Adults with cardiovascular disease who help others: a prospective study of health outcomes. - Michele M Heisler; Choi, Hwajung; John D Piette; Ann Marie Rosland; Kenneth M. Langa; Stephanie Brown (J Behav Med, 2013)
Little is known about the health impact of helping behaviors among individuals with high-risk chronic diseases such as cardiovascular disease (CVD). Using a nationally representative, longitudinal survey, we examined the subsequent health of adults with CVD (n = 4,491) who spent time providing non-paid assistance to family and friends outside of their households compared with those who had provided no assistance. After both adjusting for baseline characteristics and using propensity score matching methods, spending up to 200 h over the prior 12 months helping others was associated with lower odds of experiencing a new CVD event or dying in the subsequent 2 years. Providing up to 100 h of assistance was associated with reporting fewer depressive symptoms. This threshold effect raises the question of whether assistance beyond a certain number of hours may impose a burden that mitigates health benefits from helping others. Health care providers could play an important role exploring ways that patients with CVD can provide beneficial levels of assistance to others in their own social networks or communities, thereby possibly also improving their own health.
Copyright - Springer Science Business Media New York 2013 Last updated - 2013-04-30 DOI - 2922261571; 76454332; 69709; BVMD; 22481214; SPVLBVMD108653629414
Keywords: Activities of Daily Living; Aged; Cardiovascular Diseases; depression; Female; Health Status; Helping Behavior; Humans; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Time Factors

Advance care planning and the quality of end-of-life care in older adults. - Bischoff, Kara E; Rebecca L. Sudore; Yinghui Miao; W John Boscardin; Alexander K Smith (J Am Geriatr Soc, 2013)
OBJECTIVES: To determine whether advance care planning influences quality of end-of-life care. DESIGN: In this observational cohort study, Medicare data and survey data from the Health and Retirement Study (HRS) were combined to determine whether advance care planning was associated with quality metrics. SETTING: The nationally representative HRS. PARTICIPANTS: Four thousand three hundred ninety-nine decedent subjects (mean age 82.6 at death, 55% women). MEASUREMENTS: Advance care planning (ACP) was defined as having an advance directive (AD), durable power of attorney (DPOA) or having discussed preferences for end-of-life care with a next of kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤ 3 days). RESULTS: Seventy-six percent of subjects engaged in ACP. Ninety-two percent of ADs stated a preference to prioritize comfort. After adjustment, subjects who engaged in ACP were less likely to die in a hospital (adjusted relative risk (aRR) = 0.87, 95% confidence interval (CI) = 0.80-0.94), more likely to be enrolled in hospice (aRR = 1.68, 95% CI = 1.43-1.97), and less likely to receive hospice for 3 days or less before death (aRR = 0.88, 95% CI = 0.85-0.91). Having an AD, a DPOA or an ACP discussion were each independently associated with a significant increase in hospice use (P < .01 for all). CONCLUSION: ACP was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an AD, assigning a DPOA and conducting ACP discussions are all important elements of ACP.
Keywords: Adaptation, Psychological; Advance care planning; Aged, 80 and over; Female; Humans; Male; Quality of Life; Terminal Care; United States

The apolipoprotein E genotype predicts longitudinal transitions to mild cognitive impairment but not to Alzheimer's dementia: findings from a nationally representative study. - Brainerd, C. J.; V. F. Reyna; Ronald C Petersen; Glenn E Smith; Kenney, A. E.; C. J. Gross; Taub, E. S.; Brenda L Plassman; Gwenith G Fisher (Neuropsychology, 2013)
OBJECTIVE: The ε4 allele of the apolipoprotein E (APOE) genotype is the most widely accepted genetic risk factor for Alzheimer's dementia (AD), but findings on whether it is a risk factor for the AD prodrome, mild cognitive impairment (MCI), have been inconsistent. In a prospective longitudinal design, we investigated (a) whether transitions to MCI and other forms of neurocognitive impairment without dementia (CIND) are more frequent among normal ε4 carriers than among noncarriers and (b) whether subsequent transitions to AD from MCI and from other forms of CIND are more frequent among ε4 carriers than among noncarriers. METHOD: The frequency of the ε4 allele was studied in older adults (mean age > 70), who had participated in two or more waves of neuropsychological testing and diagnosis in the Aging, Demographics, and Memory Study (ADAMS) of the United States Department of Health and Human Services, National Institutes of Health, National Institute on Aging's Health and Retirement Study, conducted by the University of Michigan. The association between ε4 and longitudinal transitions to specific types of CIND and dementia can be determined with this data set. RESULTS: Epsilon 4 increased the rate of progression from normal functioning to MCI (58% of new diagnoses were carriers) but not to other forms of CIND. The rate of progression to AD from MCI or from other forms of CIND was not increased by ε4. CONCLUSIONS: The results support the hypothesis that ε4 is a risk factor for transitions from normal functioning to MCI but not for subsequent transitions to AD. In the ADAMS sample, the reason ε4 is elevated in AD individuals is because it is already elevated in MCI individuals, who are the primary source of new AD diagnoses.
Keywords: Aged; Aged, 80 and over; Alzheimer disease; Apolipoproteins E; Cognitive Dysfunction; disease progression; Female; Genetic Predisposition to Disease; Genetic Testing; Genotype; Humans; Logistic Models; Longitudinal Studies; Male; National Institutes of Health (U.S.); Neuropsychological tests; Risk Factors; United States

BMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach. - Chiu, Ching-Ju; Linda A. Wray; Lu, Feng-hwa; Elizabeth A Beverly (J Gen Intern Med, 2013)
BACKGROUND: Few longitudinal studies have examined associations between body mass index (BMI) changes in adults with diabetes and the development of disability. OBJECTIVE: To investigate association patterns between BMI and disability in middle-aged adults with diabetes. DESIGN AND SETTING: Retrospective cohort design with data from the 1992-2006 Health and Retirement Study (HRS). A group-based joint trajectory method identified distinct BMI change trajectories and their link to subsequent disability trajectories. PARTICIPANTS: U.S. nationally representative adults aged 51-61 who reported a diagnosis of diabetes in the 1992 HRS (N = 1,064). MEASUREMENTS: BMI and self-reported disability score were the main variables. Sociodemographic, clinical, behavioral, and diabetes-related factors were also examined. RESULTS: Four distinct weight trajectories (stable normal weight, 28.7 %; stable overweight, 46.2 %; loss and regain obese, 18.0 %; weight cumulating morbidly obese, 7.1 %) and three disability trajectories (little or low increase, 34.4 %; moderate increase, 45.4 %; chronic high increase, 20.2 %) best characterized the long-term patterns of BMI and disability change in middle-aged adults with diabetes. Adults in stable normal weight had the highest probability of being in the little/low increase disability group; however, one in five adults in that group progressed into chronic high disability, a higher proportion compared to the stable overweight group. CONCLUSIONS: Although there were various ways in which the two trajectories were linked, the beneficial impacts of optimizing weight in adults with diabetes were supported. In addition, the complexity of diabetes control in those with relatively normal weight was highlighted from this study.
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Keywords: Activities of Daily Living; Body Mass Index; Diabetes Mellitus, Type 2; Disability Evaluation; Disabled Persons; Female; Humans; Longitudinal Studies; Male; Middle Aged; Models, Statistical; Obesity; Obesity, Morbid; Overweight; Retrospective Studies; United States; Weight Gain; Weight Loss

Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study. - Paula A Weigel; Jason Hockenberry; Suzanne E Bentler; Frederic D Wolinsky (J Manipulative Physiol Ther, 2013)
OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms. METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods. RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health. CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Cohort Studies; Databases, Factual; Disability Evaluation; Female; Geriatric Assessment; Humans; Low Back Pain; Male; Manipulation, Chiropractic; Medicare; Mobility Limitation; Musculoskeletal Diseases; Patient Satisfaction; Quality of Life; Risk Assessment; Sex Factors; Treatment Outcome; United States

Cohorts based on decade of death: no evidence for secular trends favoring later cohorts in cognitive aging and terminal decline in the AHEAD study. - Hülür, Gizem; Frank J Infurna; Ram, Nilam; Denis Gerstorf (Psychol Aging, 2013)
Studies of birth-year cohorts examined over the same age range often report secular trends favoring later-born cohorts, who are cognitively fitter and show less steep cognitive declines than earlier-born cohorts. However, there is initial evidence that those advantages of later-born cohorts do not carry into the last years of life, suggesting that pervasive mortality-related processes minimize differences that were apparent earlier in life. Elaborating this work from an alternative perspective on cohort differences, we compared rates of cognitive aging and terminal decline in episodic memory between cohorts based on the year participants had died, earlier (between 1993 and 1999) or later in historical time (between 2000 and 2010). Specifically, we compared trajectories of cognitive decline in 2 death-year cohorts of participants in the Asset and Health Dynamics Among the Oldest Old study that were matched on age at death and education and controlled for a variety of additional covariates. Results revealed little evidence of secular trends favoring later cohorts. To the contrary, the cohort that died in the 2000s showed a less favorable trajectory of age-related memory decline than the cohort that died in the 1990s. In examinations of change in relation to time to death, the cohort dying in the 2000s experienced even steeper terminal declines than the cohort dying in the 1990s. We suggest that secular increases in "manufacturing" survival may exacerbate age- and mortality-related cognitive declines among the oldest old.
Keywords: Aged; Aged, 80 and over; Aging; Death; Epidemiologic Research Design; Female; Health Surveys; Humans; Longitudinal Studies; Male; Memory Disorders; Memory, Episodic; Time Factors; United States

Combining direct and proxy assessments to reduce attrition bias in a longitudinal study. - Bei Wu; Tchetgen Tchetgen, Eric J; Theresa L Osypuk; White, Kellee; Mujahid, Mahasin; M. Maria Glymour (Alzheimer Dis Assoc Disord, 2013)
Retaining severely impaired individuals poses a major challenge in longitudinal studies of determinants of dementia or memory decline. In the Health and Retirement Study (HRS), participants complete direct memory assessments biennially until they are too impaired to complete the interview. Thereafter, proxy informants, typically spouses, assess the subject's memory and cognitive function using standardized instruments. Because there is no common scale for direct memory assessments and proxy assessments, proxy reports are often excluded from longitudinal analyses. The Aging, Demographics, and Memory Study (ADAMS) implemented full neuropsychological examinations on a subsample (n=856) of HRS participants, including respondents with direct or proxy cognitive assessments in the prior HRS core interview. Using data from the ADAMS, we developed an approach to estimating a dementia probability and a composite memory score on the basis of either proxy or direct assessments in HRS core interviews. The prediction model achieved a c-statistic of 94.3% for DSM diagnosed dementia in the ADAMS sample. We applied these scoring rules to HRS core sample respondents born 1923 or earlier (n=5483) for biennial assessments from 1995 to 2008. Compared with estimates excluding proxy respondents in the full cohort, incorporating information from proxy respondents increased estimated prevalence of dementia by 12 percentage points in 2008 (average age=89) and suggested accelerated rates of memory decline over time.
Keywords: Aged; Bias; Caregivers; Dementia; Female; Humans; Longitudinal Studies; Male; Neuropsychological tests; Prevalence; Proxy

Dementia and out-of-pocket spending on health care services. - Delavande, Adeline; Michael D Hurd; Martorell, Paco; Kenneth M. Langa (Alzheimers Dement, 2013)
BACKGROUND: High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods. Because it leads to disability and the loss of independence, dementia may put patients and their families at risk for high OOP spending, especially for long-term care services. METHODS: We used data from the Aging, Demographics, and Memory Study, a nationally representative subsample (n = 743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared with those with cognitive impairment without dementia and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications-two types of health care that are frequently paid for OOP. Multivariate and logistic regression models were used to adjust for the influence of potential confounders. RESULTS: After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared with those with normal cognition ($8216 for those with dementia vs. $2570 for those with normal cognition, P < .01). Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (P < .01). Dementia was not associated with the likelihood of visiting the dentist (P = .76) or foregoing prescription medications owing to cost (P = .34). CONCLUSIONS: Dementia is associated with high levels of OOP spending but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not "crowd out" spending on these other health care services.
Keywords: Aged; Dementia; Female; Financing, Personal; Health Expenditures; Humans; Male

Disability during the last two years of life. - Alexander K Smith; Louise C Walter; Yinghui Miao; W John Boscardin; Kenneth E Covinsky (JAMA Intern Med, 2013)
IMPORTANCE: Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life. OBJECTIVE: To determine national estimates of disability during the last 2 years of life. DESIGN: Prospective cohort study. SETTING: A nationally representative study of older adults in the United States. PARTICIPANTS: Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex. MAIN OUTCOMES AND MEASURES: Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet. RESULTS: There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death. CONCLUSIONS AND RELEVANCE: Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.
Copyright - Copyright American Medical Association Sep 9, 2013 Last updated - 2013-09-18 SubjectsTermNotLitGenreText - United States--US
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Disability Evaluation; Disabled Persons; Educational Status; Female; Frail Elderly; Humans; Income; Longitudinal Studies; Male; Marital Status; Middle Aged; Prospective Studies; Sex Distribution; Socioeconomic factors; United States

Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study. - Benjamin D Capistrant; Paola Gilsanz; J Robin Moon; Anna Kosheleva; Kristen K Patton; M. Maria Glymour (Ethn Dis, 2013)
OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites. DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years. OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages. METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale). RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95% CI: 1.33, 1.61; Blacks: HR=1.42, 95% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13% excess hazard of CVD mortality (HR=1.13, 95% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65. CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.
Keywords: Aged; Black or African American; Cardiovascular Diseases; depression; Female; Humans; Male; Middle Aged; Proportional Hazards Models; Risk Assessment; Risk Factors; White People

Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study. - Nishant K. Sekaran; Choi, Hwajung; Rodney A. Hayward; Kenneth M. Langa (J Am Geriatr Soc, 2013)
OBJECTIVES: To determine whether falling would be a marker for future difficulty with activities of daily (ADLs) that would vary according to fall frequency and associated injury. DESIGN: Longitudinal analysis. SETTING: Community. PARTICIPANTS: Nationally representative cohort of 2,020 community-living, functionally independent older adults aged 65 to 69 at baseline followed from 1998 to 2008. MEASUREMENTS: ADL difficulty. RESULTS: Experiencing one fall with injury (odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.29-2.48), at least two falls without injury (OR = 2.36, 95% CI = 1.80-3.09), or at least two falls with at least one injury (OR = 3.75, 95% CI = 2.55-5.53) in the prior 2 years was independently associated with higher rates of ADL difficulty after adjustment for sociodemographic, behavioral, and clinical covariates. CONCLUSION: Falling is an important marker for future ADL difficulty in younger, functionally independent older adults. Individuals who fall frequently or report injury are at highest risk.
Keywords: Accidental Falls; Activities of Daily Living; Aged; Aging; Disability Evaluation; Disabled Persons; Female; Follow-Up Studies; Geriatric Assessment; Health Status; Humans; Male; Odds Ratio; Retrospective Studies; Risk Factors; United States; Wounds and Injuries

Former stepparents' contact with their stepchildren after midlife. - Claire Noël-Miller (J Gerontol B Psychol Sci Soc Sci, 2013)
OBJECTIVES: Based on the life course perspective and gender differences in stepparental roles, this study examines frequency of social contact between mid- to late-life stepparents and their stepchildren after stepparents' marriage to their stepchildren's biological parent has been dissolved through widowhood or divorce. METHOD: Using 5 waves of panel data on stepparent-stepchild pairs from the Health and Retirement Study (N = 12,947 stepchild observations on 4,063 stepchildren belonging to 1,663 stepparents) spanning 10 years (1998-2008), I estimate ordered logit multilevel models predicting former stepparent-stepchild contact frequency. RESULTS: Results indicate that former stepparents have notably less frequent contact with their stepchildren than current stepparents, particularly following divorce. Widowed stepparents' contact with their stepchildren diminishes gradually following union disruption, whereas divorced stepparents' contact frequency drops abruptly. Former stepfathers have less contact with their stepchildren than former stepmothers. Finally, I uncover evidence of the moderating role of (step)parents' marriage length and stepparents' number of biological children on widowed stepparent-stepchild contact frequency. DISCUSSION: Older stepparents' social contact with their stepchildren is largely conditional on stepparents' enduring marital bond to their stepchildren's biological parent. This study contributes to a growing literature portraying relatively weak ties between older adults and their stepchildren.
Copyright - Copyright Oxford University Press, UK May 2013 Last updated - 2013-04-19 DOI - 2948942401; 77441762; 9698; PGN2; INODPGN20000698908
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Family Characteristics; Female; Health Surveys; Humans; Male; Marital Status; Middle Aged; Parent-Child Relations; Parents; Social Support; Young Adult

Functional limitations in older adults who have cognitive impairment without dementia. - Tanya R Gure; Kenneth M. Langa; Gwenith G Fisher; John D Piette; Brenda L Plassman (J Geriatr Psychiatry Neurol, 2013)
OBJECTIVE: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND). METHODS: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents. RESULTS: Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%). CONCLUSIONS: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.
NLM Title Abbreviation: J Geriatr Psychiatry Neurol
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Cognitive Dysfunction; Dementia; Female; Humans; Male; Neuropsychological tests; Severity of Illness Index; Surveys and Questionnaires

GWAS of 126,559 individuals identifies genetic variants associated with educational attainment. - Cornelius A Rietveld; Sarah E Medland; Derringer, Jaime; Yang, Jian; Tõnu Esko; Martin, Nicolas W; Westra, Harm-Jan; Shakhbazov, Konstantin; Abdel Abdellaoui; Agrawal, Arpana; Albrecht, Eva; Alizadeh, Behrooz Z; et al. (Science, 2013)
A genome-wide association study (GWAS) of educational attainment was conducted in a discovery sample of 101,069 individuals and a replication sample of 25,490. Three independent single-nucleotide polymorphisms (SNPs) are genome-wide significant (rs9320913, rs11584700, rs4851266), and all three replicate. Estimated effects sizes are small (coefficient of determination R(2) ≈ 0.02%), approximately 1 month of schooling per allele. A linear polygenic score from all measured SNPs accounts for ≈2% of the variance in both educational attainment and cognitive function. Genes in the region of the loci have previously been associated with health, cognitive, and central nervous system phenotypes, and bioinformatics analyses suggest the involvement of the anterior caudate nucleus. These findings provide promising candidate SNPs for follow-up work, and our effect size estimates can anchor power analyses in social-science genetics.
Keywords: Cognition; Educational Status; Endophenotypes; Female; Genetic Loci; Genome-Wide Association Study; Humans; Male; Multifactorial Inheritance; Polymorphism, Single Nucleotide

Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States. - Emma Aguila; José J Escarce; Leng, Mei; Morales, Leo (J Aging Health, 2013)
OBJECTIVE: Investigate the "salmon-bias" hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status. METHOD: Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome. RESULTS: The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators. DISCUSSION: Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.
Keywords: Aged; Emigrants and Immigrants; Emigration and Immigration; Female; Health Status; Health Surveys; Humans; Male; Mexican Americans; Mexico; Middle Aged; Risk Factors; Risk-Taking; Social Class; United States

Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis. - Kandauda Wickrama; Jay A. Mancini; Kwag, Kyunghwa; Kwon, Josephine (J Gerontol B Psychol Sci Soc Sci, 2013)
OBJECTIVES: This study examines (a) the heterogeneity in individual multidimensional health trajectories and (b) the socioeconomic stratification of individual multidimensional health trajectories during the late older years. METHOD: This study used prospective data from 1,945 adults, 75 to 85 years old, collected over an 8-year period from the Health and Retirement Study. To examine inconsistent findings in the research literature, a latent trajectory class analysis was performed. RESULTS: Multidimensional overall health trajectories showed three heterogeneous latent classes (maintaining, persistently high, and deteriorating), and profiles of ascribed and achieved socioeconomic characteristics of multidimensional health trajectory classes showed a significant social and racial/ethnic stratification in late older years. DISCUSSION: Past adverse socioeconomic circumstances, including childhood and adulthood adversity, are potential sources of unobserved heterogeneity of multidimensional health trajectories even in late older years. The identification of members of latent trajectory health classes and the associated antecedents linked to health class membership are consistent with a life-course conceptual framework. Thus, multidimensional health capturing the full range of health problems needs to be investigated for proper examination of socioeconomic correlates of health. This facilitates the understanding of the associations between life-course experiences and health in late old age that ultimately have implications for prevention and intervention.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; depression; Female; Health Status; Health Transition; Humans; Longitudinal Studies; Male; Marriage; Memory Disorders; Middle Aged; Socioeconomic factors

Hospital and nursing home use from 2002 to 2008 among U.S. older adults with cognitive impairment, not dementia in 2002. - Daniel O. Clark; Timothy E. Stump; Tu, Wanzhu; Douglas K Miller; Kenneth M. Langa; Frederick W Unverzagt; Christopher M. Callahan (Alzheimer Dis Assoc Disord, 2013)
Little is known about health care use in the cognitive impairment, not dementia (CIND) subpopulation. Using a cohort of 7130 persons aged 71 years or over from the Health and Retirement Survey, we compared mean and total health care use from 2002 to 2008 for those with no cognitive impairment, CIND, or dementia in 2002. Cognitive status was determined using a validated method based on self or proxy interview measures. Health care use was also based on self or proxy reports. On the basis of the Health and Retirement Survey, the CIND subpopulation in 2002 was 5.3 million or 23% of the total population 71 years of age or over. Mean hospital nights was similar and mean nursing home nights was less in persons with CIND compared with persons with dementia. The CIND subpopulation, however, had more total hospital and nursing home nights--71,000 total hospital nights and 223,000 total nursing home nights versus 32,000 hospital nights and 138,000 nursing home nights in the dementia subpopulation. A relatively large population and high health care use result in a large health care impact of the CIND subpopulation.
Keywords: Aged; Aged, 80 and over; Aging; Cognition Disorders; Dementia; Female; Homes for the Aged; Hospitalization; Humans; Male; Nursing homes; United States

Impact of cigarette smoking on utilization of nursing home services. - Kenneth E. Warner; Ryan J McCammon; Brant E Fries; Kenneth M. Langa (Nicotine Tob Res, 2013)
INTRODUCTION: Few studies have examined the effects of smoking on nursing home utilization, generally using poor data on smoking status. No previous study has distinguished utilization for recent from long-term quitters. METHODS: Using the Health and Retirement Study, we assessed nursing home utilization by never-smokers, long-term quitters (quit >3 years), recent quitters (quit ≤3 years), and current smokers. We used logistic regression to evaluate the likelihood of a nursing home admission. For those with an admission, we used negative binomial regression on the number of nursing home nights. Finally, we employed zero-inflated negative binomial regression to estimate nights for the full sample. RESULTS: Controlling for other variables, compared with never-smokers, long-term quitters have an odds ratio (OR) for nursing home admission of 1.18 (95% CI: 1.07-1.2), current smokers 1.39 (1.23-1.57), and recent quitters 1.55 (1.29-1.87). The probability of admission rises rapidly with age and is lower for African Americans and Hispanics, more affluent respondents, respondents with a spouse present in the home, and respondents with a living child. Given admission, smoking status is not associated with length of stay (LOS). LOS is longer for older respondents and women and shorter for more affluent respondents and those with spouses present. CONCLUSIONS: Compared with otherwise identical never-smokers, former and current smokers have a significantly increased risk of nursing home admission. That recent quitters are at greatest risk of admission is consistent with evidence that many stop smoking because they are sick, often due to smoking.
Keywords: Age Factors; Aged; Aged, 80 and over; Black or African American; Cross-Sectional Studies; Female; Hispanic or Latino; Humans; Length of Stay; Logistic Models; Longitudinal Studies; Male; Middle Aged; Nursing homes; Risk; Self Report; Smoking; Socioeconomic factors; United States; White People

The influence of unpaid work on the transition out of full-time paid work. - Dawn C Carr; Ben Lennox Kail (Gerontologist, 2013)
PURPOSE: Continued employment after retirement and engagement in unpaid work are both important ways of diminishing the negative economic effects of the retirement of baby boomer cohorts on society. Little research, however, examines the relationship between paid and unpaid work at the transition from full-time work. Using a resource perspective framework this study examines how engagement in unpaid work prior to and at the transition from full-time work influences whether individuals partially or fully retire. DESIGN AND METHODS: This study used a sample of 2,236 Americans between the ages 50 and 68, who were interviewed between 1998 and 2008. Logistic regression was used to estimate transitioning into partial retirement (relative to full retirement) after leaving full-time work. RESULTS: We found that the odds of transitioning into part-time work were increased by continuous volunteering (78%) and reduced by starting parental (84%), grandchild (41%), and spousal (90%) caregiving and unaffected by all other patterns of engagement in unpaid work. IMPLICATIONS: Our findings suggest that volunteering is complementary with a transition to part-time work, and starting a new caregiving role at this transitioncreates a barrier to continued employment. In order to provide workers the opportunity to engage in the work force longer at the brink of retirement, it may be necessary to increase the support mechanisms for those who experience new caregiving responsibilities.
Keywords: Age Factors; Aged; Employment; Female; Humans; Interviews as Topic; Logistic Models; Male; Middle Aged; Retirement; Salaries and Fringe Benefits; Volunteers; Work

Latent heterogeneity in long-term trajectories of body mass index in older adults. - Anda Botoseneanu; Jersey Liang (J Aging Health, 2013)
OBJECTIVE: To evaluate latent heterogeneity in long-term trajectories of body weight in older adults. METHODS: We analyzed 14-year longitudinal data on 10,314 older adults from the Health and Retirement Study. Semiparametric mixture models identified latent subgroups of similar trajectories of body mass index (BMI). RESULTS: Five distinct trajectory subgroups emerged: normal starting-BMI with accelerated increase over time (trajectory #1), overweight and increasing (trajectory #2), borderline-obese and increasing (trajectory #3), obese and increasing (trajectory #4), and morbidly obese with decelerating gain (trajectory #5). Blacks and Hispanics had greater risk of membership in ascending high-BMI trajectory groups. Females had approximately half the risk of following overweight and obese increasing BMI trajectories compared with males. DISCUSSION: Distinct latent subgroups of BMI trajectories and significant racial/ethnic and gender trajectory heterogeneity exist in the older adult population. The propensity of men and minorities to experience high-risk BMI trajectories may exacerbate existing disparities in morbidity/ mortality in older age.
Keywords: Aging; Black or African American; Body Mass Index; Female; Hispanic or Latino; Humans; Longitudinal Studies; Male; Middle Aged; Obesity; Obesity, Morbid; Overweight; Risk Factors; Sex Distribution; United States

Longer lived parents: protective associations with cancer incidence and overall mortality. - Ambarish Dutta; Henley, William; Robine, Jean-Marie; Kenneth M. Langa; Robert B Wallace; David Melzer (J Gerontol A Biol Sci Med Sci, 2013)
BACKGROUND: Children of centenarians have lower cardiovascular disease prevalence and live longer. We aimed to estimate associations between the full range of parental attained ages and health status in a middle-aged U.S. representative sample. METHODS: Using Health and Retirement Study data, models estimated disease incidence and mortality hazards for respondents aged 51-61 years at baseline, followed up for 18 years. Full adjustment included sex, race, smoking, wealth, education, body mass index, and childhood socioeconomic status. Mother's and father's attained age distributions were used to define short-, intermediate-, and long-lived groups, yielding a ranked parental longevity score (n = 6,055, excluding short-long discordance). Linear models (n = 8,340) tested mother's or father's attained ages, adjusted for each other. RESULTS: With increasing mother's or father's survival (>65 years), all-cause mortality declined 19% (hazard ratio [HR] = 0.81, 95% CI: 0.76-0.86, p < .001) and 14% per decade (HR = 0.87, 95% CI: 0.81-0.92, p < .001). Estimates changed only modestly when fully adjusted. Parent-in-law survival was not associated with mortality (n = 1,809, HR = 1.00, 95% CI: 0.90-1.12, p = .98). Offspring with one or two long-lived parents had lower cancer incidence (938 cases, HR per parental longevity score = 0.76, 95% CI: 0.61-0.94, p = .01) versus two intermediate parents. Similar HRs for diabetes (HR = 0.89, 95% CI: 0.84-0.96, p = .001), heart disease (HR = 0.88, 95% CI: 0.82-0.93, p < .001), and stroke (HR = 0.86, 95% CI: 0.78-0.95, p = .002) were significant, but there was no trend for arthritis. CONCLUSIONS: The results provide the first robust evidence that increasing parental attained age is associated with lower cancer incidence in offspring. Health advantages of having centenarian parents extend to a wider range of parental longevity and may provide a quantitative trait of slower aging.
Keywords: Aged; Aged, 80 and over; Female; Humans; Incidence; Longevity; Male; Middle Aged; Mortality; Neoplasms; Parents

Monetary costs of dementia in the United States. - Michael D Hurd; Martorell, Paco; Delavande, Adeline; Kathleen J Mullen; Kenneth M. Langa (N Engl J Med, 2013)
BACKGROUND: Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase. METHODS: In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers. RESULTS: The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost. CONCLUSIONS: Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).
Keywords: Aged; Aged, 80 and over; Cost of Illness; Dementia; Female; Health Care Costs; Home Care Services; Home Nursing; Humans; Longitudinal Studies; Male; Medicare; Middle Aged; Nursing homes; United States

Out-of-pocket spending in the last five years of life. - Amy Kelley; Kathleen McGarry; Sean Fahle; Samuel M Marshall; Qingling Du; Jonathan S Skinner (J Gen Intern Med, 2013)
BACKGROUND: A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life. DESIGN: Using the nationally representative Health and Retirement Study (HRS) cohort, we conducted retrospective analyses of Medicare beneficiaries' total out-of-pocket healthcare expenditures over the last 5 years of life. PARTICIPANTS: We identified HRS decedents between 2002 and 2008; defined a 5 year study period using each subject's date of death; and excluded those without Medicare coverage at the beginning of this period (n = 3,209). MAIN MEASURES: We examined total out-of-pocket healthcare expenditures in the last 5 years of life and expenditures as a percentage of baseline household assets. We then stratified results by marital status and cause of death. All measurements were adjusted for inflation to 2008 US dollars. RESULTS: Average out-of-pocket expenditures in the 5 years prior to death were $38,688 (95 % Confidence Interval $36,868, $40,508) for individuals, and $51,030 (95 % CI $47,649, $54,412) for couples in which one spouse dies. Spending was highly skewed, with the median and 90th percentile equal to $22,885 and $89,106, respectively, for individuals, and $39,759 and $94,823, respectively, for couples. Overall, 25 % of subjects' expenditures exceeded baseline total household assets, and 43 % of subjects' spending surpassed their non-housing assets. Among those survived by a spouse, 10 % exceeded total baseline assets and 24 % exceeded non-housing assets. By cause of death, average spending ranged from $31,069 for gastrointestinal disease to $66,155 for Alzheimer's disease. CONCLUSION: Despite Medicare coverage, elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life.
Keywords: Aged; Cause of Death; Female; Health Expenditures; Health Services for the Aged; Humans; Male; Marital Status; Medicare; Retrospective Studies; Socioeconomic factors; Terminal Care; United States

Pain among older Hispanics in the United States: is acculturation associated with pain? - Jimenez, Nathalia; Dansie, Elizabeth; Buchwald, Dedra; Goldberg, Jack (Pain Med, 2013)
BACKGROUND: Previous studies suggest that acculturation may influence the experience of pain. STUDY DESIGN: We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States. METHODS SUBJECTS: Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008. MEASURES: We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain. ANALYSIS: We applied logistic regression using generalized estimating equations, with NHW as the reference category. RESULTS: Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95% confidence interval [CI  = 1.1-1.4) and intensity (OR = 1.6; 95% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95% CI 0.6-0.9). CONCLUSION: Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference.
Keywords: Acculturation; Aged; Confidence Intervals; Cross-Sectional Studies; Female; Health Status; Hispanic or Latino; Humans; Language; Logistic Models; Male; Middle Aged; Odds Ratio; pain; Pain Measurement; Prevalence; Socioeconomic factors; United States

Pain as a risk factor for disability or death. - James S Andrews; Irena Cenzer; Yelin, Edward; Kenneth E Covinsky (J Am Geriatr Soc, 2013)
OBJECTIVES: To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older. DESIGN: Prospective cohort study. SETTING: The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals. PARTICIPANTS: Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL. MEASUREMENTS: Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility). RESULTS: At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results. CONCLUSION: Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.
Date revised - 2013-05-01 Last updated - 2013-05-31 DOI - 0b2ff290-e53b-4073-a3d7csamfg102v; 17944301; 0002-8614; 1532-5415 SubjectsTermNotLitGenreText - Demography; Mortality; Mobility; Risk factors; Disabilities; Survival; Pain
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Cohort Studies; Disabled Persons; Female; Geriatric Assessment; Health Status; Humans; Life Style; Male; Middle Aged; pain; Prevalence; Prognosis; Prospective Studies; Severity of Illness Index; Sex Distribution; Sex Factors; United States

Patterns of older Americans' health care utilization over time. - Richard J. Manski; John F Moeller; Haiyan Chen; Jody Schimmel; Patricia A St Clair; John V Pepper (Am J Public Health, 2013)
OBJECTIVES: We analyzed correlates of older Americans' continuous and transitional health care utilization over 4 years. METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods. RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction. CONCLUSIONS: Older individuals' health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.
Keywords: Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Delivery of Health Care; Female; Health Services; Health Status; Health Surveys; Home Care Services; Hospitalization; Humans; Income; Insurance Coverage; Logistic Models; Longitudinal Studies; Male; Middle Aged; Office Visits; Patient Acceptance of Health Care; Time Factors; United States

Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults. - Markus Jokela; G David Batty; Solja T. Nyberg; Virtanen, Marianna; Nabi, Hermann; Archana Singh-Manoux; Mika Kivimäki (Am J Epidemiol, 2013)
Personality may influence the risk of death, but the evidence remains inconsistent. We examined associations between personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and the risk of death from all causes through individual-participant meta-analysis of 76,150 participants from 7 cohorts (the British Household Panel Survey, 2006-2009; the German Socio-Economic Panel Study, 2005-2010; the Household, Income and Labour Dynamics in Australia Survey, 2006-2010; the US Health and Retirement Study, 2006-2010; the Midlife in the United States Study, 1995-2004; and the Wisconsin Longitudinal Study's graduate and sibling samples, 1993-2009). During 444,770 person-years at risk, 3,947 participants (54.4% women) died (mean age at baseline = 50.9 years; mean follow-up = 5.9 years). Only low conscientiousness-reflecting low persistence, poor self-control, and lack of long-term planning-was associated with elevated mortality risk when taking into account age, sex, ethnicity/nationality, and all 5 personality traits. Individuals in the lowest tertile of conscientiousness had a 1.4 times higher risk of death (hazard ratio = 1.37, 95% confidence interval: 1.18, 1.58) compared with individuals in the top 2 tertiles. This association remained after further adjustment for health behaviors, marital status, and education. In conclusion, of the higher-order personality traits measured by the five-factor model, only conscientiousness appears to be related to mortality risk across populations.
Keywords: Age Factors; Anxiety Disorders; Cohort Studies; Extraversion, Psychological; Female; Humans; Male; Middle Aged; Mortality; Neuroticism; Personality; Prospective Studies; Risk Factors; Sex Factors; Socioeconomic factors

Personality profile of the children of long-lived parents. - Evangelia E Antoniou; Ambarish Dutta; Kenneth M. Langa; David Melzer; David J Llewellyn (J Gerontol B Psychol Sci Soc Sci, 2013)
OBJECTIVES: Past research has shown that parental longevity is related to offspring physical health and longevity. Preliminary studies suggest that parental longevity may be linked to the offspring's personality traits. A comprehensive 5-factor personality model has been related to physical health, but the association with parental longevity has not yet been investigated. We used a 5-factor personality model to investigate the relationship between parental longevity and offspring personality. METHOD: Data from the longitudinal Health and Retirement Study (HRS) was used in the analyses. Using the Midlife Development Inventory and the Life Orientation test, the relationship between parental attained age and offspring personality was assessed using regression models for both men and women. RESULTS: Male offspring of long-lived fathers and mothers were more likely to be open to new experiences (p < .01) and be more extroverted (p = .03) compared with male offspring of short-lived fathers or mothers. Maternal or paternal attained age had no effect on the female offspring personality traits. DISCUSSION: Personality is an important phenotype to consider when investigating genetic and environmental determinants of longevity. Further research is needed to investigate the potential of gender-specific mechanisms.
Keywords: Aged; Extraversion, Psychological; Fathers; Female; Health Status; Humans; Interviews as Topic; Longevity; Longitudinal Studies; Male; Mothers; Parents; Personality; Personality Inventory; Sex Factors

Predicting 10-year mortality for older adults. - Cruz, Marisa; Kenneth E Covinsky; Eric W Widera; Stijacic-Cenzer, Irena; Sei J. Lee (JAMA, 2013)
Keywords: Aged; Aged, 80 and over; Cohort Studies; Female; Forecasting; Humans; Kaplan-Meier Estimate; Life Expectancy; Male; Middle Aged; Mortality; Risk Assessment; United States

A prospective study of volunteerism and hypertension risk in older adults. - Rodlescia S. Sneed; Cohen, Sheldon (Psychol Aging, 2013)
The purpose of the current study was to determine whether volunteerism is prospectively associated with hypertension risk among older adults. Participants provided data during the 2006 and 2010 waves of the Health and Retirement Study, a longitudinal panel survey using a nationally representative sample of community-dwelling older adults (age > 50 years). Volunteerism and blood pressure were measured at baseline and again 4 years later. Analyses excluded individuals hypertensive at baseline and controlled for age, race, sex, education, baseline systolic/diastolic blood pressure, and major chronic illnesses. Those who had volunteered at least 200 hr in the 12 months prior to baseline were less likely to develop hypertension (OR = 0.60; 95% CI [0.40, 0.90]) than nonvolunteers. There was no association between volunteerism and hypertension risk at lower levels of volunteer participation. Volunteering at least 200 hr was also associated with greater increases in psychological well-being (B = 0.99, β = .05, p = .006) and physical activity (B = 0.21, β = .05, p = .04) compared with nonvolunteers; however, these factors did not explain the association of volunteerism with hypertension risk.
Copyright - Copyright American Psychological Association Jun 2013 Last updated - 2013-06-30
Keywords: Aged; Aged, 80 and over; Female; Health Surveys; Humans; Hypertension; Male; Middle Aged; Prospective Studies; Risk Assessment; Time Factors; Volunteers

Race differences in the relationship between formal volunteering and hypertension. - Jane Tavares; Jeffrey A Burr; Jan E Mutchler (J Gerontol B Psychol Sci Soc Sci, 2013)
OBJECTIVES: This study investigated race differences in the relationship between formal volunteering and hypertension prevalence among middle-aged and older adults. METHOD: Using data from the 2004 and 2006 Health and Retirement Study (N = 5,666; 677 African Americans and 4,989 whites), we examined regression models stratified by race to estimate relationships among hypertension prevalence, systolic and diastolic blood pressure, and volunteer status and hours spent volunteering among persons aged 51 years old and older. RESULTS: White volunteers had a lower risk of hypertension than white nonvolunteers. A threshold effect was also present; compared with nonvolunteers, volunteering a moderate number of hours was associated with lowest risk of hypertension for whites. Results for hypertension were consistent with results from alternative models of systolic and diastolic blood pressure. We found no statistically significant relationship between volunteering activity and hypertension/blood pressure for African Americans. DISCUSSION: There may be unmeasured cultural differences related to the meaning of volunteering and contextual differences in volunteering that account for the race differences we observed. Research is needed to determine the pathways through which volunteering is related to hypertension risk and that may help explain race differences identified here.
Keywords: Black or African American; Blood pressure; Female; Humans; Hypertension; Logistic Models; Male; Middle Aged; Prevalence; Risk Factors; United States; Volunteers; White People

The role of pain in understanding racial/ethnic differences in the frequency of physical activity among older adults. - Grubert, Elizabeth; Tamara A. Baker; McGeever, Kelly; Benjamin A Shaw (J Aging Health, 2013)
OBJECTIVE: To evaluate racial/ethnic differences in physical activity among white, black, and Hispanic adults aged 65 years and older, and to assess the potential role of pain as a mediator. METHODS: Analyses were based on data from the 2008 Health and Retirement Study. Logistic regression was used to evaluate associations between race/ethnicity and pain and the odds of regular physical activity. RESULTS: Compared to Whites, the odds of both light physical activity and moderate/vigorous physical activity were lower among Blacks, but not Hispanics. A graded inverse association between levels of pain severity and the odds of physical activity was found, but pain did not mediate racial/ethnic differences in physical activity. DISCUSSION: When compared to Whites, older Blacks appear to have relatively low rates of physical activity even without comparatively high levels of pain, while older Hispanics experience relatively high rates of pain, but are perhaps more resilient to the effects of pain on physical activity.
Keywords: Aged; Aged, 80 and over; Black or African American; Female; Health Surveys; Hispanic or Latino; Humans; Male; Motor Activity; pain; Severity of Illness Index; United States; White People

Self-rated health and morbidity onset among late midlife U.S. adults. - Kenzie Latham; Chuck W Peek (J Gerontol B Psychol Sci Soc Sci, 2013)
OBJECTIVES: Although self-rated health (SRH) is recognized as a strong and consistent predictor of mortality and functional health decline, there are relatively few studies examining SRH as a predictor of morbidity. This study examines the capacity of SRH to predict the onset of chronic disease among the late midlife population (ages 51-61 years). METHOD: Utilizing the first 9 waves (1992-2008) of the Health and Retirement Study, event history analysis was used to estimate the effect of SRH on incidence of 6 major chronic diseases (coronary heart disease, diabetes, stroke, lung disease, arthritis, and cancer) among those who reported none of these conditions at baseline (N = 4,770). RESULTS: SRH was a significant predictor of onset of any chronic condition and all specific chronic conditions excluding cancer. The effect was particularly pronounced for stroke. DISCUSSION: This research provides the strongest and most comprehensive evidence to date of the relationship between SRH and incident morbidity.
Keywords: Chronic disease; Cohort Studies; Female; Health Status; Humans; Male; Middle Aged; Morbidity; Predictive Value of Tests; Self Concept; Self Report; United States

The socioeconomic origins of physical functioning among older U.S. adults. - Jennifer Karas Montez (Adv Life Course Res, 2013)
Mounting evidence finds that adult health reflects socioeconomic circumstances (SES) in early life and adulthood. However, it is unclear how the health consequences of SES in early life and adulthood accumulate-for example, additively, synergistically. This study tests four hypotheses about how the health effects of early-life SES (measured by parental education) and adult SES (measured by own education) accumulate to shape functional limitations, whether the accumulation differs between men and women, and the extent to which key mechanisms explain the accumulation. It uses data from the 1994-2010 Health and Retirement Study on U.S. adults 50-100 years of age (N=24,026). The physical functioning benefits of parental and own education accumulated additively among men. While the physical functioning benefits generally accumulated among women, the functioning benefits from one's own education were dampened among women with low-educated mothers. The dampening partly reflected a strong tie between mothers' education level and women's obesity risk. Taken together, the findings reveal subtle differences between men and women in the life course origins of physical functioning. They also shed light on a key mechanism-obesity-that may help explain why a growing number of studies find that early-life SES is especially important for women's health.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Educational Status; Female; Health Behavior; Health Status; Humans; Longitudinal Studies; Male; Middle Aged; Obesity; Sex Factors; Socioeconomic factors; United States

Spouses of stroke survivors may be at risk for poor cognitive functioning: a cross-sectional population-based study. - Peii Chen; Amanda L. Botticello (Top Stroke Rehabil, 2013)
BACKGROUND: Stroke often results in chronic disability and the need for long-term assistance, which is provided in large part by spouses. Stroke caregivers experience poorer health and well-being compared with non-caregivers, but less is known about the specific toll that caregiving may exact on cognitive functioning. OBJECTIVE: To investigate whether persons caring for a spouse who experienced a recent stroke may be at risk for poor cognitive functioning compared with non-caregivers. METHODS: Existing data from the United States' Health and Retirement Study (HRS) were used to identify 146 caregivers from among couples in which 1 individual reported surviving a recent stroke and experiencing functional limitations. This cross-sectional population-based analysis compared the stroke caregivers with 3,416 non-caregivers in time orientation, working memory, semantic memory, learning, and episodic memory. RESULTS: Overall, the caregiver group was considerably more disadvantaged than the non-caregiver group in terms of background characteristics, socioeconomic status, health, and well-being. Results of weighted Poisson regression models indicated that stroke caregivers were at risk for poorer performance than non-caregivers in working memory, semantic memory, learning, and episodic memory. The gap between stroke caregivers and non-caregivers in episodic memory remained after adjusting for systematic differences between the 2 groups across an array of risk factors. CONCLUSIONS: Spousal caregivers of stroke survivors may be at risk for poor cognitive functioning. More work is needed to identify the processes that may contribute to the diminished cognitive capacity among these adults so that interventions may be developed to reduce caregiver burden and promote cognitive health.
Keywords: Aged; Aged, 80 and over; Cognition Disorders; Community Health Planning; Cross-Sectional Studies; Female; Humans; Male; Neuropsychological tests; Retrospective Studies; Spouses; Stroke; Survivors; United States

Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset. - Benjamin D Capistrant; Qianyi Wang; Sze Y Liu; M. Maria Glymour (J Am Geriatr Soc, 2013)
OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke. DESIGN: Prospective, observational study. SETTING: Community-dwelling Health and Retirement Study (HRS) cohort. PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441). MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor's diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates. RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards. CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.
Keywords: Activities of Daily Living; Age of Onset; Aged; Aged, 80 and over; Bayes Theorem; Disability Evaluation; Disabled Persons; Female; Follow-Up Studies; Geriatric Assessment; Humans; Male; Middle Aged; Morbidity; Prospective Studies; Risk Assessment; Risk Factors; Socioeconomic factors; Stroke; Stroke Rehabilitation; Survival Rate; Survivors; Time Factors; United States

Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. - Dimitry S Davydow; Catherine L Hough; Kenneth M. Langa; Theodore J Iwashyna (Am J Geriatr Psychiatry, 2013)
OBJECTIVES: To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms. DESIGN: Prospective longitudinal cohort study. SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006). PARTICIPANTS: A total of 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview. MEASUREMENTS: Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims. RESULTS: The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.73, 1.34) nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, presepsis substantial depressive symptoms (RR: 2.20; 95% CI: 1.66, 2.90) and worse postsepsis functional impairment (RR: 1.08 per new limitation; 95% CI: 1.03, 1.13) were independently associated with substantial depressive symptoms after sepsis. CONCLUSIONS: The prevalence of substantial depressive symptoms in severe sepsis survivors is high but is not increased relative to their presepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions before hospital discharge, may improve outcomes.
Keywords: Aged; Aged, 80 and over; Cohort Studies; depression; Female; Hospitalization; Humans; Longitudinal Studies; Male; Poisson Distribution; Prospective Studies; Regression Analysis; Risk Factors; Sepsis; Severity of Illness Index; Survivors; United States

Trends in depressive symptom burden among older adults in the United States from 1998 to 2008. - Zivin, Kara; Paul A Pirraglia; Ryan J McCammon; Kenneth M. Langa; Sandeep Vijan (J Gen Intern Med, 2013)
CONTEXT: Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown. OBJECTIVE: To examine trends in depressive symptoms among older adults in the US between 1998 and 2008. DESIGN: Serial cross-sectional analysis of six biennial assessments. SETTING: Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N = 16,184 in 1998). MAIN OUTCOME MEASURE: The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics. RESULTS: Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13-1.19), with significant increases in those aged ≥ 60 relative to those aged 55-59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60. CONCLUSIONS: Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.
Keywords: Age Factors; Aged; Aged, 80 and over; Cohort Studies; Cost of Illness; Cross-Sectional Studies; depression; Female; Humans; Male; Middle Aged; United States

Trends in late-life activity limitations in the United States: an update from five national surveys. - Vicki A Freedman; Brenda C Spillman; Patricia Andreski; Jennifer C. Cornman; Eileen M. Crimmins; Kramarow, Ellen; Lubitz, James; Linda G Martin; Sharon S. Merkin; Robert F. Schoeni; Teresa Seeman; Timothy A Waidmann (Demography, 2013)
This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Disabled Persons; Female; Health Surveys; Humans; Male; Mobility Limitation; Models, Statistical; United States

Type of high-school credentials and older age ADL and IADL limitations: is the GED credential equivalent to a diploma? - Sze Y Liu; Chavan, Niraj R.; M. Maria Glymour (Gerontologist, 2013)
PURPOSE: Educational attainment is a robust predictor of disability in elderly Americans: older adults with high-school (HS) diplomas have substantially lower disability than individuals who did not complete HS. General Educational Development (GED) diplomas now comprise almost 20% of new HS credentials issued annually in the United States but it is unknown whether the apparent health advantages of HS diplomas extend to GED credentials. This study examines whether adults older than 50 years with GEDs have higher odds of incident instrumental or basic activities of daily living (IADLs) limitations compared with HS degree holders. METHODS: We compared odds of incident IADL limitations by HS credential type using discrete-time survival models among 9,426 Health and Retirement Study participants followed from 1998 through 2008. RESULTS: HS degree holders had lower odds of incident IADLs than GED holders (OR = 0.72, 95% CI = 0.58, 0.90 and OR = 0.69, 95% CI = 0.56, 0.86 for ADLs and IADLs, respectively). There was no significant difference in odds of incident IADL limitations between GED holders and respondents without HS credentials (OR = 0.89, 95% CI = 0.71, 1.11 for ADLs; OR = 0.88, 95% CI = 0.70, 1.12 for IADLs). IMPLICATIONS: Although GEDs are widely accepted as equivalent to high school diplomas, they are not associated with comparable health advantages for physical limitations in older age.
Keywords: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Aging; Disabled Persons; Educational Status; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Socioeconomic factors; United States

Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals. - Padmaja Ayyagari; Deb, Partha; Jason M. Fletcher; William T Gallo; Jody L Sindelar (Health Econ, 2013)
This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.
Keywords: Adult; Aged; Aged, 80 and over; Alcohol Drinking; Alcoholic Beverages; Behavior; Body Height; Costs and Cost Analysis; Female; Health Status; Humans; Male; Middle Aged; Models, Econometric; Socioeconomic factors; Taxes; United States

Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults. - Richard G Wight; Carol S Aneshensel; Barrett, Christopher; Michelle J Ko; Joshua Chodosh; Arun S Karlamangla (J Epidemiol Community Health, 2013)
BACKGROUND: Little is known about how a neighbourhood's unemployment history may set the stage for depressive symptomatology. This study examines the effects of urban neighbourhood unemployment history on current depressive symptoms and subsequent symptom trajectories among residentially stable late middle age and older adults. Contingent effects between neighbourhood unemployment and individual-level employment status (ie, cross-level interactions) are also assessed. METHODS: Individual-level survey data are from four waves (2000, 2002, 2004 and 2006) of the original cohort of the nationally representative US Health and Retirement Study. Neighbourhoods are operationalised with US Census tracts for which historical average proportion unemployed between 1990 and 2000 and change in proportion unemployed between 1990 and 2000 are used to characterise the neighbourhood's unemployment history. Hierarchical linear regressions estimate three-level (time, individual and neighbourhood) growth models. RESULTS: Symptoms in 2000 are highest among those residing in neighbourhoods characterised by high historical average unemployment beginning in 1990 and increasing unemployment between 1990 and 2000, net of a wide range of socio-demographic controls including individual-level employment status. These neighbourhood unemployment effects are not contingent upon individual-level employment status in 2000. 6-year trajectories of depressive symptoms decrease over time on average but are not significantly influenced by the neighbourhood's unemployment history. CONCLUSIONS: Given the current US recession, future studies that do not consider historical employment conditions may underestimate the mental health impact of urban neighbourhood context. The findings suggest that exposure to neighbourhood unemployment earlier in life may be consequential to mental health later in life.
Keywords: Age Factors; depression; Female; Humans; Logistic Models; Longitudinal Studies; Male; Middle Aged; Multilevel Analysis; Residence Characteristics; Retirement; Risk Factors; Socioeconomic factors; Stress, Psychological; Surveys and Questionnaires; Time Factors; Unemployment; United States; Urban Population

Vascular depression: an early warning sign of frailty. - Daniel Paulson; Peter A Lichtenberg (Aging Ment Health, 2013)
OBJECTIVES: Frailty is a common geriatric disorder associated with activities of daily living (ADL) impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004 ), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis. METHODS: We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first represented respondents with either high cerebrovascular burden (CVB; at least two cerebrovascular risk factors) or probable depression (score ≥3 on the 8-item Center for Epidemiological Studies Depression Scale (CES-D)), and the second represented respondents with both high CVB and probable depression. RESULTS: At baseline, the prevalence of frailty was 31.5%. Over four years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004. DISCUSSION: These findings suggest that vascular depression is a prodrome for frailty.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Cerebrovascular Disorders; depression; Disabled Persons; Female; Follow-Up Studies; Frail Elderly; Geriatric Assessment; Health Status; Humans; Incidence; Logistic Models; Male; Prevalence; Psychiatric Status Rating Scales; Risk Factors; Socioeconomic factors; United States

What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline. - Hector M González; Wassim Tarraf; Mary E Bowen; Michelle D Johnson-Jennings; Gwenith G Fisher (Neuroepidemiology, 2013)
BACKGROUND/AIMS: To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans. METHODS: We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n=8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health. RESULTS: Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time. CONCLUSIONS: Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered.
Keywords: Aged; Aged, 80 and over; Cognition Disorders; Cognitive Reserve; Cohort Studies; Female; Humans; Longevity; Longitudinal Studies; Male; Parents; Prospective Studies; Socioeconomic factors; United States

Women's receipt of Social Security retirement benefits: expectations compared to elections. - Gillen, Martie; Claudia J Heath (J Women Aging, 2013)
This research contributes knowledge regarding the options of early, normal, or delayed receipt of Social Security retirement benefits and research-based findings regarding women's expected and actual timing of election of Social Security retirement benefits. First, descriptive analyses of alternative retirement options, based on Social Security retirement benefit rules, are provided. Second, the 2000, 2002, 2004, and 2006 waves of Health and Retirement Study (HRS) data are used to analyze women's anticipated and actual election of Social Security retirement benefits. Third, based on these considerations, recommendations are made regarding Social Security retirement benefit receipt alternatives.
Keywords: Age Factors; Aged; Decision making; Female; Humans; Longitudinal Studies; Middle Aged; Pensions; Retirement; Social Security; Socioeconomic factors; Time Factors; United States

Work stress and depressive symptoms in older employees: impact of national labour and social policies. - Lunau, T.; Morten Wahrendorf; Dragano, N.; Johannes Siegrist (BMC Public Health, 2013)
BACKGROUND: Maintaining health and work ability among older employees is a primary target of national labour and social policies (NLSP) in Europe. Depression makes a significant contribution to early retirement, and chronic work-related stress is associated with elevated risks of depression. We test this latter association among older employees and explore to what extent indicators of distinct NLSP modify the association between work stress and depressive symptoms. We choose six indicators, classified in three categories: (1) investment in active labour market policies, (2) employment protection, (3) level of distributive justice. METHODS: We use data from three longitudinal ageing studies (SHARE, HRS, ELSA) including 5650 men and women in 13 countries. Information on work stress (effort-reward imbalance, low work control) and depressive symptoms (CES-D, EURO-D) was obtained. Six NLSP indicators were selected from OECD databases. Associations of work stress (2004) with depressive symptoms (2006) and their modification by policy indicators were analysed using logistic multilevel models. RESULTS: Risk of depressive symptoms at follow-up is higher among those experiencing effort-reward imbalance (OR: 1.55 95% CI 1.27-1.89) and low control (OR: 1.46 95% CI 1.19-1.79) at work. Interaction terms indicate a modifying effect of a majority of protective NLSP indicators on the strength of associations of effort - reward imbalance with depressive symptoms. CONCLUSIONS: Work stress is associated with elevated risk of prospective depressive symptoms among older employees from 13 European countries. Protective labour and social policies modify the strength of these associations. If further supported findings may have important policy implications.
Keywords: depression; Employment; Europe; Female; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Public Policy; Risk Factors; Stress, Psychological; Surveys and Questionnaires

Is working later in life good or bad for health? An investigation of multiple health outcomes. - Kandauda Wickrama; Catherine W. O'Neal; Kyung H. Kwag; Lee, Tae K. (J Gerontol B Psychol Sci Soc Sci, 2013)
OBJECTIVES: To examine the mutual influences between changes in work status and multiple dimensions of health outcomes (immediate memory, physical disability, and depressive symptoms) over later years. METHODS: We used a subsample of 8,524 older adults who participated in the Health and Retirement Study from 1998 to 2008 and were 62 years or older in 1998 to examine work status and health outcomes after controlling for age and background characteristics. RESULTS: We present results of cross-lagged auto-regressive models. Work status (level of work) predicted subsequent residual changes in immediate memory over time, whereas immediate memory predicted subsequent residual changes in work status over time, even after controlling for physical disability and depressive symptoms. Similar results were indicated for the associations between work status and physical disability and depressive symptoms over time. DISCUSSION: Consistent with social causation and social selection traditions, the findings support bi-directional associations among changes in work status (the level of work), immediate memory, physical disability, and depressive symptoms in later years. Practical implications are discussed.
Keywords: Activities of Daily Living; Age Factors; Aged; depression; Educational Status; Employment; Female; Health Status; Humans; Longitudinal Studies; Male; Memory, Short-Term; Middle Aged; Neuropsychological tests; Psychiatric Status Rating Scales; Sex Factors

Antigenic challenge in the etiology of autoimmune disease in women. - Mary A M Rogers; Deborah A Levine; Neil Blumberg; Gwenith G Fisher; Mohammed U Kabeto; Kenneth M. Langa (J Autoimmun, 2012)
Infection has long been implicated as a trigger for autoimmune disease. Other antigenic challenges include receipt of allogeneic tissue or blood resulting in immunomodulation. We investigated antigenic challenges as possible risk factors for autoimmune disease in women using the Health and Retirement Study, a nationally representative longitudinal study, linked to Medicare files, years 1991-2007. The prevalence of autoimmune disease (rheumatoid arthritis, Hashimoto's disease, Graves' disease, systemic lupus erythematosus, celiac disease, systemic sclerosis, Sjögren syndrome and multiple sclerosis) was 1.4% in older women (95% CI: 1.3%, 1.5%) with significant variation across regions of the United States. The risk of autoimmune disease increased by 41% (95% CI of incidence rate ratio (IRR): 1.10, 1.81) with a prior infection-related medical visit. The risk of autoimmune disease increased by 90% (95% CI of IRR: 1.36, 2.66) with a prior transfusion without infection. Parity was not associated with autoimmune disease. Women less than 65 years of age and Jewish women had significantly elevated risk of developing autoimmune disease, as did individuals with a history of heart disease or end-stage renal disease. Antigenic challenges, such as infection and allogeneic blood transfusion, are significant risk factors for the development of autoimmune disease in older women.
Rogers, Mary A M Levine, Deborah A Blumberg, Neil Fisher, Gwenith G Kabeto, Mohammed Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ HL078603/HL/NHLBI NIH HHS/ HL095467/HL/NHLBI NIH HHS/ HL100051/HL/NHLBI NIH HHS/ R21 HL093129-01A1/HL/NHLBI NIH HHS/ R21 HL093129-02/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ England J Autoimmun. 2012 May;38(2-3):J97-J102. Epub 2011 Aug 30.
Keywords: Aged; Aged, 80 and over; Antigens; Autoimmune Diseases; Female; Humans; Incidence; Middle Aged; Prevalence; Risk Factors; United States

Association of chronic diseases and impairments with disability in older adults: a decade of change? - William W. Hung; Joseph S. Ross; Boockvar, Kenneth S; Albert L Siu (Med Care, 2012)
BACKGROUND: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults. OBJECTIVE: To examine how the associations of chronic disease and impairment with specific disability have changed over time. RESEARCH DESIGN: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study. SUBJECTS: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008. MEASUREMENTS: : Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL. RESULTS: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99% confidence interval (CI), 1.06-1.46; OR = 1.07; 99% CI, 0.90-1.27; OR = 1.00; 99% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99% CI, 1.13-1.54; OR=0.97; 99% CI, 0.82-1.14; OR = 0.99; 99% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99% CI, 1.01-1.46; OR = 1.37; 99% CI, 1.15-1.64; OR = 1.52; 99% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99% CI, 1.33-2.03; OR = 1.63; 99% CI, 1.32-2.01; OR = 2.11; 99% CI, 1.73-2.57). CONCLUSIONS: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.
Keywords: Activities of Daily Living; Aged; Aging; Cardiovascular Diseases; Chronic disease; Cognition Disorders; Cross-Sectional Studies; Diabetes Mellitus; Disabled Persons; Female; Health Surveys; Hearing loss; Humans; Hypertension; Male; Mobility Limitation; Residence Characteristics; Respiratory Tract Diseases; Self Care; Socioeconomic factors; United States; Vision Disorders

Beware of being unaware: racial/ethnic disparities in chronic illness in the USA. - Chatterji, Pinka; Heesoo Joo; Kajal Chatterji Lahiri (Health Econ, 2012)
We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness - the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes.
Keywords: Aged; Biomarkers; Black People; Chronic disease; Data collection; Diabetes Mellitus; ethnicity; Female; Health Knowledge, Attitudes, Practice; Health Status Disparities; Hispanic or Latino; Humans; Hypertension; Male; Racial Groups; Self Report; United States; White People

Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study. - M. O. Rakoski; Ryan J McCammon; John D Piette; Theodore J Iwashyna; J. A. Marrero; Lok, Anna S; Kenneth M. Langa; Volk, Michael L (Hepatology, 2012)
UNLABELLED: Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients' health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; P < 0.001 for all bivariable comparisons). They also had greater functional disability (P < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week (P < 0.001), at an annual cost of US $4700 per person. CONCLUSION: Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population.
Keywords: Aged; Black People; Caregivers; Comorbidity; Cost of Illness; Databases, Factual; Disability Evaluation; Female; Health Care Costs; Health Status; Hispanic or Latino; Humans; Incidence; Liver Cirrhosis; Male; Medicaid; Medicare; Prevalence; Prospective Studies; Retirement; United States; White People

Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study. - Victoria A. Shaffer; Edgar C. Merkle; Angela Fagerlin; Jennifer J Griggs; Kenneth M. Langa; Theodore J Iwashyna (Med Care, 2012)
OBJECTIVES: This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy. SUBJECTS: Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims. MEASURES: The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory and attention. We defined the smallest clinically significant change as 0.4 points per year. RESULTS: We used Bayesian hierarchical linear models to test the hypotheses, adjusting for multiple possible confounders. Eighty-eight patients were treated with chemotherapy; 277 were not. The mean age at diagnosis was 75.5. Patients were followed for a median of 3.1 years after diagnosis, with a range of 0 to 8.3 years. We found no differences in the rates of cognitive decline before and after diagnosis for patients who received chemotherapy in adjusted models (P=0.86, one-sided 95% posterior intervals lower bound: 0.09 worse after chemotherapy), where patients served as their own controls. Moreover, the rate of cognitive decline after diagnosis did not differ between patients who had chemotherapy and those who did not (P=0.84, one-sided 95% posterior intervals lower bound: 0.11 worse for chemotherapy group in adjusted model). CONCLUSIONS: There was no evidence of cognitive decline associated with chemotherapy in this sample of older adults with breast and colorectal cancer.
Keywords: Age Factors; Aged; Aged, 80 and over; Aging; Antineoplastic Agents; Antineoplastic Protocols; Bayes Theorem; Breast Neoplasms; Cognition Disorders; Colorectal Neoplasms; Female; Health Behavior; Humans; Interviews as Topic; Male; Memory; Prospective Studies

Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries. - Paula A Weigel; Jason Hockenberry; Suzanne E Bentler; Kaskie, Brian; Frederic D Wolinsky (Journal of Manipulative & Physiological Therapeutics, 2012)
OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine. METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample. RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9% to 10.9% over the 17-year period. CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.
Keywords: Age Factors; Aged; Aged, 80 and over; Chiropractic; Combined Modality Therapy; Episode of Care; Female; Geriatric Assessment; Health Care Surveys; Health Services; Humans; Incidence; Insurance Claim Reporting; Low Back Pain; Medicare Part B; Musculoskeletal Diseases; Primary Health Care; Retrospective Studies; Sex Factors; Treatment Outcome; United States

Clinical complexity and mortality in middle-aged and older adults with diabetes. - Christine T Cigolle; Mohammed U Kabeto; Pearl G. Lee; Caroline S Blaum (J Gerontol A Biol Sci Med Sci, 2012)
BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit. METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models. RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%. CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.
Keywords: Activities of Daily Living; Aged; Comorbidity; Diabetes Complications; Diabetes Mellitus; Female; Health Status; Humans; Male; Middle Aged; Proportional Hazards Models; Self Care

Cohort differences in the availability of informal caregivers: are the Boomers at risk? - Lindsay H Ryan; Jacqui Smith; Toni C Antonucci; James S Jackson (Gerontologist, 2012)
PURPOSE OF THE STUDY: We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age. DESIGN AND METHODS: Population data from the U.S. Census and from the Health and Retirement Study (HRS) are used to identify a cohort similar to the BBs on marital status and fertility rates. Using generalized linear mixed models and 10-year longitudinal data from Depression and WWII parents (DWP; n = 1,052) and the parents of BBs (PBB; n = 3,573) in the HRS, we examine cohort differences in the time-varying likelihoods of being married and of having an adult child living within 10 miles. RESULTS: The DWP had similar informal care resources at entry to old age as is expected in the BB. Longitudinal analyses of the DWP and PBB cohorts in HRS reveal that the availability of family changes over time and that the DWP cohort was significantly less likely to have a spouse or a grown child living nearby. IMPLICATIONS: These findings, and future projections based on them, have significant implications for institutions and public policy concerned with the informal caregiving needs of the Boomer cohort as they age.
Keywords: Aged; Aged, 80 and over; Aging; Caregivers; Censuses; Family Characteristics; Female; Health Status; Humans; Likelihood Functions; Longitudinal Studies; Male; Middle Aged; Nuclear Family; Population Growth; Residence Characteristics; Retirement; Risk; Socioeconomic factors

A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults. - Daniel O. Clark; Timothy E. Stump; Tu, Wanzhu; Douglas K Miller (Medical Care, 2012)
BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs. OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data. METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model. RESULTS: At 2-year follow-up, 8.0% and 7.3% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness. CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data.
Keywords: Accidental Falls; Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Aging; Body Mass Index; Chronic disease; Female; Humans; Male; Mobility Limitation; Models, Statistical; Risk Assessment; Sex Factors

Coverage or costs: the role of health insurance in labor market reentry among early retirees. - Ben Lennox Kail (J Gerontol B Psychol Sci Soc Sci, 2012)
OBJECTIVES: This study evaluated the impact of insurance coverage on the odds of returning to work after early retirement and the change in insurance coverage after returning to work. METHOD: The Health and Retirement Study was used to estimate hierarchical linear models of transitions to full-time work and part-time work relative to remaining retired. A chi-square test was also used to assess change in insurance coverage after returning to work. RESULTS: Insurance coverage was unrelated to the odds of transitioning to full-time work. However, relative to employer-provided insurance, private nongroup insurance increased the odds of transitioning to part-time work, whereas public insurance reduced the odds of making this transition. Additionally, after returning to work, insurance coverage increased among those who were without employer-provided insurance in retirement. DISCUSSION: Results indicated that source of coverage may be more useful in explaining returns to part-time work than simply whether people have coverage at all. In other words, the mechanism underlying the positive relationship between insurance and returning to work appeared to be limited to those who return to work because of the cost of private nongroup insurance. Among these people, however, there was some evidence that they are able to secure new coverage once they return to work.
Keywords: Employment; Female; Health Benefit Plans, Employee; Health Surveys; Humans; Insurance Coverage; Insurance, Health; Male; Middle Aged; Retirement; United States

The cumulative effect of unemployment on risks for acute myocardial infarction. - Matthew E Dupre; Linda K George; Liu, Guangya; Eric D Peterson (Arch Intern Med, 2012)
BACKGROUND: Employment instability is a major source of strain affecting an increasing number of adults in the United States. Little is known about the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI). METHODS: We investigated the associations between different dimensions of unemployment and the risks for AMI in US adults in a prospective cohort study of adults (N = 13,451) aged 51 to 75 years in the Health and Retirement Study with biennial follow-up interviews from 1992 to 2010. Unadjusted rates of age-specific AMI were used to demonstrate observed differences by employment status, cumulative number of job losses, and cumulative time unemployed. Cox proportional hazards models were used to examine the multivariate effects of cumulative work histories on AMI while adjusting for sociodemographic background and confounding risk factors. RESULTS: The median age of the study cohort was 62 years, and 1061 AMI events (7.9%) occurred during the 165,169 person-years of observation. Among the sample, 14.0% of subjects were unemployed at baseline, 69.7% had 1 or more cumulative job losses, and 35.1% had spent time unemployed. Unadjusted plots showed that age-specific rates of AMI differed significantly for each dimension of work history. Multivariate models showed that AMI risks were significantly higher among the unemployed (hazard ratio, 1.35 [95% CI, 1.10-1.66]) and that risks increased incrementally from 1 job loss (1.22 [1.04-1.42]) to 4 or more cumulative job losses (1.63 [1.29-2.07]) compared with no job loss. Risks for AMI were particularly elevated within the first year of unemployment (hazard ratio, 1.27 [95% CI, 1.01-1.60]) but not thereafter. Results were robust after adjustments for multiple clinical, socioeconomic, and behavioral risk factors. CONCLUSIONS: Unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.
Keywords: Female; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stress, Psychological; Survival Rate; Unemployment; United States

Current and long-term spousal caregiving and onset of cardiovascular disease. - Benjamin D Capistrant; J Robin Moon; Lisa F Berkman; M. Maria Glymour (J Epidemiol Community Health, 2012)
BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans. METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living ≥14 h/week according to the care recipients' report in the most recent prior biennial survey; we define providing ≥14 h/week of care at two consecutive biennial surveys as 'long-term caregiving'. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD. RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95% CI 0.06 to 1.28). CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.
Keywords: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Cardiovascular Diseases; Caregivers; Female; Follow-Up Studies; Humans; Incidence; Interviews as Topic; Long-term Care; Male; Middle Aged; Proportional Hazards Models; Risk Factors; Self Report; Socioeconomic factors; Spouses; Stress, Psychological; United States

Depressive symptoms and psychosocial stress at work among older employees in three continents. - Johannes Siegrist; Lunau, T.; Morten Wahrendorf; Dragano, N. (Global Health, 2012)
BACKGROUND: To assess whether an association of psychosocial stress at work with depressive symptoms among older employees is evident in a set of comparable empirical studies from Europe, North America and Asia. METHODS: Cross-sectional and longitudinal multivariate regression analyses of data from 4 cohort studies with elder workers (2004 and 2006) testing associations of psychosocial stress at work ('effort-reward imbalance'; 'low control') with depressive symptoms. RESULTS: Cross-sectional analyses from 17 countries with 14.236 participants reveal elevated odds ratios of depressive symptoms among people experiencing high work stress compared to those with low or no work stress. Adjusted odds ratios vary from 1.64 (95% CI 1.02-2.63) in Japan to 1.97 (95% CI 1.75-2.23) in Europe and 2.28 (95% CI 1.59-3.28) in the USA. Odds ratios from additional longitudinal analyses (in 13 countries) controlling for baseline depression are smaller, but remain in part significant. CONCLUSION: Findings indicate that psychosocial stress at work might be a relevant risk factor for depressive symptoms among older employees across countries and continents. This observation may call for global policy efforts to improve quality of work in view of a rapidly aging workforce, in particular in times of economic globalization.
Keywords: Asia; Cross-Sectional Studies; Data collection; depression; Europe; Female; Humans; Longitudinal Studies; Male; Middle Aged; North America; Prevalence; Regression Analysis; Risk Factors; Stress, Psychological; Work

Depressive symptoms in spouses of older patients with severe sepsis. - Dimitry S Davydow; Catherine L Hough; Kenneth M. Langa; Theodore J Iwashyna (Crit Care Med, 2012)
OBJECTIVE: To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse's presepsis history, whether this risk differs by sex, and is associated with a sepsis patient's disability after hospitalization. DESIGN: Prospective longitudinal cohort study. SETTING: Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008). PATIENTS: Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis. MEASUREMENTS AND MAIN RESULTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20% at a median of 1.1 yrs presepsis to 34% at a median of 1 yr postsepsis) with an odds ratio of 3.74 (95% confidence interval: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (odds ratio 1.90, 95% confidence interval 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (odds ratio 2.86, 95% confidence interval 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (odds ratio 1.35 per activities of daily living limitation of sepsis survivor, 95% confidence interval 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives' depression (odds ratio 2.61, 95% confidence interval 0.93, 7.38). CONCLUSIONS: Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their loved one dies and when their loved one survives.
Keywords: Age Factors; Aged; depression; Female; Hospitalization; Humans; Male; Multivariate Analysis; Prospective Studies; Psychiatric Status Rating Scales; Sepsis; Sex Factors; Spouses; Time Factors; United States

Despite 'welcome to Medicare' benefit, one in eight enrollees delay first use of part B services for at least two years. - Frank A Sloan; Kofi F Acquah; Paul P Lee; Devdutta G. Sangvai (Health Aff (Millwood), 2012)
Much research has focused on the possible overuse of health care services within Medicare, but there is also substantial evidence of underuse. In recent years, Congress has added a "welcome to Medicare" physician visit and a number of preventive services with no cost sharing to the Medicare benefit package to encourage early and appropriate use of services. We examined national longitudinal data on first claims for Part B services-the portion of Medicare that covers physician visits-to learn how people used these benefits. We found that 12 percent of people, or about one in eight, who enrolled in Medicare at age sixty-five waited more than two years before making their first use of care covered by Part B. In part, this delay reflected patterns of use before enrollment, in that people who sought preventive care before turning sixty-five continued to do so after enrolling in Medicare. Enrollees with Medigap coverage, higher household wealth, and a higher level of education typically received care under Part B sooner than others, whereas having greater tolerance for risk was more likely to lead enrollees to delay use of Part B services. Men had a lower probability of using Part B services early than women; blacks and members of other minority groups were less likely to use services early than whites. Although the "welcome to Medicare" checkup does not appear to have had a positive effect on use of services soon after enrollment, the percentage of beneficiaries receiving Part B services in the first two years after enrollment has steadily increased over time. Whether or not delays in receipt of care should be a considerable public policy concern may depend on what factors are leading specific categories of enrollees to delay care and how such delays affect health.
Keywords: Aged; Female; Humans; Insurance Claim Review; Male; Medicare Part B; Time Factors; United States

Disability and decline in physical function associated with hospital use at end of life. - Amy Kelley; Susan L Ettner; R Sean Morrison; Qingling Du; Catherine A Sarkisian (J Gen Intern Med, 2012)
BACKGROUND: Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions. OBJECTIVE: To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use. DESIGN/PARTICIPANTS: We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000-2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI). KEY RESULTS: Median hospital days was 7 (range = 0-183). 53% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47-9.05, depending on category). Dementia was associated with fewer days (-3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27). CONCLUSIONS: Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Chronic disease; Dementia; Disability Evaluation; Disabled Persons; Female; Frail Elderly; Geriatric Assessment; Hospitalization; Humans; Length of Stay; Longitudinal Studies; Male; Medicare; Socioeconomic factors; Terminal Care; United States

The Disability burden of COPD. - Thornton Snider, Julia; J. A. Romley; Ken S Wong; Zhang, Jie; Eber, Michael; Dana P Goldman (COPD, 2012)
Affecting an estimated 12.6 million people and causing over 100,000 deaths per year, chronic obstructive pulmonary disease (COPD) exacts a heavy burden on American society. Despite knowledge of the impact of COPD on morbidity, mortality, and health care costs, little is known about the association of the disease with economic outcomes such as employment and the collection of disability. We quantify the impact of COPD on Americans aged 51 and older-in particular, their employment prospects and their likelihood of collecting federal disability benefits-by conducting longitudinal regression analysis using the Health and Retirement Study. Controlling for initial health status and a variety of sociodemographic factors, we find that COPD is associated with a decrease in the likelihood of employment of 8.6 percentage points (OR = 0.58, 95% CI 0.50-0.67), from 44% to 35%. This association rivals that of stroke and is larger than those of heart disease, cancer, hypertension, and diabetes. Furthermore, COPD is associated with a 3.9 percentage point (OR 2.52, 95% CI 2.00-3.17) increase in the likelihood of collecting Social Security Disability Insurance (SSDI), from 3.2% to 7.1%, as well as a 1.7 percentage point (OR 2.87, 95% CI 2.02-4.08) increase in the likelihood of collecting Supplemental Security Income (SSI), from 1.0% to 2.7%. The associations of COPD with SSDI and SSI are the largest of any of the conditions studied. Our results are consistent with the hypothesis that COPD imposes a substantial burden on American society by inhibiting employment and creating disability.
Keywords: Aged; Cost of Illness; Disabled Persons; Employment; Female; Humans; Income; Insurance, Disability; Likelihood Functions; Logistic Models; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Social Security; United States

Effect of obesity on falls, injury, and disability. - Christine L Himes; Sandra L Reynolds (J Am Geriatr Soc, 2012)
OBJECTIVES: To examine the effect of obesity on the propensity of older adults to fall, sustain a fall-related injury, and develop disability in activities of daily living (ADLs) after a fall. DESIGN: Longitudinal population-based survey. SETTING: Five waves of the Health and Retirement Study (HRS), 1998-2006. PARTICIPANTS: Ten thousand seven hundred fifty-five respondents aged 65 and older in 31,602 person-intervals. MEASUREMENTS: Falls within any 2-year interval (9,621 falls). Injuries requiring medical attention (3,130 injuries). Increased ADL disability after a fall within any 2-year interval (2,162 events). Underweight and three classes of obesity (body mass index (BMI) 30.0-34.9 kg/m(2) , Class 1) 35.0-39.9 kg/m(2) , Class 2; ≥40.0 kg/m(2) , Class 3), calculated from self-reported height and weight. Self-reported presence of lower body limitation, pain, dizziness, or vision problems. Self-reported doctor's diagnosis of diabetes mellitus, stroke, or arthritis. RESULTS: Compared with normal-weight respondents, the odds ratios (OR) for risk of falling were 1.12 (95% confidence interval (CI) = 1.01-1.24) for obesity Class 1, 1.26 (95% CI = 1.05-1.51) for obesity Class 2, and 1.50 (95% CI = 1.21-1.86) for obesity Class 3. Conditional on falling, only obesity Class 3 was related to a lower propensity for a fall-related injury (OR = 0.62, 95% CI = 0.44-0.87). Obesity Classes 1 and 2 were associated with a higher risk of greater ADL disability after a fall than normal-weight respondents (OR = 1.17, 95% CI = 1.02-1.34; OR = 1.39, 95% CI = 1.10-1.75, respectively). Being underweight was not related to risk of falling or to reported injury or greater ADL limitation after a fall. The presence of measured health problems and chronic conditions was associated with greater risk of falling and, of those who fell, greater ADL limitation but not serious injury. CONCLUSION: Obesity appears to be associated with greater risk of falling in older adults, as well as a higher risk of greater ADL disability after a fall. Obesity (BMI ≥ 40 kg/m(2) ) may reduce the risk of injury from a fall. Further investigation of the mechanisms of obesity on falls and related health outcomes is warranted.
Himes, Christine L Reynolds, Sandra L United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2012 Jan;60(1):124-9. doi: 10.1111/j.1532-5415.2011.03767.x. Epub 2011 Dec 8.
Keywords: Accidental Falls; Activities of Daily Living; Aged; Body Mass Index; Disability Evaluation; Disabled Persons; Female; Follow-Up Studies; Humans; Incidence; Male; Obesity; Odds Ratio; Prevalence; Retrospective Studies; Risk Factors; United States; Wounds and Injuries

The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study. - Anda Botoseneanu; Jersey Liang (J Gerontol A Biol Sci Med Sci, 2012)
BACKGROUND: Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group. METHODS: We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI. RESULTS: Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory. CONCLUSIONS: In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.
Keywords: Aged; Aging; Alcohol Drinking; Body Mass Index; Cohort Studies; Female; Health Behavior; Health Status; Humans; Linear Models; Longitudinal Studies; Male; Middle Aged; Motor Activity; Smoking; Socioeconomic factors; United States

Elevated depressive symptoms and incident stroke in Hispanic, African-American, and White older Americans. - M. Maria Glymour; Jessica J. Yen; Anna Kosheleva; J Robin Moon; Benjamin D Capistrant; Kristen K Patton (J Behav Med, 2012)
Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36-1.73) and among blacks (HR = 1.31; 95% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics.
Keywords: Age Factors; Aged; Black or African American; depression; Female; Health Surveys; Hispanic or Latino; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Predictive Value of Tests; Prevalence; Risk Factors; Stroke; United States; White People

Ethnic/race differences in the attrition of older American survey respondents: implications for health-related research. - Natalia A. Zhivan; Alfonso Ang; Hortensia Amaro; William A. Vega; Kyriakos S Markides (Health Serv Res, 2012)
OBJECTIVE: To compare models of attrition across race/ethnic groups of aging populations and discuss implications for health-related research. DATA SOURCES: The Health and Retirement Study (1992-2008). STUDY DESIGN: A competing risks model was estimated using a multinomial logit model when respondents faced competing types of risks, such as dying, being lost from the study, and nonresponse in some years for different groups of elderly. Key explanatory variables were foreign birth, health insurance, and health status. PRINCIPAL FINDINGS: Variables describing foreign birth, health insurance, and health status differed in their prediction of attrition across ethnic groups of aging populations. CONCLUSIONS: Differences in the predictors of attrition across ethnic groups of elderly could potentially lead to biased estimates in health-related research using longitudinal data sources.
Keywords: Bias; ethnicity; Female; Health Care Surveys; Health Services Research; Health Surveys; Hispanic or Latino; Humans; Male; Mexican Americans; Middle Aged; Racial Groups; Risk; Socioeconomic factors; United States

An examination of healthy aging across a conceptual continuum: prevalence estimates, demographic patterns, and validity. - Sara J McLaughlin; Alan M Jette; Cathleen M. Connell (J Gerontol A Biol Sci Med Sci, 2012)
BACKGROUND: Although the notion of healthy aging has gained wide acceptance in gerontology, measuring the phenomenon is challenging. Guided by a prominent conceptualization of healthy aging, we examined how shifting from a more to less stringent definition of healthy aging influences prevalence estimates, demographic patterns, and validity. METHODS: Data are from adults aged 65 years and older who participated in the Health and Retirement Study. We examined four operational definitions of healthy aging. For each, we calculated prevalence estimates and examined the odds of healthy aging by age, education, gender, and race-ethnicity in 2006. We also examined the association between healthy aging and both self-rated health and death. RESULTS: Across definitions, the prevalence of healthy aging ranged from 3.3% to 35.5%. For all definitions, those classified as experiencing healthy aging had lower odds of fair or poor self-rated health and death over an 8-year period. The odds of being classified as "healthy" were lower among those of advanced age, those with less education, and women than for their corresponding counterparts across all definitions. CONCLUSIONS: Moving across the conceptual continuum--from a more to less rigid definition of healthy aging--markedly increases the measured prevalence of healthy aging. Importantly, results suggest that all examined definitions identified a subgroup of older adults who had substantially lower odds of reporting fair or poor health and dying over an 8-year period, providing evidence of the validity of our definitions. Conceptualizations that emphasize symptomatic disease and functional health may be particularly useful for public health purposes.
Keywords: Aged; Aged, 80 and over; Aging; Cognition; Female; health; Humans; Male; Odds Ratio; Prevalence; Reproducibility of Results

Gardening as a potential activity to reduce falls in older adults. - Tuo-Yu Chen; Megan C Janke (J Aging Phys Act, 2012)
This study examines whether participation in gardening predicts reduced fall risk and performance on balance and gait-speed measures in older adults. Data on adults age 65 and older (N = 3,237) from the Health and Retirement Study and Consumption and Activities Mail Survey were analyzed. Participants who spent 1 hr or more gardening in the past week were defined as gardeners, resulting in a total of 1,585 gardeners and 1,652 nongardeners. Independent t tests, chi square, and regression analyses were conducted to examine the relationship between gardening and health outcomes. Findings indicate that gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardeners. Significantly fewer gardeners than nongardeners reported a fall in the past 2 yr. The findings suggest that gardening may be a potential activity to incorporate into future fall-prevention programs.
Keywords: Accidental Falls; Age Factors; Aged; Aged, 80 and over; Aging; Chi-Square Distribution; Confidence Intervals; Exercise Test; Female; Gait; Gardening; Humans; Leisure activities; Male; Motor Activity; Odds Ratio; Postural Balance; Risk Assessment; Self Report; Task Performance and Analysis

Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults. - Jiyoung Lyu; SeungAh H. Lee (J Aging Health, 2012)
OBJECTIVE: This study investigated gender differences in the relationship between excessive drinking and two cognitive domains among older adults. METHOD: Using data from the Health and Retirement Study, 3,888 females and 2,350 males were analyzed separately. Multivariate regression was used to analyze the association between excessive drinking and fluid intelligence score. Logistic regression was conducted to examine the relationship between excessive drinking and crystallized intelligence. RESULTS: Multivariate analysis showed that compared to non-excessive drinking, excessive drinking did not have a significant impact on fluid intelligence for either women or men, but it had a significantly negative association with a high crystallized intelligence score for women. DISCUSSION: Findings suggest that the relationship between excessive drinking and cognition varies with gender when crystallized intelligence is measured. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.
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Keywords: Aged; Alcohol Drinking; Alcohol-Related Disorders; Cognition; Cognition Disorders; Cross-Sectional Studies; Female; Humans; Intelligence; Male; Multivariate Analysis; Regression Analysis; Sex Factors

The growth in Social Security benefits among the retirement-age population from increases in the cap on covered earnings. - Alan L Gustman; Thomas L. Steinmeier; N. Tabatabai (Soc Secur Bull, 2012)
Analysts have proposed raising the maximum level of earnings subject to the Social Security payroll tax (the "tax max") to improve long-term Social Security Trust Fund solvency. This article investigates how raising the tax max leads to the "leakage" of portions of the additional revenue into higher benefit payments. Using Health and Retirement Study data matched to Social Security earnings records, we compare historical payroll tax payments and benefit amounts for Early Boomers (born 1948-1953) with tax and benefit simulations had they been subject to the tax max (adjusted for wage growth) faced by cohorts 12 and 24 years older. We find that 43.2 percent of the additional payroll tax revenue attributable to tax max increases affecting Early Boomers relative to taxes paid by the cohort 12 years older leaked into higher benefits. For Early Boomers relative to those 24 years older, we find 53.5 percent leakage.
Keywords: Aged; Cohort Studies; Female; Humans; Insurance Benefits; Male; Middle Aged; Models, Econometric; Public Policy; Salaries and Fringe Benefits; Social Security; Taxes; United States

Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. - Alexander K Smith; Ellen P McCarthy; Ellen Weber; Irena Cenzer; W John Boscardin; Jonathan Fisher; Kenneth E Covinsky (Health Aff (Millwood), 2012)
Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.
Keywords: Aged; Aged, 80 and over; Emergency Service, Hospital; Female; Hospital Mortality; Hospitalization; Humans; Insurance Claim Review; Male; Terminal Care; Terminally Ill; United States

Health behavior change following chronic illness in middle and later life. - Jason T Newsom; Nathalie Huguet; Michael J. McCarthy; Pamela Ramage-Morin; Mark S Kaplan; Julie Bernier; Bentson McFarland; Jillian Oderkirk (J Gerontol B Psychol Sci Soc Sci, 2012)
OBJECTIVES: Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life. METHODS: Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease. RESULTS: Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors. DISCUSSION: Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.
Keywords: Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Chi-Square Distribution; Chronic disease; Diabetes Mellitus; Exercise; Female; Health Behavior; Heart Diseases; Humans; Longitudinal Studies; Lung Diseases; Male; Middle Aged; Neoplasms; Smoking; Stroke; Time Factors

Health investment decisions in response to diabetes information in older Americans. - Alexander N Slade (J Health Econ, 2012)
Diabetes is a very common and serious chronic disease, and one of the fastest growing disease burdens in the United States. Further, health behaviors, such as exercise, smoking, drinking, as well as weight status, are instrumental to diabetes management and the reduction of its medical consequences. Nine waves of the Health and Retirement Study are used to model the role of a recent diabetes diagnosis and medication on present and subsequent weight status, exercise, drinking and smoking activity. Several non-linear dynamic population average probit models are estimated. Results suggest that compared to non-diagnosed individuals at risk for high blood sugar, diagnosed diabetics respond initially in terms of increasing exercise, losing weight, and curbing smoking and drinking behavior, but the effect diminishes after diagnosis. Evidence of recidivism is also found in these outcomes, especially weight status and physical activity, suggesting that some behavioral responses to diabetes may be short-lived.
Keywords: Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Body Weight; Decision making; Diabetes Mellitus; Empirical Research; Exercise; Female; Health Behavior; Health Surveys; Humans; Male; Middle Aged; Models, Psychological; Smoking; United States

Health service use among the previously uninsured: is subsidized health insurance enough? - Decker, Sandra L; Jalpa A Doshi; Amy E. Knaup; Daniel Polsky (Health Econ, 2012)
Although it has been shown that gaining Medicare coverage at age 65 years increases health service use among the uninsured, difficulty in changing habits or differences in the characteristics of previously uninsured compared with insured individuals may mean that the previously uninsured continue to use the healthcare system differently from others. This study uses Medicare claims data linked to two different surveys--the National Health Interview Survey and the Health and Retirement Study--to describe the relationship between insurance status before age 65 years and the use of Medicare-covered services beginning at age 65 years. Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16% fewer visits to office-based physicians but make 18% and 43% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented.
Keywords: Aged; Female; Health Care Surveys; Health Services; Health Status; Humans; Insurance Coverage; Insurance, Health; Male; Medically Uninsured; Medicare; Middle Aged; Socioeconomic factors; United States

Higher rates of Clostridium difficile infection among smokers. - Mary A M Rogers; M. Todd Greene; Sanjay Saint; Carol E Chenoweth; Preeti N Malani; Itishree Trivedi; David M. Aronoff (PLoS One, 2012)
OBJECTIVES: Cigarette smoking has been shown to be related to inflammatory bowel disease. We investigated whether smoking affected the probability of developing Clostridium difficile infection (CDI). METHODS: We conducted a longitudinal study of 16,781 older individuals from the nationally representative Health and Retirement Study. Data were linked to files from the Centers for Medicare and Medicaid Services. RESULTS: Overall, the rate of CDI in older individuals was 220.6 per 100,000 person-years (95% CI 193.3, 248.0). Rates of CDI were 281.6/100,000 person-years in current smokers, 229.0/100,000 in former smokers and 189.1/100,000 person-years in never smokers. The odds of CDI were 33% greater in former smokers (95% CI: 8%, 65%) and 80% greater in current smokers (95% CI: 33%, 145%) when compared to never smokers. When the number of CDI-related visits was evaluated, current smokers had a 75% increased rate of CDI compared to never smokers (95% CI: 15%, 167%). CONCLUSIONS: Smoking is associated with developing a Clostridium difficile infection. Current smokers have the highest risk, followed by former smokers, when compared to rates of infection in never smokers.
Keywords: Clostridioides difficile; Enterocolitis, Pseudomembranous; Female; Humans; Male; Middle Aged; Smoking; United States

The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States. - Kim, Jinhyun; Virginia E. Richardson (Health Soc Care Community, 2012)
Socioeconomic inequalities and lack of private health insurance have been viewed as significant contributors to health disparities in the United States. However, few studies have examined their impact on physical functioning over time, especially in later life. The current study investigated the impact of socioeconomic inequalities and lack of private health insurance on individuals' growth trajectories in physical functioning, as measured by activities of daily living. Data from the Health and Retirement Study (1994-2006) were used for this study, 6519 black and white adults who provided in-depth information about health, socioeconomic, financial and health insurance information were analysed. Latent growth curve modelling was used to estimate the initial level of physical functioning and its rate of change over time. Results showed that higher level of income and assets and having private health insurance significantly predicted better physical functioning. In particular, decline in physical functioning was slower among those who had private health insurance. Interestingly, changes in economic status, such as decreases in income and assets, had a greater impact on women's physical functioning than on men's. Black adults did not suffer more rapid declines in physical functioning than white adults after controlling for socioeconomic status. The current longitudinal study suggested that anti-poverty and health insurance policies should be enhanced to reduce the negative impact of socioeconomic inequalities on physical functioning throughout an individual's life course.
Kim, Jinhyun Richardson, Virginia England Health and social care in the community Health Soc Care Community. 2012 Jan;20(1):42-51. doi: 10.1111/j.1365-2524.2011.01012.x. Epub 2011 Jul 6.
Keywords: Activities of Daily Living; Aged; Black or African American; Female; Health Status; Healthcare Disparities; Humans; Longitudinal Studies; Male; Medically Uninsured; Middle Aged; Poverty; Sex Factors; Socioeconomic factors; Time Factors; United States; White People

The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status. - Donna M Zulman; Ann Marie Rosland; Choi, Hwajung; Kenneth M. Langa; Michele M Heisler (Patient Educ Couns, 2012)
OBJECTIVE: To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change. METHODS: Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004. RESULTS: In multivariate analyses (N=1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff=8.1, p<0.01 and -4.1, p<0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff=0.16, p<0.01), and with perceived worsening diabetes status in 2004 (adj OR=1.36, p<0.05), with much of this latter relationship explained by diabetes distress. CONCLUSION: Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time. PRACTICE IMPLICATIONS: Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress.
Zulman, Donna M Rosland, Ann-Marie Choi, Hwajung Langa, Kenneth M Heisler, Michele U01 AG09740/AG/NIA NIH HHS/ Ireland Patient Educ Couns. 2012 Apr;87(1):74-80. Epub 2011 Aug 15.
Keywords: Aged; Blood Glucose Self-Monitoring; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Disease Management; Female; Glycated Hemoglobin; Health Knowledge, Attitudes, Practice; Health Status; Humans; Interviews as Topic; Male; Middle Aged; Multivariate Analysis; Risk Factors; Self Care; Self Efficacy; Severity of Illness Index; Social Support; Stress, Psychological; Surveys and Questionnaires; Treatment Outcome

Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults. - Melissa H. Roberts; Douglas W Mapel (Am J Epidemiol, 2012)
The authors examined whether peak expiratory flow (PEF) is a valid measure of health status in older adults. Survey and test data from the 2006 and 2008 cycles of the Health and Retirement Study, a longitudinal study of US adults over age 50 years (with biennial surveys initiated in 1992), were used to develop predicted PEF regression models and to examine relations between low PEF values and other clinical factors. Low PEF (<80% of predicted value) was prevalent among persons with chronic conditions, including frequent pain, obstructive lung disease, heart disease, diabetes, and psychological distress. Persons with higher physical disability scores had substantially higher adjusted odds of having low PEF, on par with those for conditions known to be associated with poor health (cancer, heart disease, and stroke). In a multivariate regression model for difficulty with mobility, PEF remained an independent factor (odds ratio (OR) = 1.69, 95% confidence interval (CI): 1.53, 1.86). Persons with low PEF in 2006 were more likely to be hospitalized (OR = 1.26, 95% CI: 1.10, 1.43) within the subsequent 2 years and to estimate their chances of surviving for 10 or more years at less than 50% (OR = 1.69, 95% CI: 1.24, 2.30). PEF is a valid measure of health status in older persons, and low PEF is an independent predictor of hospitalization and poor subjective mortality assessment.
Roberts, Melissa H Mapel, Douglas W United States Am J Epidemiol. 2012 Jul 15;176(2):127-34. Epub 2012 Jun 28.
Keywords: Activities of Daily Living; Aged; Chronic disease; Cohort Studies; Comorbidity; Diabetes Mellitus; Female; Health Services; Health Status; Heart Diseases; Hospitalization; Humans; Incidence; Logistic Models; Longitudinal Studies; Lung Diseases; Male; Middle Aged; Neoplasms; Odds Ratio; Peak Expiratory Flow Rate; Population Surveillance; Stroke; United States

Loneliness, health, and mortality in old age: a national longitudinal study. - Ye Luo; Louise C Hawkley; Linda J. Waite; John T. Cacioppo (Soc Sci Med, 2012)
This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works.
Keywords: Aged; Aged, 80 and over; Aging; Cohort Studies; depression; Female; Health Behavior; Health Status; Humans; Interpersonal Relations; Loneliness; Longitudinal Studies; Male; Middle Aged; Mortality; Social Support; Socioeconomic factors; United States

Loneliness in older persons: a predictor of functional decline and death. - Perissinotto, Carla M; Irena Cenzer; Kenneth E Covinsky (Arch Intern Med, 2012)
BACKGROUND: Loneliness is a common source of distress, suffering, and impaired quality of life in older persons. We examined the relationship between loneliness, functional decline, and death in adults older than 60 years in the United States. METHODS: This is a longitudinal cohort study of 1604 participants in the psychosocial module of the Health and Retirement Study, a nationally representative study of older persons. Baseline assessment was in 2002 and follow-up assessments occurred every 2 years until 2008. Subjects were asked if they (1) feel left out, (2) feel isolated, or (3) lack companionship. Subjects were categorized as not lonely if they responded hardly ever to all 3 questions and lonely if they responded some of the time or often to any of the 3 questions. The primary outcomes were time to death over 6 years and functional decline over 6 years on the following 4 measures: difficulty on an increased number of activities of daily living (ADL), difficulty in an increased number of upper extremity tasks, decline in mobility, or increased difficulty in stair climbing. Multivariate analyses adjusted for demographic variables, socioeconomic status, living situation, depression, and various medical conditions. RESULTS: The mean age of subjects was 71 years. Fifty-nine percent were women; 81% were white, 11%, black, and 6%, Hispanic; and 18% lived alone. Among the elderly participants, 43% reported feeling lonely. Loneliness was associated with all outcome measures. Lonely subjects were more likely to experience decline in ADL (24.8% vs 12.5%; adjusted risk ratio [RR], 1.59; 95% CI, 1.23-2.07); develop difficulties with upper extremity tasks (41.5% vs 28.3%; adjusted RR, 1.28; 95% CI, 1.08-1.52); experience decline in mobility (38.1% vs 29.4%; adjusted RR, 1.18; 95% CI, 0.99-1.41); or experience difficulty in climbing (40.8% vs 27.9%; adjusted RR, 1.31; 95% CI, 1.10-1.57). Loneliness was associated with an increased risk of death (22.8% vs 14.2%; adjusted HR, 1.45; 95% CI, 1.11-1.88). CONCLUSION: Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Female; Humans; Loneliness; Longitudinal Studies; Male; Middle Aged; Mortality; United States; Upper Extremity; Walking

Long-term rate of change in memory functioning before and after stroke onset. - Qianyi Wang; Benjamin D Capistrant; Amy Ehntholt; M. Maria Glymour (Stroke, 2012)
BACKGROUND AND PURPOSE: Memory impairment is a predictor and a consequence of stroke, but memory decline is common even in healthy elderly individuals. We compared the long-term trajectory of memory functioning before and after stroke with memory change in stroke-free elderly individuals. METHODS: Health and Retirement Study participants aged 50 years and older (n=17 340) with no stroke history at baseline were interviewed biennially up to 10 years for first self-reported or proxy-reported stroke (n=1574). Age-, sex-, and race-adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among 3 groups: 1189 stroke survivors; 385 stroke decedents; and 15 766 cohort members who remained stroke-free. RESULTS: Before stroke onset, individuals who later survived stroke had significantly (P<0.001) faster average annual rates of memory decline (-0.143 points per year) than those who remained stroke-free throughout follow-up (-0.101 points per year). Stroke decedents had even faster prestroke memory decline (-0.212 points per year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable with 3.7 years of age-related decline in stroke-free cohort members. After stroke, memory in stroke survivors continued to decline at -0.142 points per year, similar to their prestroke rates (P=0.93). Approximately 50% of the memory difference between stroke survivors soon after stroke and age-matched stroke-free individuals was attributable to prestroke memory. CONCLUSIONS: Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults.
Keywords: Aged; Aged, 80 and over; Cohort Studies; disease progression; Female; Follow-Up Studies; Humans; Linear Models; Longitudinal Studies; Male; Memory; Memory Disorders; Middle Aged; Stroke; Survivors; Time Factors

Marriage, gender and obesity in later life. - Sven E. Wilson (Econ Hum Biol, 2012)
A large body of literature argues that marriage promotes health and increases longevity. But do these benefits extend to maintaining a healthy body weight, as the economic theory of health investment suggests they should? They do not. Using the Health and Retirement Study (HRS), I find that entry into marriage among both men and women aged 51-70 is associated with weight gain and exit from marriage with weight loss. I evaluate three additional theories with respect to the cross-sectional and longitudinal variation in the data. First, it may be that a broader set of shared risk factors (such as social obligations regarding meals) raises body mass for married couples. However, the shared risk factor model predicts that the intra-couple correlation should increase with respect to marital duration. Instead, it declines. Second, scholars have recently promoted a "crisis" model of marriage in which marital transitions, not marital status, determine differences in body mass. The crisis model is consistent with short-term effects seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood. And transition models, in general, cannot explain significant cross-sectional differences across marital states in a population that is no longer experiencing many transitions, nor can it account for the prominent gender differences (in late middle-age, the heaviest group is unmarried women and the lightest are unmarried men). Third, I argue that pressures of the marriage market, in combination with gendered preferences regarding partner BMI, can account for all the longitudinal and cross-sectional patterns found in the data.
Keywords: Age Factors; Aged; Body Mass Index; Female; Humans; Male; Marital Status; Middle Aged; Models, Statistical; Obesity; Sex Factors; United States; Weight Gain; Weight Loss

Maternal age and offspring adult health: evidence from the health and retirement study. - Mikko Myrskylä; Andrew Fenelon (Demography, 2012)
Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age-offspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25-34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age-offspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.
Keywords: Adolescent; Adult; Adult children; Aging; Body Weights and Measures; Educational Status; Female; Health Status; Humans; Maternal Age; Middle Aged; Mortality; Prospective Studies; Socioeconomic factors; Young Adult

Measurement equivalence in ADL and IADL difficulty across international surveys of aging: findings from the HRS, SHARE, and ELSA. - Kitty S. Chan; Judith D Kasper; Jason Brandt; Liliana E Pezzin (J Gerontol B Psychol Sci Soc Sci, 2012)
OBJECTIVE: To examine the measurement equivalence of items on disability across three international surveys of aging. METHOD: Data for persons aged 65 and older were drawn from the Health and Retirement Survey (HRS, n = 10,905), English Longitudinal Study of Aging (ELSA, n = 5,437), and Survey of Health, Ageing and Retirement in Europe (SHARE, n = 13,408). Differential item functioning (DIF) was assessed using item response theory (IRT) methods for activities of daily living (ADL) and instrumental activities of daily living (IADL) items. RESULTS: HRS and SHARE exhibited measurement equivalence, but 6 of 11 items in ELSA demonstrated meaningful DIF. At the scale level, this item-level DIF affected scores reflecting greater disability. IRT methods also spread out score distributions and shifted scores higher (toward greater disability). Results for mean disability differences by demographic characteristics, using original and DIF-adjusted scores, were the same overall but differed for some subgroup comparisons involving ELSA. DISCUSSION: Testing and adjusting for DIF is one means of minimizing measurement error in cross-national survey comparisons. IRT methods were used to evaluate potential measurement bias in disability comparisons across three international surveys of aging. The analysis also suggested DIF was mitigated for scales including both ADL and IADL and that summary indexes (counts of limitations) likely underestimate mean disability in these international populations.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Bias; Europe; Female; Health Surveys; Humans; Internationality; Longitudinal Studies; Male; United States

Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes. - Mary R Janevic; Sara J McLaughlin; Cathleen M. Connell (Med Care, 2012)
OBJECTIVES: Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation." RESEARCH DESIGN: Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation. RESULTS: Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95% CI, 0.19-0.61). CONCLUSIONS: Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients' beliefs about how much physical activity is adequate.
Medical care Med Care. 2011 Dec 20.
Keywords: Age Factors; Data collection; Diabetes Mellitus; Disclosure; Dyspnea; Exercise; Female; Guideline Adherence; Guidelines as Topic; Health Status; Humans; Male; Middle Aged; Sedentary Behavior; Sex Factors; Socioeconomic factors; United States

Predictors of self-report of heart failure in a population-based survey of older adults. - Tanya R Gure; Ryan J McCammon; Christine T Cigolle; Todd M Koelling; Caroline S Blaum; Kenneth M. Langa (Circ Cardiovasc Qual Outcomes, 2012)
BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims. METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged ≥ 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6%. Self-report of HF and claims agreement was 87% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with ≥ 4 HF claims (OR, 2.74; 95% CI, 1.36-5.52). Blacks (OR, 0.28; 95% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model. CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.
Keywords: Age Factors; Aged; Aged, 80 and over; Algorithms; Awareness; Chi-Square Distribution; Comorbidity; Female; Health Knowledge, Attitudes, Practice; Health Status; Health Surveys; Heart Failure; Humans; Insurance Claim Review; Logistic Models; Male; Medicare; Odds Ratio; Patients; Predictive Value of Tests; Self Report; Socioeconomic factors; United States

Presepsis depressive symptoms are associated with incident cognitive impairment in survivors of severe sepsis: a prospective cohort study of older Americans. - Dimitry S Davydow; Catherine L Hough; Kenneth M. Langa; Theodore J Iwashyna (J Am Geriatr Soc, 2012)
OBJECTIVES: To test the hypothesis that presepsis depressive symptoms are associated with risk of new cognitive impairment in survivors of severe sepsis. DESIGN: Prospective longitudinal cohort study. SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006). PARTICIPANTS: Four hundred forty-seven individuals with normal presepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview. MEASUREMENTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively using a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status (TICS). Logistic regression with robust standard errors was used to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (mild or moderate to severe cognitive impairment) at any interview after sepsis. RESULTS: The prevalence of substantial depressive symptoms in participants with normal cognition before sepsis was 38% (95% confidence interval (CI) = 34-42%). After severe sepsis, 18% (95% CI = 15-20%) of survivors had incident cognitive impairment. In unadjusted analyses, presepsis substantial depressive symptoms were associated with postsepsis incident cognitive impairment (odds ratio (OR) = 2.56, 95% CI = 1.53-4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and presepsis TICS scores, substantial presepsis depressive symptoms remained the strongest factor associated with postsepsis incident cognitive impairment (OR = 2.58, 95% CI = 1.45-4.59). CONCLUSION: Substantial presepsis depressive symptoms are independently associated with incident postsepsis cognitive impairment. Depressed older adults may be particularly at risk of developing cognitive impairment after a serious medical illness.
Keywords: Aged; Aged, 80 and over; Cognition Disorders; Cohort Studies; depression; Female; Humans; Longitudinal Studies; Male; Sepsis; Survivors

Prevalence of cognitive impairment in older adults with heart failure. - Tanya R Gure; Caroline S Blaum; Bruno J Giordani; Todd M Koelling; Andrzej T Galecki; Susan J Pressler; Scott L Hummel; Kenneth M. Langa (J Am Geriatr Soc, 2012)
OBJECTIVES: To determine the prevalence of cognitive impairment in older adults with heart failure (HF). DESIGN: Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims. SETTING: United States, community. PARTICIPANTS: Six thousand one hundred eighty-nine individuals aged 67 and older. MEASUREMENTS: An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups. RESULTS: The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15%, and the prevalence of mild cognitive impairment was 24%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95% confidence interval = 1.14-2.02). CONCLUSION: Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.
Keywords: Aged; Aged, 80 and over; Algorithms; Chi-Square Distribution; Cognition Disorders; Cross-Sectional Studies; Demography; Female; Heart Failure; Humans; Logistic Models; Male; Medicare; Prevalence; United States

Progressive and accelerated disability onset by race/ethnicity and education among late midlife and older adults. - Kenzie Latham (J Aging Health, 2012)
OBJECTIVE: This study explores the pace of severe disability onset with an emphasis on the role of race/ethnicity and education. More specifically, this research examines whether race/ethnicity and educational attainment are independent predictors of progressive and accelerated disability onset. METHOD: Using the Health and Retirement Study (HRS) Waves 2 to 10 (1994-2010), a series of discrete-time Cox proportional hazards models with multiple competing events were created to ascertain whether respondents developed progressive or accelerated disability in subsequent waves. RESULTS: Black and Hispanic respondents were at an increased risk of developing progressive disability. Respondents without a high school degree were more likely to experience progressive or accelerated disability. DISCUSSION: Low educational attainment was a particularly strong predictor of accelerated disability onset and may represent an acute lack of resources over the life course. Race and ethnicity were important predictors of progressive disability onset, which may reflect racial/ethnic variations in the disabling process.
Keywords: Black or African American; Disabled Persons; disease progression; Educational Status; Female; Follow-Up Studies; Health Status Disparities; Hispanic or Latino; Humans; Male; Middle Aged; Qualitative Research; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; United States; White People

A prospective cohort study of health behavior profiles after age 50 and mortality risk. - Benjamin A Shaw; Agahi, Neda (BMC Public Health, 2012)
BACKGROUND: This study examines the mortality risk associated with distinct combinations of multiple risk behaviors in middle-aged and older adults, and assesses whether the mortality risks of certain health behaviors are moderated by the presence of other risk behaviors. METHODS: Data for this prospective cohort study are from the Health and Retirement Study (HRS), a nationwide sample of adults older than 50 years. Baseline data are from respondents (n = 19,662) to the 1998 wave of the HRS. Twelve distinct health behavior profiles were created, based on each respondent's smoking, physical activity, and alcohol use status in 1998. Mortality risk was estimated through 2008 using Cox regression. RESULTS: Smoking was associated with elevated risk for mortality within all behavioral profiles, but risk was greatest when combined with heavy drinking, both for middle-aged (ages 51-65) and older (ages 66+) adults. Profiles that included physical inactivity were also associated with increased mortality risk in both age groups. However, the impact of inactivity was clearly evident only among non-smokers; among smokers, the risk of inactivity was less evident, and seemingly overshadowed by the risk of smoking. Moderate drinking was protective relative to abstinence among non-smokers, and relative to heavy drinking among smokers. CONCLUSIONS: In both middle-aged and older adults, multiple unhealthy behaviors increase mortality risk. However, the level of risk varies across unique combinations of unhealthy behaviors. These findings highlight the role that lifestyle improvements could play in promoting healthy aging, and provide insight into which behavioral combinations should receive top priority for intervention.
Keywords: Aged; Alcohol-Related Disorders; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Regression Analysis; Risk Assessment; Risk-Taking; Sedentary Behavior; Smoking; United States

A prospective examination of the relationship between physical activity and dementia risk in later life. - Mary E Bowen (Am J Health Promot, 2012)
PURPOSE: To examine the relationship between vigorous physical activity and dementia risk. DESIGN: Prospective study design utilizing physical activity data from the Health and Retirement Study and cognitive outcome data from the Aging, Demographics, and Memory Study. SETTING: Community-based. SUBJECTS: Adults age 71 and over (N  =  808) with 3 to 7 years of physical activity information prior to dementia/no dementia diagnosis. MEASURES: Physical activity was measured by participation in vigorous activities such as aerobics, sports, running, bicycling, and heavy housework three or more times per week (yes/no). Dementia diagnosis was based on an expert panel (e.g., neuropsychologists, neurologists, geropsychiatrists) who performed and reviewed a battery of neuropsychological tests. ANALYSIS: Binary logistic regression models were used to account for demographic characteristics, genetic risk factors (one or two apolipoprotein E ε4 alleles), health behaviors (e.g., smoking, drinking alcohol), health indicators (body mass index), and health conditions (e.g., diabetes, heart disease) in a sequential model-building process. RESULTS: The relationship between vigorous physical activity and dementia risk remained robust across models. In the final model, older adults who were physically active were 21% (p ≤ .05) less likely than their counterparts to be diagnosed with dementia. CONCLUSION: Vigorous physical activity may reduce the risk for dementia independently of the factors examined here. This study's findings are important given that few preventative strategies for dementia have been explored beyond hormonal therapy and anti-inflammatory drugs.
Keywords: Age Factors; Aged; Aged, 80 and over; Aging; Body Mass Index; Confidence Intervals; Dementia; disease progression; Exercise; Female; Health Promotion; Health Status Indicators; Health Surveys; Humans; Logistic Models; Male; Motor Activity; Multivariate Analysis; Odds Ratio; Prospective Studies; Psychometrics; Risk Factors; United States

Race/ethnic and nativity disparities in later life physical performance: the role of health and socioeconomic status over the life course. - Steven A Haas; Patrick M. Krueger; Leah Rohlfsen (J Gerontol B Psychol Sci Soc Sci, 2012)
OBJECTIVES: We examine race/ethnic and nativity differences in objective measures of physical performance (i.e., peak expiratory flow, grip strength, and gait speed) in a nationally representative sample of older Whites, Blacks, and Hispanics. We also examine whether detailed measures of childhood and adult health and socioeconomic status (SES) mediate race/ethnic differences in physical performance. METHOD: We use data from the Health and Retirement Study, a population-based sample of older Americans born before 1947, and 3 measures of physical performance. Nested ordinary least squares models examine whether childhood and adult health and SES mediate race/ethnic differences in performance. RESULTS: We find large and significant race/ethnic and nativity differences in lung function, grip strength, and gait speed. Adjusting for childhood and current adult health and SES reduces race/ethnic differences in physical performance but does not eliminate them entirely. Childhood health and SES as well as more proximal levels of SES are important determinants of race/ethnic disparities in later life physical performance. DISCUSSION: The analysis highlights that a large proportion of race/ethnic and nativity disparities result from health and socioeconomic disadvantages in both early life and adulthood and thus suggests multiple intervention points at which disparities can be reduced.
Keywords: Aged; Aged, 80 and over; Aging; ethnicity; Female; Gait; Hand Strength; Health Status; Health Status Disparities; Health Surveys; Humans; Male; Middle Aged; Racial Groups; Respiratory Function Tests; Social Class; United States

Race-ethnicity and health trajectories: tests of three hypotheses across multiple groups and health outcomes. - Tyson H Brown; Angela M O'Rand; Daniel E Adkins (J Health Soc Behav, 2012)
Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.
Keywords: Age Factors; Aging; Black or African American; ethnicity; Female; Health Behavior; Health Status Disparities; Health Surveys; Humans; Male; Mexican Americans; Middle Aged; Racial Groups; Risk Factors; Socioeconomic factors; Sociology, Medical; White People

Racial and ethnic differences in hypertension risk: new diagnoses after age 50. - A. R. Quinones; Jersey Liang; Wen Ye (Ethn Dis, 2012)
OBJECTIVES: Our study examines the differences in estimated risk of developing hypertension in Whites, Blacks, and Mexican-Americans aged > or = 50 for a period of 11 years. DESIGN, SETTING, AND PARTICIPANTS: Data came from 9,259 respondents who reported being hypertension-free at the baseline in the Health and Retirement Study (HRS) with up to five time intervals (1998-2006). Discrete-time survival models were used to analyze ethnic variations in the probability of developing hypertension. MAIN OUTCOME MEASURE: Estimated odds of developing hypertension. RESULTS: The risk of newly diagnosed hypertension increased between 1995 and 2006 for HRS participants aged > or = 50. After adjusting for demographic and health status, the probability of incident hypertension among Black Americans was .10 during the period of 1995/96-1998, which increased steadily to .17 in 2004-2006, with cumulative incidence over the 11-year period at 51%. In contrast, among White Americans the risk was .07 during 1995/96-1998 and .13 in 2004-2006, with cumulative incidence at 43%. For Mexican-Americans, the probability also increased from .08 during 1995/ 96-1998 to .14 during 2004-2006, with cumulative incidence at 42%. CONCLUSIONS: 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 accounted for.
Keywords: Age Factors; Aged; Black or African American; Cohort Studies; Female; Health Status Disparities; Humans; Hypertension; Incidence; Male; Mexican Americans; Middle Aged; Risk Factors; Socioeconomic factors; White People

The relationship between body weight, frailty, and the disablement process. - Mary E Bowen (J Gerontol B Psychol Sci Soc Sci, 2012)
OBJECTIVES: To prospectively examine the relationship between body weight, frailty, and the disablement process. METHOD: Longitudinal data from the Health and Retirement Study (1998-2006) were used to examine the relationship between being underweight, overweight, or obese (compared with normal weight) and the onset and progression of functional limitations and disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) among a nationally representative sample of community-dwelling older adults (aged 50 and older) with characteristics of frailty (n= 11,491). Nonlinear multilevel models additionally adjusted for demographic characteristics and intra-individual changes in body weight, socioeconomic status, health behaviors, and health conditions over the course of 8 years. RESULTS: Compared with their nonfrail normal weight counterparts, prefrail obese respondents have a 16% (p ≤ 0.001) reduction in the expected functional limitations rate and frail overweight and obese respondents have a 10% (p ≤ 0.01) and 36% (p ≤ 0.001) reduction in the expected functional limitations rate, respectively. In addition, frail obese respondents have a 27% (p ≤ 0.05) reduction in the expected ADL disability rate. DISCUSSION: This study's findings suggest that underweight, overweight, and obese status differentially affect the risk for functional limitations and disabilities in IADL and ADL. Among prefrail and frail adults, some excess body weight in later life may be beneficial, reducing the rate of functional limitations and disability.
Keywords: Activities of Daily Living; Aged; Body Weight; Cross-Sectional Studies; Disability Evaluation; Disabled Persons; Female; Frail Elderly; Geriatric Assessment; Health Behavior; Health Surveys; Humans; Life Style; Longitudinal Studies; Male; Middle Aged; Overweight; Physical Fitness; Prospective Studies; sarcopenia; Socioeconomic factors; Thinness; United States

The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. - Denise G Feil; Carolyn Wei Zhu; David L Sultzer (J Behav Med, 2012)
Although nearly one-third of older diabetics are cognitively impaired, their diabetes management remains poorly understood. To examine the relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. Cross-sectional observational analysis. 1,398 persons with diabetes, aged 60 years or older, who responded to the 2003 Health and Retirement Study Diabetes Survey. We conducted logistic regressions on the effects of cognitive impairment on respondents' self-management ability after controlling for diabetes comorbidities, demographics, and clinical characteristics. Participants with greater cognitive impairment were less likely to adhere to exercise (Adjusted Odds ratio [AOR] = 0.725 and 0.712 for moderate and severe cognitive impairment, both P < 0.05), and to diet (AOR = 0.906 and 0.618 for moderate and severe cognitive impairment, both P < 0.01). Cognitive impairment is associated with worse self-care and may pose challenges to diabetic older persons, notably in diet and exercise. Cognitive screening may be indicated in this high risk group.
Keywords: Aged; Aged, 80 and over; Blood Glucose; Cognition Disorders; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Exercise; Female; Health Surveys; Humans; Male; Middle Aged; Self Care

Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study. - Dominic J Cirillo; Robert B Wallace (BMC Geriatr, 2012)
BACKGROUND: Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders. METHODS: Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation. RESULTS: The prevalence of RLS among U.S. elders born before 1947 was 10.6%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46). CONCLUSIONS: RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Body Mass Index; Cross-Sectional Studies; Disabled Persons; Female; Humans; Male; Middle Aged; Prevalence; Restless Legs Syndrome; Risk Factors; United States

Risk factors of falls in community-dwelling older adults: logistic regression tree analysis. - Takashi Yamashita; Noe, Douglas A.; John A. Bailer (Gerontologist, 2012)
PURPOSE OF THE STUDY: A novel logistic regression tree-based method was applied to identify fall risk factors and possible interaction effects of those risk factors. DESIGN AND METHODS: A nationally representative sample of American older adults aged 65 years and older (N = 9,592) in the Health and Retirement Study 2004 and 2006 modules was used. Logistic Tree with Unbiased Selection, a computer algorithm for tree-based modeling, recursively split the entire group in the data set into mutually exclusive subgroups and fit a logistic regression model in each subgroup to generate an easily interpreted tree diagram. RESULTS: A subgroup of older adults with a fall history and either no activities of daily living (ADL) limitation and at least one instrumental activity of daily living or at least one ADL limitation was classified as at high risk of falling. Additionally, within each identified subgroup, the best predictor of falls varied over subgroups and was also evaluated. IMPLICATIONS: Application of tree-based methods may provide useful information for intervention program design and resource allocation planning targeting subpopulations of older adults at risk of falls.
Keywords: Accidental Falls; Activities of Daily Living; Aged; Aged, 80 and over; Decision Trees; Female; Geriatric Assessment; Health Surveys; Humans; Logistic Models; Male; Predictive Value of Tests; Residence Characteristics; Risk Assessment; Socioeconomic factors; United States

Self- and other-oriented potential lifetime traumatic events as predictors of loneliness in the second half of life. - Yuval Palgi; Amit Shrira; Menachem Ben-Ezra; Sharon Shiovitz-Ezra; Liat Ayalon (Aging Ment Health, 2012)
OBJECTIVES: This study examined the relationship between self- and other-oriented potential lifetime traumatic events (PLTE) and loneliness at the second half of life. METHOD: The sample was comprised of 7446 respondents who completed the Health and Retirement Study (HRS) 2006 psychosocial questionnaire. PLTE were classified into self-oriented PLTE, defined as traumatic events that primarily inflict the self (e.g., being abused by parents) and other-oriented PLTE, defined as events that affect the self by primarily targeting others (e.g., death of one's child). We evaluated the role of self- and other-oriented PLTE as predictors of loneliness, as evaluated by the short R-UCLA. Analyses were stratified by age at which trauma happened categorized into four life periods (0-17, 18-30, 31-49, 50+). RESULTS: The results showed that PLTE is positively related to loneliness. Moreover, the number of other-oriented PLTE, and even more pronouncedly self-oriented PLTE, that happened up until adulthood were the strongest predictors of loneliness at the second half of life. CONCLUSION: The study suggests that self- and other-oriented PLTE reported to have occurred early in life are associated with perceived loneliness in the second half of life.
Keywords: Age Factors; Aged; Aged, 80 and over; Child; Child Abuse; Cross-Sectional Studies; depression; Female; Forecasting; Humans; Life Change Events; Loneliness; Male; Middle Aged; Self Psychology; Wounds and Injuries

Self-care and health outcomes of diabetes mellitus. - MinKyoung Song; Sarah J Ratcliffe; Nancy C Tkacs; Barbara Riegel (Clin Nurs Res, 2012)
Studies show that self-care improves diabetes mellitus (DM) outcomes; however, previous studies have focused on self-care maintenance, and little is known about self-care management. The objective of this study is to examine the influence of DM self-care maintenance and management on number of hospitalizations and hospitalization days. A cohort design with secondary analysis of data from the Health and Retirement Study 2002-2004 was used. Data from 726 adults with DM were analyzed with logistic regression and negative binomial regression adjusting for covariates. Self-care maintenance and management were significant determinants of hospitalization outcomes. Establishing a goal for HbA1c (self-care management) and eating ≥2 snacks or desserts per day (self-care maintenance) were associated with a decrease in hospitalizations (IRR = 0.860, p = .001; IRR = 0.914, p = .043, respectively). DM self-care maintenance and management influence health outcomes but in different ways. These data provide evidence that both elements are needed in the education of patients about DM.
Keywords: Adult; Aged; Aged, 80 and over; Clinical Nursing Research; Diabetes Mellitus; Female; Follow-Up Studies; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Self Care; Treatment Outcome

Self-rated health and the "first move" around retirement: a longitudinal study of older Americans. - Nan E. Johnson (J Rural Health, 2012)
PURPOSE: I examine whether less favorable self-rated health raises the risk of outmigration more for young-old adults (aged 53-63 at the start of the 10-year longitudinal study in 1994) in nonmetro than metro counties and increases the odds that both groups of outmigrants will choose metro over nonmetro destinations. Finally, I examine whether nonmetro outmigrants are more likely than metro outmigrants to cite a health concern or a desire to get closer to relatives or friends as a reason for the migration. METHODS: I use the Health and Retirement Study (HRS) to track the main residences of nonmetro and metro older adults from 1994-2003. With a discrete-time Event History Analysis, I assess the joint effects of nonmetro/metro residence in 1994 and self-rated health (updated at each biennial wave) upon the risk of a first migration. Those who migrated were asked to recall why. FINDINGS: At worse levels of self-rated health, the odds of remaining in a nonmetro county of residence drop in favor of migrating to another nonmetro county. Among migrants, the worse the self-rated health, the higher the odds of within-type migration (nonmetro-nonmetro and metro-metro) over cross-type migration (nonmetro-metro and metro-nonmetro). The percentages of migrants citing a health concern or a desire to live closer to relatives or friends as a reason for migration do not differ by county type of origin. CONCLUSIONS: An implication for rural health policy is that young-old adults with worse self-rated health tend to remain in nonmetro areas, even when they migrate.
Keywords: Aged; Female; Health Status; Humans; Longitudinal Studies; Male; Middle Aged; Population Dynamics; Retirement

Self-reported and measured hypertension among older US- and foreign-born adults. - White, Kellee; Mauricio Avendano; Benjamin D Capistrant; J Robin Moon; Sze Y Liu; M. Maria Glymour (J Immigr Minor Health, 2012)
Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n = 13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9%), whites (82.8%), and Hispanics (84.0%), and both foreign-born (83.2%) and US-born (84.0%). Specificity was above 90% for both US-born and foreign-born, but higher for whites (92.8%) than blacks (86.0%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.
Copyright - Springer Science Business Media, LLC 2012 Language of summary - English Location - United States--US Pages - 721-6 ProQuest ID - 1022672464 Document feature - References SubjectsTermNotLitGenreText - United States--US Last updated - 2012-07-11 Place of publication - New York Corporate institution author - White, Kellee; Avenda o, Mauricio; Capistrant, Benjamin D; Robin Moon, J; Liu, Sze Y; Maria Glymour, M DOI - 2699707771; 70149852; 53471; JIMH; 22109587; SPVLJIMH109031449549
Keywords: Aged; Black or African American; Blood Pressure Determination; Emigrants and Immigrants; Female; Hispanic or Latino; Humans; Hypertension; Male; Middle Aged; Nutrition Surveys; Reproducibility of Results; Self Report; United States; White People

The significance of education for mortality compression in the United States. - Dustin C. Brown; Mark D Hayward; Jennifer Karas Montez; Robert A Hummer; Chi-Tsun Chiu; Mira M Hidajat (Demography, 2012)
Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population's socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process.
Keywords: Aged; Aged, 80 and over; Aging; Educational Status; Female; Health Status Disparities; Humans; Life Expectancy; Male; Middle Aged; Mortality; Mortality, Premature; Sex Distribution; Socioeconomic factors; United States

Social isolation, loneliness and health among older adults. - Caitlin E. Coyle; Dugan, Elizabeth (J Aging Health, 2012)
OBJECTIVE: To examine the relationship of social isolation, loneliness and health outcomes among older adults. METHODS: Using data from the Leave Behind Questionnaire of the Health and Retirement Study (2006 and 2008), (n = 11,825) several indicators of social isolation were scaled and the Hughes 3-Item Loneliness Scale was used. Two measures of health (self-rated health and mental health conditions) were examined using logistic regression. RESULTS: Loneliness and social isolation were not highly correlated with one another (r = 0.201, p = 0.000). Loneliness was associated with higher odds of having a mental health problem (OR: 1.17; CI: [1.13, 1.21], p = 0.000); and isolation was associated with higher odds of reporting one's health as being fair/poor (OR:1.39; CI: [1.21, 1.59], p = 0.000). DISCUSSION: The results suggest that global measures of isolation, that fail to distinguish between social isolation and feelings of loneliness, may not detect the impact on physical and mental health in older adults.
Keywords: Aged; Cross-Sectional Studies; Diagnostic Self Evaluation; Female; Health Status; Humans; Logistic Models; Loneliness; Male; Mental Disorders; Middle Aged; Risk Factors; social isolation

Spousal caregiving and incident hypertension. - Benjamin D Capistrant; J Robin Moon; M. Maria Glymour (Am J Hypertens, 2012)
BACKGROUND: Caring for one's spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults. METHODS: Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing ≥14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs. RESULTS: After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings. CONCLUSIONS: Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults.
Keywords: Activities of Daily Living; Aged; Cardiovascular Diseases; Caregivers; Female; Follow-Up Studies; Humans; Hypertension; Male; Memory Disorders; Middle Aged; Odds Ratio; Spouses; Stress, Psychological

Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions. - Theodore J Iwashyna; Netzer, Giora; Kenneth M. Langa; Christine T Cigolle (Am J Respir Crit Care Med, 2012)
RATIONALE: Survivors of critical illness suffer significant limitations and disabilities. OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs. METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory. MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls. CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.
Iwashyna, Theodore J Netzer, Giora Langa, Kenneth M Cigolle, Christine K08 AG031837/AG/NIA NIH HHS/ K08 HL091249/HL/NHLBI NIH HHS/ K12 RR023250/RR/NCRR NIH HHS/ P30-AG028747/AG/NIA NIH HHS/ P60 DK-20572/DK/NIDDK NIH HHS/ R01 AG030155/AG/NIA NIH HHS/ U01 AG09740/AG/NIA NIH HHS/ UL1RR024986/RR/NCRR NIH HHS/ Am J Respir Crit Care Med. 2012 Apr 15;185(8):835-41. Epub 2012 Feb 9.
Keywords: Aged; Aged, 80 and over; Body Mass Index; Chronic pain; Cohort Studies; Comorbidity; Critical Illness; Disabled Persons; disease progression; Female; Geriatric Assessment; Hearing Disorders; Hospitalization; Humans; Incidence; Male; Musculoskeletal Diseases; Prognosis; Retrospective Studies; Risk Assessment; Sepsis; Survival Analysis; Survivors; Thinness; Time; Treatment Outcome; Urinary incontinence; Vision Disorders

Stability and change in financial transfers from adult children to older parents. - Maximiliane E Szinovacz; Adam Davey (Can J Aging, 2012)
We sought to identify the extent and predictors of longitudinal changes in adult children's financial assistance to parents and in transfer networks over a two-year period. Analyses rely on pooled data from 1994 to 2000 of the Health and Retirement Study, using families in which adult children with no more than four siblings financially supported parents over two years. Change in the help network occurred in about 40 per cent of these families over the two-year period. When change occurred, it most commonly involved cessation of support by a child, followed by addition of another child to the network, whereas exchange of supporting children was relatively rare. Change reflected children's ability to provide care and the burden created by parents' needs. However, the size and composition of the adult-child network and of the initial support group also played an important role. Results highlight the dynamic and systemic nature of intergenerational financial networks.
Keywords: Adult children; Aged; Female; Financial Support; Humans; Male; Middle Aged; Parent-Child Relations; Parents

Stroke incidence in older US Hispanics: is foreign birth protective? - J Robin Moon; Benjamin D Capistrant; Ichiro Kawachi; Mauricio Avendano; Subramanian, S V; Lisa M. Bates; M. Maria Glymour (Stroke, 2012)
BACKGROUND AND PURPOSE: Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites. METHODS: Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites. RESULTS: In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95% CI, 1.08-1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95% CI, 0.80-1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95% CI, 0.41-0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites. CONCLUSIONS: In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.
Moon, J Robin Capistrant, Benjamin D Kawachi, Ichiro Avendano, Mauricio Subramanian, S V Bates, Lisa M Glymour, M Maria T32-HL098048-01/HL/NHLBI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Stroke. 2012 May;43(5):1224-9. Epub 2012 Feb 21.
Keywords: Age Factors; Aged; Cohort Studies; Emigration and Immigration; Female; Hispanic or Latino; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Retrospective Studies; Risk Factors; Socioeconomic factors; Stroke; United States; White People

Subjective social status and functional decline in older adults. - Bonnie Chen; Kenneth E Covinsky; Irena Cenzer; Nancy E Adler; Brie A Williams (J Gen Intern Med, 2012)
BACKGROUND: It is unknown whether subjective assessment of social status predicts health outcomes in older adults. OBJECTIVE: To describe the relationship between subjective social status and functional decline in older adults. DESIGN: Longitudinal cohort study. SETTING: The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008). PARTICIPANTS: Two thousand five hundred and twenty-three community-dwelling older adults. MAIN MEASURES: Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death) KEY RESULTS: Mean age was 64; 46% were male, 85% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4 years, 50% in the lowest SSS group declined in function, compared to the middle and highest groups (28% and 26%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.-9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08-1.73). CONCLUSIONS: In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.
Keywords: Activities of Daily Living; Aged; Aging; Female; Health Status Disparities; Humans; Longitudinal Studies; Male; Middle Aged; Mobility Limitation; Risk Factors; Self Report; Social Class

Tests and expenditures in the initial evaluation of peripheral neuropathy. - Brian C. Callaghan; Ryan J McCammon; Kevin Kerber; Xiao Xu; Kenneth M. Langa; Eva L Feldman (Arch Intern Med, 2012)
BACKGROUND: Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing. METHODS: We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods. RESULTS: Of the 12, 673 patients, 1031 (8.1%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2% of patients, whereas a glucose tolerance test was rarely obtained (1.0%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period ($14,362 vs $8067, P < .001). CONCLUSIONS: Patients diagnosed as having peripheral neuropathy typically undergo many tests, but testing patterns are highly variable. Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests. Expenditures increase substantially in the diagnostic period. More research is needed to define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy.
Keywords: Aged; Antibodies, Antinuclear; Blood Cell Count; Blood Protein Electrophoresis; Blood Sedimentation; Brain; Diagnostic Tests, Routine; Electromyography; Female; Glucose Tolerance Test; Glycated Hemoglobin; Health Expenditures; Humans; International Classification of Diseases; Magnetic Resonance Imaging; Male; Medicare; Neural Conduction; Peripheral Nervous System Diseases; Quality Assurance, Health Care; Spine; Thyrotropin; United States; Vitamin B 12

Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study. - J Robin Moon; M. Maria Glymour; Subramanian, S V; Mauricio Avendano; Ichiro Kawachi (Soc Sci Med, 2012)
Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.
Keywords: Age Factors; Aged; Cardiovascular Diseases; Female; Health Behavior; Health Surveys; Humans; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Retirement; Risk Factors; Sex Factors; Socioeconomic factors; Survival Analysis; Time Factors; United States

Triggers of hospitalization for venous thromboembolism. - Mary A M Rogers; Deborah A Levine; Neil Blumberg; Scott A Flanders; Vineet Chopra; Kenneth M. Langa (Circulation, 2012)
BACKGROUND: The rate of hospitalization for venous thromboembolism (VTE) is increasing in the United States. Although predictors of hospital-acquired VTE are well-known, triggers of VTE before hospitalization are not as clearly defined. The objective of this study was to evaluate triggers of hospitalization for VTE. METHODS AND RESULTS: A case-crossover study was conducted. Subjects were participants in the Health and Retirement Study, a nationally representative sample of older Americans. Data were linked to Medicare files for hospital and nursing home stays, emergency department visits, outpatient visits including physician visits, and home health visits from years 1991 to 2007 (n=16 781). The outcome was hospitalization for venous thromboembolism (n=399). Exposures during the 90-day period before hospitalization for VTE were compared with exposures occurring in 4 comparison periods. Infection was the most common trigger of hospitalization for VTE, occurring in 52.4% of the risk periods before hospitalization. The adjusted incidence rate ratios (IRRs; 95% confidence interval) were 2.90 (2.13, 3.94) for all infection, 2.63 (1.90, 3.63) for infection without a previous hospital or skilled nursing facility stay, and 6.92 (4.46, 10.72) for infection with a previous hospital or skilled nursing facility stay. Erythropoiesis-stimulating agents and blood transfusion were also associated with VTE hospitalization (IRR=9.33, 95% confidence interval: 1.19, 73.42; IRR=2.57, 95% confidence interval: 1.17, 5.64; respectively). Other predictors included major surgeries, fractures (IRR=2.81), immobility (IRR=4.23), and chemotherapy (IRR=5.70). These predictors, combined, accounted for a large proportion (69.7%) of exposures before VTE hospitalization as opposed to 35.3% in the comparison periods. CONCLUSIONS: Risk prediction algorithms for VTE should be reevaluated to include infection, erythropoiesis-stimulating agents, and blood transfusion.
Rogers, Mary A M Levine, Deborah A Blumberg, Neil Flanders, Scott A Chopra, Vineet Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ R01 HL095467/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Circulation. 2012 May 1;125(17):2092-9. Epub 2012 Apr 3.
Keywords: Aged; Ambulatory Care Facilities; Comorbidity; Cross-Over Studies; Emergency Service, Hospital; Female; Hematinics; Home Care Services; Hospitalization; Humans; Immobilization; Incidence; Infections; Male; Medicare; Middle Aged; Office Visits; Postoperative Complications; Pulmonary Embolism; Risk Factors; Skilled Nursing Facilities; Transfusion Reaction; United States; Venous Thrombosis

Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke. - Nandi, Arijit; M. Maria Glymour; Ichiro Kawachi; Tyler J VanderWeele (Epidemiology, 2012)
BACKGROUND: Early-life socioeconomic status (SES) is associated with adult chronic disease, but it is unclear whether this effect is mediated entirely via adult SES or whether there is a direct effect of adverse early-life SES on adult disease. Major challenges in evaluating these alternatives include imprecise measurement of early-life SES and bias in conventional regression methods to assess mediation. In particular, conventional regression approaches to direct effect estimation are biased when there is time-varying confounding of the association between adult SES and chronic disease by chronic disease risk factors. METHODS: First-reported heart disease, diabetes, and stroke diagnoses were assessed in a national sample of 9760 Health and Retirement Study participants followed biennially from 1992 through 2006. Early-life and adult SES measures were derived using exploratory and confirmatory factor analysis. Early-life SES was measured by parental education, father's occupation, region of birth, and childhood rural residence. Adult SES was measured by respondent's education, occupation, labor force status, household income, and household wealth. Using marginal structural models, we estimated the direct effect of early-life SES on chronic disease onset that was not mediated by adult SES. Marginal structural models were estimated with stabilized inverse probability-weighted log-linear models to adjust for risk factors that may have confounded associations between adult SES and chronic disease. RESULTS: During follow-up, 24%, 18%, and 9% of participants experienced first onset of heart disease, diabetes, and stroke, respectively. Comparing those in the most disadvantaged with the least disadvantaged quartile, early-life SES was associated with coronary heart disease (risk ratio = 1.30 [95% confidence interval = 1.12-1.51]) and diabetes (1.23 [1.02-1.48]) and marginally associated with stroke via pathways not mediated by adult SES. CONCLUSIONS: Our results suggest that early-life socioeconomic experiences directly influence adult chronic disease outcomes.
Nandi, Arijit Glymour, M Maria Kawachi, Ichiro VanderWeele, Tyler J HD060696/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Epidemiology. 2012 Mar;23(2):223-32.
Keywords: Age Factors; Age of Onset; Child; Diabetes Mellitus; Educational Status; Female; Heart Diseases; Humans; Income; Linear Models; Male; Middle Aged; Models, Statistical; Risk Factors; Social Class; Social Conditions; Socioeconomic factors; Stroke; United States

Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England. - Philippa J Clarke; Jacqui Smith (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities. METHOD: Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control. RESULTS: Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe. DISCUSSION: These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Cross-Cultural Comparison; Culture; Disabled Persons; England; Female; Gait; Health Status; Humans; Internal-External Control; Longitudinal Studies; Male; Mobility Limitation; Politics; Social Values; Socioeconomic factors; United States

Anticipatory ex ante moral hazard and the effect of Medicare on prevention. - de Preux, Laure B (Health Econ, 2011)
This paper extends the ex ante moral hazard model to allow healthy lifestyles to reduce the probability of illness in future periods, so that current preventive behaviour may be affected by anticipated changes in future insurance coverage. In the United States, Medicare is offered to almost all the population at the age of 65. We use nine waves of the US Health and Retirement Study to compare lifestyles before and after 65 of those insured and not insured pre 65. The double-robust approach, which combines propensity score and regression, is used to compare trends in lifestyle (physical activity, smoking, drinking) of the two groups before and after receiving Medicare, using both difference-in-differences and difference-in-differences-in-differences. There is no clear effect of the receipt of Medicare or its anticipation on alcohol consumption nor smoking behaviour, but the previously uninsured do reduce physical activity just before receiving Medicare.
de Preux, Laure B Comparative Study England Health economics Health Econ. 2011 Sep;20(9):1056-72. doi: 10.1002/hec.1778.
Keywords: Age Factors; Aged; Alcohol Drinking; Female; Health Behavior; Health Services; Humans; Insurance Coverage; Male; Medically Uninsured; Medicare; Middle Aged; Morals; Motor Activity; Proportional Hazards Models; Regression Analysis; Smoking; United States

Is the apolipoprotein e genotype a biomarker for mild cognitive impairment? Findings from a nationally representative study. - Brainerd, Charles J; V. F. Reyna; Ronald C Petersen; Glenn E Smith; Taub, Emily S (Neuropsychology, 2011)
OBJECTIVE: Although the ε4 allele of the apolipoprotein E (APOE) genotype is a known risk factor for Alzheimer's dementia (AD), prior findings on whether it is also a risk factor for mild cognitive impairment (MCI) have been inconsistent. We tested two contrasting explanations: (a) an ε4-AD specificity hypothesis, and (b) a measurement insensitivity hypothesis. METHOD: The frequency of the ε4 allele was investigated in older adults (mean age > 70) with various types of cognitive impairment (including MCI) and various types of dementia (including AD) with the aging, demographics, and memory study (ADAMS) of the National Institute on Aging's Health and Retirement Study (HRS). The ADAMS controls sources of Type I and Type II error that are posited in the ε4-AD specificity hypothesis and the measurement insensitivity hypothesis, and it is the only nationally representative data set on aging and cognitive impairment. RESULTS: ε4 was a reliable predictor of MCI, with a frequency of 32% in MCI subjects versus 20% in healthy control subjects. This link was specific to MCI because ε4 was not a risk factor for other forms of cognitive impairment without dementia. CONCLUSIONS: The results support the measurement insensitivity hypothesis rather than the ε4-AD specificity hypothesis and are consistent with recent research showing modest reductions in cognitive performance among normal functioning ε4 carriers.
Brainerd, Charles J Reyna, Valerie F Petersen, Ronald C Smith, Glenn E Taub, Emily S 1RC1AG036915-01/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Neuropsychology. 2011 Nov;25(6):679-89.
Keywords: Aged; Aged, 80 and over; Aging; Analysis of Variance; Apolipoprotein E4; Cognitive Dysfunction; Dementia; Female; Gene Frequency; Genetic Markers; Genetic Testing; Genotype; Humans; Male; National Institute on Aging (U.S.); Neuropsychological tests; Reference Values; Reproducibility of Results; Risk Factors; United States

Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study. - Eileen M. Crimmins; Jung K Kim; Kenneth M. Langa; David R Weir (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]). METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS. RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively. DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.
Crimmins, Eileen M Kim, Jung Ki Langa, Kenneth M Weir, David R P30 AG17265/AG/NIA NIH HHS/United States U01 AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Jul;66 Suppl 1:i162-71.
Keywords: Age Factors; Aged; Aged, 80 and over; Cognition; Cognition Disorders; Dementia; Educational Status; Female; Humans; Interviews as Topic; Logistic Models; Longitudinal Studies; Male; Multivariate Analysis; Neuropsychological tests; Odds Ratio; Prevalence; Sex Factors; United States

Can Food Stamps help to reduce Medicare spending on diabetes? - Lauren Hersch Nicholas (Econ Hum Biol, 2011)
Diabetes is rapidly escalating amongst low-income, older adults at great cost to the Medicare program. We use longitudinal survey data from the Health and Retirement Study linked to administrative Medicare records and biomarker data to assess the relationship between Food Stamp receipt and diabetes health outcomes. We find no significant difference in Medicare spending, outpatient utilization, diabetes hospitalizations and blood sugar (HbA1c) levels between recipients and income-eligible non-recipients after controlling for a detailed set of covariates including individual fixed effects and measures of diabetes treatment compliance. As one-third of elderly Food Stamp recipients are currently diabetic, greater coordination between the Food Stamp, Medicare, and Medicaid programs may improve health outcomes for this group.
Keywords: Aged; Aged, 80 and over; Biomarkers; Confidence Intervals; Cross-Sectional Studies; Diabetes Mellitus; Female; Glycated Hemoglobin; Health Care Costs; Humans; Longitudinal Studies; Male; Medicare; Middle Aged; Odds Ratio; Outpatients; Poverty; Prevalence; Public Assistance; Regression Analysis; Social Welfare; Treatment Outcome; United States

Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: the Aging, Demographics, and Memory Study (ADAMS). - Okura, Toru; Kenneth M. Langa (Alzheimer Dis Assoc Disord, 2011)
OBJECTIVES: To estimate the quantity of informal care associated with neuropsychiatric symptoms in older adults with cognitive impairment. DESIGN: Cross-sectional analysis. SETTING: The Aging, Demographics, and Memory Study. PARTICIPANTS: A sample (n=450) of adults aged 71 years and older with cognitive impairment drawn form the Health and Retirement Study. MEASUREMENTS: The presence of neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) was identified using the neuropsychiatric inventory. Cognitive category [normal, cognitive impairment without dementia (CIND), or dementia] was assigned by a consensus panel. The hours per week of active help and supervision were ascertained by informant questionnaire. RESULTS: Among older adults with CIND or dementia, those with no neuropsychiatric symptoms received an average of 10.2 hours of active help and 10.9 hours of supervision per week from informal caregivers. Those with 1 or 2 neuropsychiatric symptoms received an additional 10.0 hours of active help and 12.4 hours of supervision per week, while those with 3 or more symptoms received an additional 18.2 hours of active help and 28.7 hours of supervision per week (P<0.001). The presence of irritation (14.7 additional hours) was associated with the greatest number of additional hours of active help. The presence of aberrant motor behaviors (17.7 additional hours) and disinhibition (17.5 additional hours) were associated with the greatest number of additional hours of supervision. CONCLUSIONS: Neuropsychiatric symptoms among those with CIND or dementia are associated with a significant increase in the provision of informal care. This care represents a significant time commitment for families and a significant economic cost to society.
Okura, Toru Langa, Kenneth M R01 AG027010/AG/NIA NIH HHS/United States R01 AG030155-01/AG/NIA NIH HHS/United States R01 AG030155-02/AG/NIA NIH HHS/United States R01 AG030155-03/AG/NIA NIH HHS/United States R01 AG030155-04/AG/NIA NIH HHS/United States R01 AG030155-05/AG/NIA NIH HHS/United States U01 AG09740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Alzheimer disease and associated disorders Nihms259646 Alzheimer Dis Assoc Disord. 2011 Apr-Jun;25(2):116-21.
Keywords: Aged; Aged, 80 and over; Caregivers; Cognition Disorders; Cost of Illness; Cross-Sectional Studies; Female; Humans; Male; Neuropsychological tests

Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study. - Gwenith G Fisher; Melissa M Franks; Brenda L Plassman; Stephanie Brown; Guy G Potter; David J Llewellyn; Mary A M Rogers; Kenneth M. Langa (J Am Geriatr Soc, 2011)
OBJECTIVES: To compare the characteristics and outcomes of caregivers of adults with dementia with those of caregivers of adults with cognitive impairment, not dementia (CIND). DESIGN: Cross-sectional. SETTING: In-home assessment for cognitive impairment and self-administered caregiving questionnaire. PARTICIPANTS: One hundred sixty-nine primary family caregivers of participants in the Aging, Demographics, and Memory Study (ADAMS). ADAMS participants were aged 71 and older drawn from the nationally representative Health and Retirement Study. MEASUREMENTS: Neuropsychological testing, neurological examination, clinical assessment, and medical history were used to assign a diagnosis of normal cognition, CIND, or dementia. Caregiving measures included caregiving time, functional limitations, depressive symptoms, physical and emotional strain, caregiving rewards, caregiver health, and demographic characteristics. RESULTS: Dementia caregivers spent approximately 9 hours per day providing care, compared with 4 hours per day for CIND caregivers (P=.001). Forty-four percent of dementia caregivers exhibited depressive symptoms, compared with 26.5% of CIND caregivers (P=.03). Physical and emotional strains were similar in both groups of caregivers. Regardless of the strains, nearly all caregivers reported some benefits from providing care. Behavioral problems (P=.01) and difficulty with instrumental activities of daily living (P=.01) in persons with CIND partially explained emotional strain experienced by CIND caregivers. For those with dementia, behavioral problems predicted caregiver emotional strain (P<.001) and depressive symptoms (P=.01). CONCLUSION: Although support services are available to dementia caregivers, CIND caregivers also expend considerable time and experience strains. The real caregiver burden of cognitive impairment in the U.S. population may therefore be greatly underestimated if people who have reached the diagnostic threshold for dementia are focused on exclusively.
Keywords: Activities of Daily Living; Aged; Analysis of Variance; Caregivers; Cognition Disorders; Cross-Sectional Studies; Dementia; Female; Humans; Linear Models; Male; Neuropsychological tests; Time Factors; United States

Changes in the prevalence of cognitive impairment among older Americans, 1993-2004: overall trends and differences by race/ethnicity. - Sheffield, Kristin M; M. Kristen Peek (Am J Epidemiol, 2011)
The authors used data from 6 waves of the Health and Retirement Study to evaluate changes in the prevalence of cognitive impairment among adults 70 years of age or older from 1993 to 2004. Having sampling weights for each wave enabled the authors to create merged waves that represented cross-sections of the community-dwelling older population for that year. Logistic regression analyses with year as the predictor were used to estimate trends and determine the contribution of sociodemographic and health status variables to decreasing trends in the prevalence of cognitive impairment over time (score ≤8 on a modified Telephone Interview Cognitive Screen). Results showed an annual decline in the prevalence of cognitive impairment of 3.4% after adjustment for age, gender, and prior test exposure (odds ratio (OR) = 0.966, 95% confidence interval (CI): 0.941, 0.992). The addition of socioeconomic variables to the model attenuated the trend by 72.1%. The annual percentage of decline in impairment was larger for blacks (OR = 0.943, 95% CI: 0.914, 0.973) and Hispanics (OR = 0.954, 95% CI: 0.912, 0.997) than for whites (OR = 0.971, 95% CI: 0.936, 1.006), although the differences were not statistically significant. Linear probability models used in secondary analyses showed larger percentage-point declines for blacks and Hispanics. Improvements in educational level contributed to declines in cognitive impairment among older adults-particularly blacks and Hispanics-in the United States.
Sheffield, Kristin M Peek, M Kristen T32-AG00270/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States American journal of epidemiology Am J Epidemiol. 2011 Aug 1;174(3):274-83. Epub 2011 May 27.
Keywords: Age Factors; Aged; Black People; Chi-Square Distribution; Cognition Disorders; Confidence Intervals; ethnicity; Female; Health Behavior; Health Status; Hispanic or Latino; Humans; Logistic Models; Longitudinal Studies; Male; Odds Ratio; Prevalence; Racial Groups; Socioeconomic factors; United States; White People

Childhood health and labor market inequality over the life course. - Steven A Haas; M. Maria Glymour; Lisa F Berkman (J Health Soc Behav, 2011)
The authors use data from the Health and Retirement Study's Earnings Benefit File, which links Health and Retirement Study to Social Security Administration records, to estimate the impact of childhood health on earnings curves between the ages of 25 and 50 years. They also investigate the extent to which diminished educational attainment, earlier onset of chronic health conditions, and labor force participation mediate this relationship. Those who experience poor childhood health have substantially diminished labor market earnings over the work career. For men, earnings differentials grow larger over the early to middle career and then slow down and begin to converge as they near 50 years of age. For women, earnings differentials emerge later in the career and show no evidence of convergence. Part of the child health earnings differential is accounted for by selection into diminished educational attainment, the earlier onset of chronic disease in adulthood, and, particularly for men, labor force participation.
Haas, Steven A Glymour, M Maria Berkman, Lisa F AG023399/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Journal of health and social behavior J Health Soc Behav. 2011;52(3):298-313. doi: 10.1177/0022146511410431.
Keywords: Child; Employment; Female; Health Status; Humans; Income; Male; Middle Aged; Models, Econometric; Retirement; Social Class; Social Security; Socioeconomic factors; United States

Conscientiousness and longevity: an examination of possible mediators. - Patrick L Hill; Nicholas A. Turiano; Michael D Hurd; Daniel K. Mroczek; Brent W Roberts (Health Psychol, 2011)
OBJECTIVE: Conscientious individuals tend to experience a number of health benefits, not the least of which being greater longevity. However, it remains an open question as to why this link with longevity occurs. The current study tested two possible mediators (physical health and cognitive functioning) of the link between conscientiousness and longevity. METHOD: We tested these mediators using a 10-year longitudinal sample (N = 512), a subset of the long-running Health and Retirement Study of aging adults. Measures included an adjective-rating measure of conscientiousness, self-reported health conditions, and three measures of cognitive functioning (word recall, delayed recall, and vocabulary) included in the 1996 wave of the HRS study. RESULTS: Our results found that conscientiousness significantly predicted greater longevity, even in a model including the two proposed mediator variables, gender, age, and years of education. Moreover, cognitive functioning appears to partially mediate this relationship. CONCLUSIONS: This study replicates previous research showing that conscientious individuals tend to lead longer lives, and provides further insight into why this effect occurs. In addition, it underscores the importance of measurement considerations.
Hill, Patrick L Turiano, Nicholas A Hurd, Michael D Mroczek, Daniel K Roberts, Brent W R01 AG021178-09/AG/NIA NIH HHS/United States United States Health psychology : official journal of the Division of Health Psychology, American Psychological Association Health Psychol. 2011 Sep;30(5):536-41.
Keywords: Adult; Aged; Chronic disease; Cognition; Educational Status; Female; Health Behavior; Health Status; Humans; Longevity; Longitudinal Studies; Male; Middle Aged; Personality; Proportional Hazards Models; Psychological Tests

Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008. - Afshin A Divani; Shahram Majidi; Anna M Barrett; Noorbaloochi, Siamak; Andreas R Luft (Stroke, 2011)
BACKGROUND AND PURPOSE: Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke. METHODS: We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups. RESULTS: Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95% CI, 1.16 to 2.24), falls (OR, 1.5; 95% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects. CONCLUSIONS: The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.
Divani, Afshin A Majidi, Shahram Barrett, Anna M Noorbaloochi, Siamak Luft, Andreas R K24 HD062647-01/HD/NICHD NIH HHS/United States K24 HD062647-02/HD/NICHD NIH HHS/United States K24HD062647/HD/NICHD NIH HHS/United States R01 NS055808/NS/NINDS NIH HHS/United States R01 NS055808-01A2/NS/NINDS NIH HHS/United States R01 NS055808-02/NS/NINDS NIH HHS/United States R01 NS055808-03/NS/NINDS NIH HHS/United States R01 NS055808-04/NS/NINDS NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Stroke; a journal of cerebral circulation Nihms297056 Stroke. 2011 Jul;42(7):1821-5. Epub 2011 May 19.
Keywords: Activities of Daily Living; Aged; Case-Control Studies; Cohort Studies; Comorbidity; Female; Geriatrics; Humans; Male; Quality of Life; Retirement; Risk; Social Environment; Stroke

Depression and the onset of chronic illness in older adults: a 12-year prospective study. - Mustafa C. Karakus; Lisa C Patton (J Behav Health Serv Res, 2011)
The relationship between depression and development of chronic illness among older adults is not well understood. This study uses data from the Health and Retirement Study to evaluate the relationship between depression at baseline and new onset of chronic illnesses including cancer, heart problems, arthritis, and diabetes. Analysis controlling for demographics (age, gender, race, education), health risk indicators (BMI and smoking), functional limitations (gross motor index, health limitations for work), and income show that working-age older people (ages 50-62) with depression at baseline are at significantly higher risk to develop diabetes, heart problems, and arthritis during the 12-year follow-up. No significant association was found between depression and cancer. Prevention efforts aimed at chronic illnesses among the elderly should recognize the mind-body interaction and focus on preventing or alleviating depression.
Keywords: Activities of Daily Living; Age Distribution; Aged; Chronic disease; depression; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Psychiatric Status Rating Scales; Risk Factors; Sex Distribution; Socioeconomic factors; United States

Determinants of death in the hospital among older adults. - Amy Kelley; Susan L Ettner; Neil S. Wenger; Catherine A Sarkisian (J Am Geriatr Soc, 2011)
OBJECTIVES: To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics. DESIGN: Using multivariable regression, the relationship between in-hospital death and participants' social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care. SETTING: The Health and Retirement Study, a longitudinal nationally representative cohort of older adults. PARTICIPANTS: People aged 67 and older who died between 2,000 and 2,006 (N = 3,539) were sampled. MEASUREMENTS: In-hospital death. RESULTS: Thirty-nine percent (n = 1,380) of participants died in the hospital (range 34% in Midwest to 45% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death. CONCLUSION: Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.
Kelley, Amy S Ettner, Susan L Wenger, Neil S Sarkisian, Catherine A United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2321-5. doi: 10.1111/j.1532-5415.2011.03718.x. Epub 2011 Nov 8.
Keywords: Aged; Aged, 80 and over; Female; Hospital Mortality; Humans; Male; Multivariate Analysis; Risk Factors; Socioeconomic factors

Determinants of medical expenditures in the last 6 months of life. - Amy Kelley; Susan L Ettner; R Sean Morrison; Qingling Du; Neil S. Wenger; Catherine A Sarkisian (Annals of Internal Medicine, 2011)
BACKGROUND: End-of-life medical expenditures exceed costs of care during other years, vary across regions, and are likely to be unsustainable. Identifying determinants of expenditure variation may reveal opportunities for reducing costs. OBJECTIVE: To identify patient-level determinants of Medicare expenditures at the end of life and to determine the contributions of these factors to expenditure variation while accounting for regional characteristics. It was hypothesized that race or ethnicity, social support, and functional status are independently associated with treatment intensity and controlling for regional characteristics, and that individual characteristics account for a substantial proportion of expenditure variation. DESIGN: Using data from the Health and Retirement Study, Medicare claims, and The Dartmouth Atlas of Health Care, relationships were modeled between expenditures and patient and regional characteristics. SETTING: United States, 2000 to 2006. PARTICIPANTS: 2394 Health and Retirement Study decedents aged 65.5 years or older. MEASUREMENTS: Medicare expenditures in the last 6 months of life were estimated in a series of 2-level multivariable regression models that included patient, regional, and patient and regional characteristics. RESULTS: Decline in function (rate ratio [RR], 1.64 [95% CI, 1.46 to 1.83]); Hispanic ethnicity (RR, 1.50 [CI, 1.22 to 1.85]); black race (RR, 1.43 [CI, 1.25 to 1.64]); and certain chronic diseases, including diabetes (RR, 1.16 [CI, 1.06 to 1.27]), were associated with higher expenditures. Nearby family (RR, 0.90 [CI, 0.82 to 0.98]) and dementia (RR, 0.78 CI, 0.71 to 0.87]) were associated with lower expenditures, and advance care planning had no association. Regional characteristics, including end-of-life practice patterns (RR, 1.09 [CI, 1.06 to 1.14]) and hospital beds per capita (RR, 1.01 [CI, 1.00 to 1.02]), were associated with higher expenditures. Patient characteristics explained 10% of overall variance and retained statistically significant relationships with expenditures after regional characteristics were controlled for. LIMITATION: The study limitations include the decedent sample, proxy informants, and a large proportion of unexplained variation. CONCLUSION: Patient characteristics, such as functional decline, race or ethnicity, chronic disease, and nearby family, are important determinants of expenditures at the end of life, independent of regional characteristics. PRIMARY FUNDING SOURCE: The Brookdale Foundation.
Keywords: Aged; Aged, 80 and over; Chronic disease; Ethnic Groups; Female; Health Expenditures; Humans; Income; Independent Living; Male; Medicare; Regression Analysis; Social Support; Socioeconomic factors; Terminal Care; United States

Development and validation of a brief cognitive assessment tool: the sweet 16. - Tamara G Fong; Richard N Jones; James L Rudolph; Frances Margaret Yang; Tommet, Douglas; Habtemariam, Daniel; Edward R Marcantonio; Kenneth M. Langa; Sharon K Inouye (Arch Intern Med, 2011)
BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16. METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03). CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.
Keywords: Aged; Aged, 80 and over; Cognition Disorders; Cohort Studies; Dementia; Female; Humans; Male; Neuropsychological tests; Surveys and Questionnaires

Differences in health between Americans and Western Europeans: Effects on longevity and public finance. - Pierre-Carl Michaud; Dana P Goldman; Darius Lakdawalla; Adam Gailey; Yuhui Zheng (Soc Sci Med, 2011)
In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies 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 Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.
Keywords: Activities of Daily Living; Adult; Aged; Body Mass Index; Cross-Cultural Comparison; Disabled Persons; Europe; Female; Health Expenditures; health policy; Health Status Disparities; Health Surveys; Humans; Internationality; Life Expectancy; Male; Middle Aged; Models, Economic; Models, Statistical; Mortality; Public Health; United States

Dispositional optimism protects older adults from stroke: the Health and Retirement Study. - Eric S Kim; Nansook Park; Christopher Peterson (Stroke, 2011)
BACKGROUND AND PURPOSE: Although higher optimism has been linked to an array of positive health outcomes, the association between optimism and incidence of stroke remains unclear, especially among older adults. We examined whether higher optimism was associated with a lower incidence of stroke. METHOD: Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults aged>50 years--were used. Analyses were conducted for a 2-year follow-up on the subset of 6044 adults (2542 men, 3502 women) who were stroke-free at baseline. Analyses adjusted for chronic illnesses, self-rated health, and relevant sociodemographic, behavioral, biological, and psychological factors. RESULTS: Higher optimism was associated with a lower risk of stroke. On an optimism measure ranging from 3 to 18, each unit increase in optimism was associated with an age-adjusted OR of 0.90 for stroke (95% CI, 0.84 to 0.97; P<0.01). The effect of optimism remained significant even after fully adjusting for a comprehensive set of sociodemographic, behavioral, biological, and psychological stroke risk factors. CONCLUSIONS: Optimism may play an important role in protecting against stroke among older adults.
Kim, Eric S Park, Nansook Peterson, Christopher Research Support, Non-U.S. Gov't United States Stroke; a journal of cerebral circulation Stroke. 2011 Oct;42(10):2855-9. Epub 2011 Jul 21.
Keywords: Affect; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Personality; Prospective Studies; Risk Factors; Stroke

Do biological measures mediate the relationship between education and health: A comparative study. - Goldman, Noreen; Cassio M. Turra; Rosero-Bixby, Luis; David R Weir; Eileen M. Crimmins (Soc Sci Med, 2011)
Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets - the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA - in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.
Keywords: Biomarkers; Blood pressure; Body Mass Index; Cholesterol; Costa Rica; Educational Status; Female; Health Status Disparities; Health Status Indicators; Health Surveys; Humans; Male; Middle Aged; Qualitative Research; Taiwan; United States

Does fall history influence residential adjustments? - Leland, Natalie; Frank Porell; Susan L Murphy (Gerontologist, 2011)
PURPOSE OF THE STUDY: To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years. DESIGN AND METHODS: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.e., moving, home modifications, increased use of adaptive equipment, family support, or personal care assistance) during the subsequent 2 years. RESULTS: Compared with those with no history of falls, individuals with a history of falls had higher odds of making any RA. Among those making an RA, individuals with an injurious fall were more likely than those with no history of a fall to start using adaptive equipment or increase their use of personal care assistance. IMPLICATIONS: The higher initiation of RAs among fallers may indicate proactive steps to prevent future falls and may be influenced by interactions with the health care system. To optimize fall prevention efforts, older adults would benefit from education and interventions addressing optimal use of RAs before falls occur.
Keywords: Accidental Falls; Aged; Aged, 80 and over; Decision making; Environment Design; Female; Geriatric Assessment; Humans; Male; Residential Facilities; Risk Factors

Does informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life? - Lin, I-Fen; Wu, Hsueh-Sheng (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVE: Prior studies have extensively examined the reciprocal relation between disability and depressive symptoms in late life, but little is known about whether informal care attenuates the reciprocal relation over time. This study examined whether disability and depressive symptoms mobilize informal care and whether informal care, once mobilized, protects older adults against the progression of disability and depressive symptoms. METHODS: The analysis was based on 6,454 community-dwelling older adults who were interviewed in one or more waves of the Health and Retirement Study between 1998 and 2006. Extending an autoregressive cross-lagged model, we constructed 3 cycles of the relations among disability, depressive symptoms, and informal care. Comparing the relations across 3 cycles informs us about the attenuating effect of informal care on the relation between disability and depressive symptoms over time. RESULTS: Although older adults' disability and depressive symptoms mobilized informal care initially, worsening disability and depressive symptoms often exhausted support. Receipt of care generally increased, rather than decreased, disability and depressive symptoms, and the detrimental effects remained the same over time. DISCUSSION: We need to better understand the linkage between disability and depressive symptoms and seek effective interventions to reduce caregiver strain and enhance care receivers' well-being.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Caregivers; Cohort Studies; Cost of Illness; depression; Disability Evaluation; Female; Humans; Longitudinal Studies; Male; Models, Psychological; United States

Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study. - Jennifer B Dowd; Todd, Megan (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression). METHOD: Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent's rating of each vignette character's health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent's cut-points from the vignettes and the severity of the respondent's own health problems based on these vignette cut-points. RESULTS: We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity. DISCUSSION: These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.
Keywords: Adult; Aged; Aged, 80 and over; Attitude to Health; Bias; Black People; Disability Evaluation; Educational Status; Female; Geriatric Assessment; Health Status Indicators; Health Surveys; Hispanic or Latino; Humans; Longitudinal Studies; Male; Middle Aged; Socioeconomic factors; United States; White People

Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey. - James C. Lin; Guerrieri, Joy Gioia; Alison A . Moore (J Aging Health, 2011)
OBJECTIVE: To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults. METHOD: Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods. RESULTS: Over the follow-up periods, 38.6% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged ≥65 years. Other drinking patterns were not associated with lower odds of incident functional limitation. DISCUSSION: Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.
Keywords: Activities of Daily Living; Age Factors; Aged; Alcohol Drinking; Female; Humans; Logistic Models; Male; Middle Aged; Retirement

Dynamic links between memory and functional limitations in old age: longitudinal evidence for age-based structural dynamics from the AHEAD study. - Frank J Infurna; Denis Gerstorf; Lindsay H Ryan; Jacqui Smith (Psychol Aging, 2011)
This study examined competing substantive hypotheses about dynamic (i.e., time-ordered) links between memory and functional limitations in old age. We applied the Bivariate Dual Change Score Model to 13-year longitudinal data from the Asset and Health Dynamics Among the Oldest Old Study (AHEAD; N = 6,990; ages 70 - 95). Results revealed that better memory predicted shallower increases in functional limitations. Little evidence was found for the opposite direction that functional limitations predict ensuing changes in memory. Spline models indicated that dynamic associations between memory and functional limitations were substantively similar between participants aged 70-79 and those aged 80-95. Potential covariates (gender, education, health conditions, and depressive symptoms) did not account for these differential lead-lag associations. Applying a multivariate approach, our results suggest that late-life developments in two key components of successful aging are intrinsically interrelated. Our discussion focuses on possible mechanisms why cognitive functioning may serve as a source of age-related changes in health both among the young-old and the old-old.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Cognition; depression; Female; Health Status; Humans; Interviews as Topic; Longitudinal Studies; Male; Memory; Memory Disorders; Memory, Episodic; Models, Statistical; Neuropsychological tests

Education and health: evidence on adults with diabetes. - Padmaja Ayyagari; Grossman, Daniel; Frank A Sloan (Int J Health Care Finance Econ, 2011)
Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.
Ayyagari, Padmaja Grossman, Daniel Sloan, Frank 2R37-AG-17473-05A1/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States International journal of health care finance and economics Int J Health Care Finance Econ. 2011 Mar;11(1):35-54. Epub 2011 Jan 7.
Keywords: Aged; Cognition; Cross-Sectional Studies; Diabetes Complications; Diabetes Mellitus; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Health Services; Humans; Male; Patient Education as Topic; Self Efficacy; Sex Factors; Socioeconomic factors; Time Factors

The effect of job loss on overweight and drinking. - Deb, Partha; William T Gallo; Padmaja Ayyagari; Jason M. Fletcher; Jody L Sindelar (J Health Econ, 2011)
This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g., layoffs). We improve upon this literature using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among "at risk" individuals and could lead to negative outcomes for the individuals, their families, and society at large.
Keywords: Alcohol Drinking; Body Mass Index; Female; Humans; Longitudinal Studies; Male; Middle Aged; Overweight; Unemployment; United States

Effects of smoking cessation on pain in older adults. - Yu Shi; Hooten, W Michael; David O. Warner (Nicotine Tob Res, 2011)
INTRODUCTION: Smokers are at increased risk of developing chronic pain and suffering higher pain intensity. However, nicotine has analgesic properties, and smokers may view smoking as a means to cope with pain. Smoking cessation is clearly beneficial to the long-term health of smokers. However, it is not known how abstinence from smoking affects pain. The aim of this study was to determine the association between smoking cessation and changes in pain symptoms by secondary analysis of a large longitudinal dataset of older adults. METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992 through 2006) from the nationally representative Health and Retirement Study of United States adults older than 50 years. Multivariate logistic regressions were utilized to determine the relationship between the changes in smoking status and changes in pain symptoms, controlling for demographics, depression, self-rated health, history of arthritis, and body mass index. RESULTS: In multivariate analyses, among the 4,695 smokers who reported no pain or mild pain at enrollment, smoking status was not independently associated with exacerbation of pain (odds ratio [OR]: 0.95, 95% CI: 0.84, 1.08). Among the 1,118 smokers who reported moderate to severe pain at enrollment, smoking status was not independently associated with improvement of pain (OR: 0.87, 95% CI: 0.70, 1.08). CONCLUSIONS: Smoking cessation was not independently associated with changes in pain symptoms in older adults. These results suggest that concerns regarding the effects of abstinence from smoking on pain should not pose a barrier to offering tobacco use interventions to smokers with chronic pain.
Shi, Yu Hooten, W Michael Warner, David O U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England Nicotine and tobacco research : official journal of the Society for Research on Nicotine and Tobacco Nicotine Tob Res. 2011 Oct;13(10):919-25. Epub 2011 May 12.
Keywords: Aged; Body Mass Index; depression; Female; Follow-Up Studies; Humans; Interviews as Topic; Logistic Models; Longitudinal Studies; Male; Middle Aged; Odds Ratio; pain; Pain Perception; Smoking; Smoking cessation; Smoking Prevention

Gender differences in functional limitations in adults living with type 2 diabetes: biobehavioral and psychosocial mediators. - Chiu, Ching-Ju; Linda A. Wray (Ann Behav Med, 2011)
BACKGROUND: Differences in functional limitations between adults with and without diabetes are more evident in women than they are in men. PURPOSE: This study aims to investigate if there are gender differences in biological, behavioral, and psychosocial variables, and how these gender-related variables explain the gender-functional limitations relationship in adults with type 2 diabetes. METHODS: We drew data on 1,619 adults with type 2 diabetes from the Health and Retirement Study and its diabetes-specific mail survey. The fit of a series of mediation models to the data was assessed by structural equation modeling. RESULTS: Although women had better diet and blood glucose self-monitoring behaviors than did men, they reported less favorable body mass index, glycosylated hemoglobin (HbA1c) value, blood pressure, early complications, exercise behaviors, perceived control, self-efficacy, coping, depressive symptoms, and family support than did men. Psychosocial factors made an indirect contribution in the gender-functional limitations relationship by way of their strong association with biological and behavioral factors, two factors that directly and completely mediated the gender-functional limitations relationship. CONCLUSIONS: Interventions promoting psychosocial well-being and empowering perceived diabetes control, coping, and self-efficacy in women with type 2 diabetes may help improve biological and behavioral determinants, and further, their long-term functional health.
Keywords: Adult; Aged; Aged, 80 and over; Biomarkers; Blood Glucose Self-Monitoring; Body Mass Index; Diabetes Mellitus, Type 2; Exercise; Female; Health Behavior; Humans; Male; Middle Aged; Models, Psychological; Prospective Studies; Risk Factors; Self Report; Sex Characteristics; Socioeconomic factors; United States

Gender differences in health: results from SHARE, ELSA and HRS. - Eileen M. Crimmins; Jung K Kim; Sole-Auro, Aida (Eur J Public Health, 2011)
BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA. METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health. RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled. CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women.
Keywords: Activities of Daily Living; Aged; Aging; Body Weights and Measures; Chronic disease; Employment; Female; Global Health; Health Behavior; Health Status; Humans; Male; Middle Aged; Self Report; Sex Factors

Gender, marital power, and marital quality in later life. - Jennifer R. Bulanda (J Women Aging, 2011)
This study uses data from the 1992 Health and Retirement Study to examine gender differences in marital power and marital quality among older adults and to assess whether there are gender differences in the correlates of marital quality and marital power in later life. Results show that women report lower marital happiness, marital interaction, and marital power than do men, on average. These differences persist even after controlling for a number of life-course events and transitions. Further, results show that gender differences are also evident in the relationship of employment, childrearing, caregiving, and health factors with marital quality and power.
Keywords: Female; Health Status; Health Surveys; Humans; Interpersonal Relations; Male; Marriage; Middle Aged; Power, Psychological; Quality of Life; Regression Analysis; Sex Distribution; Socioeconomic factors; United States; Women, Working

Generational jeopardy? Parents' marital transitions and the provision of financial transfers to adult children. - Shapiro, Adam; R Corey Remle (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: Transitions into and out of marriage are becoming more commonplace among persons in middle and later life. We assess the extent to which parental marital transitions influence inter vivos financial transfers to adult children at the family level. METHODS: Panel data from 6,017 households with adult children in the 1992-1998 waves of the Health and Retirement Study are analyzed in this study. RESULTS: Net of familial characteristics, those families experiencing a parental marriage were less likely than stably married households to make a financial transfer to an adult child. The effects of divorce or widowhood were modest. Divorce was associated with a slight increase in the probability of providing a transfer. Widowhood was associated with a slight increase in the total amount transferred to children. DISCUSSION: The study adds weight to the growing argument that marital transitions may alter intergenerational exchanges. The results prompt us to further question how broader demographic and marriage patterns will influence relationships between parents and children in aging societies.
Keywords: Adolescent; Adult; Adult children; Aged; Divorce; Female; Financial Support; Humans; Intergenerational Relations; Male; Marriage; Middle Aged; Prejudice; Retirement; Widowhood; Young Adult

Geriatric conditions develop in middle-aged adults with diabetes. - Christine T Cigolle; Pearl G. Lee; Kenneth M. Langa; Lee, Yuo-Yu; Zhiyi Tian; Caroline S Blaum (J Gen Intern Med, 2011)
BACKGROUND: Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions. OBJECTIVE: To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes. DESIGN: Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006). PARTICIPANTS: Respondents 51 years and older in 2004 (n=18,908). MAIN MEASURES: Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain. KEY RESULTS: Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p< 0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased. CONCLUSIONS: Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought.
Keywords: Accidental Falls; Age Factors; Aged; Aged, 80 and over; Aging; Diabetes Mellitus; Dizziness; Female; Geriatric Assessment; Health Status; Health Surveys; Humans; Longitudinal Studies; Male; Middle Aged; pain; Urinary incontinence

Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples. - Gaines, Jean M; Judith L Poey; Marx, Katherine A; J. M. Parrish; Resnick, Barbara (J Gerontol Soc Work, 2011)
Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.
Gaines, Jean M Poey, Judith L Marx, Katherine A Parrish, John M Resnick, Barbara England Journal of gerontological social work J Gerontol Soc Work. 2011 Nov;54(8):788-802. doi: 10.1080/01634372.2011.595476.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Aging; Case-Control Studies; Chronic disease; depression; Female; Geriatric Assessment; Health Services; Health Services for the Aged; Health Status; Home Care Services; Hospitalization; Humans; Interview, Psychological; Male; Middle Aged; Multivariate Analysis; Psychometrics; Retirement

Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. - Mieke Reuser; Frans J Willekens; Luc G Bonneux (Eur J Epidemiol, 2011)
Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.
Keywords: Age Factors; Aged; Aged, 80 and over; Body Mass Index; Cognition Disorders; Educational Status; Female; Health Surveys; Humans; Incidence; Life Expectancy; Life Tables; Male; Middle Aged; Prevalence; Proportional Hazards Models; Retirement; Sex Factors; Smoking; Time Factors; United States

How does health insurance affect the retirement behavior of women? - Kanika Kapur; Jeannette Rogowski (Inquiry, 2011)
The availability of health insurance is a crucial factor in the retirement decision. Women are substantially less likely to have health insurance from their own employment. Using the Health and Retirement Study, we examine the role of employer-provided retiree health insurance in the retirement decisions of single women, and women in single-earner and dual-earner couples. We compare the effect of health insurance on female and male retirement. Our results show that retiree health insurance increases retirement for all groups except single men. We find suggestive evidence that the role of health insurance for women hinges on their husbands' labor force status.
Keywords: Decision making; Female; Health Benefit Plans, Employee; Humans; Male; Models, Econometric; Multivariate Analysis; Pensions; Retirement; Spouses; United States; Women, Working

How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age? - Ana R Quiñones; Jersey Liang; Joan M. Bennett; Xiao Xu; Wen Ye (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: This research examines intra- and interpersonal differences in multiple chronic conditions reported by Americans aged 51 and older for a period up to 11 years. It focuses on how changes in multimorbidity vary across White, Black, and Mexican Americans. METHODS: Data came from 17,517 respondents of the Health and Retirement Study (1995-2006) with up to 5 repeated observations. Hierarchical linear models were employed to analyze ethnic variations in temporal changes of reported comorbidities. FINDINGS: Middle-aged and older Americans have on average nearly 2 chronic diseases at the baseline, which increased to almost 3 conditions in 11 years. White Americans differ from Black and Mexican Americans in terms of level and rate of change of multimorbidity. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to Whites. In contrast, Blacks showed an elevated level of multimorbidity throughout the 11-year period of observation, although their rate of change slowed relative to Whites. DISCUSSION: These results suggest that health differences between Black Americans and other ethnic groups including White and Mexican Americans persist in the trajectory of multimorbidity even when population heterogeneity is adjusted. Further research is needed concerning the impact of health disadvantages and differential mortality that may have occurred before middle age as well as exploring the role of nativity, the nature of self-reported diseases, and heterogeneity underlying the average trajectory of multimorbidity for ethnic elders.
Quinones, Ana R Liang, Jersey Bennett, Joan M Xu, Xiao Ye, Wen F31-AG029783/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Nov;66(6):739-49. Epub 2011 Oct 3.
Keywords: Aged; Aged, 80 and over; Aging; Black or African American; Chronic disease; Female; Follow-Up Studies; Health Behavior; Health Status Disparities; Hispanic or Latino; Humans; Linear Models; Longitudinal Studies; Male; Middle Aged; United States; White People

The impact of private long-term care insurance on the use of long-term care. - Yong Li; Gail A Jensen (Inquiry, 2011)
This paper investigates the effects of privately purchased long-term care insurance (LTCI) on three major types of long-term care services: nursing home care, paid home care, and informal care received from Family and friends. Using 2002-2008 data from the ongoing Health and Retirement Study, we analyze the determinants of long-term care utilization simultaneously with the determinants of holding LTCI. We find that LTCI has modest effects on the likelihood of using long-term care services. For the very frail elderly, private LTCI enhances their access to nursing home care. For those with moderate disability, LTCI makes it more likely that they can remain at home and receive home care services, instead of going to a nursing home. We find no evidence that formal care substitutes for informal care in the presence of LTCI. These findings suggest that if LTCI becomes much more prevalent in the future, many older adults will be able to choose the type of long-term care arrangement that best suits their needs.
Keywords: Aged; Aged, 80 and over; Decision making; Female; Health Services Accessibility; Home Care Services; Home Nursing; Humans; Insurance, Long-Term Care; Likelihood Functions; Long-term Care; Male; Models, Econometric; Nursing homes; Private Sector; Regression Analysis; United States

Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage. - J. Michael McWilliams; Alan M. Zaslavsky; Haiden A. Huskamp (JAMA, 2011)
CONTEXT: Implementation of Medicare Part D was followed by increased use of prescription medications, reduced out-of-pocket costs, and improved medication adherence. Its effects on nondrug medical spending remain unclear. OBJECTIVE: To assess differential changes in nondrug medical spending following the implementation of Part D for traditional Medicare beneficiaries with limited prior drug coverage. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative longitudinal survey data and linked Medicare claims from 2004-2007 were used to compare nondrug medical spending before and after the implementation of Part D by self-reported generosity of prescription drug coverage before 2006. Participants included 6001 elderly Medicare beneficiaries from the Health and Retirement Study, including 2538 with generous and 3463 with limited drug coverage before 2006. Comparisons were adjusted for sociodemographic and health characteristics and checked for residual confounding by conducting similar comparisons for a control cohort from 2002-2005. MAIN OUTCOME MEASURE: Nondrug medical spending assessed from claims, in total and by type of service (inpatient and skilled nursing facility vs physician services). RESULTS: Total nondrug medical spending was differentially reduced after January 1, 2006, for beneficiaries with limited prior drug coverage (-$306/quarter [95% confidence interval CI, -$586 to -$51]; P = .02), relative to beneficiaries with generous prior drug coverage. This differential reduction was explained mostly by differential changes in spending on inpatient and skilled nursing facility care (-$204/quarter [95% CI, -$447 to $2]; P = .05). Differential reductions in spending on physician services (-$67/quarter [95% CI, -$134 to -$5]; P = .03) were not associated with differential changes in outpatient visits (-0.06 visits/quarter [95% CI, -0.21 to 0.08]; P = .37), suggesting reduced spending on inpatient physician services for beneficiaries with limited prior drug coverage. In contrast, nondrug medical spending in the control cohort did not differentially change after January 1, 2004, for beneficiaries with limited prior drug coverage in 2002 ($14/quarter [95% CI, -$338 to $324]; P = .93), relative to beneficiaries with generous prior coverage. CONCLUSION: Implementation of Part D was associated with significant differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.
McWilliams, J Michael Zaslavsky, Alan M Huskamp, Haiden A Comparative Study Research Support, Non-U.S. Gov't United States JAMA : the journal of the American Medical Association JAMA. 2011 Jul 27;306(4):402-9.
Keywords: Aged; Aged, 80 and over; Cost Control; Costs and Cost Analysis; Data collection; Female; Health Expenditures; Health Services; Humans; Insurance Claim Review; Longitudinal Studies; Male; Medicare Part D; Patient Care; Physicians; Skilled Nursing Facilities; United States

Incidence of dementia and cognitive impairment, not dementia in the United States. - Brenda L Plassman; Kenneth M. Langa; Ryan J McCammon; Gwenith G Fisher; Guy G Potter; James R Burke; David C Steffens; Norman L Foster; Bruno J Giordani; Frederick W Unverzagt; Kathleen A Welsh-Bohmer; Steven G Heeringa; et al. (Ann Neurol, 2011)
OBJECTIVE: Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND. METHODS: Participants in the Aging, Demographic, and Memory Study (ADAMS) were evaluated for cognitive impairment using a comprehensive in-home assessment. A total of 456 individuals aged 72 years and older, who were not demented at baseline, were followed longitudinally from August 2001 to December 2009. An expert consensus panel assigned a diagnosis of normal cognition, CIND, or dementia and its subtypes. Using a population-weighted sample, we estimated the incidence of dementia, Alzheimer disease (AD), vascular dementia (VaD), and CIND by age. We also estimated the incidence of progression from CIND to dementia. RESULTS: The incidence of dementia was 33.3 (standard error [SE], 4.2) per 1,000 person-years and 22.9 (SE, 2.9) per 1,000 person-years for AD. The incidence of CIND was 60.4 (SE, 7.2) cases per 1,000 person-years. An estimated 120.3 (SE, 16.9) individuals per 1,000 person-years progressed from CIND to dementia. Over a 5.9-year period, about 3.4 million individuals aged 72 and older in the United States developed incident dementia, of whom approximately 2.3 million developed AD, and about 637,000 developed VaD. Over this same period, almost 4.8 million individuals developed incident CIND. INTERPRETATION: The incidence of CIND is greater than the incidence of dementia, and those with CIND are at high risk of progressing to dementia, making CIND a potentially valuable target for treatments aimed at slowing cognitive decline.
Keywords: Aged; Aged, 80 and over; Alzheimer disease; Cognition Disorders; Cohort Studies; Dementia; Diagnostic and Statistical Manual of Mental Disorders; disease progression; Female; Humans; Logistic Models; Longitudinal Studies; Male; Models, Statistical; United States

Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval. - Janet Kay Bobo; April A Greek (Int J Environ Res Public Health, 2011)
Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.
Bobo, Janet Kay Greek, April A AA016534/AA/NIAAA NIH HHS/United States R24 HD042828-10/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Switzerland International journal of environmental research and public health Int J Environ Res Public Health. 2011 Aug;8(8):3263-76. Epub 2011 Aug 5.
Keywords: Aged; Alcohol Drinking; Alcoholic Intoxication; Alcoholism; Cohort Studies; depression; Ethanol; Female; Follow-Up Studies; Humans; Longitudinal Studies; Middle Aged; Retirement; Risk Factors; Smoking; Surveys and Questionnaires; United States

The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006. - Richard J. Manski; John F Moeller; Patricia A St Clair; Jody Schimmel; Haiyan Chen; John V Pepper (Am J Public Health, 2011)
OBJECTIVES: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status. METHODS: We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates. RESULTS: We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods. CONCLUSIONS: Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.
Keywords: Age Factors; Aged; Dental Care; Employment; Female; Health Care Surveys; Humans; Insurance, Dental; Male; Medically Uninsured; Middle Aged; Retirement; Socioeconomic factors; United States

Job strain, depressive symptoms, and drinking behavior among older adults: results from the health and retirement study. - Briana Mezuk; Amy S B Bohnert; Scott M Ratliff; Zivin, Kara (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVE: To examine the relationship between job strain and two indicators of mental health, depression and alcohol misuse, among currently employed older adults. METHOD: Data come from the 2004 and 2006 waves of the Health and Retirement Study (N = 2,902). Multivariable logistic regression modeling was used to determine the association between job strain, indicated by the imbalance of job stress and job satisfaction, with depression and alcohol misuse. RESULTS: High job strain (indicated by high job stress combined with low job satisfaction) was associated with elevated depressive symptoms (odds ratio [OR] = 2.98, 95% confidence interval [CI]: 1.99-4.45) relative to low job strain after adjusting for sociodemographic characteristics, labor force status, and occupation. High job stress combined with high job satisfaction (OR = 1.93) and low job stress combined with low job satisfaction (OR = 1.94) were also associated with depressive symptoms to a lesser degree. Job strain was unrelated to either moderate or heavy drinking. These associations did not vary by gender or age. DISCUSSION: Job strain is associated with elevated depressive symptoms among older workers. In contrast to results from investigations of younger workers, job strain was unrelated to alcohol misuse. These findings can inform the development and implementation of workplace health promotion programs that reflect the mental health needs of the aging workforce.
Keywords: Age Factors; Aged; Alcoholism; Cohort Studies; Depressive Disorder; Female; Health Behavior; Health Surveys; Humans; Job Satisfaction; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Retirement; Sex Factors; Statistics as Topic; Stress, Psychological; United States

Lifecourse socioeconomic circumstances and multimorbidity among older adults. - Reginald D. Tucker-Seeley; Li, Yi; Sorensen, Glorian; Subramanian, S V (BMC Public Health, 2011)
BACKGROUND: Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity. METHODS: Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions. RESULTS: Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity. CONCLUSIONS: This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.
Tucker-Seeley, Reginald D Li, Yi Sorensen, Glorian Subramanian, S V England BMC public health BMC Public Health. 2011 May 14;11:313.
Keywords: Aged; Chronic disease; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Social Class; United States

Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. - Frederic D Wolinsky; Suzanne E Bentler; Jason Hockenberry; Michael P Jones; Maksym Obrizan; Paula A Weigel; Kaskie, Brian; Robert B Wallace (BMC Geriatr, 2011)
BACKGROUND: Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines. METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop. RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline. CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Cohort Studies; Disabled Persons; Female; Follow-Up Studies; Geriatric Assessment; Health Surveys; Humans; Insurance Benefits; Longitudinal Studies; Male; Medicare; Mobility Limitation; Prospective Studies; Time Factors; United States

Memory predicts changes in depressive symptoms in older adults: a bidirectional longitudinal analysis. - Jajodia, Archana; Borders, Ashley (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: Although research indicates that depressive symptoms and memory performance are related in older adults, the temporal associations between these variables remain unclear. This study examined whether depressive symptoms predicted later memory change and whether memory predicted later change in depressive symptoms. METHODS: The sample consisted of more than 14,000 adults from the Health and Retirement Study, a biannual longitudinal study of health and retirement in Americans older than age 50 years. Measures of delayed recall and depressive symptoms served as the main study variables. We included age, sex, education, and history of vascular diseases as covariates. RESULTS: Using dynamic change models with latent difference scores, we found that memory performance predicted change in depressive symptoms 2 years later. Depressive symptoms did not predict later change in memory. The inclusion of vascular health variables diminished the size of the observed relationship, suggesting that biological processes may partially explain the effect of memory on depressive symptoms. IMPLICATIONS: Future research should explore both biological and psychological processes that may explain the association between worse memory performance and subsequent increases in depressive symptoms.
Keywords: Aged; Aged, 80 and over; Comorbidity; Dementia, Vascular; depression; Female; Geriatric Assessment; Humans; Longitudinal Studies; Male; Mental Recall; Middle Aged; Models, Psychological; Retirement; Statistics as Topic; United States

Mortgage delinquency and changes in access to health resources and depressive symptoms in a nationally representative cohort of Americans older than 50 years. - Dawn E Alley; Jennifer Lloyd; José A Pagán; Craig E Pollack; Michelle Shardell; Carolyn Cannuscio (Am J Public Health, 2011)
OBJECTIVES: We evaluated associations between mortgage delinquency and changes in health and health-relevant resources over 2 years, with data from the Health and Retirement Study, a longitudinal survey representative of US adults older than 50 years. METHODS: In 2008, participants reported whether they had fallen behind on mortgage payments since 2006 (n = 2474). We used logistic regression to compare changes in health (incidence of elevated depressive symptoms, major declines in self-rated health) and access to health-relevant resources (food, prescription medications) between participants who fell behind on their mortgage payments and those who did not. RESULTS: Compared with nondelinquent participants, the mortgage-delinquent group had worse health status and less access to health-relevant resources at baseline. They were also significantly more likely to develop incident depressive symptoms (odds ratio [OR] = 8.60; 95% confidence interval [CI] = 3.38, 21.85), food insecurity (OR = 7.53; 95% CI = 3.01, 18.84), and cost-related medication nonadherence (OR = 8.66; 95% CI = 3.72, 20.16) during follow-up. CONCLUSIONS: Mortgage delinquency was associated with significant elevations in the incidence of mental health impairments and health-relevant material disadvantage. Widespread mortgage default may have important public health implications.
Keywords: depression; Drug Costs; Economic Recession; Female; Health Services Accessibility; Health Status; Housing; Humans; Male; Medication Adherence; Middle Aged; Socioeconomic factors; Stress, Psychological; United States

Multiple trajectories of depressive symptoms in middle and late life: racial/ethnic variations. - Jersey Liang; Xiao Xu; Ana R Quiñones; Joan M. Bennett; Wen Ye (Psychol Aging, 2011)
This research aims to identify distinct courses of depressive symptoms among middle-aged and older Americans and to ascertain how these courses vary by race/ethnicity. Data came from the 1995-2006 Health and Retirement Study which involved a national sample of 17,196 Americans over 50 years of age with up to six repeated observations. Depressive symptoms were measured by an abbreviated version of the Center for Epidemiologic Studies Depression scale. Semiparametric group based mixture models (Proc Traj) were used for data analysis. Six major trajectories were identified: (a) minimal depressive symptoms (15.9%), (b) low depressive symptoms (36.3%), (c) moderate and stable depressive symptoms (29.2%), (d) high but decreasing depressive symptoms (6.6%), (e) moderate but increasing depressive symptoms (8.3%), and (f) persistently high depressive symptoms (3.6%). Adjustment of time-varying covariates (e.g., income and health conditions) resulted in a similar set of distinct trajectories. Relative to White Americans, Black and Hispanic Americans were significantly more likely to be in trajectories of more elevated depressive symptoms. In addition, they were more likely to experience increasing and decreasing depressive symptoms. Racial and ethnic variations in trajectory groups were partially mediated by SES, marital status, and health conditions, particularly when both interpersonal and intrapersonal differences in these variables were taken into account.
Liang, Jersey Xu, Xiao Quinones, Ana R Bennett, Joan M Ye, Wen 5P30AG024824/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States UL1RR024986/RR/NCRR NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. United States Psychology and aging Psychol Aging. 2011 Dec;26(4):761-77. Epub 2011 Aug 29.
Keywords: Age Factors; Aged; Black or African American; depression; disease progression; Female; Health Status Disparities; Hispanic or Latino; Humans; Longitudinal Studies; Male; Middle Aged; Models, Statistical; Socioeconomic factors; Time Factors; United States; White People

Neighborhoods and chronic disease onset in later life. - Vicki A Freedman; Irina B Grafova; Jeannette Rogowski (Am J Public Health, 2011)
OBJECTIVES: To strengthen existing evidence on the role of neighborhoods in chronic disease onset in later life, we investigated associations between multiple neighborhood features and 2-year onset of 6 common conditions using a national sample of older adults. METHODS: Neighborhood features for adults aged 55 years or older in the 2002 Health and Retirement Study were measured by use of previously validated scales reflecting the built, social, and economic environment. Two-level random-intercept logistic models predicting the onset of heart problems, hypertension, stroke, diabetes, cancer, and arthritis by 2004 were estimated. RESULTS: In adjusted models, living in more economically disadvantaged areas predicted the onset of heart problems for women (odds ratio [OR] = 1.20; P < .05). Living in more highly segregated, higher-crime areas was associated with greater chances of developing cancer for men (OR = 1.31; P < .05) and women (OR = 1.25; P < .05). CONCLUSIONS: The neighborhood economic environment is associated with heart disease onset for women, and neighborhood-level social stressors are associated with cancer onset for men and women. The social and biological mechanisms that underlie these associations require further investigation.
Keywords: Aged; Chronic disease; Environment Design; Factor Analysis, Statistical; Female; Health Resources; Health Status Disparities; Humans; Logistic Models; Male; Middle Aged; Poverty Areas; Residence Characteristics; Risk Factors; Small-Area Analysis; Social Environment; Social Problems; Socioeconomic factors; United States

Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study. - Okura, Toru; Brenda L Plassman; David C Steffens; David J Llewellyn; Guy G Potter; Kenneth M. Langa (J Am Geriatr Soc, 2011)
OBJECTIVES: To examine the association between neuropsychiatric symptoms and risk of institutionalization and death. DESIGN: Analysis of longitudinal data. SETTING: The Aging, Demographics, and Memory Study (ADAMS). PARTICIPANTS: Five hundred thirty-seven adults aged 71 and older with cognitive impairment drawn from the Health and Retirement Study (HRS). MEASUREMENTS: Neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) and caregiver distress were identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned cognitive category. Date of nursing home placement and information on death, functional limitations, medical comorbidity, and sociodemographic characteristics were obtained from the HRS and ADAMS. RESULTS: Overall, the presence of one or more neuropsychiatric symptoms was not associated with a significantly higher risk for institutionalization or death during the 5-year study period, although when assessing each symptom individually, depression, delusions, and agitation were each associated with a significantly higher risk of institutionalization (hazard rate (HR)=3.06, 95% confidence interval (CI)=1.09-8.59 for depression; HR=5.74, 95% CI=1.94-16.96 for clinically significant delusions; HR=4.70, 95% CI=1.07-20.70 for clinically significant agitation). Caregiver distress mediated the association between delusions and agitation and institutionalization. Depression and hallucinations were associated with significantly higher mortality (HR=1.56, 95% CI=1.08-2.26 for depression; HR=2.59, 95% CI=1.09-6.16 for clinically significant hallucinations). CONCLUSION: Some, but not all, neuropsychiatric symptoms are associated with a higher risk of institutionalization and death in people with cognitive impairment, and caregiver distress also influences institutionalization. Interventions that better target and treat depression, delusions, agitation, and hallucinations, as well as caregiver distress, may help delay or prevent these negative clinical outcomes.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Behavioral Symptoms; Caregivers; Cognition Disorders; Female; Humans; Institutionalization; Male; Neuropsychological tests; Proportional Hazards Models

Partner caregiving in older cohabiting couples. - Claire Noël-Miller (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: Despite the rapidly increasing prevalence of cohabitation among older adults, the caregiving literature has exclusively focused on formally married individuals. Extending prior work on intra-couple care, this study contrasts frail cohabitors' patterns of care receipt from a partner to that of frail spouses. METHODS: Using nationally representative panel data from the Health and Retirement Study (2000, 2002, 2004, and 2006), we estimate random effects cross-sectional times series models predicting frail cohabitors' likelihood of receiving partner care compared with their married counterparts'. Conditional on the receipt of intra-couple care, we also examine differences in marital and nonmarital partners' caregiving hours and caregiving involvement relative to other helpers. RESULTS: Net of sociodemographic, disability, and comorbidity factors, we find that cohabitors are less likely to receive partner care than married individuals. However, caregiving nonmarital partners provide as many hours of care as spouses while providing a substantially larger share of disabled respondents' care than marital partners. DISCUSSION: Cohabitation and marriage have distinct implications for older adults' patterns of partner care receipt. This study adds weight to a growing body of research emphasizing the importance of accounting for older adults' nontraditional union forms and of examining the ramifications of cohabitation for older adults' well-being.
Noel-Miller, Claire M Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 May;66(3):341-53. Epub 2011 Apr 11.
Keywords: Aged; Caregivers; Disabled Persons; Family Characteristics; Female; Frail Elderly; Humans; Interpersonal Relations; Male; Marriage; Middle Aged; Sex Factors; Single Person; Social Support

Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education. - Chiu, Ching-Ju; Linda A. Wray (Gerontologist, 2011)
PURPOSE: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education. DESIGN AND METHODS: Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50. RESULTS: Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model. IMPLICATIONS: This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education.
Keywords: Activities of Daily Living; Age Distribution; Aged; Aged, 80 and over; Cross-Sectional Studies; Diabetes Mellitus; Disabled Persons; Educational Status; ethnicity; Female; Health Status; Humans; Longitudinal Studies; Male; Middle Aged; Models, Theoretical; Racial Groups; Sex Distribution; Time Factors; United States

A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. - Frederic D Wolinsky; Suzanne E Bentler; Jason Hockenberry; Michael P Jones; Paula A Weigel; Kaskie, Brian; Robert B Wallace (BMC Public Health, 2011)
BACKGROUND: Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function. METHODS: We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests. RESULTS: Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status. CONCLUSIONS: In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.
Keywords: Aged; Aged, 80 and over; Aging; Cognition; Cognition Disorders; Cohort Studies; Female; Humans; Interviews as Topic; Male; Medicare; Mental Health; Outcome Assessment, Health Care; Prospective Studies; Regression Analysis; Risk Factors; United States

Recent trends in chronic disease, impairment and disability among older adults in the United States. - William W. Hung; Joseph S. Ross; Boockvar, Kenneth S; Albert L Siu (BMC Geriatr, 2011)
BACKGROUND: To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults. METHODS: We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS: The proportion of older adults reporting no chronic disease decreased from 13.1% (95% Confidence Interval [CI], 12.4%-13.8%) in 1998 to 7.8% (95% CI, 7.2%-8.4%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9% (95% CI, 86.2%-89.6%) in 1998 to 92.2% (95% CI, 91.6%-92.8%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7% (95% CI, 11.0%-12.4%) in 1998 to 17.4% (95% CI, 16.6%-18.2%) in 2008. The proportion of older adults reporting no impairments was 47.3% (95% CI, 46.3%-48.4%) in 1998 and 44.4% (95% CI, 43.3%-45.5%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2% (95% CI, 6.7%-7.7%) in 1998 and 7.3% (95% CI, 6.8%-7.9%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3% (95% CI, 25.4%-27.2%) in 1998 and 25.4% (95% CI, 24.5%-26.3%) in 2008. CONCLUSIONS: Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.
Hung, William W Ross, Joseph S Boockvar, Kenneth S Siu, Albert L K08 AG032886/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England BMC geriatrics BMC Geriatr. 2011 Aug 18;11:47.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Chronic disease; Disabled Persons; Female; Health Surveys; Humans; Longitudinal Studies; Male; United States; Visually Impaired Persons

Recruitment and retention of minority participants in the health and retirement study. - Mary Beth Ofstedal; David R Weir (Gerontologist, 2011)
PURPOSE: Minority oversamples of African Americans and Hispanics have been a key feature of the Health and Retirement Study (HRS) design from its origins in 1992. The objective of this article was to assess the quality of the HRS with respect to the recruitment and retention of minority respondents. DESIGN AND METHODS: To evaluate minority recruitment efforts, we examine baseline response rates for the early baby boom cohort that was added in the 2004 wave and the representativeness of this cohort with regard to demographic, socioeconomic, and health characteristics. To evaluate retention, we focus on minority differentials in 2008 interview, nonresponse and mortality outcomes for the full HRS sample. We also examine minority differentials in participation in supplemental components of the HRS. RESULTS: Minority response rates at baseline and in longitudinal follow-ups for the main HRS interview have been equal to or better than that of majority Whites. Conversely, response rates to some specific supplemental components have been lower for minority sample members. IMPLICATIONS: The oversample strategies that the HRS has employed have been successful at identifying and recruiting minority participants at response rates very comparable with that of Whites and others. Minority differentials in participation in supplemental components have been overcome to some extent through interviewer training and targeted follow-up strategies. The HRS experience suggests that well-trained interviewers can overcome most if not all of whatever race and ethnic differentials exist in willingness to participate in surveys, including those involving biological data collection.
Ofstedal, Mary B Weir, David R U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The Gerontologist Gerontologist. 2011 Jun;51 Suppl 1:S8-20.
Keywords: Aged; Biomarkers; Black or African American; Female; Health Promotion; Health Surveys; Hispanic or Latino; Humans; Male; Middle Aged; Minority Groups; Minority health; National Health Programs; Patient Dropouts; Patient Selection; Retirement; Sampling Studies; Surveys and Questionnaires; United States

Regional variation in the association between advance directives and end-of-life Medicare expenditures. - Lauren Hersch Nicholas; Kenneth M. Langa; Theodore J Iwashyna; David R Weir (JAMA, 2011)
CONTEXT: It is unclear if advance directives (living wills) are associated with end-of-life expenditures and treatments. OBJECTIVE: To examine regional variation in the associations between treatment-limiting advance directive use, end-of-life Medicare expenditures, and use of palliative and intensive treatments. DESIGN, SETTING, AND PATIENTS: Prospectively collected survey data from the Health and Retirement Study for 3302 Medicare beneficiaries who died between 1998 and 2007 linked to Medicare claims and the National Death Index. Multivariable regression models examined associations between advance directives, end-of-life Medicare expenditures, and treatments by level of Medicare spending in the decedent's hospital referral region. MAIN OUTCOME MEASURES: Medicare expenditures, life-sustaining treatments, hospice care, and in-hospital death over the last 6 months of life. RESULTS: Advance directives specifying limits in care were associated with lower spending in hospital referral regions with high average levels of end-of-life expenditures (-$5585 per decedent; 95% CI, -$10,903 to -$267), but there was no difference in spending in hospital referral regions with low or medium levels of end-of-life expenditures. Directives were associated with lower adjusted probabilities of in-hospital death in high- and medium-spending regions (-9.8%; 95% CI, -16% to -3% in high-spending regions; -5.3%; 95% CI, -10% to -0.4% in medium-spending regions). Advance directives were associated with higher adjusted probabilities of hospice use in high- and medium-spending regions (17%; 95% CI, 11% to 23% in high-spending regions, 11%; 95% CI, 6% to 16% in medium-spending regions), but not in low-spending regions. CONCLUSION: Advance directives specifying limitations in end-of-life care were associated with significantly lower levels of Medicare spending, lower likelihood of in-hospital death, and higher use of hospice care in regions characterized by higher levels of end-of-life spending.
Keywords: Advance directives; Aged; Aged, 80 and over; Data collection; Female; Health Expenditures; Hospice Care; Hospital Mortality; Hospitals; Humans; Kidney Failure, Chronic; Male; Medicare; Palliative care; Prospective Studies; Regression Analysis; Terminal Care; United States

Social characteristics and health status of exceptionally long-lived Americans in the Health and Retirement Study. - Jennifer A Ailshire; Hiram Beltrán-Sánchez; Eileen M. Crimmins (J Am Geriatr Soc, 2011)
OBJECTIVES: To characterize the social characteristics and physical, functional, mental, and cognitive health of exceptional survivors in the United States and how the experience of exceptional longevity differs according to social status. DESIGN: Nationally representative longitudinal study of older Americans. SETTING: United States. PARTICIPANTS: One thousand six hundred forty-nine men and women born from 1900 to 1911 from the Health and Retirement Study: 1,424 nonsurvivors who died before reaching the age of 97 and 225 exceptional survivors who survived to age 97 and older. MEASUREMENTS: Self-reported data on sociodemographic characteristics, social environment, physical and mental health, and physical and cognitive function. RESULTS: At baseline, exceptional survivors were more likely to live independently and had fewer diseases, better mental health, and better physical and cognitive function than those who did not survive to age 97. Exceptional survivors experienced declines from baseline in all health domains upon reaching 97 years of age, but between one-fifth and one-third of exceptional survivors remained disease free, with no functional limitations or depressive symptoms, and one-fifth retained high cognitive function. Of exceptional survivors, men were healthier than women, and whites were generally healthier than nonwhites. Highly educated exceptional survivors had better cognitive function than their less-educated counterparts. CONCLUSION: On average, exceptional survivors are relatively healthy and high functioning for most of their lives and experience health declines only upon reaching maximum longevity. Heterogeneity in the population of exceptionally old adults indicates that, although many individuals reach maximum longevity in a state of poor health and functioning, a considerable portion of exceptional survivors remain healthy and high-functioning even in very old age.
Ailshire, Jennifer A Beltran-Sanchez, Hiram Crimmins, Eileen M United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2241-8. doi: 10.1111/j.1532-5415.2011.03723.x.
Keywords: Age Factors; Aged, 80 and over; Female; Geriatric Assessment; Health Status; Humans; Longevity; Longitudinal Studies; Male; Social Class; Sociology; United States

Social stratification of body weight trajectory in middle-age and older americans: results from a 14-year longitudinal study. - Anda Botoseneanu; Jersey Liang (J Aging Health, 2011)
OBJECTIVE: To depict the trajectory of BMI from middle to late adulthood and to examine social variations in BMI trajectories. METHOD: Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative sample of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using hierarchical linear modeling with time-constant and time-varying covariates. RESULTS: BMI increased linearly over time. 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. Younger age-at-baseline predicted lower BMI level and lower rate of increase. No gender differences were found. DISCUSSION: Observed racial/ethnic and educational differences in BMI trajectory from middle to old age inform policies and interventions aimed at modifying health risks and reducing health disparities in old age.
Keywords: Age Factors; Aged; Aging; Body Mass Index; ethnicity; Female; Health Status Disparities; Humans; Linear Models; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Obesity; Psychometrics; Risk Assessment; Self Report; Social Class; Socioeconomic factors; Time Factors; United States

Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA. - Rasmus Hoffmann (Soc Sci Med, 2011)
Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.
Keywords: Aged; Aged, 80 and over; Analysis of Variance; Cross-Cultural Comparison; Denmark; Educational Status; Female; Health Expenditures; Humans; Income; Life Expectancy; Male; Middle Aged; Mortality; Political Systems; Social Class; Social Welfare; United States

Socioeconomic inequalities in self-rated health among middle-aged and older adults. - Kim, Jinhyun (Soc Work Health Care, 2011)
Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females' decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.
Keywords: Aged; Female; Health Status Disparities; Humans; Insurance Coverage; Insurance, Health; Male; Middle Aged; Self Report; Sex Factors; Socioeconomic factors

Socioeconomic status and race/ethnicity independently predict health decline among older diabetics. - Emily J Nicklett (BMC Public Health, 2011)
BACKGROUND: There are pervasive racial and socioeconomic differences in health status among older adults with type 2 diabetes. The extent to which racial/ethnic and socioeconomic disparities unfold to differential health outcomes has yet to be investigated among older adults with diabetes. This study examines whether or not race/ethnicity and SES are independent predictors of steeper rates of decline in self-rated health among older adults in the U.S. with type 2 diabetes. METHODS: The study population was a subset of diabetic adults aged 65 and older from the Health and Retirement Study. Respondents were followed up to 16 years. Multilevel cumulative logit regression models were used to examine the contributions of socioeconomic indicators, race/ethnicity, and covariates over time. Health decline was measured as a change in self-reported health status over the follow-up period. RESULTS: Relative to whites, blacks had a significantly lower cumulative odds of better health status over time (OR: 0.61, p < .0001). Hispanics reported significantly lower cumulative odds better health over time relative to whites (OR: 0.59, p < .05). Although these disparities narrowed when socioeconomic characteristics were added to the model, significant differences remained. Including socioeconomic status did not remove the health effects of race/ethnicity among blacks and Hispanics. CONCLUSIONS: The author found that race/ethnicity and some socioeconomic indicators were independent predictors of health decline among older adults with diabetes.
Nicklett, Emily J Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. England BMC public health BMC Public Health. 2011 Sep 2;11:684.
Keywords: Aged; Aged, 80 and over; Black People; Diabetes Mellitus, Type 2; Diagnostic Self Evaluation; Female; Follow-Up Studies; Health Status Disparities; Hispanic or Latino; Humans; Male; Social Class; United States; White People

Sources of variability in estimates of the prevalence of Alzheimer's disease in the United States. - Robert S Wilson; David R Weir; Sue E Leurgans; Denis A Evans; Liesi Hebert; Kenneth M. Langa; Brenda L Plassman; Brent J. Small; David A Bennett (Alzheimers Dement, 2011)
BACKGROUND: The prevalence of Alzheimer's disease (AD) in the United States was estimated at 2.3 million in 2002 by the Aging, Demographics, and Memory Study (ADAMS), which is almost 50% less than the estimate of 4.5 million in 2000 derived from the Chicago Health and Aging Project. METHODS: We considered how differences in diagnostic criteria may have contributed to these differences in AD prevalence. RESULTS: We identified several important differences in diagnostic criteria that may have contributed to the differing estimates of AD prevalence. Two factors were especially noteworthy. First, the Diagnostic and Statistical Manual of Mental Disorders III-R and IV criteria of functional limitation documented by an informant used in ADAMS effectively concentrated the diagnosis of dementia toward a relatively higher level of cognitive impairment. ADAMS separately identified a category of cognitive impairment not dementia and within that group there were a substantial number of cases with "prodromal" AD (a maximum of 1.95 million with upweighting). Second, a substantial proportion of dementia in ADAMS was attributed to either vascular disease (representing a maximum of 0.59 million with upweighting) or undetermined etiology (a maximum of 0.34 million), whereas most dementia, including mixed dementia, was attributed to AD in the Chicago Health and Aging Project. CONCLUSION: The diagnosis of AD in population studies is a complex process. When a diagnosis of AD excludes persons meeting criteria for vascular dementia, when not all persons with dementia are assigned an etiology, and when a diagnosis of dementia requires an informant report of functional limitations, the prevalence is substantially lower and the diagnosed cases most likely have a relatively higher level of impairment.
Keywords: Aged; Aged, 80 and over; Alzheimer disease; Community Health Planning; Comorbidity; Dementia; Diagnosis, Differential; Female; Humans; Incidence; Male; Prevalence; United States

Spousal associations between functional limitation and depressive symptom trajectories: Longitudinal findings from the study of Asset and Health Dynamics Among the Oldest Old (AHEAD). - Christiane A Hoppmann; Denis Gerstorf; Anita Hibbert (Health Psychol, 2011)
OBJECTIVE: To examine spousal associations between functional limitation and depressive symptom trajectories in a national sample of older long-term married couples. DESIGN: We used 14.5-year longitudinal data on functional limitations and depressive symptoms from 1,704 couples participating in the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD). MAIN OUTCOME MEASURES: Activities of daily living and a short version of the Center for Epidemiologic Studies Depression scale were used. RESULTS: Between-person difference findings corroborate previous research by showing that levels and changes in functional limitations and depressive symptoms are closely interrelated among wives and husbands. Our results further demonstrate sizable associations in levels and changes in functional limitations and depressive symptoms between spouses. For example, functional limitation levels in one spouse were associated with depressive symptom levels in the other spouse. Spousal associations remained after controlling for individual (age, education, cognition) and spousal covariates (marriage duration, number of children) and did not differ between women and men. CONCLUSION: Our findings highlight the important role of marital relationships in shaping health trajectories in old age because they show that some of the well-documented between-person differences in functional limitations and depressive symptoms are in fact related to spouses.
Hoppmann, Christiane A Gerstorf, Denis Hibbert, Anita U01 AG009740-12/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Nihms256806 Health Psychol. 2011 Mar;30(2):153-62.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Aging; depression; Female; Humans; Longitudinal Studies; Male; Psychometrics; Spouses; United States

Subsidized housing not subsidized health: health status and fatigue among elders in public housing and other community settings. - Parsons, Pamela L; Briana Mezuk; Scott M Ratliff; Kate L Lapane (Ethn Dis, 2011)
OBJECTIVES: To estimate trends in the prevalence of fatigue among elders living in public housing or in the community; to compare health status of elders living in public housing to their community-dwelling counterparts. DESIGN: Cross-sectional study. SETTING: Community-dwelling elders who reported ever residing in public housing were compared to those living in other community settings. PARTICIPANTS: Participants of the Health and Retirement Study (seven waves of interviews conducted from 1995 through 2006) interviewed in 2006 with complete data on housing status, self-report measures of health status and measures of functioning (n = 16,191). MEASUREMENTS: Self-reported fatigue, functioning, and other health conditions. We also evaluated four functional indices: overall mobility, large muscle functioning, gross motor functioning, and fine motor functioning. RESULTS: Those reporting having lived in public housing were twice as likely to rate their health as fair or poor relative to those with no public housing experience (57.3% vs 26.9%, respectively). Cardiac conditions, stroke, hypertension, diabetes, arthritis and psychiatric problems were all more prevalent in those living in public housing relative to community-dwelling elders not living in public housing. Fatigue was more prevalent in persons residing in public housing (26.7%) as compared to other community-dwelling elders (17.8%). CONCLUSION: The health status of persons residing in public housing is poor. Fatigue and comorbid conditions are highly prevalent and more common in those living in public housing. Developing care models that meet the needs of this oft-neglected population is warranted.
Parsons, Pamela L Mezuk, Briana Ratliff, Scott Lapane, Kate L K12 HD055881/HD/NICHD NIH HHS/United States UL1 RR031990-01/RR/NCRR NIH HHS/United States UL1RR031990/RR/NCRR NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States Ethnicity and disease Nihms287854 Ethn Dis. 2011 Winter;21(1):85-90.
Keywords: Aged; Chronic disease; Comorbidity; Cross-Sectional Studies; Fatigue; Female; Health Status Disparities; Humans; Male; Poverty; Prevalence; Public Housing; United States

Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach. - David F Warner; Tyson H Brown (Soc Sci Med, 2011)
A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings & Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.
Keywords: Age Factors; Black or African American; Disability Evaluation; Disabled Persons; Female; Health Status Disparities; Health Surveys; Hispanic or Latino; Humans; Male; Middle Aged; Models, Statistical; Models, Theoretical; Sex Factors; Social Class; United States; White People

The urban neighborhood and cognitive functioning in late middle age. - Carol S Aneshensel; Michelle J Ko; Joshua Chodosh; Richard G Wight (J Health Soc Behav, 2011)
This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.
Keywords: Activities of Daily Living; Age Factors; Aged; Aging; Chi-Square Distribution; Cognition; Cognition Disorders; ethnicity; Female; Health Status Disparities; Humans; Male; Middle Aged; Psychometrics; Residence Characteristics; Risk Factors; Socioeconomic factors; United States; Urban Population

Utilization of blood transfusion among older adults in the United States. - Mary A M Rogers; Neil Blumberg; Heal, Joanna M; Kenneth M. Langa (Transfusion, 2011)
BACKGROUND: While there have been epidemiologic studies of blood donors, the characteristics of individuals who receive transfusions have not been well described for the US population. STUDY DESIGN AND METHODS: Subjects were from the nationally representative Health and Retirement Study whose data were linked to Medicare files from 1991 through 2007 (n = 16,377). A cohort study was conducted to assess the frequency of transfusion in older Americans over time and to describe the characteristics of blood recipients. RESULTS: Thirty-one percent (95% confidence interval [CI], 30%-33%) of older Americans received at least one transfusion within a 10-year period and 5.8% (95% CI, 5.4%-6.2%) experienced repeated transfusion-related visits within 30 days. The mean number of transfusion-related visits was 2.3 over a 10-year period (95% CI, 2.2-2.4). Older Americans who lived in the South were most likely to receive a transfusion (34%), independent of demographic and health-related factors, while those who lived in the western United States were the least likely (26%). Predictors of transfusion included smoking, low body mass index, and a history of cancer, diabetes mellitus, end-stage renal disease, and heart disease. African-Americans and Mexican-Americans had greater rates of blood utilization than other races and other Hispanics (respectively). There were also differences in transfusion utilization by education, marital status, religion, and alcohol use. CONCLUSIONS: Transfusion is common in older Americans. Regional variations in blood use are not explained by patient characteristics alone.
Keywords: Age Distribution; Aged; Aged, 80 and over; Black or African American; Blood Transfusion; Female; Humans; Male; United States; White People

Volunteer transitions among older adults: the role of human, social, and cultural capital in later life. - Tay K. McNamara; Guillermo Ernest Gonzales (J Gerontol B Psychol Sci Soc Sci, 2011)
OBJECTIVES: We aim to understand how human, social, and cultural capitals are associated with the volunteer process, that is, engagement (starting), intensity (number of hours), and cessation (stopping), among older adults. METHOD: Data from the 2000 through 2008 Health and Retirement Study and the 2001 through 2009 Consumption and Activity Mail Survey provide a sample of 4,526 respondents. Random-effects pooled time series analyses incorporate not only the presence of various types of capital but also the quality of that capital. RESULTS: Human and cultural capitals were positively associated with increased volunteer involvement. Effects of social capital (relationships in the family, employment status, and the community) depended on the quality of the relationships, not necessarily on their presence alone. DISCUSSION: Results suggest that bolstering older adults' capitals, particularly among lower socioeconomic status groups, can increase volunteer engagement and intensity and reduce cessation. Additionally, a variety of organizational policies including respite programs for caregivers and employer policies allowing employees to reduce their work hours might indirectly affect participation rates and commitment. Potential pools of volunteers exist in families, workplaces, and religious organizations, but more research is necessary to identify how to recruit and retain individuals in social networks where volunteer participatory rates are low.
Keywords: Aged; Aging; Caregivers; Community Participation; Cost of Illness; Educational Status; Employment; Female; Health Status; Health Surveys; Humans; Likelihood Functions; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Religion and Psychology; Social Environment; Social Identification; Social Support; Socioeconomic factors; United States; Volunteers

Volunteering and hypertension risk in later life. - Jeffrey A Burr; Jane Tavares; Jan E Mutchler (J Aging Health, 2011)
OBJECTIVE: This study examined the relationship between volunteer activity and hypertension, a risk factor for cardiovascular disease, renal failure, and cognitive impairment. METHOD: Employing data from the Health and Retirement Study, we estimated regression models of hypertension status that include volunteer activity and psychosocial and health behavior risk factors for middle-aged and older persons. RESULTS: Multivariate analyses showed volunteers had lower hypertension risk and lower systolic and diastolic blood pressure than nonvolunteers and that a threshold effect was present, whereby a modest amount of volunteer time commitment (but not a high amount) was associated with lower risk of hypertension. We did neither find support that psychosocial and health behaviors mediated this relationship nor find support for a moderating effect of volunteering for the relationships among health behaviors and hypertension. DISCUSSION: The results of this study indicate that research is needed to determine what mediates the relationship between volunteering and hypertension.
Keywords: Aged; Aged, 80 and over; Body Mass Index; Confidence Intervals; Female; Health Behavior; health policy; Health Status; Humans; Hypertension; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Psychometrics; Regression Analysis; Risk Factors; Social Support; Surveys and Questionnaires; Volunteers

Volunteering, driving status, and mortality in U.S. retirees. - Sei J. Lee; Michael A Steinman; Erwin J Tan (J Am Geriatr Soc, 2011)
OBJECTIVES: To evaluate how accounting for driving status altered the relationship between volunteering and mortality in U.S. retirees. DESIGN: Observational prospective cohort. SETTING: Nationally representative sample from the Health and Retirement Study in 2000 and 2002 followed to 2006. PARTICIPANTS: Retirees aged 65 and older (N=6,408). MEASUREMENTS: Participants self-reported their volunteering, driving status, age, sex, race or ethnicity, presence of chronic conditions, geriatric syndromes, socioeconomic factors, functional limitations, and psychosocial factors. Death by December 31, 2006, was the outcome. RESULTS: For drivers, mortality in volunteers (9%) and nonvolunteers (12%) was similar; for limited or non-drivers, mortality for volunteers (15%) was markedly lower than for nonvolunteers (32%). Adjusted results showed that, for drivers, the volunteering-mortality odds ratio (OR) was 0.90 (95% confidence interval (CI)=0.66-1.22), whereas for limited or nondrivers, the OR was 0.62 (95% CI=0.49-0.78) (interaction P=.05). The effect of driving status was greater for rural participants, with greater differences between rural drivers and rural limited or nondrivers (interaction P=.02) and between urban drivers and urban limited or nondrivers (interaction P=.81). CONCLUSION: The influence of volunteering in decreasing mortality seems to be stronger in rural retirees who are limited or nondrivers. This may be because rural or nondriving retirees are more likely to be socially isolated and thus receive more benefit from the greater social integration from volunteering.
Lee, Sei J Steinman, Michael A Tan, Erwin J K23 AG030999/AG/NIA NIH HHS/United States KL2RR024130/RR/NCRR NIH HHS/United States P30-AG02133/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Journal of the American Geriatrics Society Nihms289698 J Am Geriatr Soc. 2011 Feb;59(2):274-80. doi: 10.1111/j.1532-5415.2010.03265.x.
Keywords: Activities of Daily Living; Aged; Automobile Driving; Female; Health Status; Humans; Male; Prospective Studies; Retirement; Risk Factors; Social Behavior; Survival Rate; United States; Volunteers

Activities of daily living, social support, and future health of older Americans. - Bozo, Ozlem; Charles A Guarnaccia (J Psychol, 2010)
The authors investigated the relation of activities of daily living (ADL) and social support satisfaction to illness status 10 years later among 4,870 married older adults in the Health and Retirement Study (F. Juster & R. Suzman, 1995). The authors tested the direct and indirect effects of 1992 ADL, as well as family and friends support satisfaction and spousal social support satisfaction on 2002 illness status. The hierarchical multiple regressions found, controlling for 1992 illness status, ADL protected against future illness, and family and friends and spousal support satisfaction had small, surprisingly positive, effects on greater 2002 illness. The ADL x Family and Friends Support Satisfaction and the ADL x Spousal Support Satisfaction crossproduct interactions were also small positive predictors of later illness. The authors discuss several possible mechanisms that explained this unexpected result. The authors concluded that, depending on whether the recipient is in need of support and depending on the source of the support, the older adults do or do not benefit from the support.
Using Smart Source Parsing Jan-Feb Index Medicus
Keywords: Activities of Daily Living; Adaptation, Psychological; Aged; Aging; Caregivers; Chronic disease; Female; Friends; Humans; Longitudinal Studies; Male; Middle Aged; Personal Satisfaction; Retirement; Risk Factors; Sick Role; Social Support; Spouses

Advance directives and outcomes of surrogate decision making before death. - Maria J Silveira; Scott Y H Kim; Kenneth M. Langa (N Engl J Med, 2010)
BACKGROUND: Recent discussions about health care reform have raised questions regarding the value of advance directives. METHODS: We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. RESULTS: Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. CONCLUSIONS: Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.
Keywords: Advance directives; Aged; Aged, 80 and over; Decision making; Female; Humans; Living Wills; Logistic Models; Male; Mental Competency; Middle Aged; Proxy; Terminal Care; United States

Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline. - Janet Kay Bobo; April A Greek; Daniel H. Klepinger; Jerald R Herting (J Am Geriatr Soc, 2010)
OBJECTIVES: To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up. DESIGN: Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age. SETTING: Study data were obtained from detailed interviews conducted in the home or by telephone. PARTICIPANTS: One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995. MEASUREMENTS: Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003. RESULTS: All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9% of cohort), infrequent and nondrinkers (61.8%), consistent drinkers (25.9%), and decreasing drinkers (7.4%). Corresponding NLS values from the drinks per day model were 8.8%, 61.4%, 21.2%, and 8.6%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively. CONCLUSION: Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.
Keywords: Aged; Aging; Alcohol Drinking; Alcoholism; Cohort Studies; Female; Follow-Up Studies; Humans; Life Change Events; Middle Aged; Retirement; Risk Factors; Surveys and Questionnaires; United States

Alcohol-consumption trajectories and associated characteristics among adults older than age 50. - Alyssa C Platt; Frank A Sloan; Philip Costanzo (J Stud Alcohol Drugs, 2010)
OBJECTIVE: This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period. METHOD: Data were taken from the Health and Retirement Study. The study sample included individuals ages 51-61 in 1992 who survived the sample period (1992-2006) and had at least five interviews with alcohol consumption information, yielding an analysis sample of 6,787 (3,760 women). We employed linear regression to determine drinking trajectories over 1992-2006. Based on these findings, each sample person was classified into one of five drinking categories. We used multinomial logit analysis to assess the relationship between personal demographic, income, health, and attitudinal characteristics as well as life events and drinking-trajectory category. RESULTS: Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95% CI [1.09, 1.31]), male, White (RRR = 3.54, 95% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health. A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems. CONCLUSIONS: There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.
Keywords: Age Factors; Alcohol Drinking; Alcohol-Related Disorders; Educational Status; Female; Follow-Up Studies; Health Status; Health Surveys; Humans; Life Change Events; Linear Models; Male; Middle Aged; Sex Factors; Socioeconomic factors; Time Factors

Can racial disparity in health between black and white Americans be attributed to racial disparities in body weight and socioeconomic status? - Kahng, Sang Kyoung (Health Soc Work, 2010)
Few studies have examined to what extent racial disparities in chronic health conditions (CHCs) are attributable to racial differences in body weight (measured as body mass index [BMI]) and socioeconomic status (SES) among older adults. To address this gap, using longitudinal data from the Health and Retirement Study, the current study examined risk factors of CHC trajectory including race, BMI, and SES. The sample consists of 22,560 in 1998, 20,825 in 2000, and 19,004 in 2002. Data analysis was done through latent growth curve modeling. As expected, older adults presented an increasing trajectory of CHCs over time. Black Americans presented a significantly more negative CHC trajectory than did their white counterparts, confirming racial disparity in health over time. Consequent hierarchical analyses revealed that racial disparity in CHC trajectory can be explained by racial disparity in BMI and that racial disparity in BMI can be attributed to racial disparity in SES. Because low SES is closely related to unhealthy diet and negative health behaviors that may subsequently lead to obesity and chronic health conditions, the findings suggest that to address racial disparity in CHCs, it is important for social workers to continuously try to mitigate racial inequality in SES.
Keywords: Aged; Black or African American; Body Mass Index; Body Weight; Female; Health Surveys; Healthcare Disparities; Humans; Male; Middle Aged; Social Class; United States; White People

The case for involving adult children outside of the household in the self-management support of older adults with chronic illnesses. - John D Piette; Ann Marie Rosland; Maria J Silveira; Mohammed U Kabeto; Kenneth M. Langa (Chronic Illn, 2010)
OBJECTIVES: This study sought to (1) identify barriers to spousal support for chronic illness self-care among community-dwelling older adults; and (2) describe the potential availability of self-care support from adult children living outside of the household. METHODS: Nationally representative US sample of chronically ill adults aged 51+ were interviewed as part of the Health and Retirement Study (N = 14,862). Both participants and their spouses (when available) reported information about their health and functioning. Participants also reported information about their contact with adult children and the quality of those relationships. RESULTS: More than one-third (38%) of chronically ill older adults in the US are unmarried; and when spouses are available, the majority of them have multiple chronic diseases and functional limitations. However, the vast majority of chronically ill older adults (93%, representing roughly 60 million Americans) have adult children, with half having children living over 10 miles away. Most respondents with children (78%) reported at least weekly telephone contact and that these relationships were positive. Roughly 19 million older chronically ill Americans have adult children living at a distance but none nearby; these children are in frequent telephone contact and respondents (including those with multiple chronic diseases) report that the relationships are positive. DISCUSSION: As the gap between available health services for disease management and the need among community-dwelling patients continues to grow, adult children-including those living at a distance-represent an important resource for improving self-care support for people with chronic diseases.
Keywords: Adult; Chronic disease; Family Relations; Female; Humans; Male; Middle Aged; Self Care; Social Support

Causes and consequences of early-life health. - Case, Anne; Paxson, Christina (Demography, 2010)
We examine the consequences of child health for economic and health outcomes in adulthood, using height as a marker of childhood health. After reviewing previous evidence, we present a conceptual framework that highlights data limitations and methodological problems that complicate the study of this topic. We then present estimates of the associations between height and a range of outcomes--including schooling, employment, earnings, health, and cognitive ability--measured in five data sets from early to late adulthood. These results indicate that, on average, taller individuals attain higher levels of education. Height is also positively associated with better economic, health, and cognitive outcomes. These associations are only partially explained by the higher average educational attainment of taller individuals. We then use data from the National Longitudinal Survey of Youth 1979 Children and Young Adults survey to document the associations between health, cognitive development, and growth in childhood. Even among children with the same mother, taller siblings score better on cognitive tests and progress through school more quickly. Part of the differences found between siblings arises from differences in their birth weights and lengths attributable to mother's behaviors while pregnant. Taken together, these results support the hypothesis that childhood health influences health and economic status throughout adulthood.
Keywords: Adolescent; Adult; Aged; Body Height; Child; Child Development; Child, Preschool; Educational Status; Employment; Family Characteristics; Female; Health Status; Humans; Income; Infant; Infant, Newborn; Longitudinal Studies; Male; Middle Aged; Pregnancy; Prenatal Exposure Delayed Effects; Regression Analysis; Socioeconomic factors; United Kingdom

Characteristics of physical measurement consent in a population-based survey of older adults. - Joseph W Sakshaug; Mick P. Couper; Mary Beth Ofstedal (Med Care, 2010)
BACKGROUND: Collecting physical measurements in population-based health surveys has increased in recent years, yet little is known about the characteristics of those who consent to these measurements. OBJECTIVE: To examine the characteristics of persons who consent to physical measurements across several domains, including one's demographic background, health status, resistance behavior toward the survey interview, and interviewer characteristics. RESEARCH DESIGN, SUBJECTS, AND MEASURES: We conducted a secondary data analysis of the 2006 Health and Retirement Study, a nationally-representative panel survey of older adults aged 51 and older. We performed multilevel logistic regressions on a sample of 7457 respondents who were eligible for physical measurements. The primary outcome measure was consent to all physical measurements. RESULTS: Seventy-nine percent (unweighted) of eligible respondents consented to all physical measurements. In weighted multilevel logistic regressions controlling for respondent demographics, current health status, survey resistance indicators, and interviewer characteristics, the propensity to consent was significantly greater among Hispanic respondents matched with bilingual Hispanic interviewers, patients with diabetes, and those who visited a doctor in the past 2 years. The propensity to consent was significantly lower among younger respondents, those who have several Nagi functional limitations and infrequently participate in "mildly vigorous" activities, and those interviewed by black interviewers. Survey resistance indicators, such as number of contact attempts and interviewer observations of resistant behavior in prior wave iterations of the Health and Retirement Study were also negatively associated with physical measurement consent. The propensity to consent was unrelated to prior medical diagnoses, including high blood pressure, cancer (excluding skin), lung disease, heart abnormalities, stroke, and arthritis, and matching of interviewer and respondent on race and gender. CONCLUSIONS: Physical measurement consent is not strongly associated with one's health status, though the findings are somewhat mixed. We recommend that physical measurement results be adjusted for characteristics associated with the likelihood of consent, particularly functional limitations, to reduce potential bias. Otherwise, health researchers should exercise caution when generalizing physical measurement results to the population at large, including persons with functional limitations that may affect their participation.
Keywords: Age Factors; Aged; Female; Health Status; Health Surveys; Humans; Male; Middle Aged; Physical Examination; Socioeconomic factors

Childhood socioeconomic position and disability in later life: results of the health and retirement study. - Mary E Bowen; Hector M González (Am J Public Health, 2010)
OBJECTIVES: We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life. METHODS: We used longitudinal data from the nationally representative Health and Retirement Study (1998-2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS: Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities. CONCLUSIONS: Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life.
Keywords: Activities of Daily Living; Cohort Studies; Disabled Persons; Female; Humans; Male; Michigan; Middle Aged; Prospective Studies; Retirement; Risk Assessment; Social Class

Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. - Caroline S Blaum; Christine T Cigolle; Cynthia Boyd; Jennifer L. Wolff; Zhiyi Tian; Kenneth M. Langa; David R Weir (Med Care, 2010)
BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions. OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics. DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey. SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million). MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c. RESULTS: Nearly 22% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6% vs. 7.3%, P < 0.04.). CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.
Keywords: Aged; Cross-Sectional Studies; Diabetes Complications; Diabetes Mellitus, Type 2; Female; Glycemic Index; Health Status; Health Surveys; Humans; Male; Middle Aged; Quality of Health Care; Self Care; Severity of Illness Index; Treatment Failure; United States

Comparison study on functional outcomes and perceived quality of life between all-inclusive and fee-for-service continuing care retirement communities. - Young, Yuchi (J Am Med Dir Assoc, 2010)
OBJECTIVE: To examine the associations between 2 types of continuing care retirement communities' (CCRC) residents regarding physical function and perceived quality of life. METHODS: Cross-sectional study (n=406). Eligibility criteria include age 65 years or older, residents of independent living units, and intact cognition (MMSE>or=24). All-inclusive CCRCs provide unlimited access to home health services and nursing home care as needed in return for the entry and monthly fee. Fee-for-service CCRCs offer home health and nursing home services at a full fee-for-service rate. Outcomes were functional status (ADLs and IADLs) and perceived quality of life. Multivariate regressions were used to examine the associations between residents of different types of CCRCs on selected outcomes while adjusting for covariates. RESULTS: The all-inclusive CCRC sample was more likely to be married (53.8% versus 33.4%; P < .001), with more years of education (17.9 versus 14.4; P < .0001), and had few physician visits in the previous year in comparison to the FFS CCRC sample. Multivariate results indicate that the FFS group had worse ADL (beta=0.95; P=.0003), IADL (beta=0.57; P=.02) function than the all-inclusive group. There was no significant difference in perceived quality of life scores between the 2 groups. CONCLUSIONS: Residents of both CCRCs reported equally good quality of life scores. Residents of the all-inclusive CCRC seem to have had better ADL and IADL function than the FFS CCRC residents. Prepaid home health services and nursing home care in the all-inclusive CCRC may facilitate ADL and IADL functional independence.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Cross-Sectional Studies; Fee-for-Service Plans; Female; Humans; Male; New York; Outcome Assessment, Health Care; Quality of Life; Residential Facilities

Continuity of care with a primary care physician and mortality in older adults. - Frederic D Wolinsky; Suzanne E Bentler; Li Liu; John F Geweke; Elizabeth A Cook; Maksym Obrizan; Elizabeth A Chrischilles; Kara B Wright; Michael P Jones; Gary E Rosenthal; Robert L. Ohsfeldt; Robert B Wallace (J Gerontol A Biol Sci Med Sci, 2010)
BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality. METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met. RESULTS: Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure). CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.
Keywords: Aged; Continuity of Patient Care; Female; Health Services for the Aged; Humans; Male; Mortality; Physicians, Family

Coronary heart disease from a life-course approach: findings from the health and retirement study, 1998-2004. - Mary E Bowen (J Aging Health, 2010)
OBJECTIVE: Guided by a life-course approach to chronic disease, this study examined the ways in which childhood deprivation (low parental education and father's manual occupation) may be associated with coronary heart disease (CHD). METHOD: Multilevel modeling techniques and a nationally representative sample of Americans above age 50 from the Health and Retirement Study (HRS; N = 18,465) were used to examine childhood and CHD relationships over the course of 6 years (1998-2004). RESULTS: Having a father with </=8 years of education was associated with 11% higher odds of CHD, accounting for demographic characteristics, adult socioeconomic status (SES; education, income, and wealth), CHD risks (diabetes, hypertension, cigarette smoking, and obesity), and other factors (childhood health, exercise, stroke, and marital status). DISCUSSION: Policies and programs aimed at improving the conditions of poor children and their families may effectively reduce the prevalence of CHD in later life.
Keywords: Age Factors; Aged; Aging; Coronary Artery Disease; Educational Status; Female; Health Status Disparities; Health Surveys; Humans; Income; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Poverty; Prevalence; Retirement; Risk Assessment; Risk Factors; Self Report; Social Class; Socioeconomic factors; United States

Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. - Oksuzyan, Anna; Eileen M. Crimmins; Saito, Yasuhiko; Angela M O'Rand; James W Vaupel; Christensen, Kaare (Eur J Epidemiol, 2010)
The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.
Keywords: Aged; Aged, 80 and over; Denmark; Disability Evaluation; Female; Health Status; Humans; Japan; Male; Middle Aged; Mortality; Sex Distribution; United States

Dental care coverage and retirement. - Richard J. Manski; John F Moeller; Jody Schimmel; Patricia A St Clair; Haiyan Chen; Larry S. Magder; John V Pepper (J Public Health Dent, 2010)
OBJECTIVES: 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). METHODS: 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. We also estimate a multivariate model controlling for potentially confounding variables. RESULTS: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage. CONCLUSIONS: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.
Keywords: Aged; Employment; ethnicity; Female; Humans; Income; Insurance, Dental; Male; Middle Aged; Models, Statistical; Multivariate Analysis; Retirement; United States

Dental care expenditures and retirement. - Richard J. Manski; John F Moeller; Haiyan Chen; Patricia A St Clair; Jody Schimmel; Larry S. Magder; John V Pepper (J Public Health Dent, 2010)
OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS). METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables. RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status. CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.
Keywords: Age Factors; Aged; Dental Care; Educational Status; ethnicity; Female; Financing, Personal; Humans; Income; Insurance Coverage; Insurance, Dental; Male; Marital Status; Middle Aged; Mouth, Edentulous; Retirement; United States

Dental care utilization and retirement. - Richard J. Manski; John F Moeller; Haiyan Chen; Patricia A St Clair; Jody Schimmel; Larry S. Magder; John V Pepper (J Public Health Dent, 2010)
OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS). METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables. RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate. CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.
Manski, Richard J Moeller, John Chen, Haiyan St Clair, Patricia A Schimmel, Jody Magder, Larry Pepper, John V R01 AG026090-01A2/AG/NIA NIH HHS/United States R01 AG026090-03/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Nihms172468 J Public Health Dent. 2010 Winter;70(1):67-75.
Keywords: Aged; Confounding Factors, Epidemiologic; Dental Care; Employment; ethnicity; Female; health policy; Humans; Income; Insurance, Dental; Leisure activities; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Retirement; Socioeconomic factors; United States