomic status is not statistically significantly related to the probability of expecting future care, but lower socioeconomic households are more likely to receive care. I directly evaluate the accuracy of parents' predictions using the panel nature of the data. Among households that expect future care from children, over 60 percent do not receive care after the initial onset of a disability and nearly 50 percent still do not receive care after living with disabilities for five years. Among households that do not anticipate care from children, approximately 25 percent unexpectedly receive care after the initial onset of a disability, while slightly more than 50 percent receive care after needing help for five years. Further analysis reveals that inaccurately predicting care from children is associated with some economic and psychological costs, whereas unexpectedly receiving care is correlated with some economic and psychological benefits. JF - Economics PB - University of Maryland, College Park UR - https://drum.lib.umd.edu/handle/1903/1400 U4 - Parent Child Relations ER - TY - THES T1 - Environmental Influences on Aging in Place Y1 - 2004 A1 - Battisto, Dina G. KW - Health Conditions and Status KW - Healthcare KW - Housing KW - Public Policy AB - Older adults express a strong desire to age in place and this desire increases dramatically with age. Despite their intentions, the disparities between the residential environment and the aging individual are becoming more pronounced with the increase of home-related falls, home modifications, and forced relocations. Two common strategies linked to aging in place are: 1) enhance capabilities of an individual through medical and service interventions such as medications, prostheses, and behavior changes; and 2) reduce environmental constraints and demands. While considerable research targets the first strategy, very few empirical studies show how the environment contributes to aging in place. To understand the environmental influences on aging in place, this research is organized around three general inquiries: 1) explore the factors that are common to people who choose to stay at home as long as possible versus moving, 2) understand the environmental context that is associated with aging in place, and 3) understand an older adult's decision-making process when deciding if and how to age in place. Two environmental perspectives provide a theoretical framework for this study. First, person-environment theories in aging research emphasize "person-environment fit" using interaction models. Second, theories of place in environmental psychology demonstrate the importance of the experiential quality of home for older adults. A "two-phase" research design is used to provide two complementary ways to collect and analyze information on the environmental influences on aging in place. First, correlational research is performed using multiple waves of data previously collected from longitudinal surveys by Asset and Health Dynamics among the Oldest-Old (AHEAD) and the Health and Retirement Study (HRS). Second, face-to-face interviews with older adults 70 years and over living at home allow for a more in-depth understanding of the connections between physical properties of the home, symbolic associations and behaviors. The significance of this study stems from the multi-methodological approach, the focus on the environmental factors contributing to aging in place, and the translation of research findings into a set of empirically-based design recommendations. Findings from this research provide evidence that an environmental approach is a prerequisite to aging in place. PB - University of Michigan CY - United States -- Michigan UR - https://deepblue.lib.umich.edu/handle/2027.42/124620 U4 - Public health JO - Environmental Influences on Aging in Place ER - TY - THES T1 - Essays on Elderly Labor Force Participation, Pension Structure, and Partial Retirement T2 - Economics Y1 - 2004 A1 - Sharon Lynn Hermes KW - Employment and Labor Force KW - Healthcare KW - Net Worth and Assets AB - Increasingly, older Americans are postponing retirement or re-entering the workforce after retirement. This research examines the effect of pension structure changes and the different ways older workers partially retire by transitioning from full time work to part-time work, by changing jobs, or by returning to work from full retirement. Defined contribution pension growth makes retirement income increasingly tied to financial markets, implying that older workers need to postpone retirement in recessions, precisely when jobs are scarce. Using data from the Health and Retirement Study, a difference-in-differences analysis comparing older workers with defined benefit and defined contribution pensions before and after the stock market crash in 2000 reveals that the probability of retirement for people aged 63-64 with only defined contribution pensions fell by over 34 percentage points from 1998 to 2002. As men and women work longer, partial retirement has become an important option for older workers. Studies suggest that workers in the private sector cannot work fewer hours as they age on their career job because defined benefit pensions restrict inservice distributions prior to the plan's normal retirement age. Using an instrumental variables regression, I find little evidence ERISA regulated defined benefit pensions cause partial retirees to change employers prior to attaining the normal retirement age. However, many older workers not affected by ERISA also change jobs in partial retirement, which suggests the presence of constraints not identified in the model or that changing employers is in itself desirable as people age. Although partial retirement usually refers to workers voluntarily transitioning from full-time work to complete retirement, health or financial problems may be causing these changes. I find partial retirees are less healthy than similar full-time workers and report their health constrains work ability. In addition, over 26% of partial retirees return to work after retirement and hourly wages of partial retirees (previously retired) fall substantially more than hourly wages of partial retirees who transitioned directly from full-time work. Regression analysis indicates retirees with defined benefit pensions rarely return to work. Women, though return to work if their spouse's health deteriorates, while men re-enter the workforce if their spouse works. JF - Economics PB - University of Notre Dame VL - Doctor of Philosophy UR - https://curate.nd.edu/show/2z10wq0045w U4 - Gerontology ER - TY - THES T1 - Examining the Effect of Welfare Reform on the Economic Well-Being of the Elderly Y1 - 2004 A1 - Eun-Young Choi KW - Demographics KW - Employment and Labor Force KW - Healthcare KW - Methodology KW - Women and Minorities AB - This study examines the impact of passage of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (commonly referred to as the Welfare Reform Act) on the economic well-being of the elderly. Longitudinal data from the 1994 and 1998 waves of the Health and Retirement Study were used to examine change in participation of several public welfare programs. Change in respondents' participation in SSI, Food Stamps, and Medicaid between pre- and post-Welfare Reform years were examined using the one-way chi-square test. Multivariate analysis was conducted to analyze the factors associated with moving into poverty and with leaving welfare, SSI, Food Stamps and Medicaid. Results indicate that elderly tended to leave Food Stamps and Medicaid after Welfare Reform but there was not enough evidence to say that this result is a direct result of Welfare Reform. Results of logistic analysis of leaving Food Stamps and Medicaid indicate, not surprisingly, income and job status were statistically significant factors in leaving these welfare programs. PB - University of Missouri - Columbia U4 - Welfare JO - Examining the Effect of Welfare Reform on the Economic Well-Being of the Elderly 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 - THES T1 - How Alternative Definitions of Retirement and Social Class Shape Conclusions about the Retired Population Y1 - 2004 A1 - Araiza, Isabel KW - Demographics KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction KW - Women and Minorities AB - The conceptualization and operationalization of retirement remains a challenge in retirement research. Those studies which have examined multiple conceptualizations of retirement often limit the investigation to two, three, or four definitions of retirement. These studies also produce contradictory results with respect to the degree of overlap among various definitions of retirement. Moreover, in the investigation of the relationship between predictor variables and the probability of retirement, push and pull factors (such as pension receipt and health) are often the focal point of the inquiry. While most studies include in their analysis a class measure as a control variable for the model, seldom is the relationship between social class and the probability of retirement the focal point of the investigation. This study employs data from the 1998 wave of the Health and Retirement Study to perform an extensive analysis of seven operationalizations of retirement and five operationalizations of social class to evaluate how the use of alternative definitions of retirement and social class shape conclusions drawn about the composition of the retired population. Analyses are performed for the entire sample selected for this study, as well as for Non-Hispanic White, Hispanic, and Non-Hispanic Black subgroups. The results of the analyses indicate that different operationalizations of retirement affect the characterization the retired population; moreover the use of different operationalizations of social class influences the perceptions of the socio-economic condition of the retired population. Despite socio-economic achievements, the findings suggest that initial inequalities associated with ascriptive traits like race and gender continue to constrain women and minorities' life course trajectories. While it is not possible to conduct a comprehensive examination of operationalizations of retirement in gerontological literature, this study includes operationalizations of retirement that acknowledge retirement as an event, an identity, and a process. PB - Boston College CY - United States -- Massachusetts UR - https://search.proquest.com/openview/5a3ae1f763042c14661718032d4a886e/1?pq-origsite=gscholar&cbl=18750&diss=y U4 - Gerontology JO - How Alternative Definitions of Retirement and Social Class Shape Conclusions about the Retired Population 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 - The Impact of New Health Problems on Self-Reported Health Over Time Y1 - 2004 A1 - Jun Xu A1 - Werner, R. A1 - Daniel Polsky KW - Healthcare AB - Background: Many cross-sectional studies have found that self-reported health is highly correlated with physical and functional indicators of health. However, the extent to which self-reported health changes with new health problems and over time has not been well documented. Objectives: To investigate how self-reported health changes over time following a new acute or chronic health problem. Research Design: Using 6 years of longitudinal data for 7388 subjects from the Health and Retirement Study of the US, we assessed self-reported health after a new health problem over 2, 4, and 6 year intervals. Seven health problems (cancer, heart disease, lung disease, diabetes, high blood pressure, psychiatric disorders, and arthritis) were included in logistic regression models to predict the impact of new health problems on self-reported health over time. The probability of recovery of self-reported health was predicted using an interaction between length of time since the new health problem occurred and the new health problem. Results: All seven new health problems examined were associated with a significant decline in self-reported health. People who reported new cancer, heart disease, and lung disease experienced the greatest decline in health status. For most health problems, self-reported health improved over time. Relative to people with no new health problems, people with new cancer and heart disease had the most significant recovery in self-reported health over time. Conclusions: Self-reported health typically gets worse after a new health problem and gradually improves over time. This pattern is particularly true for cancer and heart problems. PB - University of Michigan Population Studies Center, PSC Publications U4 - Health Problems ER - TY - JOUR T1 - The Influence of Prescription Drug Use on Long-Term Care Insurance Ownership JF - Risk Management and Insurance Review Y1 - 2004 A1 - Bernet, Patrick Michael KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Long‐term care insurance (LTCI) can be an effective way of protecting individual assets from nonacute medical costs not covered by traditional health insurance. Prior research suggests a number of economic, health, and family structure factors related to the decision to purchase LTCI. Theories that health and income shocks precipitate precautionary saving introduce the possibility that prescription drug use may also play a role in such decisions. Findings that poor health increases the propensity to insure against risk in asset holdings provide another possible relation to LTCI. This study extends prior research to investigate the link between the routine use of prescription drugs and the decision to purchase LTCI. Using data from the Health and Retirement Survey, logistic regression is employed to test the significance of LTCI policy ownership determinants. In addition to lending empirical support to theories on intrafamily moral hazard, results indicate that there is a positive relationship between routine drug use and LTCI purchase decisions. VL - 7 IS - 2 U4 - Insurance, Long Term Care/Prescription Fees ER - TY - THES T1 - A Longitudinal Look at the Predictors of Four Types of Retirement Y1 - 2004 A1 - Weymouth, Penny L. KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - The general purpose of the study was to further the understanding of the retirement process. More specifically, the study investigated several personal and work-related predictors of individual retirement status that have received relatively little past examination. By gaining a better understanding of the retirement process, policy makers and organizational leaders can use this knowledge to make informed decisions affecting older workers, their organizations, and society in general. Public release data of the Health and Retirement Study (HRS)--a recent, large, representative, national panel study that focuses on the health, retirement, and aging of persons born between the years of 1931 and 1941--were analyzed. In-home, face-to-face interviews were conducted in 1992, with follow-up interviews conducted every two years by phone. From survey years 1992 through 2000, samples of working individuals over the age of 50 were used to examine nine hypotheses and four different operationalizations of retirement. The hypotheses involved the following predictor variables: gender, partner status, characteristics of one's partner (i.e., retirement status and health), number of dependents, obsolescence of job skills, "demanding" job characteristics, perceived age-related discrimination, work and retirement attitudes, and flexibility of organizational policies regarding older workers. Event history analysis using logistic regression was used to predict the dichotomous criterion variables, while linear mixed model analysis for repeated measures was used to predict the continuous dependent variable. After statistically controlling variables such as age, health, and finances, results indicated that gender, partner's retirement status, work and retirement attitudes, and organizational flexibility were each predictors of at least one type of retirement. In addition, the statistical interaction of gender with partner status predicted retirement defined in several ways. The study expanded what is known about retirement predictors by examining actual versus intended retirement behavior and increased the generalizability of past research by utilizing national panel data. The study also highlighted the importance of clearly defining retirement measures and explored the complete versus partial retirement typology. It was suggested that flexible work options may improve work and retirement attitudes by making the transition into retirement a gradual process, and may keep older employees in the work force longer. PB - Central Michigan University CY - United States -- Michigan U4 - Gerontology JO - A Longitudinal Look at the Predictors of Four Types of Retirement ER - TY - THES T1 - Marital Status Differences in Working Life after Age 50: A sex-stratified analysis Y1 - 2004 A1 - David F Warner KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Healthcare AB - Although retirement is a prominent feature of the modern life course, prior research has largely focused on the experiences of men or married couples. However, rising female labor force participation and decreasing marital stability means that many women are entering later-life with substantial work histories, but also without the economic protections of marriage. Men too are increasingly entering later-life nonmarried. Given the rapidly aging population, it is imperative to understand the implications of these demographic shifts for the organization of working life in the later-years for men and women. Drawing on data from the 1992-2000 waves of the Health and Retirement Study (HRS), this research expands on prior studies by examining marital status differences in working life and retirement for both men and women. The HRS is a nationally representative sample of noninstitutionalized adults over the age of 50. Population-based working life tables are estimated using discrete-time hazard models. Results indicate that older men are more likely to be in the labor force than are women, due to both lower exit risks and higher reentry risks. Among men, the married have longer working lives and lower retirement risks than divorced, widowed and never married men. Never married men have the shortest working life. The opposite is true for women; married women have shorter working lives and higher risks of retirement than divorced widowed and never married women. Divorced and never married women spend the most remaining years in the labor force. Both nonmarried men and women spend more years disabled than the married. Differences in socioeconomic resources, primarily, mediate some, but not all, of the effect of divorced and widowhood on the risk of retirement for women. Differences in socioeconomic resources, health and current family context do not account for the higher risk of retirement for divorced, widowed and never married men relative to the married. In fact, if nonmarried men had the characteristics of married men, they would be even more likely to retire. PB - The Pennsylvania State University CY - United States -- Pennsylvania UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=845711461&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - Gerontology JO - Marital Status Differences in Working Life after Age 50: A sex-stratified analysis ER - TY - RPRT T1 - Motivation for Money and Care that Adult Children Provide for Parents: Evidence from Point Blank Survey Questions Y1 - 2004 A1 - Cox, Donald A1 - Beth J Soldo KW - Adult children KW - Healthcare AB - When adult children provide care for their aging parents, they often do so at great expense to themselves incurring psychic, monetary, emotional, and even physical costs, in conjunction with care that is labor intensive and, at the extreme, unrelenting. While the nature of parent care and the profile of care giving children are well described in the literatures of the social sciences, we still lack insight into why adult children undertake parent care without compensation or compulsion. In this paper, we adopt a novel, direct-question approach using newly available data from a special module fielded in the 2000 Health and Retirement Study that included questions on motivations for, and concerns with, the provision of familial assistance. We discover several new things about the provision of care in families. Transfers are not always provided free of pressure from other family members, for example, and familial norms of obligations and traditions appear to matter for many respondents. These findings suggest that the standard set of economic considerations utility interdependence, budget constraints, exchange, and the like are insufficient for a complete understanding of private transfer behavior. Though one must always be skeptical about reading too much into what people say about why they do the things they do (or think they will do) we nonetheless conclude that point-blank questions offer, at the very least, a worthwhile complement to the more conventional methods for unraveling motivations for private, intergenerational transfers. 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/motivation-for-money-and-care-that-adult-children-provide-for-parents-evidence-from-qpoint-blankq-s/ U4 - Adult Children/Caregiving/Transfers ER - TY - THES T1 - Physical activity and employment decisions under working hours inflexibility Y1 - 2004 A1 - Chung-Ping A. Loh KW - Employment and Labor Force KW - Healthcare AB - Although the substantial health benefits of physical activity have long been known to the public, most U.S. adults do not engage in frequent physical activity. Lack of time is one of the most frequently cited reasons for the failure to engage in exercise. However, the potential role of lifestyle and labor market factors in contributing to this shortage of time for exercise has never been carefully examined. This dissertation investigates how restrictions on the number of working hours affect an individual's likelihood of engaging in frequent physical activity. In the theoretical section, a complete set of employment scenarios is structurally described and a comparative static analysis is used to demonstrate the effect of a working hours constraint on physical activity under different scenarios. It is also shown that the effect of a constraint varies with the degree of disparity between required and desired working time. In the empirical model, the exercise decision is modeled under both flexible and inflexible labor market circumstances. To address the selection problem associated with the effect of a constraint on an individual's time allocation, this study allows the employment decision to be structurally determined by the imposition of a working hours constraint, the available number of working hours, the desired level of labor supply, and the utility comparison between work alternatives. The model is estimated using a sample from the first wave of the Health and Retirement Study (HRS) of males between 51 and 61 years of age. The working hours constraint is found to reduce the amount of physical activity for the overemployed and increase it for the underemployed. The effect grows as the difference between offered and desired number of hours increases. Simulation results suggest that constraints on working hours have reduced the overall rate of frequent physical activity by 2.5 to 5%. In other words, they are responsible for the inactiveness of approximately 6 to 12% of the older population represented by my sample. The obvious implication of the results is that regulating or eliminating working hour constraints may be a policy option to promote frequent physical activity. PB - University of North Carolina at Chapel Hill UR - https://search.proquest.com/openview/4d2d5608ef42df801df4064a6c8c7ef1/1?pq-origsite=gscholar&cbl=18750&diss=y U4 - Health Sciences, Public Health (0573) JO - Physical activity and employment decisions under working hours inflexibility ER - TY - JOUR T1 - Predicting Nursing Home Admission: Estimates from a seven-year follow-up of a nationally representative sample of older Americans JF - Alzheimer Disease and Associated Disorders Y1 - 2004 A1 - Banaszak-Holl, Jane A1 - A. Mark Fendrick A1 - Norman L Foster A1 - A. Regula Herzog A1 - Mohammed U Kabeto A1 - Kent, David A1 - Walter L. Straus A1 - Kenneth M. Langa KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This study determines whether prevalence and predictors of nursing home admission changed in the 1990s, during a period of dramatic changes in the service provision for and medical care of chronic impairments. Data from the 1993-2000 surveys of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a longitudinal and nationally representative sample, were used. Proportional hazard models were used to determine the effects of dementia, physical functioning, clinical conditions, and sociodemographics on the likelihood of nursing home admission. Of the 6,676 respondents, 17 were admitted to a nursing home. Models excluding functional impairment demonstrated significant effects of chronic medical conditions and dementia on the risk of institutionalization. After controlling for functional impairment, dementia still had significant and strong effects on institutionalization but clinical conditions did not, suggesting that the impact of dementia goes beyond its effect on physical functioning. Nursing home admissions did not decrease during the study period, and the impact of dementia on the risk of nursing home admission did not decrease. Interventions for individuals with dementia should impact the behavioral aspects of the condition and slow disease progression in addition to improving physical functioning. PB - 18 VL - 18 IS - 2 U4 - Nursing Homes/Dementia/Sociodemographic/Proportional Hazards Models ER - TY - JOUR T1 - Race/Ethnicity and Marital Status in IADL Caregiver Networks JF - Research on Aging Y1 - 2004 A1 - Sheila Feld A1 - Ruth E Dunkle A1 - Tracy Schroepfer KW - Adult children KW - Demographics KW - Healthcare AB - Racial/ethnic variations in instrumental activities of daily living (IADL) caregiver network composition were examined in a nationally representative sample of elders, using task specificity and hierarchical compensatory theoretical perspectives. Logistic regressions tested network differences among White, Black, and Mexican American elders (n = 531 married, n = 800 unmarried). Findings concerning racial/ethnic differences were partially dependent on marital status, differentiation of spouses from other informal helpers among married elders, and which racial/ethnic groups were compared. Networks including formal caregivers did not differentiate married or unmarried Black from White elders but were more common among unmarried Mexican American elders than for comparable White and Black elders. Married Black elders with solely informal networks were more likely than comparable White elders to have informal helpers other than the spouse. Racial/ethnic similarities and differences in caregiver networks are discussed relative to their sociocultural context, including marital status, elder s and spouse s health, and financial resources. PB - 26 VL - 26 IS - 5 U4 - Caregivers/Ethnicity/Marital Status ER - TY - CHAP T1 - Race/Ethnicity, Socioeconomic Status, and Health T2 - Critical Perspectives on Race and Ethnic Differences in Health in Later Life Y1 - 2004 A1 - Eileen M. Crimmins A1 - Mark D Hayward A1 - Teresa Seeman ED - Norman B. Anderson ED - Randy A. Bulatao ED - Barney Cohen KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Mounting evidence indicates that racial/ethnic differences in morbidity and mortality are tied to socioeconomic resources (Hayward, Crimmins, Miles, and Yu, 2000; Williams and Collins, 1995). Largely because of data availability, most of this evidence is based on the health experiences of blacks and whites, with much less evidence on the role of socioeconomic factors in understanding racial/ethnic disparities when Americans of Asian or Pacific Island descent, Hispanics, and Native Americans are part of the picture. The potential power of the socioeconomic status (SES) paradigm in understanding health disparities—including racial/ethnic disparities—is evident in the fact that socioeconomic differences in health outcomes have been widely documented for most health conditions in most countries. People who are poorer and who have less education are more likely to suffer from diseases, to experience loss of functioning, to be cognitively and physically impaired, and to experience higher mortality rates (Adler, Boyce, Chesney, Folkman, and Syme, 1993; Adler et al., 1994; Marmot, Kogevinas, and Elston, 1987; Marmot, Ryff, Bumpass, Shipley, and Marks, 1997; Preston and Taubman, 1994; Williams, 1990). In the United States, few health problems are more likely to occur among those who are better off, and some health conditions are particularly sensitive to SES. In recent years socioeconomic differences in health also appear to be increasing in the United States and in other developed countries (Crimmins and Saito, 2001; Feldman, Makuc, Kleinman, and Coroni-Huntley, 1989; Manton, 1997; Marmot, 1994; Pappas, Queen, Hadden, and Fisher, 1993; Preston and Elo, 1995). JF - Critical Perspectives on Race and Ethnic Differences in Health in Later Life PB - National Academy of Sciences UR - https://www.ncbi.nlm.nih.gov/books/NBK25526/#:~:text=Socioeconomic%20status%20is%20obviously%20related,health%20outcomes%20relative%20to%20whites. U4 - Racial Differences/socioeconomic Status/African Americans/Hispanic/health disparities/MORTALITY ER - TY - THES T1 - Retirement Transitions: The role of shocks to household resources Y1 - 2004 A1 - Kim, Sora KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - The role of shocks to household resources in affecting retirement transitions among older employees was analyzed using data from the Health and Retirement Study (HRS). The transitions of reverse retirement and partial retirement were of particular interest. The objectives of the study were: 1) To explore how shocks, or unexpected changes to financial and human resources, affect retirement transitions, and 2) To explore the relative importance of shocks in making retirement transitions. The study sample consisted of 2,514 HRS respondents, born between 1926 and 1938, who changed employment status between 1998 and 2000 or between 2000 and 2002. A multinomial Logit model was used in order to make comparisons among the four retirement transition groups. The empirical model included institutional variables and demographic and environmental control variables. The results suggest that just as the paths to retirement are diverse and complex, so are their determinants. Shocks to financial resources had the largest effects on reverse retirement transitions. Shocks to human resources, including family structure and health, affected all retirement transitions. Institutional variables had the largest marginal effects on partial retirement. As expected, positive shocks to assets decreased the odds of reverse retirement, and negative income shocks had larger marginal effects on retirement transitions than positive income shocks. However, positive asset shocks had larger marginal effects on retirement transitions than negative asset shocks. The partial retirement group was distinguished from the reverse retirement group in terms of financial shock impacts; for members of the partial retirement group, rather than shocks to resources, institutional supports were key determinants. Fewer significant effects on the odds of partial retirement over traditional retirement were found, and the effects were smaller than those for reverse retirement and retirement from part-time employment in terms of their magnitudes. The loss of human resources was important across the transition groups, with greater impact of shock to marital status on women's labor force transitions compared to men's. To reduce shocks to household resources under uncertainty, retirement education should encompass information on asset allocation and financial risk. These topics may help workers more effectively plan for retirement. PB - The Ohio State University CY - United States -- Ohio UR - https://search.proquest.com/openview/f7f4076a33407410a70e40feb8aa40c4/1?pq-origsite=gscholar&cbl=18750&diss=y U4 - Gerontology JO - Retirement Transitions: The role of shocks to household resources ER - TY - JOUR T1 - Review of: The smoking puzzle: Information, risk perception, and choice JF - Journal of Economic Literature Y1 - 2004 A1 - Jahn K. Hakes KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy PB - 42 VL - 42 IS - 4 N1 - ProCite field 3 : Clemson University U4 - General Welfare/Basic Needs/Living Standards/Health Production/Health/Quality of Life/Smoking/Econometric and Statistical Methods ER - TY - THES T1 - TREAT 'EM: Triangulation, Risk, and the Economics of Alcoholism and Treatment among Elders in Medicare T2 - College of Health and Human Development Y1 - 2004 A1 - Pringle, Kristine Elmendorf KW - Health Conditions and Status KW - Healthcare KW - Public Policy AB - This dissertation is divided into three distinct, but related studies on alcoholism among elderly persons. The purpose of the first study was to triangulate between two large, secondary data sources to determine the risk factors for both diagnosed and self-reported alcoholism. Claims data from the Medicare Current Beneficiary Survey were used to examine individuals with diagnosed alcoholism and survey responses to the CAGE questions in the Health and Retirement Study were used to examine individuals with self-reported alcoholism. The results of study one suggest that less than half of individuals who self-report would be diagnosed (4.31% versus 1.87%, respectively), and some groups may be at particularly high risk of under-diagnosis. The purpose of the second study was to examine factors associated with alcohol treatment among a sample of 390 elderly Medicare beneficiaries already diagnosed with alcoholism and to produce cost estimates for alcohol treatment. A generalized linear model with a gamma distribution and log link was used to estimate treatment costs in the 12 months following diagnosis. The results of study two suggest that about half (52.6%) of elderly individuals diagnosed with alcoholism receive any treatment for alcoholism, and certain groups of diagnosed elderly may be at high risk of under-treatment. The cost of alcohol treatment for individuals diagnosed with alcoholism is $9,714.16 per year. The purpose of the third study was to test the cost-offset hypothesis, (a phenomenon where treatment for alcohol problems reduces the use of medical services), using five years of claims data from the Medicare Current Beneficiary Survey. Two distinct methodological approaches, propensity scoring and difference-in-differences, were used to estimate treatment effects. Although insufficient power likely limited my ability to detect significant differences, the results of this study are encouraging and warrant further study of larger samples over longer periods of time. Taken together, the results of this research particularly highlight the need for targeted interventions to increase detection of those not yet diagnosed and treatment seeking among those already diagnosed with alcoholism. Such interventions may reduce the need for subsequent medical hospitalizations caused by the complications of alcoholism, especially among those with acute onset. JF - College of Health and Human Development PB - The Pennsylvania State University CY - Pittsburgh, PA VL - Doctor of Philosophy UR - https://search.proquest.com/openview/c1d6b04d7dbedab173796daea3cc914d/1?pq-origsite=gscholar&cbl=18750&diss=y U4 - Health care JO - TREAT 'EM: Triangulation, Risk, and the Economics of Alcoholism and Treatment among Elders in Medicare ER - TY - RPRT T1 - The Annuity Puzzle Gets Bigger Y1 - 2003 A1 - Petrova, Petia KW - Healthcare KW - Net Worth and Assets AB - Economic theory predicts that the gains from annuitization are substantial, but annuities are rare in practice. Who buys private annuities? Most of the literature concentrates on standard economic considerations, like preferences and prices, which fail to explain much of the variation in the propensity to annuitize. I add to this approach in two ways, first by exploring whether growing up in a rich family can make someone more patient and, therefore, more prone to annuitize. Second, I draw from recent literature in psychology on the problem of overconfidence , and argue that it could apply to someone s estimation of his or her life expectancy and hence to his or her propensity to annuitize. I find that appealing to these kinds of explanations does little to resolve the annuity puzzle. PB - Center for Retirement Research at Boston College N1 - The research reported herein was supported by the Center for Retirement Research at Boston College pursuant to a grant from the U.S. Social Security Administration funded as part of the Retirement Research Consortium. U4 - Annuities/Psychology ER - TY - JOUR T1 - Assistance to Aging Parents and Parents-in-Law: Does lineage affect family allocation decisions? JF - Journal of Marriage and the Family Y1 - 2003 A1 - Kim Shuey A1 - Melissa A. Hardy KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - In this analysis we used data from the Health and Retirement Study to examine how, couples organize transfers of assistance to aging parents and whether the flow of assistance is structured by family lineage. We found evidence of a tradeoff between types of assistance and a unilineal pattern of assistance. Few couples provided both time and money, and few assisted parents and parents-in-law. The determinants of assistance varied by type of care, recipient, and patterns of parental survival. Couples were more responsive to the needs of the wife's parent(s) and were less likely to exclude her parents from care even tinder circumstances of competition. Controlling for resources, African American and Hispanic couples were consistently more likely to provide assistance. PB - 65 VL - 65 IS - 2 U4 - Aging/Caregiving/Intergenerational Transfers ER - TY - JOUR T1 - The Costs of Arthritis JF - Arthritis and Rheumatism Y1 - 2003 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Yelin, Edward A1 - Song, Jing A1 - Rowland W Chang KW - Health Conditions and Status KW - Healthcare AB - Arthritis and rheumatic conditions (i.e., arthritis) are responsible for major health care expenditures and disability burdens. The impact of arthritis is not restrained by national boundaries. It is one of the most prevalent chronic conditions and is a leading cause of disability in Australia (1), Canada (2,3), Europe (4), the United Kingdom (5), and the United States (6,7), affecting an estimated 3 million Australians, 6 million Canadians, 8 million in the UK, almost 43 million people in the US, and 103 million across Europe. With the aging of the baby boomers, these numbers and the associated disabilities will quickly escalate. By 2020 in the US alone, arthritis is projected to affect 60 million people, and the activities of 12 million people may be limited by arthritis (6). The growing magnitude of people affected by arthritis motivates the need to review what is known about its national costs to identify areas where current information is lacking. In addition, it is important to determine targets for public health efforts that will reduce the costs of and burden from arthritis. This knowledge will facilitate planning research agendas that support informed public policy decisions. PB - 49 VL - 49 IS - 1 U4 - Arthritis/Health Care Costs ER - TY - JOUR T1 - Effect of Childlessness on Nursing Home and Home Health Care Use JF - Journal of Aging and Social Policy Y1 - 2003 A1 - Aykan, Hakan KW - Adult children KW - Healthcare AB - This study examines the likelihood of nursing home and home health care use for childless older Americans. Four research questions are addressed: 1) Are the childless elderly at a greater risk of nursing home and home health care use? 2) Is it childlessness per se or not having children with particular characteristics that affects the likelihood of using these formal long-term care services? 3) Does having additional children beyond the first one have a significant effect on the use of these services? 4) Are the effects of childlessness different on the likelihood of nursing home and home health care use? Longitudinal data from the first (1993) and second (1995) waves of the Asset and Health Dynamics Among the Oldest Old survey (AHEAD) and multinomial logistic regression models are used for the analyses. Separate models are developed for women and men, each controlling for a variety of demographic, socioeconomic, and health-related characteristics of sample persons. Findings indicate childlessness as an important risk factor, especially for older women's use of nursing home services. Implications of findings for planning for long-term care needs of the baby boom generation are discussed. PB - 15 VL - 15 IS - 1 U4 - Children/Home Care Services/Nursing Homes ER - TY - RPRT T1 - The Effects of Private Insurance on Measures of Health: Evidence from the Health and Retirement Study Y1 - 2003 A1 - Avi Dor A1 - Joseph J Sudano A1 - David W. Baker KW - Healthcare KW - Medicare/Medicaid/Health Insurance PB - Cambridge, MA, National Bureau of Economic Research UR - http://papers.nber.org/papers/W9774 U4 - Health Insurance Coverage/Health Services ER - TY - JOUR T1 - An Examination of the Impact of Health on Wealth Depletion of the Elderly JF - The Journals of Gerontology: Social Sciences Y1 - 2003 A1 - Jinkook Lee A1 - Hyungsoo Kim KW - Demographics KW - Healthcare KW - Net Worth and Assets AB - Objectives. This study investigates the effects of new health events and existing health conditions on wealth depletion in elderly individuals. Methods. A model deriving from life-cycle theory is proposed and estimated using Waves 1 and 2 of the Asset and Health Dynamics of the Oldest Old (AHEAD) data set. Results. Both new health events and existing health conditions significantly influence wealth depletion of elders, but their impacts differ across marital status. Whereas an occurrence of new health events brought wealth depletion of elders in married households, having existing chronic health conditions was associated with wealth depletion of elders in single households. Discussion. Poor health, both a new health event and existing chronic conditions, leads to considerable wealth depletion in elderly individuals. Considering the significant impacts of health on wealth, the public needs to be better informed of potential health events in later life and the associated financial burden. Additional health insurance plays an important role in preventing elders from financial hardship. PB - 58B VL - 58B UR - http://psychsoc.gerontologyjournals.org/ IS - 2 U4 - Wealth/Elderly/Health Care Costs ER - TY - JOUR T1 - Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults JF - Journal of the American Medical Association Y1 - 2003 A1 - J. Michael McWilliams A1 - Alan M. Zaslavsky A1 - Meara, Ellen A1 - John Z. Ayanian KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Context Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health.Objective To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults.Design and Setting Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years.Participants A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n=167), intermittently uninsured (n=216), or continuously insured (n=1820) in 1994 and 1996, prior to Medicare eligibility.Main Outcome Measures Individuals' reports of receiving cholesterol testi ng, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years.Results The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4 vs 17.7 ; change of -17.7 95 Cl, -29.3 to -6.2 ; P=.003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2 vs 7.7 ; difference of 21.5 95 Cl, 0.2 to 42.9 1; P=.048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3 vs 15.0 ; change of -15.3 95 Cl, -29.9 to -0.7 1; P=.04) and prostate examination in men (45.2 vs 20.0 ; change of -25.2 95 Cl, -45.4 to -5.1 ; P=.01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eligibility, but not greater increases in arthritis treatments. Among adults with hypertension, differences in use of antihypertensive medications between continuously uninsured and insured adults were essentially unchanged after Medicare coverage.Conclusions Previously uninsured adults substantially increased their use of covered basic clinical services but not medications after gaining Medicare coverage. An affordable option through which near-elderly uninsured adults could purchase Medicare coverage might have similar effects. PB - 290 VL - 290 IS - 6 U4 - Medicare/Health Services/Health Insurance Coverage ER - TY - BOOK T1 - Parsing the Smoking Puzzle: Information, Risk Perception, and Choice Y1 - 2003 A1 - Frank A Sloan A1 - Donald H. Taylor Jr. A1 - V. Kerry Smith KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy KW - Risk Taking AB - Examines how perceptions of the risks of smoking are updated as older individuals receive new personalized information and how risk perceptions affect smoking behavior. Highlights the potential for reducing cigarette consumption using a message about a smoker's quality of life at the end of life. Based on data collected in the Health and Retirement Study (HRS), a national panel survey conducted by the University of Michigan's Institute for Social Research on adults aged fifty one to sixty one in the baseline year of the survey (1992), and on information from focus group meetings and interviews with current or former smokers. Surveys government policy and industry advertising with regard to smoking over the past fifty to one hundred years and their effectiveness in influencing cigarette demand. Summarizes existing knowledge and HRS findings on the effects of smoking on mortality and morbidity. Focuses on the survey respondent's assessment of the probability that they will live to age seventy five; examines how well individuals predict their own survival; and explores how people use new information about their own health to update their longevity expectations. Presents new information on smoking cessation and relapse patterns in older adults, paying special attention to the impact of health shocks. Considers whether it is possible to design information messages that mimic the information conveyed to middle aged smokers by personal health shocks and investigates the factors that may make a message especially salient for smokers. Incorporates new findings into an economic analysis of the demand for cigarettes and evaluates the potential impact of a new information policy on daily cigarette consumption of smokers in the sixth and seventh decade of life. Presents policy implications. Sloan is at Duke University. Smith is at North Carolina State University. Taylor is at the Stanford Institute of Public Policy, Duke University. Index. PB - Harvard University Press CY - Cambridge, MA UR - https://www.hup.harvard.edu/catalog.php?isbn=9780674010390 U4 - Smoking/Risk Behavior/Health Education/General Welfare/Basic Needs/Living Standards/Quality of Life/Health Production/Health/Econometric and Statistical Methods ER - TY - THES T1 - Relative Deprivation and Resource Utilization as Explanations for SES Differentials in Adult Morbidity and Mortality T2 - Sociomedical Sciences Y1 - 2003 A1 - Donna M. Vallone KW - Demographics KW - Healthcare AB - Several hypotheses have been proposed to explain how socioeconomic status translates into different health outcomes, especially in the context of the industrialized world. This dissertation sought to examine the relative merit of two theoretical explanations, Relative Deprivation and Resource Utilization, by providing supporting evidence as to the whether material resources or psychosocial processes matter more in mediating the associations between SES, health, and longevity. To test the relative contribution of each perspective, gender-specific prospective cohorts were constructed using the Health and Retirement Study (HRS) dataset. Measures of SES, relative deprivation, and resource utilization were specified in logistic regression models to examine the extent to which each mechanism could account for the direct effect of SES on three health outcomes: self-reported health, having any life-threatening condition, and mortality. Relative deprivation was measured using two indicators: relative income position, the difference between a respondent's household income and the median income level of the respondent's residential state, county and zip code, and financial dissatisfaction. Resource utilization was measured using a summative score that indexed the extent to which respondents engaged in or employed health-promoting, risk-reducing strategies. Results indicate that financial dissatisfaction, rather than relative income position, mediates a portion of the SES-health association, although it is not found to act as the primary mechanism through which social conditions influence morbidity and mortality as theorized by Wilkinson. While health-related resource utilization as measured is not found to mediate the SES-health association, results indicate that resource utilization as specified by Link and Phelan is linked to both SES and health outcomes. Findings suggest that the mechanisms through which SES shapes health outcomes are complex and multifactorial, comprised of both material and psychosocial components. JF - Sociomedical Sciences PB - Columbia University VL - Doctor of Philosophy U4 - Health Services ER - TY - RPRT T1 - Social Security Reform and the Exchange of Bequests for Elder Care Y1 - 2003 A1 - Brown, Meta KW - Adult children KW - Healthcare AB - The majority of elderly Americans who receive long-term care outside of institutions are cared for in part by their children. We have little evidence, however, on the financial and social mechanisms securing the supply of elder care. In recent data on older U.S. families, I find that children rarely receive direct payment for their help. Further, inter-vivos transfers from unmarried parents to their adult children do not favor caregivers. Given the lack of evidence of any spotmarket for family care, the central question of this study is whether end-of-life transfers act as compensation for caregiving children. An empirical study of parents division of bequests and life insurance among their children shows a positive association between children s transfer shares and both current and predicted caregiver status. In order to investigate the dependence of family care outcomes on children s time costs and parents wealth and care needs, I present a dynamic model of the asset choices of an elderly parent who wishes to elicit care from her children. Model estimates indicate that children respond to parents care needs and bequeathable wealth in the decision to provide care, and that children with greater time costs provide care only at higher levels of bequeathable wealth. Finally, a policy simulation based on model estimates predicts that a 5 to 6 percentage point increase in the rate at which unmarried elderly parents receive family care would result from reforms in which the expected present values of both public and private pensions were included in parents bequests. However, a more modest change in public retirement benefits, designed to mimic the broad-brush characteristics of an existing proposal for Social Security reform, is predicted to have a negligible effect on care 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/social-security-reform-and-the-exchange-of-bequests-for-elder-care/ U4 - Bequest Motives/Caregiving/Intergenerational Transfers ER - TY - JOUR T1 - Analyzing the Relationship Between Health Insurance, Health Costs, and Health Care Utilization JF - Economic Perspectives Y1 - 2002 A1 - Eric French A1 - Kamboj, Kirti KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - In this article, we provide an empirical analysis of the determinants of whether an individual purchases health insurance coverage. We describe the relationship between health insurance, health costs, and health care utilization of the elderly, using data from the Health and Retirement Survey and the Assets and Health Dynamics among the Oldest Old. We show how health costs and health care utilization depend upon access to health insurance for individuals aged 50 and older. PB - 3Q VL - 3Q UR - http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.199.7494&rep=rep1&type=pdf U4 - Health Insurance Coverage/Health Care Costs/Health Care Utilization ER - TY - BOOK T1 - Annual Review of Gerontology and Geriatrics: Economic Outcomes in Later Life Y1 - 2002 A1 - Crystal, Stephen A1 - Dennis G. Shea KW - Healthcare KW - Net Worth and Assets AB - Leading scholars focus on the economics of aging, with a particular emphasis on the economic future of the baby boom generation. Key themes include the influence of early advantages on later-life economic outcomes (the cumulative advantage/cumulative disadvantage hypothesis); the relationship between inequalities in economic status and inequalities in health status and access to health care; and the consequences of societal choices concerning retirement income systems and policies for financing acute and long-term health care. PB - Springer Publishing Co., Inc. CY - New York VL - 22 N1 - ProCite field 8 : eds U4 - Economic Status/Geriatrics ER - TY - JOUR T1 - Another Look at Aggregate Changes in Severe Cognitive Impairment: Further investigation into the cumulative effects of three survey design issues JF - The Journals of Gerontology Series B Y1 - 2002 A1 - Vicki A Freedman A1 - Aykan, Hakan A1 - Linda G Martin KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - OBJECTIVES: This study explored whether previously reported declines in severe cognitive impairment were robust to cumulative effects of potentially confounding survey design issues. METHODS: Using the 1993 Asset and Health Dynamics of the Oldest Old study (n = 7,443) and 1998 Health and Retirement Survey (HRS; n = 7,624) the proportion of persons ages 70 and older with severe cognitive impairment was calculated under various assumptions about item nonresponse, differential loss to follow-up, and the size and composition of the nursing home population. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents ratings of memory and judgment were used. Chi-square tests were adjusted to account for complex survey designs. RESULTS: Ignoring loss to follow-up, excluding nursing home residents, and assigning a low score to those refusing subscales yielded a statistically significant decline in severe cognitive impairment from 5.8 in 1993 to 3.8 in 1998, or an average annual decline of 6.9 . When cumulative effects of survey design issues were considered and design effects incorporated into statistical tests, statistically significant declines persisted, albeit at a reduced average annual rate, ranging from 2.5 to 6.9 per year. DISCUSSION: Previously reported improvements in severe cognitive impairment appear to be robust to a variety of specifications. Replication with future waves of the HRS and other data is warranted. PB - 57B VL - 57 IS - 2 U4 - Age Distribution/Aged, 80 and Over/Chi Square Distribution/Cognition Disorders/Classification/Diagnosis/Epidemiology/Confounding Factors (Epidemiology)/Follow up Studies/Geriatric Assessment/Health Surveys/Human/Mass Screening/Methods/Standards/Middle Age/Population Surveillance/Questionnaires/Standards/Research Design/Standards/Severity of Illness Index/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - COBRA, Spouse Coverage, and Health Insurance Decisions of Older Households JF - Journal of Forensic Economics Y1 - 2002 A1 - Mark C. Berger KW - Consumption and Savings KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Insurance KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - We use the Health and Retirement Study (HRS) to model the health insurance coverage decisions of older households over time. We estimate coverage decisions as functions of eligibility for various types of health insurance, including the Consolidated Omnibus Budget Reconciliation Act (COBRA) and coverage through current employers of household members, and other characteristics. A bivariate probit model is used to jointly estimate the coverage decisions of husbands and wives and to allow for correlation between unobservable characteristics of the spouses. We use the results to simulate changes in household health insurance coverage that result from events that enable the household to qualify for COBRA coverage. PB - 15 VL - 15 IS - 2 N1 - ProCite field 3 : U KY U4 - Public Policy/Health Insurance/Health Care/Economics of the Elderly/Unemployment/Health/Insurance 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 - THES T1 - Dynamic Models of the Social Security Disability Insurance Application Y1 - 2002 A1 - Gumus, Gulcin KW - Healthcare KW - Social Security AB - This dissertation develops dynamic structural models--option value and dynamic programming models of the Social Security Disability Insurance (SSDI) application decision. In the first chapter, we estimate the time to application following the onset of a health condition that first begins to affect the kind or amount of work that a currently employed person can do. We use the Health and Retirement Study (HRS) augmented by linked restricted access Social Security earnings record data. We test both the in-sample and out-of-sample predictive accuracy of our models using multinomial likelihood ratio tests based on discrete periods. Based on their predictive validity, we find that our option value model is superior to both our dynamic programming model and our reduced form hazard model. We also investigate the robustness of the results by only including individuals for whom restricted access Social Security earnings record data are available in our sample. These results are virtually the same as the ones for the full sample. In the second chapter, we use the preferred option value model estimates from the first chapter to simulate application timing under alternative SSDI policies. Three types of disability policy reforms are simulated: changing the benefit amounts, changing program eligibility stringency by changing the acceptance rates, and extending employer accommodation to all individuals with work limiting health conditions. Our simulations suggest all three of these policy changes would have substantial effects on lifetime application rates and on expected spell lengths until application for SSDI, and hence on SSDI caseloads. PB - Cornell University N1 - RDA U4 - Social Security Disability Insurance JO - Dynamic Models of the Social Security Disability Insurance Application ER - TY - RPRT T1 - End-of-Life Transfers and the Decision to Care for a Parent Y1 - 2002 A1 - Brown, Meta KW - Adult children KW - Healthcare AB - The majority of disabled elderly parents in the U.S. who receive ongoing care are cared for by their children. We have little evidence, however, on the financial and social mechanisms securing the supply of elder care. In recent data on older U.S. families, I find that children rarely receive direct payment for their help. The central question of this study is whether end-of-life transfers act as indirect compensation for caregiving children. I present a dynamic model of the asset choices of a disabled elderly parent in which all intentional bequests are motivated by exchange for care. The parameters of the behavioral model are estimated using AHEAD data on families with unmarried parents who are currently in need of long-term care. Model estimates indicate that the willingness of the adult children in the sample to provide care for their parents responds positively to parents. bequeathable wealth, and the increment to bequeathable assets accompanying care increases with the child.s cost of time. Though these results are consistent with the predictions of the exchange hypothesis, other features of the estimates suggest a substantial altruistic component to caregiving. For example, children whose parents require help with more instrumental activities of daily living, such as shopping and using the telephone, are more likely to provide care at any bequest level. Finally, a policy simulation based on model estimates predicts that a shift of 43 percent of the value of parents. annuitized pensions and Social Security to bequeathable benefits would induce a 4 to 6 percentage point increase in the rate of family caregiving. PB - University of Wisconsin-Madison UR - http://www.econ.jhu.edu/seminars/Spring2003/appMicro/metaBrown.pdf N1 - Center for Retirement Research at Boston College pursuant to a grant from the U.S. Social Security Administration funded as a part of the Retirement Research Consortium U4 - Altruism/Bequest Motives/Bequests/Caregiving ER - TY - THES T1 - Essays on the Economics of Aging and Education Y1 - 2002 A1 - Todd E. Elder KW - Education KW - Employment and Labor Force KW - Healthcare AB - This dissertation examines several key questions concerning school choice and the retirement and employment behavior of older workers while paying special attention to the potential biases resulting from unobserved heterogeneity. This first essay investigates the phenomenon of involuntary job loss among workers over the age of 50 by providing estimates of a dynamic job search model applied to a sample of displaced workers in the Health and Retirement Study (HRS). The estimated models imply that reservation wages are low in comparison to the distribution of observed wages, particularly for full-time jobs. Simulations indicate that both market opportunities and age-related preferences for leisure are responsible for the observed unemployment durations. In the second essay I use data from the HRS to study the effects of employer-provided retiree health insurance (EPRHI) on retirement behavior. I find that EPRHI increases transitions out of employment for those nearing age 65. Similarly, access to EPRHI encourages subsequent retirement for those who have experienced an involuntary job loss. These findings are robust to controls for worker heterogeneity, job characteristics such as workplace flexibility, and changes in assets, pension availability, and earnings opportunities. Failing to control for heterogeneity and job characteristics overstates the impact of EPRHI on labor force transitions. In the third essay I examine the validity of three instrumental variables intended to overcome problems due to unobserved heterogeneity in estimating the effects of Catholic schools on a wide variety of outcomes. Three separate methodologies suggest that religious affiliation, proximity to Catholic schools, and the interaction between these two measures are not useful sources of identification of the Catholic school effect, at least in currently available data. In particular, the potential biases in 2SLS estimates are substantial. The discrepancy between these results and previous estimates of Catholic schooling effects stem in part from functional form assumptions that appear to be playing a larger role in identification than the exclusion restrictions. PB - Northwestern University UR - Database ID: DAI-A 63/04, p. 1479, Oct 2002. U4 - Education, Adult and Continuing (0516) JO - Essays on the Economics of Aging and Education ER - TY - JOUR T1 - Gender and Ethnic/Racial Disparities in Health Care Utilization Among Older Adults JF - The Journals of Gerontology: Social Sciences Y1 - 2002 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Song, Jing A1 - Rowland W Chang KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Women and Minorities AB - OBJECTIVE: We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults. METHODS: Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access. RESULTS: African American men had fewer physician contacts; minority and non-Hispanic White women used fewer hospital or outpatient surgery services; minority men used less outpatient surgery; and Hispanic women were less likely to use nursing home care, compared with non-Hispanic White men, controlling for predisposing factors and measures of need. Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. However, economic access accounted for minority disparities in dental care, which is not covered by Medicare. DISCUSSION: Medicare plays a significant role in providing older women and minorities access to medical services. Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities. PB - 57B VL - 57B UR - http://psychsoc.gerontologyjournals.org/contents-by-date.0.shtml IS - 4 U4 - Aged, 80 and Over/Blacks/Statistics and Numerical Data/Comparative Study/Cross Cultural Comparison/Health Services for the Aged/Utilization/Hispanic Americans/Statistics and Numerical Data/Human/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Utilization Review/Whites/Statistics and Numerical Data ER - TY - RPRT T1 - Long-Term Care, Formal Home Health Care, and Informal Care Y1 - 2002 A1 - Byrne, David A1 - Goeree, Michelle S. A1 - Hiedemann, Bridget A1 - Steven N. Stern KW - Health Conditions and Status KW - Healthcare PB - University of Virginia, Dept. of Economics CY - Charlottesville, VA UR - https://pdfs.semanticscholar.org/ae6a/0d50ea5ea07818288b478c8fdecbfa3f0fc4.pdf?_ga=2.124059916.720161521.1595010693-1957489956.1593535391 N1 - RDA 1998-005 U4 - Long-Term Care/Health ER - TY - THES T1 - Older Workers and their Selection of Partial and Full Retirement: Evidence from Health and Retirement Study Y1 - 2002 A1 - Kim, Haejeong KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - The purpose was to investigate older workers' retirement transitions by examining factors associated with partial retirement and full retirement during a four-year period. The study used data from three waves of the Health and Retirement Study. The sample consisted of 3,268 primary respondents who were working full time in Wave 1. A conceptual model was developed based on the life-cycle retirement model, the lifecycle income hypothesis, disengagement theory, activity theory, continuity theory, lifecourse perspectives, role theory, and the findings of previous research on retirement behavior. Binary logit regression and multinomial logit regression analyses were employed for model estimation. Major findings from the multinomial logit using baseline predictors to examine partial and full retirement in Wave 3 are 1) unearned income, Individual Retirement Account and Keogh plans positively impact the likelihood of partial retirement versus full-time work, while the ownership of defined benefit plans and the ownership of defined contribution plans negatively impact partial retirement versus full-time work; 2) the number of chronic conditions positively impact the likelihood of partial retirement; 3) perceived age discrimination, age, male, and a college degree are positively associated with the likelihood of partial retirement; 4) the expected age of Social Security benefit receipt is negatively related to the likelihood of full retirement versus full time work, while the ownership of defined benefit plans, the ownership of both defined benefit and defined contribution plans, the ownership of IRA and Keogh plans, the ownership of health insurance after retirement are positively related to the likelihood of full retirement; 5) excellent and good health, and the meaning of work is more important are negatively associated with the likelihood of full retirement; and 6) age is positively associated with the likelihood of full retirement. The conflicting effects of pension plans on partial retirement and full retirement show that pension are a stimulus to encourage working although part-time, while pension plans are important as retirement incentives for the full retirement decision. Theoretical, empirical, and practical implications are presented based on the findings. PB - Purdue University CY - United States -- Indiana UR - https://docs.lib.purdue.edu/dissertations/AAI3099808/ U4 - Retirement planning JO - Older Workers and their Selection of Partial and Full Retirement: Evidence from Health and Retirement Study 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 - Retirement Planning and Health Outcomes in the Health and Retirement Study JF - Southwest Journal on Aging Y1 - 2002 A1 - L.M. Albert A1 - Sandra L Reynolds KW - Healthcare KW - Retirement Planning and Satisfaction PB - 18 VL - 18 U4 - Retirement planning/health outcomes ER - TY - CHAP T1 - Size of Incentive Effects in a Longitudinal Study T2 - American Association for Public Research 2002 Y1 - 2002 A1 - Rogers, Willard KW - Healthcare KW - Methodology AB - This paper describes an experiment conducted as part of one wave of the Health and Retirement Study (HRS), which is a longitudinal survey of a nationally representative sample of persons who were born in 1947 or before. Interviews have been conducted biennially since 1992. The general practice, after wave 1, has been to include a check for $20 along with an advance letter sent to each sample member prior to their being contacted, by telephone or face-to-face, by an interviewer. The experiment consisted of changing the amount of the incentive check for randomly selected sample members, with the objective of examining the effect of incentive size in the response rate, on the amount of effort required to finalize the case, and the quality of the data obtained from respondents. In this paper, we examine the effects of the size of the incentive on the response rate on the immediate wave, and also briefly examine the effects on the number of calls. JF - American Association for Public Research 2002 PB - American Statistical Association CY - Alexandria, VA UR - http://www.asasrms.org/Proceedings/y2002/Files/JSM2002-000340.pdf U4 - Panel attrition/Repsonse rate ER - TY - JOUR T1 - Who Expects to Continue Working After Age 62? The retirement plans of couples JF - The Journals of Gerontology: Social Sciences Y1 - 2002 A1 - Pienta, Amy M. A1 - Mark D Hayward KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Expectations KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction KW - Risk Taking AB - OBJECTIVES: This study examines the individual, spousal, and household characteristics associated with the retirement expectations of husbands and wives. METHODS: Using data from the 1992 Health and Retirement Study, subjective probabilities of working full-time after reaching age 62 and age 65 are used to measure retirement expectations. The retirement expectations of husbands and wives are modeled simultaneously using a joint-generalized least-squares approach. RESULTS: Within a marriage, retirement expectations are shaped by individual, spousal, and household characteristics. We observe some gender differences in cross-spousal influence with wives' retirement expectations being more influenced by husbands' resources and constraints than vice versa. Nonetheless, individual and household factors associated with retirement expectations are widely shared by husbands and wives. DISCUSSION: Husbands and wives both respond to individual and joint constraints and opportunities when planning for retirement. Findings support that there is considerable overlap in retirement planning of husbands and wives during early parts of the retirement decision-making process. However, inequity in cross-spousal influences is a defining characteristic of retirement decision making. Implications for both policy makers and practitioners are briefly discussed. PB - 57B VL - 57B IS - 4 U4 - Choice Behavior/Employment/Female/Gender Identity/Health Status/Health Surveys/Middle Age/Retirement Expectations/Retirement Planning/Spouses/Psychology/Support, Non U.S. Government/Support, U.S. Government--PHS ER - TY - JOUR T1 - Aggregate Changes in Severe Cognitive Impairment Among Older Americans: 1993 and 1998 JF - The Journals of Gerontology: Social Sciences Y1 - 2001 A1 - Vicki A Freedman A1 - Aykan, Hakan A1 - Linda G Martin KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - OBJECTIVES: This study explored whether improvements in cognitive functioning occurred during the 1990s among older Americans and investigated several possible explanations for such changes. METHODS: Using the 1993 Asset and Health Dynamics of the Oldest Old study (N = 7,443) and 1998 Health and Retirement Survey (N = 7,624), this study examined aggregate changes in the proportion of the noninstitutionalized population aged 70 and older with severe cognitive impairment. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents, ratings of memory and judgment were used. Logistic regression was used to investigate potential explanations for aggregate changes. RESULTS: The percentage of older Americans with severe cognitive impairment declined from 6.1 in 1993 to 3.6 in 1998 (p .001). The decline was statistically significant among self-respondents but not among those with proxy interviews. Improvements between 1993 and 1998 were not explained by shifts in demographic and socioeconomic factors or by changes in the prevalence of stroke, vision, or hearing impairments. DISCUSSION: As a group, older persons, especially those well into their 80s, appear to have better cognitive functioning today than they did in the early 1990s. PB - 56B VL - 56B UR - http://psychsoc.gerontologyjournals.org/ IS - 2 U4 - Age Factors/Aging/Physiology/Cognition Disorders/Diagnosis/Epidemiology/Educational Status/Female/Middle Age/Neuropsychological Tests/Severity of Illness Index/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Antihypertensive Medication Use in Hispanic Adults: A comparison with Black adults and White adults JF - Medical Care Y1 - 2001 A1 - Joseph J Sudano A1 - David W. Baker KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Risk Taking KW - Women and Minorities AB - BACKGROUND. Variations in awareness, treatment, and control of hypertension among different racial/ethnic groups have been widely reported. It is unclear whether these differences are explained fully by differences in socioeconomic status, insurance coverage, health status, and health behaviors, or whether these differences indicate that racial/ethnic subgroups have unique barriers to hypertension control. OBJECTIVES. Determine whether there are significant differences between racial/ethnic groups in medication use for hypertension after adjusting for potentially confounding variables. RESEARCH DESIGN. Cross-sectional analysis of the 1992 Health and Retirement Study. SUBJECTS. 2450 non-Hispanic white, 939 non-Hispanic black, and 345 Hispanic participants, ages 51 to 61, reporting a history of hypertension. MEASURES. Self-reported current antihypertensive medication use. We used logistic regression to adjust for demographics, socioeconomic status, health status, insurance, and health risk behaviors. RESULTS. 63.6 of white adults, 72.6 of black adults, and 52.5 of Hispanic adults reported current medication use to control hypertension (P 0.001 across all three groups). In stratified analysis, the lower rate of use for Hispanic adults was consistent regardless of gender, insurance coverage, or health status. After controlling for all variables, the adjusted prevalence for Hispanic adults was 50.8 and 73.3 for black adults. CONCLUSIONS. The differences in antihypertensive medication use between white adults, black adults, and Hispanic adults, particularly the markedly lower rates among Hispanic adults, are not explained by differences in demographics, socioeconomic status, health insurance coverage, health status, or health risk behaviors. Alternative explanations for these results and areas for future research and intervention are explored. PB - 39 VL - 39 IS - 6 U4 - Antihypertensive Agents/Ethnicity/Gender/Comparative Study/Cross Sectional Studies/Drug Utilization Review/Health Services Research/Minorities/Hypertension/Logistic Models/Middle Age/Risk Factors/Social Class/Support, U.S. Government--PHS ER - TY - RPRT T1 - Are There Unhealthy Cities? The Impact of Metropolitan Context on Health in Late Middle Age Y1 - 2001 A1 - Mary Elizabeth Hughes KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - Recently, several authors have argued that individual health is shaped in part by the characteristics of the cities in which individuals live. Particular attention has been devoted to metropolitan income distribution, residential segregation, and employment conditions. While these ideas are compelling, they have yet to be adequately tested. I expand on previous research in four ways. First, I use multilevel data that includes characteristics of both individuals and the cities in which they live. Second, my data are longitudinal, tracing the health impact of metropolitan context over a 4-year period. Third, I examine several dimensions of health. Finally, I focus on a narrow age range. Data for my analysis are drawn from waves 1-3 of the Health and Retirement Study, an ongoing longitudinal survey of persons born between 1931 and 1941. I limit my analysis to respondents living in metropolitan areas, yielding an effective sample size of approximately 6,900 persons. I appended data characterizing respondents' metropolitan areas, drawn from a variety of sources, to their individual data records. I use hierarchical linear modeling to examine the impact of metropolitan characteristics on self-rated health, presence of a mobility limitation, depressive symptoms, and presence of a chronic disease. PB - Southern Sociological Society U4 - Metropolitan Areas/Urban Population/Health/Health Problems/Social Environment/Middle Aged Adults ER - TY - JOUR T1 - Balancing Elder Care Responsibilities and Work: The Impact on Emotional Health JF - Journal of Business and Psychology Y1 - 2001 A1 - Lee, Jo Ann A1 - Walker, Matthew A1 - Shoup, Richard KW - Adult children KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare AB - As the elderly population over 85 and the amount of women in the workforce both rise there is an increasing number of persons that must divide their time between working and caring for an elderly relative. These researchers hypothesize that (1a) the relationship between caregiver status and emotional health will be resultant on whether or not the respondent is employed; (1b) those people that are caregivers and employed are expected to have more problems with emotional stability; (2) these problems will grow as the caregiver becomes more involved with the elderly person; and (3) male caregivers are expected to fair better, emotionally, than female caregivers. They found mixed support for hypothesis 1a and no support for hypothesis 1b. However, hypothesis 2 was supported as more emotional difficulties evolved when a caregiver became more involved with the elderly person. Hypothesis 3, found support in that depression was more prevalent in the women caregivers than the men, but other emotional factors did not show significant relationships. PB - 16 VL - 16 IS - 2 U4 - Labor Force Participation/Health Status/Caregiver Status/Family/Transfers 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 - Betwixt and Between: Targeting coverage reforms to those approaching Medicare JF - Health Affairs Y1 - 2001 A1 - Dennis G. Shea A1 - Pamela F. Short A1 - M. Paige Powell KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Income KW - Insurance KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Net Worth and Assets AB - Recent Medicare buy-in proposals agree on setting eligibility at age sixty-two but disagree on linking eligibility to loss of employer insurance or ability to pay. We examine arguments for targeting incremental coverage for older Americans in these ways. While access to retiree health insurance is declining, we question whether targeting loss of employer insurance can address many older Americans' insurance problems. Furthermore, focusing on persons ages sixty-two to sixty-four misses a large group of persons in poor health with limited resources. Efforts to improve coverage for older Americans should consider trade-offs between defining eligibility by age versus ability to pay. PB - 20 VL - 20 IS - 1 U4 - Age Factors/Eligibility Determination/Financing, Personal/Health Benefit Plans, Employee/Health Care Reform/Health Status/Income/Insurance Coverage/Medicare/Middle Age/Poverty/Support, Non U.S. Government ER - TY - RPRT T1 - Breast Cancer Survival, Work, and Earnings Y1 - 2001 A1 - Cathy J. Bradley A1 - Bednarek, Heather A1 - David Neumark KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Other KW - Retirement Planning and Satisfaction KW - Social Security KW - Women and Minorities AB - Relying on data from the Health and Retirement Study, we examine differences between breast cancer survivors and a non-cancer control group in employment, hours worked, wages, and earnings. Overall, breast cancer has a negative impact on the decision to work. However, among survivors who work, hours of work and, correspondingly, annual earnings are higher compared to women in the non-cancer control group. These findings suggest that while breast cancer has a negative effect on women's employment, breast cancer may not be debilitating for those who remain in the work force. We explore numerous possible biases underlying our estimates especially selection based on information in the Health and Retirement Study, and examine related evidence from supplemental data sources. JF - NBER Working Paper PB - The National Bureau of Economic Research CY - Cambridge, MA U4 - Breast Neoplasms/Economics/Mortality/Radiography/Cohort Studies/Diagnostic Tests, Routine/Efficiency/Employment/Economics/Statistics and Numerical Data/Female/Human/Longitudinal Studies/Mammography/Utilization/Middle Age/Models, Econometric/Probability/Research Design/Retirement/Salaries and Fringe Benefits/Statistics and Numerical Data/Social Security/Support, U.S. Government--PHS/Survivors/Statistics and Numerical Data/United States/Epidemiology/Women, Working/Statistics and Numerical Data ER - TY - THES T1 - Capital and Health Status in Near-old Adults Y1 - 2001 A1 - Frytak, Jennifer R. KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - Background. The existence of socioeconomic status (SES) differentials in health status has been widely recognized in the literature; the differentials appear to be widest in near-old adults (ages 55-64). Different disciplines have proposed a variety of explanatory mechanisms thought to account for the relationship between SES and health. However, no consensus has been reached in the literature regarding the best explanation for SES differentials in health. Objective. This study investigates how different types of financial, human, and social resources-defined hereafter as capital are associated with producing health in low versus high SES groups. Data source. Wave 1 (1992) and Wave 2 (1994) of the Health and Retirement Study. Study design. This research attempts to combine economic and sociological perspectives into a capital-based approach to exploring SES differentials in health. Measures of financial, human, and social capital were developed. The sample was divided into high and low SES groups. Latent variable structural equation modeling was used to examine the relative effects of the different types of capital on health for each SES group. The differences in the SES subgroup capital coefficients were compared across the subgroups. Results. Capital was found to work differently in the different SES groups. Financial capital generally had a greater direct protective effect on health in the low versus high SES group. Social capital had a greater direct protective effect on self-rated health in the high versus the low SES group; all social capital effects on health were indirect for the low SES group. The effects of human capital were mixed. Human capital generally had the largest protective effects on health within both groups. Conclusions. We found support for the contention that a differential distribution of social, personal, and economic resources within the social structure are fundamental causes of differentials in population health for near-old adults. If social stratification is not considered explicitly in health policy, a general improvement in population health may be achieved but not a lessening of the SES differentials in health. PB - University of Minnesota U4 - Health Status JO - Capital and Health Status in Near-old Adults ER - TY - JOUR T1 - Demographics Shape Prevention Programs JF - Employee Benefit Plan Review Y1 - 2001 A1 - Unattributed KW - Demographics KW - Healthcare PB - 55 VL - 55 IS - 11 U4 - Health Care/Demographics ER - TY - JOUR T1 - Eddies in the Stream: The Prevalence of Uncertain Plans for Retirement JF - The Journals of Gerontology: Social Sciences Y1 - 2001 A1 - David J Ekerdt A1 - Kyle J Hackney A1 - Karl Kosloski A1 - S. DeViney KW - Demographics KW - Employment and Labor Force KW - End of life decisions KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Retirement Planning and Satisfaction KW - Time Use AB - OBJECTIVE: This study examined an assumption of retirement theory that typifies older workers as preretirees who are planfully engaged in paths toward retirement. METHODS: Using survey responses among workers in the 1992 and 1994 waves of the Health and Retirement Study, we described the prevalence of nonsubstantive answers to questions about the expected form and timing of retirement (e.g., don't know, haven't thought about it ). We tested explanations for this uncertainty as an artifact of the survey process, but also as an outcome of the opportunity structure for retirement planning. RESULTS: Survey procedure did generate some of these noncommittal responses. Depending on question type, approximately 10 to 40 of workers did not state when or how they would retire, and such responses were less prevalent across age and time. In addition, categorical uncertainty about form and timing was theoretically predictable in a framework that supposed that workers less subject to a socially attended life--at work or away--would be more undecided about the future. DISCUSSION: Uncertainty is an authentic, meaningful stance toward retirement that theory and research design should not ignore. Just as actual transitions to retirement can be ambiguous or blurred, the expectation of retirement, as well, can be untidy. PB - 56B VL - 56B UR - http://psychsoc.gerontologyjournals.org/ IS - 3 U4 - Age Factors/Career Mobility/Data Collection/Decision Making/Employment/Psychology/Female/Human/Logistic Models/Longitudinal Studies/Middle Age/Planning Techniques/Probability/Psychological Theory/Questionnaires/Research Design/Retirement/Psychology/Support, U.S. Government--PHS/Time Factors/United States ER - TY - NEWS T1 - Elders living with their children get more Medicare-paid help T2 - University Record Y1 - 2001 A1 - Swanbrow, Diane KW - Adult children KW - Healthcare KW - Medicare/Medicaid/Health Insurance JF - University Record PB - University of Michigan CY - Ann Arbor, MI U4 - Caregiving/Medicare/Health Care/Intergenerational Relations JO - Elders living with their children get more Medicare-paid help ER - TY - CHAP T1 - How Costly Are Smokers to Other People? Longitudinal Evidence on the Near Elderly T2 - Frontiers in Health Policy Research Y1 - 2001 A1 - Gabriel A. Picone A1 - Frank A Sloan ED - Garber, Alan M. KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - This study looks at the impact that smoking has on people over the course of time. Data and studies on the costs of smoking, not just for the smoker but for people around them, are very important for many issues. People aged 51-67 are used since that is the time frame where health problems caused by smoking tend to be most prominent. The researchers calculate the costs from healthcare based on the type of insurer. In the end it is concluded that government payers and then Medicare and Medicaid take the largest amount of the financial problem for smoking. Private insurance companies did not seem to take on a great deal of the costs from this behavior. JF - Frontiers in Health Policy Research PB - MIT Press CY - Cambridge, MA N1 - ProCite field 6 : In ProCite field 8 : ed U4 - Middle Aged Adults/Smoking/Health Care Costs/Medicaid/Medicare JO - How Costly Are Smokers to Other People? Longitudinal Evidence on the Near Elderly 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 - JOUR T1 - The Impact of Involuntary Job Loss on Subsequent Alcohol Consumption by Older Workers: Findings from the Health and Retirement Survey JF - The Journals of Gerontology: Social Sciences Y1 - 2001 A1 - William T Gallo A1 - Elizabeth H Bradley A1 - Michele J. Siegel A1 - Stanislav V Kasl KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Retirement Planning and Satisfaction KW - Risk Taking AB - OBJECTIVE: To estimate the effect of involuntary job loss on subsequent alcohol consumption by older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, the authors estimated multivariate models to assess the impact of involuntary job loss on subsequent alcohol use. Two outcomes were investigated: reported daily alcohol consumption and onset of drinking. The analysis sample included 207 workers who experienced involuntary job loss between survey dates and a comparison group of 2,866 continuously employed workers. RESULTS: After baseline alcohol consumption and a variety of socioeconomic and illness-related covariates were controlled, involuntary job loss was not associated (p .05) with number of daily drinks consumed at follow-up. However, among those who did not consume alcohol at baseline, individuals who suffered involuntary job loss were twice as likely as continuously employed individuals to start drinking by follow-up (OR = 2.01; CI = 1.06-3.80). The majority of those who began drinking at follow-up reported drinking less than 1 drink per day. DISCUSSION: The findings provide evidence of a significant relationship between job loss and subsequent alcohol use among baseline nondrinkers. However, the magnitude of the changes in drinking was quite modest. PB - 56B VL - 56B UR - http://psychsoc.gerontologyjournals.org/contents-by-date.0.shtml IS - 1 U4 - Alcohol Drinking/Psychology/Female/Health Behavior/Human/Middle Age/Personnel Downsizing/Psychology/Retirement/Psychology/Risk Factors/Support, U.S. Government--PHS ER - TY - RPRT T1 - The Impact of the Cost of Long-Term Care on the Saving of the Elderly Y1 - 2001 A1 - Anthony Webb KW - Consumption and Savings KW - Healthcare AB - One of the predictions of the life-cycle model of savings behavior is that the elderly should dissave at a rate that increases with age. But there is little evidence that significant dissaving takes place at any age. One explanation is that the elderly wish to retain assets to cover the cost of long-term care. I propose a model in which the elderly are informed about both their life expectancy and their likelihood of entering long-term care, and in which the utility of consumption in long-term care differs from that of consumption at home. I consider how the Medicaid rules relating to long-term care might influence the behavior of married couples and single persons whose wealth is above or below Medicaid eligibility limits. I test the predictions on data from the 1993 and 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) dataset, which has information on expectations. I make use of interstate differences in Medicaid financial eligibility rules to investigate the effects of Medicaid on household saving. In accordance with the predictions of my model, I find no evidence that people who are eligible for Medicaid dissave more rapidly if they expect to enter long-term care. On the contrary, married couples save more if they believe it is likely that they will enter long-term care. However, even those households that do not expect to enter long-term care fail to dissave. I find that an increase in the generosity of spousal protection rules leads to a decrease in household saving. PB - University of California, San Diego UR - http://www.nber.org/ confer/2001/si2001/webb.pdf U4 - Long-Term Care/Saving ER - TY - THES T1 - Income and Wealth Differentials of Late Middle-aged United States-born and Foreign-born Households in the United States: Implications for immigrant Social Security and retirement income Y1 - 2001 A1 - Rojanawon, Wichian KW - Demographics KW - Healthcare KW - Methodology KW - Other KW - Public Policy KW - Retirement Planning and Satisfaction AB - This study examines the economic resources and retirement outlook of older foreign-born individuals and their families in the United States. Past research indicates that immigrants experience some disadvantages compared to the U.S.-Born in the labor market due to migration and adjustment to a new culture as well as difficulty with the english language. Through the political economy and life course perspectives, stressing the importance of an individual's early experiences with the labor force, it is predicted that certain disadvantages will have an impact on retirement prospects as well as issues associated with old age. Nevertheless, there is a scarcity of research on the economic status of aging immigrants in the immigrant and retirement research, including the current research and discussion on social security reform. Research questions and hypotheses are addressed by using the Wave 1 of the Health and Retirement Study (HRS) and the HRS restricted data files. Findings from this study suggest that as a group, immigrants are likely to have low social security wealth and their income, assets and investment profiles are less than those of native-born counterparts are. Immigrants are also less likely to have employer-sponsored pensions and stock investment. If they do own stocks, the value of their holdings is likely to be much less. Recommendations for addressing policy, practice, and research efforts are presented with the goal of improving the economic conditions of aging immigrants who are at risk of poverty in old age. PB - Boston College U4 - Sociology, Public and Social Welfare (0630) ER - TY - THES T1 - Nursing Home Residents' and Family Caregivers' Strategies in Financing the Costs of Long-Term Care Y1 - 2001 A1 - Mikolas-Peters, Cynthia Jean KW - Healthcare KW - Net Worth and Assets AB - This dissertation studies the ways nursing home residents and caregivers manage the costs of chronic illness and the long-term care services provided during these episodes of illness. Of particular interest was how life-course events and family background affect the ability of the disabled elderly to privately finance costs in the context of Medicaid spend-down requirements. Few studies have actually looked specifically at the influence of age and health on strategies elderly residents and their families use to finance long-term care. This study was a direct result of the lack of longitudinal surveys that include adequate measures of both the health and financial status of this population. This dissertation combines both qualitative and quantitative data sources to address these issues. The experiences of the disabled elderly were examined in an exploratory study over a three-year period. The second data source was from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Combining these two data sources were necessary in order to deeply examine the nature and consequences of changes in financing long-term care among this age group. The study's major finding was the identification of distinct strategies for financing long-term care and the importance of a continuum in explaining differences in the consumption of resources and strategies to finance care. The quality of care for the chronically ill was not addressed in this continuum. Residents' abilities to privately finance care were limited or undermined altogether when health problems and age compromised their independence to fund their care. Recognition that their experiences vary along a continuum was important since it corresponds to a decline in their wealth and maintaining control to avoid the consumption of savings and assets. Caregivers contributed support and provided services to avoid the dissaving required to finance the consumption of highly specialized services. These findings suggest that the role of the caregiver may need to be improved. Caregiver burdens are not distributed uniformly over the non-patient population among families whose parents' may or may not need care, and who contract illnesses of varying length or physical suffering. PB - University of Chicago U4 - Nursing Homes JO - Nursing Home Residents' and Family Caregivers' Strategies in Financing the Costs of Long-Term Care ER - TY - JOUR T1 - The Role of Micro-level Panel Data in Policy Research JF - Schmollers Jahrbuch: Zeitschrift fur Wirtschafts und Sozialwissenschaften/Journal of Applied Social Science Studies Y1 - 2001 A1 - R.V. Burkhauser A1 - Smeeding, Timothy M. KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Public Policy KW - Retirement Planning and Satisfaction AB - This paper focuses on the value of longitudinal micro-level data for policy centered research on behavioral and economic well-being. It provides examples of policy questions that can best be answered using such data and shows how they have been answered using data from four ongoing longitudinal panels--the BHPS (British Household Panel Study), the GSOEP (German Socio-Economic Panel), the HRS (Health and Retirement Study) and the PSID (Panel Study of Income Dynamics). Finally, it suggests a set of policy issues that can be considered using these data or from a national or a cross-national perspective. PB - 121 VL - 121 UR - http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.200.6915&rep=rep1&type=pdf IS - 4 N1 - ProCite field 3 : Cornell U; Syracuse U U4 - General Welfare/Basic Needs/Living Standards/Quality of Life/Economics of the Elderly/Provision and Effects of Welfare Programs/Retirement Policies/Public Policy/Well Being/HRS content and design ER - TY - NEWS T1 - Seniors Most in Need of Home Care May Not Get It T2 - New York Times on the Web Y1 - 2001 A1 - Reuters KW - Healthcare JF - New York Times on the Web PB - The New York Times Co. CY - New York, NY N1 - ProCite field[2]: Press Release U4 - Health Care/Home Care Services JO - Seniors Most in Need of Home Care May Not Get It ER - TY - NEWS T1 - Will the Aid You Need Be There for You? T2 - Orlando Sentinel Y1 - 2001 A1 - Hughes, Mona KW - Healthcare KW - Retirement Planning and Satisfaction JF - Orlando Sentinel PB - Orlando Sentinel CY - Orlando, FL U4 - Retirement/Health Care JO - Will the Aid You Need Be There for You? 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 - THES T1 - Comparative Models of the Impact of Social Support on Psychological Distress in Cancer Patients Y1 - 2000 A1 - Forjaz, Maria Joao Bettencourt Pereira KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - This study tested the relationship between Social Support, Psychological Distress, and Illness Stress in individuals who report cancer as a health condition. This study was based on archival data obtained from the Wave 1 of the Health and Retirement Study (HRS). The HRS provides a nationally representative sample of individuals aged 51 to 61 in 1992 and their spouses. The study sample was limited to cancer patients with a spouse or partner (n = 503). A structural equation modeling analysis procedure was used to test the theoretical models. Measures of social support were limited to variables assessing the participant's satisfaction with social support. Evidence was found for the Stress Prevention and the Support Deterioration models. This is congruent with previous research using measures of social support perception. Both the Stress Prevention and the Support Deterioration models predict a negative relationship between Illness Stress and Social Support. In addition, a univariate analysis of variance was used to test the stress buffering model. Similarly to other studies measuring the individual's degree of integration, or its perception, in the social network, the present research supported the only the Main Effect model and not the Stress Buffering model. PB - University of North Texas CY - United States -- Texas UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=727293571&Fmt=7&clientId=17822&RQT=309&VName=PQD U4 - Psychotherapy JO - Comparative Models of the Impact of Social Support on Psychological Distress in Cancer Patients ER - TY - THES T1 - Consequences of Health Events: Economics and Behavioral Outcomes in the Health and Retirement Study Y1 - 2000 A1 - Tracy Falba KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction PB - Stanford University N1 - ProCite field[9]: U4 - Health Shocks JO - Consequences of Health Events: Economics and Behavioral Outcomes in the Health and Retirement Study ER - TY - RPRT T1 - Does Mental Health Affect Transitions out of the Labor Force in Older Workers? Y1 - 2000 A1 - Linda A. Wray KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Retirement Planning and Satisfaction AB - This paper extends earlier studies on health and work by examining how mental health affects transitions out of paid work in the years prior to the traditional Social Security retirement ages. Specifically, I investigate how mental health is linked to transitions to early retirement or other unemployed state in 1996 for middle-age adults who were currently working in 1992 and, in particular, whether deficits in mental health affect those transitions. To answer those questions, I use data from the first three waves of the Health and Retirement Study, a panel study of a nationally representative sample of Americans age 51-61 in 1992. Results of logistic regression analyses indicated that mental health had a strong and significant influence on the move from paid work to unemployment in three ways, net of other documented health, job, and socioeconomic correlates of work status: (1) Above-average self-assessed mental health predicted the transition from current worker to retiree. (2) Above -average mental health played a protective role in keeping workers in the work force rather than being laid off, on sick leave, or otherwise unemployed. (3) Increased CES-D depressive symptoms between 1992 and 1994 predicted exits from paid employment and into other unemployment by 1996. The results also indicate that mental health was an even more important predictor of transitions out of paid work among middle-age workers than were physical health and functioning. PB - American Sociological Association U4 - Labor Force Participation/Mental Health/Life Stage Transitions/Retirement/Unemployment/Middle Aged Adults/Workers/role exit/sociology of health and medicine/social psychiatry (mental health) ER - TY - RPRT T1 - Drug Use Among the Elderly: An Assessment of California's Need for Prevention and Treatment Services Y1 - 2000 A1 - Wong, Mamie M. A1 - Anglin, M. Douglas KW - Health Conditions and Status KW - Healthcare PB - State of California, Dept. of Alcohol and Drug Programs N1 - RDA 1998-012 U4 - Health Status/Drug Use/Health Care 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 - BOOK T1 - Forecasting Retirement Needs and Retirement Wealth Y1 - 2000 A1 - Olivia S. Mitchell A1 - P. Brett Hammond A1 - Anna M. Rappaport KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Pensions KW - Retirement Planning and Satisfaction KW - Women and Minorities AB - Thirteen papers draw on data from the Health and Retirement Study and from other sources to explore people's preparation for and the financial challenges of retirement in the United States. Papers discuss new paths to retirement; how prepared Americans are for retirement; projected retirement wealth and saving adequacy; individual savings and investment choices associated with 401(k) plans; factors explaining retirement savings shortfalls; women's economic well -being at the end of their work lives and the factors that appear to be associated with the poorer economic status of older women relative to older men; the prospects for widow poverty; minorities facing retirement; early retirement windows; the relationship between people's expectations about their retirement, their realizations of retirement, and the role of health shocks in this process; planning for health care needs in retirement; the evaluation of pension entitlements; social security earnings and projected benefits. Mitchell is at the Wharton School, University of Pennsylvania. Hammond is with the Teachers Insurance Annuity Association-College Retirement Equities Fund (TIAA -CREF). Rappaport is at William M. Mercer, Inc. Index. PB - University of Pennsylvania Press CY - Philadelphia, PA UR - https://pensionresearchcouncil.wharton.upenn.edu/publications/books/forecasting-retirement-needs-and-retirement-wealth/ N1 - RDA 1996-002 ProCite field 8 : eds. U4 - Retirement/Retirement Policies/Economics of the Elderly/401(k) participation and balances/Women/Minorities/Health Care/Health Shocks ER - TY - JOUR T1 - A Health and Demographic Profile of Noninstitutionalized Older Americans Residing in Environments with Home Modifications. JF - Journal of Aging and Health Y1 - 2000 A1 - Tabbarah, M. A1 - Merril Silverstein A1 - Teresa Seeman KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - Healthcare KW - Housing KW - Methodology AB - OBJECTIVES. In this analysis the authors investigate the demographic characteristics, the health conditions/events, and the disabilities of community-dwelling Americans 70 years of age and older that are associated with residing in environments with specific home modifications. METHODS. Data from a large population-based study of the elderly are used to estimate logistic regression equations that reveal profiles of older individuals who are likely to have distinct home modifications. RESULTS. Having diseases such as diabetes and stroke, having experienced a hip fracture, a fall or a joint replacement, and having greater limitations with activities of daily living raise the likelihood of having home modifications. Low income, Hispanic, and African American elderly appear underrepresented among those with modifications. DISCUSSION. The authors conclude that specialized housing alternatives will be an increasingly important issue in the future as individuals aim to achieve and maintain the delicate balance between their functional ability and their living environment. PB - 12 VL - 12 IS - 2 U4 - Home Modifications/Health Status/Disability/Disability/Architectural Accessibility/Disabled Persons/Ethnicity/Interior Design and Furnishings/Self Help Devices/Socioeconomic Factors/Support, U.S. Government--PHS ER - TY - THES T1 - Intergenerational Intervivos Transfers: What is the pattern and level of financial support parents provide their adult children? Y1 - 2000 A1 - Wilkinson, Jody Ann KW - Adult children KW - Healthcare AB - Why do parents give their adult children money? What child and parental characteristics influence monetary transfers? Does the effect of these characteristics differ across low, medium, and high transfer dollar amounts? What is the parent's motive behind providing their adult child with a financial transfer? Is it based on the child's income or a life event experienced by the child (i.e., Altruism or contingent exchange)? This research examines the relationship between financial transfers and characteristics of the adult child. The data used are the 1992-1994 Health and Retirement Study (HRS), which contains a nationally representative sample of adults born between 1931 and 1941. At baseline, financial transfers to 18,463 adult children living independently from their parent's household (n = 6,001) are examined. Cross-sectional and longitudinal models are specified to determine the relationship between the financial transfer and characteristics of the adult child, controlling characteristics of the parental household across transfer levels. The motive behind the financial transfer behavior is tested using two competing theories, altruism and contingent exchange. Lastly, the relationship between race and the financial transfer as a percent of total household income is examined. Two variables consistently have the greatest effect on the amount of the financial transfer the adult child PB - Purdue University UR - https://docs.lib.purdue.edu/dissertations/AAI3018290/ U4 - Sociology, Individual and Family Studies (0628) ER - TY - THES T1 - Intervivos Transfers by Elderly At Risk for Nursing Home Placement: Implications for Federal Medicaid Policy Y1 - 2000 A1 - Gilchrist, Barbara J. KW - Adult children KW - Healthcare KW - Public Policy PB - Saint Louis University U4 - Policy JO - Intervivos Transfers by Elderly At Risk for Nursing Home Placement: Implications for Federal Medicaid Policy 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 - THES T1 - Potential to Privately Pay for Long-Term Care Services Y1 - 2000 A1 - Dougherty, Deborah D. KW - Healthcare KW - Net Worth and Assets AB - Financing long-term care for the elderly has become an issue of public versus private financing. As proposals to cut public spending are discussed, alternative methods for financing long-term care services need to be introduced. This study addresses the usage of long-term care insurance and reverse mortgages as alternative financing methods. Using the Assets and Health Dynamics of the Oldest-Old, I establish who received long-term care services and how they paid for such services. Next, I examine alternative financing methods to determine which elderly would qualify. Finally, I adjust the criteria of inclusion to increase the beneficiary group of each payment method. I find that both reverse mortgages and long-term care insurance benefit certain groups of individuals. Reverse mortgage beneficiaries included those elderly with large equity in their housing. Using a $30,000 or more home equity, I illustrate that a reverse mortgage would not cover the cost of one year in a nursing home for many elderly. Long-term care insurance, on the other hand, would benefit a majority of elderly individuals, although adjustments need to be made in the insurance market. Individuals with ADL limitations or disease conditions must be allowed to purchase such policies. Insurance premium costs need to be supplemented for those individuals who can not afford them. Individuals between the ages of 80 and 84 must also be considered for insurance policies. My results support the argument that policy discussions concerning long-term care financing should focus on three groups of elderly. Public payers are a group of elderly who rely heavily on Medicaid to cover the costs of their long-term care services. Private payers are those elderly with high incomes and assets who are financially capable of sustaining their long-term care needs. Gappers are those elderly with income and asset levels too high to qualify for Medicaid and too low to pay for their care out-of-pocket. This study indicates that the most beneficiary alternative financing method for gappers is long-term care insurance. The industry is still young, and now is the time to take a stance and make long-term care insurance the solution to financing long-term care. PB - Syracuse University U4 - Financial Management JO - Potential to Privately Pay for Long-Term Care Services ER - TY - JOUR T1 - Private Long-term Care Insurance and the Asset Protection Motive JF - The Gerontologist Y1 - 2000 A1 - Jennifer M Mellor KW - Demographics KW - End of life decisions KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Net Worth and Assets AB - This research examined the role of assets in the decision to purchase insurance for long-term care using survey data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Previous research suggests that assets matter, but the size and direction of the effect varies. An important issue regarding the role of assets has not been explored adequately--whether the effect of assets differs between less wealthy and very wealthy individuals. A methodology to control for this type of variation is employed in this analysis. Results suggest that increases in assets have the greatest influence on the probability that less wealthy individuals own long-term care insurance, and have a negligible impact on the wealthy. This has important implications for policies designed to increase long-term care insurance ownership. PB - 40 VL - 40 IS - 5 U4 - Assets/Decision Making/Health Policy/Insurance, Long Term Care/Economics/Probability/Socioeconomic Factors/Support, U.S. Government--PHS/United States ER - TY - THES T1 - Subjective Expectations of Nursing Home Use, Medicaid, and Economic Behavior by Older Americans Y1 - 2000 A1 - Merrill, Angela KW - Consumption and Savings KW - Healthcare KW - Medicare/Medicaid/Health Insurance PB - University of California at Berkeley U4 - Health Care JO - Subjective Expectations of Nursing Home Use, Medicaid, and Economic Behavior by Older Americans 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 - RPRT T1 - America's Elderly Population and Their Need for Supportive Services Y1 - 1999 A1 - Shafer, Robert KW - Health Conditions and Status KW - Healthcare AB - Abstract: Examined the characteristics of older adults and their needs for supportive services. Data were obtained from the Assets and Health Dynamics Among the Oldest-Old (AHEAD) survey on 8,222 adults aged 70 and older in 1993 and 6,047 housing units. It was found that the population aged 70 and older is largely female and increasingly so with age, rising to 79.2 percent for adults aged 90 and older. The educational achievement and occupational status of older adults reflects societywide trends, and 9 percent are currently employed. The best measures of the health of older adults and their need for assistance are measures of activities of daily living (ADLs) and instrumental ADLs (IADLs). While about 19 percent of adults aged 70-74 had difficulty with at least one ADL, 74 percent of those aged 90 and older had difficulty with at least one ADL. For IADLs, the percentage increased from 20 percent to 74 percent across the same age range. The results suggest that a variety of responses are required to meet older adults' diverse needs for supportive services. PB - Cambridge, MA, Harvard University U4 - ADL and IADL Impairments/Health Services for the Aged ER - TY - JOUR T1 - Consumer Preferences for Health Care Reform Options JF - Journal of Consumer Affairs Y1 - 1999 A1 - Gong-Soog Hong A1 - Shelley I. White-Means KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets KW - Public Policy AB - This study uses the 1992 Health and Retirement Study to examine consumer preferences for four health care reform options: tax-financed national health insurance, personally subsidized Medicare extensions, publicly subsidized nursing home insurance, and tax credits for health insurance purchases. Males, non-Caucasians, the self-employed, those in excellent health, and those who reside in the Northeast favor national health insurance, while those with high levels of liquid and non-liquid assets tend to disfavor it. Males and those with higher expectations of living in nursing homes tend to favor personally subsidized Medicare extensions to cover nursing homes and home health care. Those with higher expectations of living in nursing homes also favor publicly subsidized nursing home insurance. Relatively little support for subsidized nursing home insurance is found among males and those with high levels of liquid and non-liquid assets. The self-employed tend to support tax credits for health insurance premiums. PB - 33 VL - 33 UR - https://www.jstor.org/stable/23859957?seq=1#page_scan_tab_contents IS - 2 N1 - ProCite field 3 : Purdue U; U Memphis U4 - Health Policy/Nursing Homes/Tax Policy/Health Production--Nutrition, Mortality, Morbidity, Disability, and Economic Behavior/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Net Worth ER - TY - THES T1 - Essays on Long-Term Care of the Elderly in the United States Y1 - 1999 A1 - Aykan, Hakan KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Public Policy AB - This dissertation consists of three independent essays on long-term care of the elderly in the United States. Long-term care encompasses a wide array of increasingly important and rapidly changing issues. These issues can be divided into six broad categories: (1) use, cost, and financing; (2) special populations; (3) data development and methodology; (4) access and quality of care; (5) organization and delivery of care; and (6) consumer and caregiver behavior. The essays in this dissertation fall into the first three of these categories. The first essay uses a continuous-time hazard model to analyze the importance of state Medicaid policies in determining the risk of nursing home use among the elderly. We find that these state policies do not significantly affect the risk of older persons' nursing home use, controlling for a variety of demographic, socioeconomic, and health-related factors. Data for this analysis come from the first two waves of the Assets and Health Dynamics of the Oldest Old (AHEAD) survey. The second essay uses a multinomial logistic regression model to examine how the use of nursing home and home health care services vary for older persons with and without children. Results indicate that older women's (but not men's) use of nursing home care (but not home health care) is significantly increased for those who are childless. This essay also uses data from the first two waves of the AHEAD survey. The third essay analyzes some design issues in the Second Supplement on Aging (SOA-II) to the 1994 National Health Interview Survey (NHIS) and their implications for the use of this survey by itself or in conjunction with the Supplement on Aging conducted ten years earlier. We find that especially one of the design issues, the time-lag between the 1994 NHIS and the SOA-II, could lead to biases in analyses using the SOA-II. We address the design issues by correcting for sample selection in the SOA-II and by developing a re-weighting scheme. PB - Syracuse University UR - https://surface.syr.edu/ppa_etd/33/ U4 - Medicaid JO - Essays on Long-Term Care of the Elderly in the United States ER - TY - JOUR T1 - Formal and Informal Community Care to Older Adults: Comparative Analysis of the United States and Great Britain JF - Journal of Family and Economic Issues Y1 - 1999 A1 - Adam Davey A1 - Patsios, Demi KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - This article examines four components of community-based care for older adults with ADL limitations from a cross-national perspective, focusing on the U.S. and Great Britian. Surveys of older adults were used to determine whether differences exist between the two countries with respect to: the type of support that is primarily provided (informal sector vs. formal sector), the overall likelihood that those with at least 1 ADL limitations receive assistance, and the extent of unmet needs. Results show that the likelihood of receiving formal and informal support was significantly greater in G.B. than in the U.S. However, while high in both, the rates of unmet need did not differ between the two countries. The data also shows that community-based formal support does not substitute family help. This finding emphasizes the importance of family caregivers and further reinforces the already existing effort made by both countries to provide support for these primary support agents. PB - 20 VL - 20 IS - 3 U4 - Community Health Services/Health Services/Family/Health Status/Activities of Daily Living ER - TY - JOUR T1 - Formation of Trusts and Spend Down to Medicaid JF - The Journals of Gerontology: Social Sciences Y1 - 1999 A1 - Donald H. Taylor Jr. A1 - Frank A Sloan A1 - Edward C Norton KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Net Worth and Assets AB - OBJECTIVE: To identify the proportion of community-dwelling elderly persons (70 ) who could affect their eligibility for Medicaid financing of a nursing home stay through the use of a trust and to quantify the prevalence and predictors of trusts. METHODS: State-specific Medicaid eligibility regulations were used to determine eligibility and to identify those who could affect the same through the use of trusts. Multivariate logistic regression was used to identify correlates of having a trust. Wave 1 of the Assets and Health Dynamics of the Oldest Old (AHEAD) data base was used. RESULTS: Four in 10 elderly community dwellers could potentially qualify for Medicaid by using a trust; however, less than 10 had a trust. On average, wealthier persons had trusts. Avoidance of probate and controlling assets after death appear to be stronger motivations for trust creation among the elderly than achieving Medicaid spend down. DISCUSSION: The use of trusts was not common, and motives other than spend down were more important for those with trusts. Our results suggest little need for policy efforts to limit the use of trusts to achieve spend down. PB - 54B VL - 54B UR - https://watermark.silverchair.com/54B-4-S194.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAArkwggK1BgkqhkiG9w0BBwagggKmMIICogIBADCCApsGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMp0UUg1PuPyPtW2TQAgEQgIICbKvSCKf7gEQSGvy-WxqpuojGLR3OKgcObNMZ3E6gB4hR IS - 4 U4 - Aged, 80 and Over/Assets/Eligibility Determination/Financing, Personal/Homes for the Aged/Intergenerational Transfers/Medicaid/Nursing Homes/Support, U.S. Government--PHS/United States ER - TY - THES T1 - Medicaid, Financial Transfers, and Expectations of the Elderly Y1 - 1999 A1 - Bassett, William F. KW - Healthcare KW - Other AB - This dissertation is an empirical evaluation of several issues in the economics of aging. In the first two chapters, I use data from the Study of Assets and Health Dynamics of the Oldest Old (AHEAD) and information about the generosity of state Medicaid programs to study the incentives created by the Medicaid program's coverage of the costs associated with a long nursing home stay. The household's expectations of future nursing home use and the state's asset threshold for Medicaid eligibility are used to identify the relationship between inter-vivos asset transfers and the Medicaid nursing home benefit. These factors have small but significant effects on the incidence of transfers between elderly parents and their children and much larger effects on the total amount of transfers. In the final two chapters, my co-author and I focus on the accuracy of expectations provided by respondents, and the usefulness of these expectations in economic modeling. Specifically, we examine whether we can use the entire spectrum of subjective responses by each individual, rather than just the question (or questions) of interest, in order to glean additional information about the underlying true probabilities. We find evidence of a significant, unobserved, individual-specific component in answers to subjective probability questions in both AHEAD and the companion Health and Retirement Study. We then show that controlling for this individual component can lead to significant differences in inference when modeling the relationship between the baseline subjective responses and observed outcomes from later waves of the survey. PB - Brown University U4 - Gerontology (0351) JO - Medicaid, Financial Transfers, and Expectations of the Elderly ER - TY - THES T1 - The Tail Ends: Hedging against old age and other natural catastrophes Y1 - 1999 A1 - James Moore KW - Consumption and Savings KW - Healthcare KW - Other KW - Retirement Planning and Satisfaction KW - Risk Taking AB - This dissertation is comprised of two essays examining two different topics that can be grouped under the rubric of risk management. The first examines estimation uncertainty and its implications for risk transfer at the corporate level and the price of that risk transfer. The second explores whether households are adequately preparing for the risks they face as they age. The past few years have seen the development and growth of traded securities with payoffs tied to natural and industrial disasters. Pricing the insurance features imbedded in these securities is difficult and imprecise. This lack of pricing precision translates to greater required return premiums to holders of these securities. The first essay explores the nature of pricing uncertainty for a number of datasets, security designs, and loss distributions using both jackknife and bootstrap techniques. The economic impact of pricing uncertainty is then briefly explored given comparisons of prices from secondary market trading to more common issues with similar risk characteristics and predictions from theoretical models. Using the Health and Retirement Study, the second essay explores asset holdings among a nationally representative sample of people on the verge of retirement. We assess how much more people would need to save in order to preserve consumption levels after retirement. We find that the median older household has current wealth of approximately $325,000 including pensions, social security, housing, and other financial wealth, an amount projected to grow to $380,000 by retirement at age 62. Nevertheless, our model suggests that this median household will still need to save 16% of annual earnings to preserve pre-retirement consumption. Delaying retirement to age 65, reduces required additional saving to 7% of earnings per year. These summary statistics conceals extraordinary heterogeneity in both assets and saving needs in the older population. Older high wealth households have 45 times more assets than the poorest decile and this disparity increases with age. There are also large differences in saving targets, ranging from 38% of annual earnings for those in the lowest wealth decile to negative rates for the wealthiest decile. PB - University of Pennsylvania CY - Philadelphia UR - https://repository.upenn.edu/dissertations/AAI9926173/ U4 - Gerontology (0351) JO - The Tail Ends: Hedging against old age and other natural catastrophes ER - TY - RPRT T1 - Anchoring Effects in the HRS: Experimental and Nonexperimental Evidence Y1 - 1998 A1 - Michael D Hurd KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Retirement Planning and Satisfaction AB - The Health and Retirement Study (HRS) and a number of other major household surveys use unfolding brackets to reduce item nonresponse. However, the initial entry point into a bracketing sequence is likely to act as an anchor or point of reference to the respondent. For example, when the initial entry point is high the distribution will be shifted to the right, leading one to believe that holdings of the particular asset are greater than they truly are. This paper analyzes some experimental data on housing value from HRS wave 3 for anchoring effects. The paper also compares the distributions of assets in HRS waves 1 and 2 for evidence about any anchoring effects that may have been caused by changes in the entry points between the waves. Both the experimental data on housing values and the nonexperimental data from HRS waves 1 and 2 on assets show anchoring effects. JF - The National Bureau of Economic Research PB - National Bureau of Economic Research CY - Cambridge UR - https://www.nber.org/papers/t0219 N1 - ProCite field 8 : RAND Corporation and NBER U4 - Survey Methods/Data Collection and Data Estimation Methodology/Computer Programs/Health Status/Retirement/Retirement Policies/Health/Retirement ER - TY - THES T1 - The Availability and Utilization of Assistance by Childless Elderly and Elderly Parents: A Comparative Study T2 - Gerontology Y1 - 1998 A1 - Hayes, Melanie KW - Health Conditions and Status KW - Healthcare AB - Using data from the Survey of Asset and Health Dynamics Among the Oldest-Old, Wave 1, 1993, the differences between elderly parents and childless elderly in the sources of assistance that are available to them and utilized by them are examined. Parental status is examined for its effect on sources of assistance with activities of daily living (ADLs), instrumental activities of daily living (LADLs), expected sources of future support with ADLs/LADLs, residence in a building or community which provides personal care services and with financial management. The effect is controlled for covariates of marital status, age, sex, and household income using regression models. The examination found that the lack of or presence of children does affect who assists an elderly person. Overall, the childless respondents used more non-family sources of assistance with a broad spectrum of care needs. Implications of the findings are discussed and recommendations for future research are detailed. JF - Gerontology PB - University of Nebraska VL - Master of Arts UR - https://digitalcommons.unomaha.edu/studentwork/2081/ U4 - Health Services JO - The Availability and Utilization of Assistance by Childless Elderly and Elderly Parents: A Comparative Study ER - TY - RPRT T1 - Caring for Children and the Retirement Decision Y1 - 1998 A1 - Lumsdaine, Robin L. KW - Adult children KW - Healthcare KW - Retirement Planning and Satisfaction PB - Brown University Dept. of Economics U4 - Caregiver Status/Children/Retirement Planning ER - TY - CHAP T1 - Caring for the Elderly: The Role of Adult Children T2 - Inquiries in the economics of aging Y1 - 1998 A1 - Kathleen McGarry ED - David A Wise KW - Adult children KW - Consumption and Savings KW - Demographics KW - Healthcare KW - Methodology JF - Inquiries in the economics of aging T3 - NBER Project Report series PB - University of Chicago Press CY - Chicago and London UR - https://www.nber.org/chapters/c7084.pdf N1 - ProCite field[3]: UCLA and NBERProCite field[8]: ed. U4 - Caregiver Status/Adult Children/Economics of the Elderly/Analysis of Health Care Markets/Marriage/Marital Dissolution/Family Structure/Elderly JO - Caring for the Elderly: The Role of Adult Children ER - TY - RPRT T1 - The Costs of Illness in Middle Age Y1 - 1998 A1 - Tracy Falba A1 - Mark McClellan KW - Healthcare PB - NBER U4 - Health Care Costs ER - TY - THES T1 - The Effect of Health Status on the Labor Supply of Older Married Couples Y1 - 1998 A1 - York, Elizabeth Anne KW - Employment and Labor Force KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - The purpose of this research is to examine whether spouses increase or decrease their hours of work when their partners have poor health. The theoretical effect of caregiving on hours of paid work would suggest that caregivers would have lower hours of work due to the potential decrease in the time available for work. But compared to most other types of caregivers, spousal caregivers may also increase hours of work or enter the labor market due to the need to maintain the family's finances. This study contributes to the body of research on this topic by using measures of health status that are defined separately from the labor supply decision and by estimating a model which allows for the joint labor supply decision making process of married couples. The data come from the first wave of the Health and Retirement Study, a nationally representative study of U.S. Households in which at least one member of the household is 51 to 61 years old in 1992. The estimated results show that every additional doctor visit by her husband increases the wife's hours of work by 6.5 Hours per year. The husband's annual hours of work increase by 3.4 Hours for each day his wife stays in bed due to poor health. In a model that allows for a nonlinear relationship between spouse's time for health production and his or her partner's labor supply, the husband's hours of work increase when his wife has up to 27 doctor visits per year, and then decrease when she has more than 27 doctor visits. PB - North Carolina State University UR - Database ID: DAI-A 59/08, p. 3139, Feb 1999. U4 - Health Sciences, Public Health (0573) JO - The Effect of Health Status on the Labor Supply of Older Married Couples ER - TY - JOUR T1 - The Effect of Medicaid Coverage on Use of Health Services by Low Income Elderly People JF - Social Work Research Y1 - 1998 A1 - Lum, Y.S. A1 - Huan J. Chang KW - Demographics KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - This study examined the effect of Medicaid coverage on the use of health services among low-income elderly people in different racial, ethnic, and gender groups. Using a national representative sample of 1,542 low-income elderly people from the first wave of the Asset and Health Dynamics among the Oldest Old study, we estimated a two-part model for health services use. The results showed that Medicaid coverage was positively associated with the use of health services for low-income elderly people and that the association varied by race, ethnicity, and gender. The study concluded that the Medicaid program did not work equally well for low-income elderly people from different racial, ethnic, and gender groups. PB - Vol. 22 VL - Vol. 22 U4 - Low Income Groups/Medicaid/Health Services ER - TY - THES T1 - The Impact of Multiple Caregiving Roles on Well-being: A longitudinal study of middle-aged adults Y1 - 1998 A1 - Perez-Cahill, Danae KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - This longitudinal study examined the experience of caregiving among a nationally-representative sample of 10,537 middle-aged adults participating in Wave 1 and Wave 2 of the Health and Retirement Study. Individuals were classified as parent caregivers, child caregivers, and multiple (parent and child) caregivers. The low incidence of multiple caregiving found among these middle-aged adults questions the validity of the phenomenon described as the 'sandwich generation.' Females comprised the majority of the parent, child, and multiple caregiving groups. Contrary to expectations, black and latina caregivers were not more likely than whites to hold parent and multiple caregiving roles. A high frequency of caregiving role losses and a low frequency of caregiving role assumptions occurred between Wave 1 and Wave 2. Most notable was the finding that 41% of multiple caregivers and 70% of parent caregivers in Wave 1 became noncaregivers in Wave 2. In addition, only.4% And 6.5% Of women assumed multiple care and parent care, respectively. These findings suggest that the experience of caregiving during the middle-generation years is of short duration and likely to decrease over time. No support was found for the 'caregiving pile up effect' (Doress-Worters, 1994) among those holding multiple caregiving roles. Rather, female caregivers experienced a decrease in well-being regardless of their caregiving role transitions, while caregivers who gained or maintained caregiving reported better physical health than those who lost caregiving. In addition, caregivers' well-being did not differ from that of noncaregivers, with the exception of ADLs (better for caregivers). Ethnicity was found to play an important and complex role in predicting transitions in caregiving and well-being. As hypothesized, being a black or latina caregiver who lost parent care predicted worse well-being. With regards to the maintenance or assumption of child care, however, being a minority woman accounted for worse well-being. The negative consequences of child caregiving for latinas is especially intriguing given their greater likelihood to maintain child care. There was some support for the notion that minorities' traditional family values in support of caregiving predict better well-being for women maintaining child care or for multiple caregivers. PB - University of Massachusetts, Amherst UR - Database ID: DAI-B 59/10, p. 5584, Apr 1999 U4 - Black JO - The Impact of Multiple Caregiving Roles on Well-being: A longitudinal study of middle-aged adults ER - TY - RPRT T1 - Retiree Health Benefits and Retirement Behavior: Implications for Health Policy Y1 - 1998 A1 - Lynn A Karoly A1 - Jeannette Rogowski KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Retirement Planning and Satisfaction PB - Washington, DC, U.S. Dept. of Labor U4 - Health Policy/Retirement Behavior/Health Benefits ER - TY - JOUR T1 - Adverse Selection, Bequests, Crowding Out, and Private Demand for Insurance: Evidence from the Long-Term Care Insurance Market JF - Journal of Risk and Uncertainty Y1 - 1997 A1 - Frank A Sloan A1 - Edward C Norton KW - Consumption and Savings KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Insurance KW - Methodology AB - Adverse selection, moral hazard and crowding out by public insurance have all been proposed as theoretical reasons for why the market for private long -term care insurance has been slow to evolve in the U.S. Using national samples of the elderly and near elderly, this study investigates which is most important. The data contain direct measures of risk aversion, expectations of future nursing home use and living to old age, and the bequest motive. For both groups, we find evidence of adverse selection, and, for the elderly, crowding out of private long-term care insurance by Medicaid. However, we do not find that demand for such insurance is motivated either by bequest or exchange motives. PB - 15 VL - 15 IS - 3 N1 - ProCite field 3 : Duke U; U NC U4 - Insurance/Insurance Companies/Analysis of Health Care Markets/Economics of the Elderly/Elderly/Insurance/Nursing/Old Age ER - TY - JOUR T1 - Asset and Health Dynamics Among the Oldest Old: An overview of the AHEAD Study JF - The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences Y1 - 1997 A1 - Beth J Soldo A1 - Michael D Hurd A1 - Willard L Rodgers A1 - Robert B Wallace KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Income KW - Methodology KW - Net Worth and Assets AB - This article contains background information on the study of Asset and Health Dynamics Among the Oldest Old (AHEAD), a prospective panel survey of persons born in 1923 or earlier who were residing in the community at the time of the 1993 baseline. Interviews were sought with both spouses in married households, and an overall total of 8,222 were completed. We review the interdisciplinary scientific issues that motivated the study, describe the fundamental design decisions that structured AHEAD, and summarize the content in the core and experimental modules. The study provides unusually detailed data on cognition, family structure and transfers, and assets. Data are presented on sample selections, response rates, and oversamples of minority groups. Basic descriptive data on the demographic, health, and socioeconomic attributes of respondents also are presented. Plans for future waves of AHEAD are described, including a next-of-kin interview for decreased respondents. PB - 52B VL - 52B IS - Spec U4 - HRS content and design/Aged, 80 and Over/Family/Female/Financing, Personal/Health Services/Utilization/Health Status/Income/Longitudinal Studies/Support, U.S. Government--PHS/United States ER - TY - THES T1 - Essays on the Accumulation and Transfer of Wealth at Older Ages Y1 - 1997 A1 - John W R Phillips KW - Adult children KW - Employment and Labor Force KW - Healthcare AB - This dissertation on the economics of aging uses new data sources to examine the accumulation and transfer of assets by older persons. In Essay 1, I examine the well- being of those first-eligible for early Social Security benefits at age 62. I use the first two waves of the Health and Retirement Study to measure the well-being of individuals in the years just before and just after they are first eligible to receive early Social Security benefits. I find that the well-being of takers and postponers are quite similar. The results hold up when the sample is disaggregated by race, but the overall initial level of well-being for blacks and Latinos is low relative to white respondents. Further, I find health is a better gauge of economic well-being than is taking early Social Security benefits. In Essay 2, I examine parental transfers to children using data from the Assets and Health Dynamics of the Oldest Old Survey. Previous research has focused separately on either cash transfers, coresidence, or bequests. I combine these three sources of transfers as well as deeds to property, life insurance policies, and trust funds to analyze how such transfers are distributed to children with respect to their incomes. I use estimation techniques which estimate the pattern of transfers both within and across families. The findings suggest parents target inter vivos transfers to their relatively poorer children, while transfers made at death tend to be made to all children without regard for income differences among children. In Essay 3, I relax the assumption of independence among transfer equations from chapter two. I use a two-stage technique that accounts for the relationships among transfer types. The results suggest that there are several significant positive correlations between transfers. Failure to account for these relationships when analyzing the distribution of parental resources understates transfer probabilities. Further, I find that children who are poor relative to their siblings have the highest probability of receiving all combinations of transfers, implying that resource transfers reduce within-family income inequality. PB - Syracuse University UR - Database ID: DAI-A 59/01, p. 268, Jul 1998 U4 - Intergenerational Relations JO - Essays on the Accumulation and Transfer of Wealth at Older Ages ER - TY - THES T1 - Gender Privilege in Retirement Planning and Saving Y1 - 1997 A1 - Scott, Megan Mary KW - Adult children KW - Consumption and Savings KW - Healthcare KW - Retirement Planning and Satisfaction KW - Women and Minorities AB - This dissertation combines qualitative and quantitative methods to explore how husbands and wives divide and share retirement planning and saving. The qualitative analysis focuses primarily on testing hypotheses about how class, marital power and gender enactments influence the division of saving and financial planning activities over the lifecourse. Interviews with retired couples and ethnographic data from financial planning seminars comprise the qualitative portion of the thesis. The quantitative sections are based on a secondary analysis of data about 2451 working couples from the 1992 wave of the Health and Retirement Study which tested these hypotheses. The qualitative findings suggest that wives' savings activities--to 'stretch' household resources, like domestic labor--are undervalued. In contrast, husbands' activities--to grow and monitor accumulated reserves--are valued, often eclipsing the labor of other household members. Upon retirement, these male activities become even more salient as they replace male 'breadwinning.' Additionally, in many middle class households, the husband's earnings contribute to 'primary retirement reserves' while wives' earnings are earmarked for 'secondary savings.' The quantitative analysis indicates that balance of marital power (as resource theory suggests) influences which spouse will handle family finances, particularly for black couples. However, wives relatively lower levels of retirement planning and disadvantaged knowledge of discretionary savings reserves can not be explained by the balance of relative earnings PB - State University of New York at Stony Brook U4 - Women's Studies (0453) JO - Gender Privilege in Retirement Planning and Saving 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 - RPRT T1 - Older Couples: An Examination of Health and Retirement within the Context of the Family Y1 - 1997 A1 - Pienta, Amy M. KW - Adult children KW - Disabilities KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This paper illustrates the ways in which health experiences of one's spouse effects retirement choices of other persons in the family. To understand the consequences of health problems on one's spouse the researchers devise a theoretical model and use data from the first (1992) and second (1994) waves of the Health and Retirement Study. A longitudinal study was necessary in order to see changes across time and develop multilevel hazard models reflecting the labor force transitions due to changes in a spouses health. Poor health of ones spouse reduces the chance of a persons retiring at the time that one had initially anticipated. They also find that a person whose spouse is disabled is no more likely to become disabled themselves then one whose spouse is not disabled. The researchers were surprised to find that labor force reentry was not changed when a family member became ill or disabled. PB - Penn State University Population Research Institute U4 - Family Structure/Caregiving/Disability/Disability/Labor Force Participation/Longitudinal Studies/Health Status/Spouse ER - TY - JOUR T1 - Selection of Children to Provide Care: The effect of earlier parental transfers JF - The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences Y1 - 1997 A1 - John C Henretta A1 - Martha S. Hill A1 - Li, Wei A1 - Beth J Soldo A1 - Douglas A. Wolf KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Income KW - Methodology KW - Other AB - We use the first wave of data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study to examine the effects of past parent-to-child financial transfers on selection of a child to provide assistance with basic personal care for unmarried parents. We estimate a fixed-effects conditional logit model and find a positive and significant association between past financial transfers and a child's current helping behavior. The coefficient of past financial transfers is in the direction hypothesized, and its magnitude is 80 as large as that of gender, a well-documented powerful predictor of parental caregiving. There appears to be substantial evidence that earlier parent-to-child financial gifts play a role in determining which child in the family will provide assistance. PB - 52B VL - 52B IS - Spec U4 - Caregivers/Family/Female/Frail Elderly/Human/Income/Models, Theoretical/Parent Child Relations/Support, U.S. Government--PHS ER - TY - RPRT T1 - Long Term Care in Florida Y1 - 1996 A1 - Condon, Katherine M. KW - Demographics KW - Healthcare PB - Florida Policy Exchange Center on Aging, University of South Florida and Southeast Florida Center on Aging, Florida International University U4 - Florida/Long Term Care 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 - JOUR T1 - Overview of the Health Measures in the Health and Retirement Survey JF - The Journal of Human Resources Y1 - 1995 A1 - Robert B Wallace A1 - A. Regula Herzog KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - This report discusses the conceptual and logistical issues that lead to the items and instruments used to measure health and function status in Wave 1 of the Health and Retirement Study (HRS). Health status was conceptualized as multidimensional, and included selected major symptoms, diseases and conditions, global self-assessment of health, physical and cognitive functional status, the utilization of health services and selected elements of emotional health. In addition, two physiologic measures were obtained on a sample basis: grip strength and pulmonary maximum expiratory flow rate. Prevalence rates for major conditions and functional states are presented. Correlational analyses generally demonstrated a high rate of convergent, discriminant and construct validity. These findings should assist those intending to analyze HRS data in terms of the focus and utility of the measures employed. PB - 30 VL - 30 IS - Supplement 1995 U4 - Health Status--physical, mental, and emotional/Health Production/Economic Behavior/Health Services/Microeconomic Data Management ER - TY - RPRT T1 - Evaluating Health Care Reform Using the Health and Retirement Survey: A Case Study of the Health Security Act of 1993 Y1 - 1994 A1 - Dana P Goldman A1 - Paul J. Gertler A1 - James P Smith KW - Healthcare AB - Health care reform could dramatically alter the health care landscape. While there is substantial disagreement over the changes that should be implemented, there appears to be a consensus within the Federal Government that insurance markets need reform. To forecast the likely effects of reform, it is necessary to construct models of consumer behavior. The new Health and Retirement Survey (HRS), because of its thorough data elements and longitudinal sampling frame, is uniquely suited to answer the key behavioral questions associated with health care form. This paper describes how the HRS can be used to forecast some of the likely behavioral responses of mature Americans (aged 51 to 61) to the Health Security Act of 1993 (HSA) and as a benchmark to evaluate the impact of any health care reform. The authors draw attention to the 1992 round of the HRS as a tool for analyzing the likely impact of HSA on insurance choice, health care utilization, health outcomes, family labor supply and retirement, wealth, intergenerational transfers and living arrangements. They discuss how future waves of the HRS could be used to explain the dynamic relationships between deteriorating health, asset decumulation, and employment as individuals move further along the life-cycle. JF - RAND Drafts PB - RAND Corporation UR - https://www.rand.org/pubs/drafts/DRU669.html U4 - Health care reform ER - TY - CHAP T1 - Intergenerational Transfers: Economic, Demographic, and Social Perspectives T2 - Annual Review of Gerontology and Geriatrics: Focus on Kinship, Aging, and Social Change Y1 - 1993 A1 - Beth J Soldo A1 - Martha S. Hill ED - Maddox, George L. ED - Lawton, M. Powell KW - Adult children KW - Healthcare KW - Methodology AB - Intergenerational transfers can be studied from an economic, social gerontological, or social-psychological perspective. This chapter describes a variety of the social science theories and reviews related empirical research relevant to the major types of intergenerational transfers: a) flows of assistance from parents to children and grandchildren, b) flows of assistance from middle-aged children to elderly parents, c) coresidence of parents and children. While there seems to be remarkable consensus about the factors affecting the probability of exchange, because the various disciplines have focused on different aspects of exchange behavior at different points in the life cycle, the evidence in support of competing theories is not consistent. The chapter then focuses on the upcoming availability of the HRS and AHEAD studies as potentially providing the data necessary to capturing all of the relevant dimensions of transfer behaviors that have been missing for all disciplines. JF - Annual Review of Gerontology and Geriatrics: Focus on Kinship, Aging, and Social Change PB - Springer Publishing Company CY - New York VL - Vol. 13 N1 - ProCite field 8 : eds. U4 - Family transfers, structure/Caregiving/HRS content and design/Transfers/Adult Children/Parent Child Relations JO - Intergenerational Transfers: Economic, Demographic, and Social Perspectives ER -