Prevalence of dementia in the United States: the aging, demographics, and memory study. - Brenda L Plassman; Kenneth M. Langa; Gwenith G Fisher; Steven G Heeringa; David R Weir; Mary Beth Ofstedal; James R Burke; Michael D Hurd; Guy G Potter; Willard L Rodgers; David C Steffens; Robert J. Willis; et al. (Neuroepidemiology, 2007)
AIM: To estimate the prevalence of Alzheimer's disease (AD) and other dementias in the USA using a nationally representative sample. METHODS: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender. RESULTS: The prevalence of dementia among individuals aged 71 and older was 13.9%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0% of those aged 71-79 years to 37.4% of those aged 90 and older. CONCLUSIONS: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.
Keywords: Age Distribution; Aged; Aged, 80 and over; Cohort Studies; Dementia; Female; Geriatric Assessment; Health Surveys; Humans; Logistic Models; Male; Prevalence; Sex Distribution; United States

Profiling retirees in the retirement transition and adjustment process: examining the longitudinal change patterns of retirees' psychological well-being. - Wang, Mo (Journal of Applied Psychology, 2007)
The author used role theory, continuity theory, and the life course perspective to form hypotheses regarding the different retirement transition and adjustment patterns and how different individual and contextual variables related to those patterns. The longitudinal data of 2 samples (n(1) = 994; n(2) = 1,066) from the Health and Retirement Survey were used. Three latent growth curve patterns of retirees' psychological well-being were identified as coexisting in the retiree samples through growth mixture modeling (GMM) analysis. On the basis of the latent class membership derived from GMM, retiree subgroups directly linked to different growth curve patterns were profiled with individual (e.g., bridge job status) and contextual variables (e.g., spouse working status). By recognizing the existence of multiple retiree subgroups corresponding to different psychological well-being change patterns, this study suggests that retirees do not follow a uniform adjustment pattern during the retirement process, which reconciles inconsistent previous findings. A resource perspective is further introduced to provide a more integrated theory for the current findings. The practical implications of this study are also discussed at both individual level and policy level.
Keywords: Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Quality of Life; Retirement; Social Adjustment

Racial/ethnic differences in the development of disability among older adults. - Dorothy D Dunlop; Song, Jing; Larry M Manheim; Daviglus, Martha L.; Rowland W Chang (Am J Public Health, 2007)
OBJECTIVES: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English. METHODS: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference. RESULTS: The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2). CONCLUSIONS: Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.
Keywords: Activities of Daily Living; Aged; Black or African American; Disabled Persons; Female; Health Behavior; Health Status Disparities; Health Surveys; Hispanic or Latino; Humans; Male; Prevalence; Proportional Hazards Models; Prospective Studies; Risk; Socioeconomic factors; Survival Analysis; United States; White People

The relationship between self-rated health and mortality in older black and white Americans. - Sei J. Lee; Sandra Y. Moody-Ayers; C. Seth Landefeld; Louise C Walter; Lindquist, Karla; Mark Segal; Kenneth E Covinsky (J Am Geriatr Soc, 2007)
OBJECTIVES: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship. DESIGN: Prospective cohort. SETTING: Communities in the United States. PARTICIPANTS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older. MEASUREMENTS: Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index. RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH. CONCLUSION: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.
Keywords: Age Distribution; Aged; Aged, 80 and over; Black People; Educational Status; Female; Health Status; Humans; Male; Middle Aged; Mortality; Population Surveillance; Prognosis; Self Disclosure; Sex Distribution; United States; White People

Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter? - Muramatsu, Naoko; yin, Hongjun; Richard T. Campbell; Ruby L Hoyem; Martha A. Jacob; Christopher Ross (J Gerontol B Psychol Sci Soc Sci, 2007)
OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects. METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier. RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%. DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.
Keywords: Aged; Aged, 80 and over; Caregivers; Cohort Studies; Cost Savings; Cost-Benefit Analysis; Female; Financing, Government; Health Expenditures; Home Care Services; Homes for the Aged; Humans; Insurance Coverage; Long-term Care; Male; Medicaid; Medicare; Nursing homes; Patient Admission; Patient Readmission; Risk Assessment; Risk Factors; State Health Plans; United States

Self-rated health trajectories and mortality among older adults. - Thomas R Miller; Frederic D Wolinsky (J Gerontol B Psychol Sci Soc Sci, 2007)
OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates. METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources. RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked. DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.
Keywords: Age Factors; Aged; Aged, 80 and over; Attitude to Health; Cardiovascular Diseases; Cause of Death; Female; Follow-Up Studies; Health Status; Health Status Indicators; Humans; Logistic Models; Longitudinal Studies; Lung Diseases; Male; Mortality; Multivariate Analysis; Risk Factors; Sex Factors; Smoking; Socioeconomic factors; Survival Analysis; United States

Should health studies measure wealth? A systematic review. - Craig E Pollack; Chideya, Sekai; Cubbin, Catherine; Brie A Williams; Dekker, Mercedes; Paula Braveman (Am J Prev Med, 2007)
BACKGROUND: Health researchers rarely measure accumulated wealth to reflect socioeconomic status/position (SES). In order to determine whether health research should more frequently include measures of wealth, this study assessed the relationship between wealth and health. METHODS: Studies published between 1990 to 2006 were systematically reviewed. Included studies used wealth and at least one other SES measure as independent variables, and a health-related dependent variable. RESULTS: Twenty-nine studies met inclusion criteria. Measures of wealth varied greatly. In most studies, greater wealth was associated with better health, even after adjusting for other SES measures. The findings appeared most consistent when using detailed wealth measures on specific assets and debts, rather than a single question. Adjusting for wealth generally decreased observed racial/ethnic disparities in health. CONCLUSIONS: Health studies should include wealth as an important SES indicator. Failure to measure wealth may result in under-estimating the contribution of SES to health, such as when studying the etiology of racial/ethnic disparities. Validation is needed for simpler approaches to measuring wealth that would be feasible in health studies.
Keywords: Bias; Biomedical Research; Female; Financing, Personal; Health Services Research; Health Status Indicators; Humans; Male; Research Design; Socioeconomic factors

Is the 'stroke belt' worn from childhood?: risk of first stroke and state of residence in childhood and adulthood. - M. Maria Glymour; Mauricio Avendano; Lisa F Berkman (Stroke, 2007)
BACKGROUND AND PURPOSE: Most Stroke Belt studies define exposure based on residence at stroke onset. We assessed whether residence in the Stroke Belt during childhood confers extra stroke risk in adulthood, even among people who left the region. METHODS: Stroke-free Health and Retirement Study participants (n=18 070) followed up (average, 8.4 years) for first stroke (1452 events) were classified as living in 1 of 7 Stroke Belt states in childhood or at study enrollment (average age, 63 years). We used Cox proportional-hazards models to compare stroke risk for people who had never lived in the Stroke Belt with those who had lived there at both ages, in childhood only, or in adulthood only. RESULTS: Compared with never having lived in the Stroke Belt, the hazard ratio for Stroke Belt residence in both childhood and adulthood was 1.23 (95% CI, 1.06, 1.43) and for Stroke Belt residence in childhood only was 1.25 (95% CI, 1.02, 1.55). Stroke Belt residence at enrollment but not during childhood was not significantly related to stroke risk (hazard ratio=1.01; 95% CI, 0.70, 1.46), but the small sample in this group resulted in wide CIs. Results changed little after risk factor adjustment, including comprehensive adult socioeconomic measures. Subgroup analyses found similar patterns by sex and birth cohort. In contrast, blacks who had lived in the Stroke Belt in childhood only did not appear to have significantly elevated stroke risk compared with blacks who had never lived in the Stroke Belt. CONCLUSIONS: The excess stroke risk for people who had lived in Stroke Belt states during childhood implicates early life exposures in the etiology of the Stroke Belt.
Keywords: Adult; Child; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Proportional Hazards Models; Risk Factors; Southeastern United States; Stroke

Urban neighborhoods and depressive symptoms among older adults. - Carol S Aneshensel; Richard G Wight; Miller-Martinez, Dana; Amanda L. Botticello; Arun S Karlamangla; Teresa Seeman (J Gerontol B Psychol Sci Soc Sci, 2007)
OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older. METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models. RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population. DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Female; Health Status Indicators; Health Surveys; Humans; Incidence; Male; Minority Groups; Peer Group; Population Dynamics; Risk Factors; Social Environment; United States; Urban Population

Use of health services by previously uninsured Medicare beneficiaries. - J. Michael McWilliams; Meara, Ellen; Alan M. Zaslavsky; John Z. Ayanian (N Engl J Med, 2007)
BACKGROUND: Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured. METHODS: We used longitudinal data from the nationally representative Health and Retirement Study to assess self-reported health care use and expenditures from 1992 through 2004 among 5158 adults who were privately insured or uninsured before Medicare coverage began at the age of 65 years. We used propensity-score methods to compare health care use and expenditures for previously insured and uninsured beneficiaries who were similar across numerous characteristics at 59 to 60 years of age and adjusted for differences in supplemental and prescription-drug coverage after 65 years of age. RESULTS: Among 2951 adults with hypertension, diabetes, heart disease, or stroke diagnosed before 65 years of age, previously uninsured adults who acquired Medicare coverage at the age of 65 reported significantly greater increases in the numbers of doctor visits (P<0.001) and hospitalizations (P=0.001) and in total medical expenditures (P=0.02) than did previously insured adults. Significant differential increases were not evident among the 2207 adults without these conditions (P>0.12 for all comparisons). In analyses adjusted for supplemental and prescription-drug coverage, previously uninsured adults with these conditions reported more doctor visits (13% relative difference, P=0.04), more hospitalizations (20% relative difference, P=0.04), and higher total medical expenditures (51% relative difference, P=0.09) from ages 65 to 72 years than did previously insured adults. CONCLUSIONS: The costs of expanding health insurance coverage for uninsured adults before they reach the age of 65 years may be partially offset by subsequent reductions in health care use and spending for these adults after the age of 65, particularly if they have cardiovascular disease or diabetes before the age of 65 years.
Keywords: Aged; Cardiovascular Diseases; Diabetes Mellitus; Female; Health Expenditures; Health Services; Hospitalization; Humans; Insurance, Health; Logistic Models; Longitudinal Studies; Male; Medically Uninsured; Medicare; Middle Aged; Socioeconomic factors; United States

Use of preventive care by the working poor in the United States. - Joseph S. Ross; Bernheim, Susannah M.; Elizabeth H Bradley; Teng, Hsun-Mei; William T Gallo (Prev Med, 2007)
OBJECTIVE: Examine the association between poverty and preventive care use among older working adults. METHOD: Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200% of the federal poverty level were defined as poor. RESULTS: Among 10,088 older working adults, overall preventive care use ranged from 38% (influenza vaccination) to 76% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95% CI, 0.86-0.96), prostate cancer (RR 0.89, 95% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95% CI, 0.84-1.01). CONCLUSION: The older working poor are at modestly increased risk for not receiving preventive care.
Keywords: Cost of Illness; Cross-Sectional Studies; Employment; Female; Health Promotion; Health Services Accessibility; Health Services Needs and Demand; Humans; Male; Mass Screening; Middle Aged; Patient Acceptance of Health Care; Poverty; Preventive Health Services; Risk Assessment; Socioeconomic factors; United States; Vulnerable Populations

Weight and depressive symptoms in older adults: direction of influence? - Valerie L Forman-Hoffman; Jon W. Yankey; Stephen L Hillis; Robert B Wallace (J Gerontol B Psychol Sci Soc Sci, 2007)
OBJECTIVE: . The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa. RESULT: . Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95% CI = 1.00-1.54; women: OR = 1.12, 95% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Body Mass Index; Cohort Studies; Comorbidity; Depressive Disorder; Female; Health Status Indicators; Health Surveys; Humans; Longitudinal Studies; Male; Middle Aged; Models, Statistical; Odds Ratio; Prospective Studies; Sex Factors; Statistics as Topic; United States; Weight Gain; Weight Loss

Changes in health for the uninsured after reaching age-eligibility for Medicare. - David W. Baker; Joseph Feinglass; Durazo-Arvizu, Ramon; Whitney P. Witt; Joseph J Sudano; Jason A. Thompson (J Gen Intern Med, 2006)
BACKGROUND: Uninsured adults in late middle age are more likely to have a health decline than individuals with private insurance. OBJECTIVE: To determine how health and the risk of future adverse health outcomes changes after the uninsured gain Medicare. DESIGN: Prospective cohort study. PARTICIPANTS: Participants (N=3,419) in the Health and Retirement Study who transitioned from private insurance or being uninsured to having Medicare coverage at the 1996, 1998, 2000, or 2002 interview. MEASUREMENTS: We analyzed risk-adjusted changes in self-reported overall health and physical functioning during the transition period to Medicare (t(-2) to t(0)) and the following 2 years (t(0) to t(2)). RESULTS: Between the interview before age 65 (t(-2)) and the first interview after reaching age 65 (t(0)), previously uninsured individuals were more likely than those who had private insurance to have a major decline in overall health (adjusted relative risk [ARR] 1.46; 95% confidence interval [CI] 1.03 to 2.04) and to develop a new physical difficulty affecting mobility (ARR 1.24; 95% CI 0.96 to 1.56) or agility (ARR 1.33; 95% CI 1.12 to 1.54). Rates of improvement were similar between the 2 groups. During the next 2 years (t(0) to t(2)), adjusted rates of declines in overall health and physical functioning were similar for individuals who were uninsured and those who had private insurance before gaining Medicare. CONCLUSIONS: Gaining Medicare does not lead to immediate health benefits for individuals who were uninsured before age 65. However, after 2 or more years of continuous coverage, the uninsured no longer have a higher risk of adverse health outcomes.
Keywords: Age Factors; Aged; Cohort Studies; Eligibility Determination; Female; Health Status; Humans; Male; Medically Uninsured; Medicare; Middle Aged; Prospective Studies; United States

Cohabitation among older adults: a national portrait. - Susan L. Brown; Lee, Gary R.; Jennifer R. Bulanda (J Gerontol B Psychol Sci Soc Sci, 2006)
OBJECTIVE: Older adults are increasingly likely to experience cohabitation, or living together unmarried in an intimate, heterosexual union. In order to begin building a conceptual framework, we provide a descriptive portrait of older adult cohabitors, emphasizing how they compare to older remarrieds and unpartnereds. METHODS: We used data from both Census 2000 and the 1998 Health and Retirement Study ( HRS; Health and Retirement Study, 1998) to estimate the size and composition of the cohabiting population aged 51 and older. Also, using HRS data, we estimated multinomial logistic regression models to identify the correlates associated with cohabitation and remarriage (vs being unpartnered) among women and men who were previously married. RESULT: More than 1 million older adults, composing 4% of the unmarried population, currently cohabit. About 90% of these individuals were previously married. We identify significant differences among cohabitors, remarrieds, and unpartnereds across several dimensions, including sociodemographic characteristics, economic resources, physical health, and social relationships. Cohabitors appear to be more disadvantaged than remarrieds, and this is especially evident for women. DISCUSSION: Older cohabitors differ from individuals of other marital statuses, and therefore future work on marital status should explicitly incorporate cohabitation.
Keywords: Activities of Daily Living; Demography; Female; Health Status; Humans; Interpersonal Relations; Male; Marriage; Middle Aged; Residence Characteristics; Sexual Partners; Surveys and Questionnaires; United States

Crediting care or marriage? Reforming Social Security family benefits. - Herd, Pamela (J Gerontol B Psychol Sci Soc Sci, 2006)
OBJECTIVE: For more than 20 years policy advocates and policymakers have argued that Social Security should reward women for raising children. Current family benefits, which only benefit women who marry, are thought to be outdated and unable to protect the neediest women. Thus, would Black and poor women fare better if family benefits were linked to parenthood, as opposed to marriage? I examined three care credit proposals that reflect the most common proposals put forth in the United States and the most common designs in other countries. METHODS: I used the 1992 Health and Retirement Study and the Current Population Survey to create a policy simulation that estimates how women reaching age 62 from 2020 to 2030 would be affected by care credits. RESULT: Black and poor women fared best with benefits linked to parenthood. The specific proposal allowed parents, from the 35 earnings years used to calculate their benefit, to substitute $15,000 for up to 9 earnings' years that fell below this level. DISCUSSION: The poorest women fare better with family benefits linked to parenthood instead of marital status. Moreover, they fare best when working women can benefit from care credits, but the care credit's value is not linked to earnings.
Keywords: Family; Female; Humans; Insurance Benefits; Marital Status; Mothers; Social Security; United States

Driving cessation and consumption expenses in the later years. - Hyungsoo Kim; Virginia E. Richardson (J Gerontol B Psychol Sci Soc Sci, 2006)
OBJECTIVES: This study examined the association between consumption and driving status among older persons within the context of selected variables, including self-rated health and functional status. METHODS: The data were from the 1998, 2000, and 2002 Health and Retirement Study and the 2003 Health and Retirement Study Consumption and Activities Mail Survey. We conducted Tobit regression analyses on five consumption categories of basic needs (such as food) and higher order needs (such as trips and dining out). RESULTS: Consumption and driving status were significantly associated, showing that driving cessation was related to a 46% to 63% reduction in spending on trips, tickets, and dining out. Another significant relationship emerged between consumption and having never driven. Driving cessation was minimally related to consumption of basic needs (such as food and clothing) and was more strongly associated with higher order needs (such as trips). DISCUSSION: The findings demonstrate the association between older people's driving status and consumption, specifically higher order activities. Older persons who drive and, presumably, have more opportunities to go to stores, restaurants, and other outside events, spend more on food, tickets, and dining out than those who cease driving or have never driven. Although the direction of causality remains unclear, these findings have implications for those concerned with alternative transportation resources for older adults.
Keywords: Aged; Automobile Driving; Economics; Female; Health Status; Humans; Male; Sex Factors; Surveys and Questionnaires; Transportation

The effect of private insurance on the health of older, working age adults: evidence from the health and retirement study. - Avi Dor; Joseph J Sudano; David W. Baker (Health Serv Res, 2006)
OBJECTIVE: Primarily, to determine if the presence of private insurance leads to improved health status, as measured by a survey-based health score. Secondarily, to explore sensitivity of estimates to adjustments for endogeneity. The study focuses on adults in late middle age who are nearing entry into Medicare. DATA SOURCES: The analysis file is drawn from the Health and Retirement Study, a national survey of relatively older adults in the labor force. The dependent variable, an index of 5 health outcome items, was obtained from the 1996 survey. Independent variables were obtained from the 1992 survey. State-level instrumental variables were obtained from the Area Resources File and the TAXSIM file. The final sample consists of 9,034 individuals of which 1,540 were uninsured. STUDY DESIGN: Estimation addresses endogeneity of the insurance participation decision in health score regressions. In addition to ordinary least squares (OLS), two models are tested: an instrumental variables (IV) model, and a model with endogenous treatment effects due to Heckman (1978). Insurance participation and health behaviors enter with a lag to allow their effects to dissipate over time. Separate regressions were run for groupings of chronic conditions. PRINCIPAL FINDINGS: The OLS model results in statistically significant albeit small effects of insurance on the computed health score, but the results may be downward biased. Adjusting for endogeneity using state-level instrumental variables yields up to a six-fold increase in the insurance effect. Results are consistent across IV and treatment effects models, and for major groupings of medical conditions. The insurance effect appears to be in the range of about 2-11 percent. There appear to be no significant differences in the insurance effect for subgroups with and without major chronic conditions. CONCLUSIONS: Extending insurance coverage to working age adults may result in improved health. By conjecture, policies aimed at expanding coverage to this population may lead to improved health at retirement and entry to Medicare, potentially leading to savings. However, further research is needed to determine whether similar results are found when alternative measures of overall health or health scores are used. Future research should also explore the use of alternative instrumental variables. Preliminary results provide no justification for targeting certain subgroups with susceptibility to certain chronic conditions rather than broad policy interventions.
Keywords: Chronic disease; Data collection; Female; Health Status; Humans; Insurance, Health; Male; Medically Uninsured; Middle Aged; Private Sector; United States

The effect of recurrent involuntary job loss on the depressive symptoms of older US workers. - William T Gallo; Elizabeth H Bradley; Teng, Hsun-Mei; Stanislav V Kasl (Int Arch Occup Environ Health, 2006)
OBJECTIVES: The objective of this study was to assess whether recurrent involuntary job loss among US workers nearing retirement resulted in increasingly less severe changes in depressive symptoms with successive job losses. METHODS: With data drawn from the US Health and Retirement Survey (HRS), we used repeated measures longitudinal analysis to investigate the effect of recurrent job loss on follow-up depressive symptoms, measured up to 2 years following job loss. Study participants include 617 individuals, aged 51-61 years at the 1992 study baseline, who had at least one job loss between 1990 and 2000. Our primary outcome variable was a continuous measure of depressive symptoms, constructed from the 8-item Center for Epidemiologic Studies-Depression (CES-D) battery administered at every HRS wave. A second, dichotomous outcome, derived from the continuous measure, measured clinically relevant depressive symptoms. The exposure (recurrent job loss) was defined by binary dummy variables representing two and three/four job losses. All job losses were the result of either plant closing or layoff. RESULTS: Our main finding indicates that, after relevant covariates are controlled, compared to one job loss, two job losses result in a modest increase in the level depressive symptoms (not significant) at two-year follow-up. Three or more job losses result, on average, in a decline in depressive symptoms to a level near pre-displacement assessment (not significant). Somewhat in contrast, two job losses were found to be associated with increased risk of clinically relevant depressive symptoms. CONCLUSIONS: The principal finding confirms our hypothesis that, among US workers nearing retirement, repeated exposure to job separation results in diminished effects on mental health. Adaptation to the job loss stressor may underlie the observed response, although other explanations, including macroeconomic developments, are possible.
Keywords: Adaptation, Physiological; depression; Employment; Female; Humans; Life Change Events; Longitudinal Studies; Male; Middle Aged; Retirement; Stress, Psychological; United States

Effects of retirement and grandchild care on depressive symptoms. - Maximiliane E Szinovacz; Adam Davey (Int J Aging Hum Dev, 2006)
This study explores how grandchild care in conjunction with grandparents' retirement affects depressive symptoms, using data from the Health and Retirement Survey. The findings demonstrate that retirement moderates the influence of grandchild care obligations on well-being, measured by depressive symptoms. For retired men, freedom from grandchild care obligations is associated with heightened well-being. Among women, continued employment seems to protect against potential negative effects of extensive grandchild care obligations on well-being. The results for men seem most in line with the argument that family care obligations spoil retirement, whereas the results for women suggest a scenario that is most compatible with the role enhancement thesis.
Keywords: Aged; Aging; Child; Child Rearing; depression; Family Characteristics; Female; Holistic health; Humans; Intergenerational Relations; Leisure activities; Longitudinal Studies; Male; Middle Aged; Retirement; Sex Factors; Social Responsibility; Surveys and Questionnaires; United States

Expansion of elderly couples' IADL caregiver networks beyond the marital dyad. - Sheila Feld; Ruth E Dunkle; Tracy Schroepfer (Int J Aging Hum Dev, 2006)
Factors influencing expansion of instrumental activities of daily living (IADL) caregiver networks beyond the spouse/partner were studied, using data from the Asset and Health Dynamics among the Oldest Old (AHEAD) nationally representative sample of American elders (ages 70 and older). Analyses were based on 427 Black and White couples in which one partner regularly received IADL assistance; nearly 20% had expanded networks. Logistic regression showed expanded networks were significantly more likely when spouses had IADL or basic personal activity of everyday living (ADL) limitations and help recipients were wives or had numerous IADL or ADL limitations; they also tended to be more common (p <.10) for couples with numerous nearby daughters and help recipients with proxies and those without serious cognitive problems. Network expansion was unrelated to recipients' number of health conditions and Medicaid coverage or couples' ages, marital duration, income, and number of proximate sons. Implications for service programs and caregiving theories of the circumstances linked to IADL assistance from outside the marital dyad are discussed.
Keywords: Activities of Daily Living; Aged; Caregivers; Female; Humans; Logistic Models; Male; Marriage; Multivariate Analysis; Self-Help Groups

Explaining US racial/ethnic disparities in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance. - Joseph J Sudano; David W. Baker (Soc Sci Med, 2006)
Pervasive health disparities continue to exist among racial/ethnic minority groups, but the factors related to these disparities have not been fully elucidated. We undertook this prospective cohort study to determine the independent contributions of socioeconomic status (SES), health behaviors, and health insurance in explaining racial/ethnic disparities in mortality and health declines. Our study period was 1992-1998, and our study population consists of a US nationally representative sample of 6286 non-Hispanic whites (W), 1391 non-Hispanic blacks (B), 405 Hispanics interviewed in English (H/E), and 318 Hispanics interviewed in Spanish (H/S), ages 51-61 in 1992 in the Health and Retirement Study. The main outcome measures were death; major decline in self-reported overall health (SROH); and combined outcome of death or major decline in SROH. Crude mortality rates over the 6-year study period for W, B, H/E and H/S were 5.8%, 10.6%, 5.8%, and 4.4%, respectively. Rates of major decline in SROH were 14.6%, 23.2%, 22.1% and 39.4%, for W, B, H/E and H/S, respectively. Higher mortality rates for B versus W were mostly explained by worse baseline health. For major decline in SROH, education, income, and net worth independently explained more of the disparities for all three minority groups as compared to health behaviors and insurance, reducing the effect for B and H/E to non-significance, while leaving a significant elevated odds ratio for H/S. Without addressing the as-yet undetermined and pernicious effects of lower SES, public health initiatives that promote changing individual health behaviors and increasing rates of insurance coverage among blacks and Hispanics will not eliminate racial/ethnic health disparities.
Keywords: Black or African American; Cohort Studies; Female; Health Behavior; Health Status Disparities; Hispanic or Latino; Humans; Insurance, Health; Logistic Models; Male; Medically Uninsured; Middle Aged; Mortality; Poverty; Risk Assessment; Social Class; Sociology, Medical; United States; White People

Functional impairment, race, and family expectations of death. - Brie A Williams; Lindquist, Karla; Sandra Y. Moody-Ayers; Louise C Walter; Kenneth E Covinsky (J Am Geriatr Soc, 2006)
OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race. DESIGN: Cross-sectional. SETTING: Community based. PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older. MEASUREMENTS: Families were interviewed within 2 years of the HRS participant's death. The primary outcome was whether death was expected. The primary predictors were the decedent's functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent's race. RESULTS: Overall, 58% of families reported that their family member's death was expected. Expecting death was strongly associated with functional impairment; 71% of families of decedents with ADL disability expected death, compared with 24% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60%) than African Americans (49%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95% CI = 0.46-0.86). CONCLUSION: Family members of older adults expected death only 58% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.
Keywords: Activities of Daily Living; Aged; Attitude to Death; Black or African American; Cross-Sectional Studies; Disabled Persons; Family; Female; Hispanic or Latino; Humans; Male; White People

Increased wealth and income as correlates of self-assessed retirement. - Caputo, Richard K. (J Gerontol Soc Work, 2006)
This study examined whether retirement implies complete withdrawal from the labor force and the role that increased wealth and income play in regard to the nature of retirement. Data came from the Health & Retirement Study, Waves 1-5. Findings indicated that most study sample pre-retirees remained in the labor force as they moved into what are considered the normal retirement years. As they moved on average from 50+ years of age to 60+ years of age, increasing percentages of study sample pre-retirees reported themselves as completely retired. Those who viewed themselves as completely retired were far less likely to work than those who did not view themselves as completely retired. Of particular importance was the finding that increased income in 2000 decreased the likelihood of self-reported complete retirement. Equally important was the finding that increased assets had no effect on retirement status with the exception of survey year 1998 when increased assets decreased the likelihood of viewing oneself as completely retired. Findings suggested that pro-work retirement policies aimed at increasing labor force participation among pre-retirees and increasing the normal retirement age can be effective. Five pro-work policies were discussed.
Keywords: Aged; Data collection; Employment; Female; Financing, Personal; Humans; Income; Interviews as Topic; Male; Middle Aged; Motivation; Organizational Policy; Pensions; Retirement; Self-Assessment; Social Security; Socioeconomic factors; United States

Insurance coverage and health care use among near-elderly women. - Xiao Xu; Patel, Divya A.; Vahratian, Anjel; Ransom, Scott B. (Womens Health Issues, 2006)
OBJECTIVES: Data on near-elderly (ages 55-64) women's access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women's health insurance coverage in the United States and how it may influence their use of health care services. METHODS: A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women's use of outpatient services, inpatient services, and prescription medication over a 2-year period. RESULTS: In 2002, 9.4% of near-elderly women in the United States were uninsured and 15.4% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost. CONCLUSIONS: The nature of a near-elderly woman's insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage.
Official publication of the Jacobs Institute of Women's Health
Keywords: Attitude to Health; Female; Health Services Accessibility; Health Services Needs and Demand; Health Status; Humans; Insurance Coverage; Insurance, Health; Medically Uninsured; Middle Aged; Patient Acceptance of Health Care; Socioeconomic factors; United States; Women's Health; Women's Health Services

Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. - John T. Cacioppo; Mary Elizabeth Hughes; Linda J. Waite; Louise C Hawkley; Ronald A. Thisted (Psychol Aging, 2006)
The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults.
Keywords: Aged; Cross-Sectional Studies; depression; Female; Follow-Up Studies; Health Status; Hostility; Humans; Loneliness; Male; Middle Aged; Risk Factors; Severity of Illness Index; Social Support; Stress, Psychological; Surveys and Questionnaires

A longitudinal study of the relationship between health behavior risk factors and dependence in activities of daily living. - Sang-Hyuk Jung; Truls Ostbye; Kyoung-Ok Park (J Prev Med Public Health, 2006)
OBJECTIVES: The purpose of this study was to shed further light on the effect of modifiable health behavior risk factors on dependence in activities of daily living, defined in a multidimensional fashion. METHODS: The study participants were 10,278 middle aged Americans in a longitudinal health study, the Health and Retirement Survey (HRS). A multi-stage probability sampling design incorporating the effect of population sizes (Metropolitan and non-metropolitan), ethnicity (the non-Hispanic White, the Hispanic, and the Black), and age (age 51-61) was utilized. Basic Activities of Daily Living (ADL) were measured using five activities necessary for survival (impairment in dressing, eating, bathing, sleeping, and moving across indoor spaces). Explanatory variables were four health behavior risk factors included smoking, exercise, Body Mass Index (BMI), and alcohol consumption. RESULTS: Most participants at baseline were ADL independent (1992). 97.8% of participants were independent in all ADL's at baseline and 78.2% were married. Approximately 27.5% were current smokers at baseline, and the subjects reported moderate or heavy exercise were 74.8%. All demographic characteristics and behavioral risk factors were significantly associated with the ADL status at Wave 4 except alcohol consumption. Risk behaviors such as current smoking, sedentary life style and high BMI at Wave 1 were associated with ADL status deterioration; however, moderate alcohol consumption tended to be more related to better ADL status than abstaining at Wave 4. ADL status at Wave 1 was the strongest factor and the next was exercise and smoking affecting ADL status at Wave 4. People who were in ADL dependent at Wave 1 were 15.17 times more likely to be ADL dependent at Wave 4 than people who were in ADL independent at Wave 1. Concerning smoking cigarettes, people who kept only light exercise or sedentary life style at Wave 1 were 1.70 times more likely to be died at Wave 4 than the people who did not smoke at Wave 1. CONCLUSIONS: All demographics and health behaviors at wave 1 had consistently similar OR trends for ADL status to each other except alcohol consumption. Smoking and exercise in health behaviors, and age and gender in demographics at Wave 1 were significant factors associated with ADL group separation at Wave 4.
Keywords: Activities of Daily Living; Alcohol Drinking; Body Mass Index; ethnicity; Exercise; Female; Health Behavior; Humans; Longitudinal Studies; Male; Middle Aged; Risk Factors; Smoking; United States

Postretirement earnings relative to preretirement earnings: gender and racial differences. - Martha N. Ozawa; Hong, Baeg-Eui (J Gerontol Soc Work, 2006)
As the social security program comes under increasing financial pressure in the coming decades, the federal government will encourage elderly people to continue to work. Data from the Social Security Administration indicate that earnings are already a sizable component of retirement income. But there is public concern about how women and minorities will fare economically in this changing policy environment. To what extent can women and minorities keep earning money after they reach retirement age? This article presents the results of a study that investigated the postretirement earnings, relative to the preretirement earnings, of women and minorities, and compared the results with those for men and whites. The major finding, based on regression analyses, was that women's postretirement earnings, relative to their preretirement earnings, were greater than those of men. Furthermore, the regression results indicate that nonwhites' postretirement earnings could not be predicted by their preretirement earnings or by any of the independent variables used in the study, including age, gender, education, marital status, number of children, occupation, and preretirement earnings.
Using Smart Source Parsing pp. May Sage Publications, Thousand Oaks CA
Keywords: Age Factors; Aged; Aged, 80 and over; Data collection; Employment; Female; Humans; Income; Male; Men; Minority Groups; Pensions; Retirement; Salaries and Fringe Benefits; Sex Factors; Social Security; Time Factors; United States; White People; women

Religious influences on preventive health care use in a nationally representative sample of middle-age women. - Benjamins, Maureen Reindl (J Behav Med, 2006)
Despite the many benefits of preventive services, they are often underutilized. Social factors, such as religion, can figure prominently in these discrepancies by either creating barriers or facilitating use. Using data from the Health and Retirement Survey (HRS, 1992-1996), the current study examines the relationship between religious attendance, religious salience, and denomination and three types of female preventive services in a sample of middle-age women (N = 4253). Findings indicate that women who attend religious services more frequently use more mammograms, Pap smears, and self-breast exams. In addition, women belonging to Mainline Protestant or Jewish denominations use certain preventive services more than Evangelical Protestants. Finally, women with higher levels of religious salience are more likely to conduct self-breast exams. These findings add important information to the public health literature concerning factors that influence preventive service use. They also add to the growing field of religion and health research where preventive health care use is emerging as a possible mechanism linking religion to a wide variety of physical health outcomes.
Keywords: Aged; Breast Self-Examination; Female; Health Behavior; Health Status Indicators; Health Surveys; Humans; Mammography; Mass Screening; Middle Aged; Papanicolaou Test; Preventive Health Services; Religion and Medicine; Religion and Psychology; Social Support; Socioeconomic factors; United States; Utilization Review; Vaginal Smears

Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions. - Adaeze B Akamigbo; Frederic D Wolinsky (Gerontologist, 2006)
PURPOSE: Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions. DESIGN AND METHODS: We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models. RESULTS: Expectations are not normally distributed: 14% of the participants refused to answer, 51% estimated no chance, 10% indicated a 1% to 50% chance, 21% indicated an 11% to 50% chance and 4% indicated a 51% to 100% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement. IMPLICATIONS: Black and White older adults' expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation.
Keywords: Age Factors; Aged; Female; Health Status; Homes for the Aged; Humans; Male; Nursing homes; Patient Admission; Risk Factors; Sex Factors; Social Support; Socioeconomic factors

Retirement patterns from career employment. - Kevin E. Cahill; Michael D. Giandrea; Joseph F. Quinn (Gerontologist, 2006)
PURPOSE: This article investigates how older Americans leave their career jobs and estimates the extent of intermediate labor force activity (bridge jobs) between full-time work on a career job and complete labor-force withdrawal. DESIGN AND METHODS: Using data from the Health and Retirement Study, we explored the work histories and retirement patterns of a cohort of retirees aged 51 to 61 in 1992 during a 10-year period in both cross-sectional and longitudinal contexts. We examined determinants of retirement patterns in a multinomial logistic regression model. RESULTS: We found that a majority of older Americans with career jobs retire gradually, in stages, rather than all at once. We also found that the utilization of bridge jobs was more common among younger respondents, respondents without defined-benefit pension plans, and respondents at both the lower and upper ends of the wage distribution. IMPLICATIONS: Older Americans are now working longer than pre-1980s trends would have predicted. Given concerns about the traditional sources of retirement income (Social Security, employer pensions, and prior savings), older Americans may have to rely more on earnings. This article suggests that many are already doing so by moving to bridge jobs after leaving their career employment.
Keywords: Aged; Aged, 80 and over; Aging; Career Choice; Employment; Female; Health Status; Humans; Income; Male; Middle Aged; Pensions; Retirement; Social Security; United States

Social status, risky health behaviors, and diabetes in middle-aged and older adults. - Linda A. Wray; Duane F. Alwin; Ryan J McCammon; Manning, Timothy; Best, Latrica E. (J Gerontol B Psychol Sci Soc Sci, 2006)
OBJECTIVE: This article investigates: (a) how social status influences diabetes prevalence and incidence; (b) how risky health behaviors contribute to the prediction of incident diabetes; (c) if the effects of health behaviors mediate the effects of social status on incident diabetes; and (d) if these effects differ in midlife and older age. METHODS: We examined nationally representative data from the 1992/1993-1998 panels of the Health and Retirement Study for middle-aged and older adults using logistic regression analyses. RESULT: The odds of prevalent diabetes were higher for people of older age, men, Black adults, and Latino adults. Higher early-life social status (e.g., parental schooling) and achieved social status (e.g., respondent schooling, economic resources) reduced the odds in both age groups. We observed similar patterns for incident diabetes in midlife but not in older age. Risky health behaviors--particularly obesity--increased the odds of incident diabetes in both age groups independent of social status. The increased odds of incident diabetes in midlife persisted for Black and Latino adults net of other social status factors. DISCUSSION: Risky health behaviors are key predictors of incident diabetes in both age groups. Economic resources also play an important protective role in incident diabetes in midlife but not in older age.
Keywords: Aged; Body Mass Index; Diabetes Mellitus; Female; Follow-Up Studies; Health Behavior; Humans; Incidence; Male; Middle Aged; Prevalence; Risk-Taking; Social Behavior; Social Class; Surveys and Questionnaires

Urban neighborhood context, educational attainment, and cognitive function among older adults. - Richard G Wight; Carol S Aneshensel; Miller-Martinez, Dana; Amanda L. Botticello; Janet R. Cummings; Arun S Karlamangla; Teresa Seeman (Am J Epidemiol, 2006)
Existing research has not addressed the potential impact of neighborhood context--educational attainment of neighbors in particular--on individual-level cognition among older adults. Using hierarchical linear modeling, the authors analyzed data from the 1993 Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a large, nationally representative sample of US adults born before 1924. Data from participants residing in urban neighborhoods (n = 3,442) were linked with 1990 US Census tract data. Findings indicate that 1) average cognitive function varies significantly across US Census tracts; 2) older adults living in low-education areas fare less well cognitively than those living in high-education areas, net of individual characteristics, including their own education; 3) this association is sustained when controlling for contextual-level median household income; and 4) the effect of individual-level educational attainment differs across neighborhoods of varying educational profiles. Promoting educational attainment among the general population living in disadvantaged neighborhoods may prove cognitively beneficial to its aging residents because it may lead to meliorations in stressful life conditions and coping deficiencies.
Keywords: Aged; Aged, 80 and over; Chi-Square Distribution; Cognition Disorders; Educational Status; Female; Humans; Linear Models; Male; Residence Characteristics; Risk Factors; Socioeconomic factors; United States; Urban Population

The validation of the Texas revised inventory of grief on an older Latino sample. - Wilson, Steve (J Soc Work End Life Palliat Care, 2006)
PURPOSE: Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample. DESIGN AND METHODS: Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos. RESULTS: While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice. IMPLICATIONS: This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context.
Keywords: Aged; Aged, 80 and over; Bereavement; Culture; Factor Analysis, Statistical; Female; Grief; Hispanic or Latino; Humans; Male; Middle Aged; Psychometrics; Reproducibility of Results; Socioeconomic factors; Surveys and Questionnaires; Texas

Why don't people buy long-term-care insurance? - Cramer, Anne Theisen; Gail A Jensen (J Gerontol B Psychol Sci Soc Sci, 2006)
OBJECTIVES: The objective of this article was to assess the determinants of an individual's decision to purchase long-term-care (LTC) insurance. This article focuses on the decision to purchase a new policy as opposed to renewing an existing policy. This study gave special consideration to the role of policy price, the savings associated with buying a policy now as opposed to later, the purchaser's education, and the purchaser's income. METHODS: Using data from the 2002 Health and Retirement Survey, we estimated logistic regressions to model consumer decisions to purchase LTC insurance. We explored several alternative measures of the price of a policy. RESULTS: Price was a significant determinant in decisions to purchase coverage. The demand for coverage, however, was price inelastic, with elasticities ranging from -0.23 to -0.87, depending on the specification of the model. The education level and income of the purchaser were also important. DISCUSSION: This analysis provides the first estimates of price elasticity of demand for LTC insurance. The finding that demand is very price inelastic suggests that state initiatives that effectively subsidize premiums as a way of stimulating purchases are likely to meet with very limited success in the present environment.
Keywords: Aged; Choice Behavior; Commerce; Decision making; Demography; Female; Humans; Insurance, Health; Long-term Care; Male; Middle Aged; United States

Disparities among older adults in measures of cognitive function by race or ethnicity. - Frank A Sloan; Wang, Jingshu (J Gerontol B Psychol Sci Soc Sci, 2005)
This study examined racial or ethnic differences in cognitive function, cross-sectionally and longitudinally, using survey data from the Asset and Health Dynamics Among the Oldest Old. A version of the Telephone Interview for Cognitive Status (TICS), proxy assessments of cognition, and difficulties in performing daily tasks were assessed. Blacks performed below Whites on the TICS at baseline and on proxy assessments of cognition. TICS score declined with age for Whites and Blacks, with some relative gains for Blacks. At baseline, Blacks more often had difficulties in performing daily tasks, with some increase in difficulties relative to Whites with age. Differences between other groups and Whites were smaller than those between Blacks and Whites.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Black or African American; Case-Control Studies; Cognition; Cognition Disorders; Cross-Sectional Studies; Female; Hispanic or Latino; Humans; Linear Models; Longitudinal Studies; Male; Racial Groups; United States

Functional impairment as a risk factor for urinary incontinence among older Americans. - Kristi Rahrig Jenkins; Fultz, Nancy H. (Neurourol Urodyn, 2005)
AIMS: Using a large nationally representative sample of older Americans we investigate four domains of functional impairment as possible risk factors for the subsequent development of urinary incontinence (UI) symptoms. METHODS: Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics among the Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UI symptoms. RESULTS: A greater number of serious chronic conditions and functional impairment in the lower body mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors that contributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, being represented by a proxy respondent, and functional impairment in the strength domain. CONCLUSIONS: Understanding the possible relationship between functional impairment and UI is an important step toward developing appropriate interventions for the prevention, treatment, or management of urine loss.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Chronic disease; Disability Evaluation; Female; Humans; Longitudinal Studies; Male; Motor Activity; Risk Factors; Socioeconomic factors; Urinary incontinence

Health events and the smoking cessation of middle aged Americans. - Tracy Falba (J Behav Med, 2005)
This study investigates the effect of serious health events including new diagnoses of heart attacks, strokes, cancers, chronic lung disease, chronic heart failure, diabetes, and heart disease on future smoking status up to 6 years postevent. Data come from the Health and Retirement Study, a nationally representative longitudinal survey of Americans aged 51-61 in 1991, followed every 2 years from 1992 to 1998. Smoking status is evaluated at each of three follow-ups, (1994, 1996, and 1998) as a function of health events between each of the four waves. Acute and chronic health events are associated with much lower likelihood of smoking both in the wave immediately following the event and up to 6 years later. However, future events do not retrospectively predict past cessation. In sum, serious health events have substantial impacts on cessation rates of older smokers. Notably, these effects persist for as much as 6 years after a health event.
Keywords: Diabetes Mellitus; Female; Health Behavior; Health Status; Heart Failure; Humans; Logistic Models; Longitudinal Studies; Male; Middle Aged; Smoking; Smoking cessation; Social Environment; Socioeconomic factors; United States

Health insurance coverage during the years preceding medicare eligibility. - David W. Baker; Joseph J Sudano (Arch Intern Med, 2005)
BACKGROUND: Adults in late middle age who lack health insurance are more likely to die or experience a decline in their overall health. Because most estimates of the uninsured are cross-sectional, the true number of individuals whose health is at risk from being uninsured is unclear. METHODS: We analyzed a nationally representative sample of 6065 US adults 51 to 57 years old who were interviewed in 1992, 1994, 1996, 1998, and 2000 as part of the Health and Retirement Study. Insurance coverage was determined at the time of each interview and classified as private, public, or uninsured. Longitudinal data were used to determine the proportion of individuals who were uninsured at any interview during the 8-year study period. RESULTS: The proportion of participants who were uninsured at the time of the 1992, 1994, 1996, 1998, and 2000 interviews was 14.3%, 10.8%, 9.7%, 8.8%, and 8.2%, respectively. People frequently transitioned between having insurance and being uninsured. As a result, despite the declining prevalence of being uninsured, the percentage who were uninsured at least once during the 8-year period rose to 23.3% by 2000; few participants (2.6%) were continuously uninsured. Only 60.1% of participants were continuously enrolled in private insurance across all 5 interviews. CONCLUSIONS: The proportion of US adults in late middle age at risk from being uninsured over a 10-year follow-up period was 2 to 3 times higher than cross-sectional estimates. At least one quarter of older adults will be uninsured at some point during the years preceding eligibility for Medicare.
Keywords: Age Factors; Black or African American; Cohort Studies; Female; Health Status; Hispanic or Latino; Humans; Insurance Coverage; Insurance, Health; Male; Medically Uninsured; Middle Aged; Sex Factors; Socioeconomic factors; United States; White People

Health, wealth, and happiness: financial resources buffer subjective well-being after the onset of a disability. - Dylan M Smith; Kenneth M. Langa; Mohammed U Kabeto; Peter A. Ubel (Psychol Sci, 2005)
We examined the hypothesis that the relationship between financial status and subjective well-being, typically found to be very small in cross-sectional studies, is moderated by health status. Specifically, we predicted that wealth would buffer well-being after the onset of a disability. Using data from the Health and Retirement Study, a longitudinal study of people at and approaching retirement age, we employed within-subjects analyses to test whether wealth measured prior to the onset of a disability protected participants' well-being from some of the negative effects of a new disability. We found support for this hypothesis: Participants who were above the median in total net worth reported a much smaller decline in well-being after a new disability than did participants who were below the median. We also found some evidence that the buffering effect of wealth faded with time, as below-median participants recovered some of their well-being.
Keywords: Activities of Daily Living; Cross-Sectional Studies; Disability Evaluation; Female; Follow-Up Studies; Happiness; Health Status; Humans; Male; Middle Aged; Quality of Life; Socioeconomic factors

Heavy alcohol use and marital dissolution in the USA. - Ostermann, Jan; Frank A Sloan; Donald H. Taylor Jr. (Soc Sci Med, 2005)
Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (combined as divorced in the analysis) for 4589 married couples during up to four repeated 2-yr follow-up periods. We found that drinking status was positively correlated between spouses. The correlations did not increase over the follow-up period. Discrepancies in alcohol consumption between spouses were more closely related to the probability of subsequent divorce than consumption levels per se. Couples with two abstainers and couples with two heavy drinkers had the lowest rates of divorce. Couples with one heavy drinker were most likely to divorce. Controlling for current consumption levels, a history of problem drinking by either spouse was not significantly associated with an increased probability of divorce. Our findings on alcohol use and marital dissolution were highly robust in alternative specifications.
Keywords: Alcohol Drinking; Alcohol-Related Disorders; Divorce; Female; Health Status; Humans; Male; Middle Aged; Social Class; United States

The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. - Ye Luo; Linda J. Waite (J Gerontol B Psychol Sci Soc Sci, 2005)
OBJECTIVES: To examine the relationships between socioeconomic status (SES) and health across the life course and their variations by gender and race/ethnicity. METHODS: The sample included 19,949 respondents aged 50 or over from the 1998 Health and Retirement Study. RESULTS: Lower childhood SES was associated with worse health outcomes in later life. Part of the effect of childhood SES on adult health occurred through childhood health. The impact of childhood SES on education and income in adulthood explained an even larger share of this effect. We also found a stronger effect of adult SES for those with lower childhood SES than for those with more advantaged childhoods. Moreover, childhood SES had a similar impact on health in later life for women and men and for Whites and non-Whites. However, college education seemed more important for women's later health, whereas income seemed more important for men's health. Education appeared to have a weaker effect on adult health for Blacks and Hispanics than for Whites. DISCUSSION: Both childhood and adult SES are important for health. The negative impact of low childhood SES can be partially ameliorated if people from a low SES position during childhood mobilize to higher status in adulthood.
Keywords: Aged; Aging; Black People; Child; Cognition; Cohort Studies; Data collection; Education; ethnicity; Female; Health Status; Hispanic or Latino; Humans; Income; Male; Mental Health; Middle Aged; Quality of Life; Retirement; Sex Factors; Social Class; White People

The impact of diabetes on employment and work productivity. - Tunceli, Kaan; Cathy J. Bradley; Nerenz, David; L Keoki Williams; Pladevall, Manel; Elston, Lafata J. (Diabetes Care, 2005)
OBJECTIVE: The purpose of this study was to longitudinally examine the effect of diabetes on labor market outcomes. RESEARCH DESIGN AND METHODS: Using secondary data from the first two waves (1992 and 1994) of the Health and Retirement Study, we identified 7,055 employed respondents (51-61 years of age), 490 of whom reported having diabetes in wave 1. We estimated the effect of diabetes in wave 1 on the probability of working in wave 2 using probit regression. For those working in wave 2, we modeled the relationships between diabetic status in wave 1 and the change in hours worked and work-loss days using ordinary least-squares regressions and modeled the presence of health-related work limitations using probit regression. All models control for health status and job characteristics and are estimated separately by sex. RESULTS: Among individuals with diabetes, the absolute probability of working was 4.4 percentage points less for women and 7.1 percentage points less for men relative to that of their counterparts without diabetes. Change in weekly hours worked was not statistically significantly associated with diabetes. Women with diabetes had 2 more work-loss days per year compared with women without diabetes. Compared with individuals without diabetes, men and women with diabetes were 5.4 and 6 percentage points (absolute increase), respectively, more likely to have work limitations. CONCLUSIONS: This article provides evidence that diabetes affects patients, employers, and society not only by reducing employment but also by contributing to work loss and health-related work limitations for those who remain employed.
Keywords: Diabetes Mellitus; Efficiency; Employment; Female; Health Status; Humans; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Odds Ratio; United States; Work

The impact of obesity on active life expectancy in older American men and women. - Sandra L Reynolds; Saito, Yasuhiko; Eileen M. Crimmins (Gerontologist, 2005)
PURPOSE: The purpose of this article is to estimate the effect of obesity on both the length of life and length of nondisabled life for older Americans. DESIGN AND METHODS: Using data from the first 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, this article develops estimates of total, active, and disabled life expectancy for obese and nonobese older men and women. We used the Interpolation of Markov Chains (IMaCh) method to estimate the average number of years obese and nonobese older persons can expect to live with and without activity of daily living (ADL) disability. RESULTS: Our findings indicate that obesity has little effect on life expectancy in adults aged 70 years and older. However, the obese are more likely to become disabled. This means that obese older adults live both more years and a higher proportion of their remaining lives disabled. IMPLICATIONS: The lack of significant differences in life expectancy by obesity status among the old suggests that obesity-related death is less of a concern than disability in this age range. Given steady increases in obesity among Americans at all ages, future disability rates may be higher than anticipated among older U.S. adults. In order to reduce disability among future cohorts of older adults, more research is needed on the causes and treatment of obesity and evaluations done on interventions to accomplish and maintain weight loss.
Keywords: Activities of Daily Living; Aged; Female; Health Status; Health Surveys; Humans; Life Expectancy; Life Tables; Logistic Models; Male; Markov chains; Obesity; Risk Factors; United States

The impact of own and spouse's urinary incontinence on depressive symptoms. - Fultz, Nancy H.; Kristi Rahrig Jenkins; Truls Ostbye; Donald H. Taylor Jr.; Mohammed U Kabeto; Kenneth M. Langa (Soc Sci Med, 2005)
This study investigated the impact of own and spouse's urinary incontinence on depressive symptoms. Attention was paid to the possibility that gender and caregiving might be important factors in understanding significant effects. We used negative binomial regression to analyze survey data for 9974 middle-aged and older respondents to the Health and Retirement Study in the USA. Results supported the hypothesis that the respondents' own urinary incontinence was associated with depressive symptoms (unadj. IRR = 1.73, 95% CIs = 1.53, 1.95 for men; unadj. IRR = 1.50, 95% CIs = 1.38, 1.63 for women). Controlling sociodemographic and health variables reduced this relationship, but it remained statistically significant for both men and women. Having an incontinent wife put men at greater risk for depressive symptoms (unadj. IRR = 1.13, 95% CIs = 1.02, 1.25), although this relation became nonsignificant with the addition of control variables. No relation between women's depressive symptoms and husbands' (in)continence status was found. Caregiving was not a significant variable in the adjusted analyses, but spouses' depressive symptoms emerged as a significant predictor of the respondents' own depressive symptoms. Health care providers must be sensitive to the emotional impact of urinary incontinence. Our findings also suggest the importance of considering the patient's mental health within a wider context, particularly including the physical and mental health of the patient's spouse.
Keywords: Aged; Caregivers; Cohort Studies; depression; Female; Humans; Male; Middle Aged; United States; Urinary incontinence

Labor market, financial, insurance and disability outcomes among near elderly Americans with depression and pain. - Tian, Haijun; Robinson, Rebecca L.; Sturm, Roland (J Ment Health Policy Econ, 2005)
BACKGROUND: The economic burden of depression has been documented, but the role of comorbid conditions is unclear. Depression and comorbid pain are particularly common, are associated with worse clinical outcomes and require different care than "pure'' depression. Does this comorbidity account for a large share of the adverse social outcomes attributed to depression? AIMS OF STUDY: We analyzed the relationship between depression and comorbid pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65. METHODS: Cross-sectional data were used from Wave 3 of the Health and Retirement Survey, a nationally representative sample of individuals aged 55-65 surveyed in 1996. Multivariate regression analyses, controlling for socio-demographics and chronic health conditions, estimated the associations between depression and pain, and economic outcomes. Outcomes included: employment and retirement status, household income, total medical expenditures, government health insurance, social security, limitations in activities of daily living (ADLs), and health limitations affecting work. Primary explanatory variables included the presence of severe pain, mild/moderate pain, or absence of pain, with or without depression. RESULTS: Compared to depression alone, depression and comorbid pain was associated with worse labor market (non-employment, retirement), financial (total medical expenditures), insurance (government insurance, social security) and disability outcomes (limitations in ADLs, health limitations affecting work), after covariate adjustment (p <or= 0.01, except retirement with p < 0.1). Findings were even more disparate as level of pain severity increased. The simulated results showed that the magnitudes of the adverse effects were attributed disproportionally to individuals with comorbid pain and depression versus "pure'' depression. Of those with depression, 51% had comorbid pain. Yet, this subgroup of depressed individuals accounted for 59% of those not employed, 61% of those with government health insurance, 79% of those with limitations in ADLs, and 72% of those with health limitations affecting work. DISCUSSION AND LIMITATION: Depression with comorbid pain, not depression alone was responsible for a large part of the higher economic burden associated with depression. The study is limited by self-reported measures of pain, depression, and outcomes. It is cross-sectional and cannot identify causal effects of depression with pain. These findings may not be generalizable to other age groups. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The depressed with comorbid pain appear to experience greater burden through increased costs and worse functioning and may require different management than those with depression alone. The depressed with comorbid pain may benefit from treatment practices and guidelines that address the duality of these conditions throughout the process of care. IMPLICATION FOR HEALTH POLICIES: The depressed with comorbid pain were more likely to receive government support than depression alone. Given the central role of employer-sponsored health insurance in the U.S., they may have worse access to health care because they leave employment or retire earlier. With the evolving state of Medicare, broad formulary access to mental health treatments might be considered. IMPLICATIONS FOR FURTHER RESEARCH: Further research should focus on causality of depression and comorbid pain on economic outcomes. Depression research should consider the heterogeneity of this disorder in outcomes assessment.
Keywords: Aged; Cost of Illness; Cross-Sectional Studies; depression; Employment; Female; Humans; Male; Middle Aged; pain; United States

Life course pathways to adult-onset diabetes. - Best, Latrica E.; Mark D Hayward; Mira M Hidajat (Soc Biol, 2005)
Early life conditions, such as socioeconomic status (SES) and health, have the potential to set in motion multiple and reinforcing pathways that shape both the prevalence and onset of diabetes among older adults. Using data from the Health and Retirement Study (1998-2002) for persons age 51 years and older, we investigated the core mediating mechanisms linking early life conditions with diabetes prevalence in 1998 and onset over a 4-year follow-up period, focusing on adult achievement processes and obesity as key mechanisms. We found that father's education is negatively associated with diabetes prevalence for older men and women. However, no markers of early life SES are directly associated with older men's and women's onset of diabetes, and the negative effects of adult SES on diabetes onset pertain only to women. Early life health affects the onset of diabetes among women--but not the prevalence--and no evidence of this association was found for men. We found no evidence that obesity is an important mechanism connecting either early life or adult SES with diabetes development in men or women. We speculate that early life SES may accelerate the development of diabetes at younger ages, and that the pathways linking life course SES, early life health, and diabetes are partly gender-specific and biological in nature.
Keywords: Aged; Child; Diabetes Mellitus, Type 2; Family Health; Female; Follow-Up Studies; Humans; Life Style; Likelihood Functions; Logistic Models; Male; Middle Aged; Obesity; Poverty; Risk Factors; Social Class; United States

Longitudinal analysis of the reciprocal effects of self-assessed global health and depressive symptoms. - Karl Kosloski; Stull, Donald E.; Kercher, Kyle; VanDussen, Daniel J. (J Gerontol B Psychol Sci Soc Sci, 2005)
This study examined whether a reciprocal relationship exists between measures of self-assessed global health and depressive symptoms, net of covariates that included chronic illness, functional disability, education, income, gender, race, and age. Analyses of five waves of data from the Rand version of the Health and Retirement Survey (N=7,475), using an autoregressive, cross-lagged panel design, indicated that self-assessed overall health had a modest but statistically significant and consistent effect on depressive symptoms. In contrast, the level of depressive symptoms had a statistically nonsignificant effect on self-assessed health. There has been growing interest in identifying the factors that inform self-assessments of overall health. The present findings indicate that self-assessed global health is not simply a manifestation of depressed affect.
Keywords: Aged; Analysis of Variance; Attitude to Health; Chronic disease; depression; Disabled Persons; Female; Health Surveys; Humans; Longitudinal Studies; Male; Middle Aged; Personality Inventory; Psychometrics; Reproducibility of Results; Self-Assessment; Statistics as Topic

Long-term risk for depressive symptoms after a medical diagnosis. - Daniel Polsky; Jalpa A Doshi; Marcus, Steven; Oslin, David; Rothbard, Aileen; Thomas, Niku; Thompson, Christy L. (Arch Intern Med, 2005)
BACKGROUND: This study examines the risk of development of significant depressive symptoms after a new diagnosis of cancer, diabetes, hypertension, heart disease, arthritis, chronic lung disease, or stroke. METHODS: The study used 5 biennial waves (1992-2000) of the Health and Retirement Study to follow a sample of 8387 adults (aged 51 to 61 years and without significant depressive symptoms in 1992) from 1994 to 2000. Time-dependent Cox regression models estimated adjusted hazard ratios (HRs) for an episode of significant depressive symptoms after a new diagnosis for each of the 7 medical conditions. RESULTS: Within 2 years of initial diagnosis, subjects with cancer had the highest hazard of depressive symptoms (HR, 3.55; 95% confidence interval [CI], 2.79-4.52), followed by subjects with chronic lung disease (HR, 2.21; 95% CI, 1.64-2.79) and heart disease (HR, 1.45; 95% CI, 1.09-1.93). The hazard for depressive symptoms for most of these diseases decreased over time; however, subjects with heart disease continued to have a higher risk for depressive symptoms even 2 to 4 years and 4 to 8 years after diagnosis, and a significantly higher hazard for depressive symptoms developed for persons with arthritis 2 to 4 years after diagnosis (HR, 1.46; 95% CI, 1.11-1.92). CONCLUSION: The findings identify several high-risk patient groups who might benefit from depression screening and monitoring to improve health outcomes in this vulnerable population facing new medical illnesses.
Keywords: Chronic disease; Comorbidity; Depressive Disorder; Female; Humans; Male; Middle Aged; Prospective Studies; Risk; Time Factors

Net worth predicts symptom burden at the end of life. - Maria J Silveira; Mohammed U Kabeto; Kenneth M. Langa (J Palliat Med, 2005)
OBJECTIVES: To explore the predictors of symptom burden at the end of life. DESIGN: Observational, secondary analysis of Health and Retirement Study (HRS) data. SETTING: USA. PARTICIPANTS: Two thousand six hundred four deceased, older adults. METHODS: Multivariate Poisson and logistic regression to explore the relationship between sociodemographic and clinical factors with symptoms. RESULTS: Fatigue, pain, dyspnea, depression, and anorexia were common and severe; 58% of participants experienced more than 3 of these during their last year of life. Sociodemographic and clinical factors were associated with the number of symptoms as well as the presence of pain, depression, and dyspnea alone. Decedents in the highest quartile of net worth had fewer symptoms (incident rate ratio [IRR] 0.90, confidence interval [CI] 0.85-0.96) and less pain (odds ratio [OR] 0.66, CI 0.51-0.85) than comparisons did. Patients with cancer experienced more pain (OR 2.02, CI 1.62-2.53) and depression (OR 1.31, CI 1.07-1.61). Patients experienced more depression (OR 2.37, CI 1.85-3.03) and dyspnea (OR 1.40, CI 1.09-1.78). LIMITATION: Use of proxy reports for primary data. CONCLUSION: Older Americans experience a large symptom burden in the last year of life, largely with treatable symptoms such as pain, dyspnea, and depression. The adequacy of symptom control relates to clinical factors as well as net worth. This association between symptoms and wealth suggests that access to health care and other social services beyond those covered by Medicare may be important in decreasing symptom burden at the end of life.
Keywords: Aged; Aged, 80 and over; Data collection; Female; Humans; Logistic Models; Male; Severity of Illness Index; Social Class; Terminally Ill; United States

Physical and mental health status of older long-term cancer survivors. - Nancy L. Keating; Norredam, Marie; Landrum, Mary Beth; Haiden A. Huskamp; Meara, Ellen (J Am Geriatr Soc, 2005)
OBJECTIVES: To assess the physical and mental health status of older long-term cancer survivors. DESIGN: Cohort study using propensity score methods to control for baseline differences between cancer survivors and controls. SETTING: General community population in the United States. PARTICIPANTS: Nine hundred sixty-four cancer patients who had survived for more than 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans aged 55 and older responding to the 2002 Health and Retirement Study. MEASUREMENTS: Medical conditions, symptoms, health behaviors, health status, mobility, activities of daily living, mental health diagnoses, self-rated memory, depressive symptoms, cognitive function, and self-reported life expectancy. RESULTS: Cancer survivors reported higher rates of lung disease (13.9% vs 9.6%; P=.001), heart condition (29.3% vs 22.9%; P<.001), arthritis (69.4% vs 59.4%; P<.001), incontinence (26.6% vs 19.7%; P=.001), frequent pain (36.4% vs 29.4%; P=.005), and obesity (27.0% vs 24.2%; P=.001) than individuals without cancer but lower rates of smoking (12.0% vs 14.8%; P=.03). Cancer survivors were less likely than persons without cancer to report excellent or very good health status (37.2% vs 44.6%; P<.001) and had more mobility (P<.001) and activity of daily living (P=.01) limitations. Cancer survivors did not differ from persons without cancer in rates of depression or cognitive function (both P>.2) but were less optimistic about their life expectancy (P=.004). CONCLUSION: The physical health status of older long-term cancer survivors is somewhat worse than that of comparable persons who have never had cancer, but they have surprisingly similar mental health status. Future research is needed to understand factors contributing to poorer health status and identify patients at highest risk of long-term cancer-related problems.
Keywords: Aged; Aged, 80 and over; Case-Control Studies; Chronic disease; Cohort Studies; Female; Health Behavior; Health Status; Humans; Logistic Models; Male; Mental Health; Middle Aged; Neoplasms; Survivors; United States

Processes of cumulative adversity: childhood disadvantage and increased risk of heart attack across the life course. - Angela M O'Rand; Jenifer Hamil-Luker (J Gerontol B Psychol Sci Soc Sci, 2005)
OBJECTIVES: This article examines how processes of cumulative adversity shape heart attack risk trajectories across the life course. METHODS: Our sample includes 9,760 Health and Retirement Study respondents born between 1931 and 1941. Using self-reported retrospective measures of respondents' early background, we first identify three latent classes with differential exposure to childhood disadvantage. Intervening covariates associated with educational attainment, employment status, income attainment, marital history, and health behaviors are added to capture sequential processes of adversity. Final latent-class cluster models estimate the cumulative impact of these covariates on three different heart attack risk trajectories between 1992 and 2002: high, increasing, and low. RESULTS: Early disadvantage and childhood illness have severe enduring effects and increase the risk for heart attack. Adult pathways, however, differentially influence trajectories of heart attack risk and mediate the effects of early disadvantage. DISCUSSION: Findings suggest that future research should consider how processes of cumulative adversity initiated in childhood influence health outcomes in older ages.
Keywords: Child; Cluster Analysis; Family Characteristics; Female; Human Development; Humans; Likelihood Functions; Male; Middle Aged; Myocardial Infarction; Psychosocial Deprivation; Regression Analysis; Risk Factors; Social Environment; Socioeconomic factors; United States

Profiles of self-rated health in midlife adults with chronic illnesses. - Finnegan, Lorna; Marion, Lucy; Cox, Cheryl (Nurs Res, 2005)
BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time. OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time. METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time. RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes. DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.
Keywords: Chronic disease; Comorbidity; Data collection; Educational Status; Exercise; Female; Health Behavior; Health Status; Humans; Male; Marital Status; Middle Aged; Nursing Research; Smoking

Racial differences in activities of daily living limitation onset in older adults with arthritis: a national cohort study. - Shih, Vivian C.; Song, Jing; Rowland W Chang; Dorothy D Dunlop (Arch Phys Med Rehabil, 2005)
OBJECTIVE: To investigate factors that predict the onset of limitations in activities of daily living (ADLs) in adults 65 years old or older who have arthritis, in order to develop public health programs for minorities (African and Hispanic Americans) and white Americans. DESIGN: Longitudinal cohort study. SETTING: National probability sample. PARTICIPANTS: Older adults with arthritis (N=3541) who participated in the 1998 and 2000 Health and Retirement Study interviews and who had no baseline ADL limitations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Onset of ADL limitations was identified from reports of 1 or more ADL task limitations at 2-year follow-up. RESULTS: Onset is most frequent among African Americans (24.4%), followed by Hispanics (22.2%), and whites (16.9%). Race specific multivariate analysis showed that the strongest risk factor predicting onset of limitations across all racial and ethnic groups is physical limitations. Low household income was significant for older minorities but not for whites. Comorbid cardiovascular disease was a unique multivariate risk factor among African Americans. CONCLUSIONS: Physical limitation is a strong risk factor for ADL limitation onset that is shared by all racial and ethnic groups. Early identification and treatment of physical limitations may prevent the onset of ADL limitations and thus improve quality of life. Race specific public health interventions should be considered to reduce the development of ADL limitations among older adults with arthritis.
Keywords: Activities of Daily Living; Aged; Arthritis; Black or African American; Female; Geriatric Assessment; Health Behavior; Health Services Needs and Demand; Hispanic or Latino; Humans; Longitudinal Studies; Male; Predictive Value of Tests; Prospective Studies; Risk Factors; United States; White People

Setting eligibility criteria for a care-coordination benefit. - Christine T Cigolle; Kenneth M. Langa; Mohammed U Kabeto; Caroline S Blaum (J Am Geriatr Soc, 2005)
OBJECTIVES: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served. DESIGN: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older. SETTING: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey. PARTICIPANTS: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries). MEASUREMENTS: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency. RESULTS: A small portion of Medicare beneficiaries (1.3-5.8%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population. CONCLUSION: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Case Management; Chronic disease; Cognition Disorders; Comorbidity; Cross-Sectional Studies; Disability Evaluation; Disease Management; Eligibility Determination; Female; Geriatric Assessment; Health Surveys; Humans; Longitudinal Studies; Male; Medicare; Middle Aged; Retirement; United States

The significance of nonmarital cohabitation: marital status and mental health benefits among middle-aged and older adults. - Susan L. Brown; Jennifer R. Bulanda; Lee, Gary R. (J Gerontol B Psychol Sci Soc Sci, 2005)
OBJECTIVES: According to the 2000 Census, about 1.2 million persons over age 50 are currently cohabiting. Do these unmarried cohabiting partnerships provide adults with mental health benefits that are similar to those enjoyed by marrieds? We extended prior work on marital status and depression by including cohabitation in our conceptualization of marital status. METHODS: We used data from the 1998 Health and Retirement Study (N = 18,598) to examine the relationship between marital status and depressive symptoms among adults over age 50. We also examined gender differences in this association. RESULTS: We found that cohabitors report more depressive symptoms, on average, than do marrieds, net of economic resources, social support, and physical health. Additional analyses revealed that only among men do cohabitors report significantly higher depression scores. Cohabiting and married women as well as cohabiting men experience similar levels of depression, and all of these groups report levels that are significantly higher than married men's. DISCUSSION: Our findings demonstrate the importance of accounting for nontraditional living arrangements among persons aged 50 and older. Cohabitation appears to be more consequential for men's than women's depressive symptoms.
Keywords: Aged; depression; Female; Humans; Insurance Benefits; Male; Marital Status; Mental Health Services; Middle Aged; Sexual Partners; Social Support; United States

Social status and risky health behaviors: results from the health and retirement study. - Linda A. Wray; Duane F. Alwin; Ryan J McCammon (J Gerontol B Psychol Sci Soc Sci, 2005)
OBJECTIVES: We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks. METHODS: We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)-and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age. RESULTS: We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age. DISCUSSION: Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.
Keywords: Aged; Aging; Alcohol Drinking; Body Weight; Exercise; Female; Health Behavior; Humans; Life Style; Likelihood Functions; Logistic Models; Longitudinal Studies; Male; Middle Aged; Smoking; Social Class; United States

A socioeconomic profile of older adults with HIV. - Joyce, Geoffrey F.; Dana P Goldman; Leibowitz, Arleen A.; Abby Alpert; Bao, Yuhua (J Health Care Poor Underserved, 2005)
The objective of this study was to assess the socioeconomic circumstances of older patients with HIV and acquired immunodeficiency syndrome (AIDS). The investigators compared subjects from a national probability sample of 2,864 respondents from the HIV Cost and Services Utilization Study (HCSUS, 1996) with 9,810 subjects from Wave 1 (1992) of the Health and Retirement Survey (HRS). Bivariate analyses compare demographic characteristics, financial resources, and health insurance status between older and younger adults and between older adults with HIV and the general population. It was found that nearly 10% of the HIV-positive population is between the ages of 50 and 61 years. Older whites with HIV are mostly homosexual men who are more well educated, more often privately insured, and more financially stable than the HIV population as a whole. In contrast, older minorities with HIV possess few economic resources in either absolute or relative terms. The success of new drug therapies and the changing demographics of the HIV population necessitate innovative policies that promote labor force participation and continuous access to antiretroviral therapies.
Keywords: Female; HIV Infections; Humans; Insurance, Health; Male; Middle Aged; Social Class

Supplemental private health insurance and depressive symptoms in older married couples. - Min, Meeyoung O.; Aloen L. Townsend; Baila Miller; Rovine, Michael J. (Int J Aging Hum Dev, 2005)
Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.
Keywords: Aged; Aged, 80 and over; Analysis of Variance; Black People; Chi-Square Distribution; depression; Female; Humans; Insurance Coverage; Insurance, Health; Linear Models; Male; Risk Factors; Spouses; United States; White People

Survival expectations of the obese: Is excess mortality reflected in perceptions? - Tracy Falba; Susan H. Busch (Obes Res, 2005)
OBJECTIVE: This study compared self-reported subjective life expectancy (i.e., probability of living to age 75) for normal-weight, overweight, and obese weight groups to examine whether individuals are internalizing information about the health risks due to excessive weight. RESEARCH METHODS AND PROCEDURES: Using data from the Health and Retirement Study, a total of 9035 individuals 51 to 61 years old were analyzed by BMI category. The primary outcome measure was individuals' reports about their own expectations of survival to age 75. Absolute and relative risks of survival were compared with published estimates of survival to age 75. RESULTS: Consistently, higher levels of BMI were associated with lower self-estimated survival probabilities. Differences relative to normal weight ranged from 4.9% (p < 0.01) for male nonsmokers to 8.8% (p < 0.001) for female nonsmokers. However, these differences were substantially less than those obtained from published survival curve estimates, suggesting that obese individuals tended to underestimate mortality risks. DISCUSSION: Individuals appeared to underestimate the mortality risks of excessive weight; thus, knowledge campaigns about the risks of obesity should remain a top priority.
Keywords: Aged; Body Mass Index; Body Weight; Diabetes Mellitus; Female; Health Surveys; Humans; Hypertension; Male; Obesity; Perception; Retirement; Smoking; Surveys and Questionnaires; Survival Rate

Understanding the racial and ethnic differences in caregiving arrangements. - Terry Y S Lum (J Gerontol Soc Work, 2005)
In this study, the relative importance of family/household structure, socioeconomic status, and culture is examined, and their connection to racial and ethnic variations in caregiving networks is explored. Each of these three domains is seen as contributing to the race/ethnic variations in caregiving arrangements.
Keywords: Aged; Caregivers; ethnicity; Family Characteristics; Female; Frail Elderly; Humans; Logistic Models; Male; Multivariate Analysis; Social work; Socioeconomic factors; United States

Use of complementary medicine in older Americans: results from the Health and Retirement Study. - Ness, Jose; Dominic J Cirillo; David R Weir; Nisly, Nicole L.; Robert B Wallace (Gerontologist, 2005)
PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy. DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices). RESULTS: Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases. IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.
Keywords: Activities of Daily Living; Aged; Chi-Square Distribution; Complementary Therapies; Female; Humans; Male; Middle Aged; Regression Analysis; Surveys and Questionnaires; United States

A variables associated with occupational and physical therapy stroke rehabilitation utilization and outcomes. - Chad Cook; Stickley, Lois; Ramey, Kevin; Knotts, Valerie J. (J Allied Health, 2005)
Many studies have reported the benefits of a comprehensive stroke team including occupational therapy/physical therapy (OT/PT) services; however, factors associated with access to these services are less known. This study used a subsample of the Health and Retirement Study database, a cross-sectional survey of more than 11,126 Americans aged 65 to 106 years within the contiguous United States. The purposes of this study were to determine the associational factors that contribute to attending OT/PT and determine if attending OT/PT leads to a reduced report of stroke-related problems. The findings indicated that fewer than 10% of stroke survivors in a noninstitutionalized, community-based setting were currently accessing OT/PT. Additionally, access to OT/PT services was highly associated with report of having an attending physician, report of stroke-related weakness, higher monthly income, and older age. The increased odds of reported continued problems associated with a past stroke were associated with failure to access OT/PT services, lower monthly income, Hispanic culture, and age. OT/PT services were typically provided to patients who reported a higher level of physical dysfunction. Despite the greater degree of severity, OT/PT intervention led to reports of lower levels of disability and problems over time.
Keywords: Aged; Aged, 80 and over; Cross-Sectional Studies; Disability Evaluation; Female; Health Services Accessibility; Humans; Male; Occupational therapy; Physical Therapy Modalities; Risk Factors; Socioeconomic factors; Stroke Rehabilitation; United States

What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings. - Peter A. Ubel; Jankovic, Aleksandra; Dylan M Smith; Kenneth M. Langa; Angela Fagerlin (Med Care, 2005)
BACKGROUND: If an 85-year-old man rates his health as 90 on a scale in which 100 represents "perfect health," would his rating mean the same thing as a 90 rating from a 25-year-old? We conducted a randomized trial of 3 different ways of eliciting subjective health ratings from participants in the Health and Retirement Study to test whether the meaning of perfect health changes as people age, causing people to recalibrate their self-reported health ratings to account for their age. METHODS: The Health and Retirement Study (HRS) is a nationally representative, prospective study of 22,000 persons born in 1947 or earlier. The data analyzed in this study come from the self-assessed health utilities module administered in 2002 to 1031 randomly selected HRS respondents. Respondents were randomized to receive one of 3 versions of a subjective health rating task. In the perfect health version, they were asked how they would rate their "current health on a scale from 0 to 100, in which 0 represents death and 100 represents perfect health." In the your-age version, the phrase "for someone your age" was added to the end of the question to encourage people to recalibrate their responses based on age, and in the 20-year-old version, the phrase "for a 20-year-old" was added to minimize recalibration. RESULTS: A total of 1015 subjects responded to the rating task (98% response rate). Health ratings varied significantly across versions, with subjects responding to the 20-year-old version reporting lower health (mean rating 66 of 100) than those responding to the your-age version (mean rating of 73, P<0.001) or the perfect health version (mean rating of 73, P<0.001). This result suggests that subjects interpret perfect health to mean "perfect health for someone your age." However, additional analysis showed that the interpretation of the phrase perfect health lies somewhere between the other 2 versions. For example, responses to the perfect health and 20-year-old versions varied significantly by respondent age (both P's<0.075), whereas responses to the your-age scale did not (P=0.8). CONCLUSION: The phrase "perfect health" is ambiguous, causing some people to recalibrate their responses based on their age. Such ambiguity threatens the validity of common subjective health ratings, thereby reducing the comparability of responses across people of different ages or different circumstances.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Attitude to Health; Calibration; Female; Geriatric Assessment; Health Status; Humans; Interviews as Topic; Male; Prospective Studies; Psychometrics; Self Concept

When is baseline adjustment useful in analyses of change? An example with education and cognitive change. - M. Maria Glymour; Weuve, Jennifer; Lisa F Berkman; Ichiro Kawachi; Robins, James M. (Am J Epidemiol, 2005)
In research on the determinants of change in health status, a crucial analytic decision is whether to adjust for baseline health status. In this paper, the authors examine the consequences of baseline adjustment, using for illustration the question of the effect of educational attainment on change in cognitive function in old age. With data from the US-based Assets and Health Dynamics Among the Oldest Old survey (n = 5,726; born before 1924), they show that adjustment for baseline cognitive test score substantially inflates regression coefficient estimates for the effect of schooling on change in cognitive test scores compared with models without baseline adjustment. To explain this finding, they consider various plausible assumptions about relations among variables. Each set of assumptions is represented by a causal diagram. The authors apply simple rules for assessing causal diagrams to demonstrate that, in many plausible situations, baseline adjustment induces a spurious statistical association between education and change in cognitive score. More generally, when exposures are associated with baseline health status, this bias can arise if change in health status preceded baseline assessment or if the dependent variable measurement is unreliable or unstable. In some cases, change-score analyses without baseline adjustment provide unbiased causal effect estimates when baseline-adjusted estimates are biased.
Keywords: Age Factors; Aged; Bias; Cognition Disorders; Educational Status; Epidemiologic Methods; Female; Health Status; Humans; Longitudinal Studies; Male; Models, Statistical; Neuropsychological tests; Regression Analysis; United States

Who foregoes survivor protection in employer-sponsored pension annuities? - Richard W. Johnson; Cori E. Uccello; Joshua H. Goldwyn (Gerontologist, 2005)
PURPOSE: Retirees in traditional pension plans must generally choose between single life annuities, which provide regular payments until death, and joint and survivor annuities, which pay less each month but continue to make payments to the spouse after the death of the retired worker. This article examines the payout decision and measures the share of married retirees with pension annuities who forego survivor protection. DESIGN AND METHODS: The analysis consists of a probit model of the pension payout decision, based on data from the 1992-2000 waves of the Health and Retirement Study. RESULTS: More than one quarter (28%) of married men and two thirds of married women receiving employer-sponsored retirement annuities declined survivor protection. Men with small pensions and limited household wealth, men in better health than their spouses, and men whose spouses have pension coverage from their own employers are more likely than other men to reject survivor protection. IMPLICATIONS: Most workers appear to make payout decisions by rationally balancing the costs and benefits of each type of annuity, suggesting that existing measures to encourage joint and survivor annuities are adequate. However, the growth in 401(k) plans, which are generally not covered by existing laws protecting spousal pension rights, may leave widows vulnerable.
Keywords: Female; Humans; Male; Multivariate Analysis; Pensions; Socioeconomic factors; Spouses; United States

Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age. - Xiaoxing He; David W. Baker (Am J Public Health, 2004)
OBJECTIVES: We examined the relation between body mass index, exercise, overall health, and physical functioning. METHODS: We studied 7867 adults aged 51 to 61 years in 1992 to 1996. Adjusted relative risks for health decline and new physical difficulties were determined with logistic regression. RESULTS: Overweight and obesity were independently associated with health decline (adjusted relative risk [ARR] = 1.29 and 1.36) and development of a new physical difficulty (ARR = 1.27 and 1.45). Regular exercise significantly reduced the risk of health decline and development of a new physical difficulty, even among obese individuals. CONCLUSIONS: Maintaining ideal body weight is important in preventing decline in overall health and physical functioning. However, regular exercise can reduce the risk of health decline even among individuals who cannot achieve ideal weight.
Keywords: Attitude to Health; Body Mass Index; Female; Health Status; Humans; Logistic Models; Male; Middle Aged; Motor Activity; Obesity; Quality of Life; Risk Assessment; Risk Factors; Risk Reduction Behavior; Self Care; United States

Born to retire: the foreshortened life course. - David J Ekerdt (Gerontologist, 2004)
Retirement is no longer a concern solely for the second half of life. Rather, the idea that we will someday retire is increasingly present to all adults and it is even urged on adolescents. The earliest reaches of adulthood are being colonized by frequent reminders that it takes individual effort to achieve retirement. The changing nature of pensions, the identification of retirement saving with financial markets, the politics of Social Security, the aging baby boom generation, and the interests of a powerful industry and of government are daily compelling people's attention to retirement as a lifelong goal. With retirement as adulthood's great project of deferred gratification, the result could be greater personal readiness to retire but also some ironic outcomes, such as a stronger retirement norm, reluctance to spend on children, and outsized expectations for later life.
Keywords: Adolescent; Adult; Aged; Child; Female; Humans; Investments; Life Style; Male; Middle Aged; Pensions; Retirement; Social Security

Changes in weight among a nationally representative cohort of adults aged 51 to 61, 1992 to 2000. - Xiaoxing He; David W. Baker (Am J Prev Med, 2004)
BACKGROUND: Few studies have examined patterns and predictors of changes in body weight among adults in late middle age. METHODS: Prospective cohort study of 7391 community-dwelling U.S. adults aged 51 to 61 years at baseline (1992), using publicly available data files from the 1992, 1994, 1996, 1998, and 2000 Health and Retirement Survey interviews. Changes in weight and body mass index (BMI) were examined for different racial/ethnic groups of men and women. The predictors of changes in body weight and BMI were determined using gender-specific linear regression. RESULTS: Mean body weight and BMI increased in both genders and all ethnic groups. The mean weight gain was higher for women (1.67 kg, 95% confidence interval [CI]=1.34-1.99) than for men (1.43 kg, 95% CI=1.17-1.68). White men and women had the lowest baseline BMI but tended to gain more weight than other racial/ethnic groups. In multivariate analyses, individuals who were older or had higher baseline weight showed less weight gain. Men were less likely to gain weight if their self-reported overall health at baseline was poor compared to those in excellent health. Regular light or vigorous recreational activities and work-related activities were not associated with less weight gain. Race, education, and income were not associated with weight gain in multivariate analyses. CONCLUSIONS: All population subgroups are at risk for weight gain. Public health messages should target diverse populations. The current levels of physical activity attained by this population do not appear to protect against weight gain.
Keywords: Body Mass Index; Body Weight; Female; Health Surveys; Humans; Linear Models; Longitudinal Studies; Male; Middle Aged; Motor Activity; Multivariate Analysis; Prospective Studies; Racial Groups; Sex Factors; United States

Cognitive deficits and the course of major depression in a cohort of middle-aged and older community-dwelling adults. - Ramin Mojtabai; Mark Olfson (J Am Geriatr Soc, 2004)
OBJECTIVES: To examine associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2- and 4-year follow-ups in a sample of community-dwelling middle-aged and older adults. DESIGN: Prospective cohort study. SETTING: A U.S. national prospective cohort study of middle-aged and older adults, the Health and Retirement Study. PARTICIPANTS: A sample of 661 participants of the 1996 wave of the Health and Retirement Study who met criteria for 12-month Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised major depression (MD). MEASUREMENTS: MD was assessed using the World Health Organization Composite International Diagnostic Interview-Short Form. Persistent significant depressive symptoms were assessed using an eight-item version of the Center for Epidemiological Studies Depression scale. RESULTS: Cognitive deficits were associated with persistent significant depressive symptoms at follow-up. In a latent state-trait analysis, two stable and strongly correlated traits best explained variations in cognitive functioning and depressive symptoms across assessment points. CONCLUSION: Trait-like cognitive deficits commonly complicate the course of MD in community-dwelling middle-aged and older adults and may help to explain the persistent course of depressive symptoms in a large subgroup of adults with MD in this age range.
Keywords: Aged; Chi-Square Distribution; Cognition Disorders; Depressive Disorder, Major; Female; Geriatric Assessment; Humans; Interviews as Topic; Logistic Models; Male; Middle Aged; Prospective Studies; Psychiatric Status Rating Scales; Residence Characteristics; Risk Factors; United States

Does urinary incontinence affect middle-aged and older women's time use and activity patterns? - Fultz, Nancy H.; Gwenith G Fisher; Kristi Rahrig Jenkins (Obstet Gynecol, 2004)
OBJECTIVE: To investigate the relationship between urinary incontinence and women's levels and hours of participation in 31 activities. METHODS: A subset of panel members from the Health and Retirement Study completed the self-administered Consumption and Activities Mail Survey questionnaire in 2001. These data were linked with Health and Retirement Study 2000 data. Analyses were limited to 2,190 female Consumption and Activities Mail Survey self-respondents born in 1947 or earlier. Logistic regression was used to predict activity participation. Linear regression was used to predict the number of hours of participation. RESULTS: The hypothesis that urinary incontinence affects women's time use and activity patterns was supported. Compared with the continent women, the incontinent women were less likely to have house cleaned, shopped, physically shown affection, or attended religious services in the recent past; and were more likely to have watched television or made music by singing or playing an instrument. Compared with continent activity participants, incontinent participants reported significantly fewer hours spent walking, communicating with friends and family by telephone or e-mail, working for pay, using a computer, and engaging in personal grooming and hygiene. CONCLUSION: These findings substantiate prior work on the relationship between urinary incontinence and quality of life, and suggest a useful route for educating patients about the impact of urinary incontinence. Clinicians must be alert to opportunities for encouraging incontinent women to be active. It is also important to consider the implications for time use and activity patterns when advising patients about treatment and management options. LEVEL OF EVIDENCE: II-2.
Keywords: Aged; Female; Humans; Interpersonal Relations; Leisure activities; Logistic Models; Middle Aged; Quality of Life; Urinary incontinence

Economic status in later life among women who raised children outside of marriage. - Richard W. Johnson; Melissa Favreault (J Gerontol B Psychol Sci Soc Sci, 2004)
OBJECTIVE: Many single mothers are likely to face special economic challenges in old age, because they often have limited employment histories and cannot rely on husbands for financial support. This article examines the economic status of these women in later life. METHODS: The analysis uses nationally representative data from the Health and Retirement Study to estimate multivariate models of income, assets, and poverty rates for women aged 65-75 in 1999. RESULT: Controlling for education, current marital status, and race and ethnicity, the models indicate that women who spent > or =10 years raising dependent children outside of marriage are 55% more likely to live in poverty at ages 65-75 than women who were always married when their children were young. DISCUSSION: The financial difficulties confronting single mothers raising children persist into later life. Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for these vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.
Keywords: Adolescent; Adult; Aged; Aging; Child; Child Rearing; Demography; Female; Humans; Illegitimacy; Middle Aged; Single-Parent Family; Social Support; Socioeconomic factors

The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement. - Donald H. Taylor Jr.; Hoenig, H. (J Am Geriatr Soc, 2004)
OBJECTIVES: To determine whether residual difficulty in functioning in spite of equipment use is linked with increased use of personal assistance. DESIGN: Longitudinal. Two waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) database were used to test the effect of residual difficulty on hours of personal assistance and bed days at Wave 1 on hours of personal assistance, bed days, and nursing home placement at Waves 1 and 2. SETTING: A nationally representative setting of community-dwelling persons aged 70 and older and their spouses, regardless of age at Wave 1 AHEAD. There was movement of some respondents into nursing homes by the Wave 2 interview. PARTICIPANTS: Respondents to the AHEAD survey, N=8,222 at Wave 1. MEASUREMENTS: The dependent variables were hours of personal assistance in the month before the AHEAD survey (Waves 1 and 2), number of days in month before the survey in which the person did not get out of bed (Waves 1 and 2), and residence in a nursing home at Wave 2. The key explanatory variable was a mutually exclusive (four category) variable that specified whether there was residual difficulty (yes/no) in indoor mobility in spite of using equipment to aid specifically with indoor mobility. The four-category variable was defined by the four categories created by a cross-tabulation of equipment use (yes/no) and difficulty with indoor mobility (yes/no). A similar four-category variable was also defined for transferring in the home. RESULTS: In cross section, equipment users with residual difficulty reported more hours of personal assistance in the case of indoor mobility impairment and were more likely to have some hours of personal assistance than those without residual difficulty with indoor mobility and transferring. Longitudinally, those with residual difficulty at Wave 1 were more likely to need some personal assistance hours at Wave 2 (odds ratio=1.67, 95% confidence interval= 1.23-2.26 for indoor mobility). For transferring, those with residual difficulty had 43 more hours of personal assistance per month (P=.001) than those for whom equipment resolved their disability. Residual disability was linked to more bed days for users of indoor mobility and transferring equipment, but it was not predictive of nursing home placement by Wave 2. CONCLUSION: Equipment for indoor mobility or transfers apparently resolves difficulty for some users of the equipment but not for others. Residual task difficulty in spite of equipment for indoor mobility and transferring is linked with worse outcomes, including increased dependency on personal assistance and more days in bed. This shows that more attention is needed to determine whether equipment prescribed is appropriate for a patient's difficulty and that follow-up assessment is crucial after equipment is prescribed.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Bed Rest; Cross-Sectional Studies; Disability Evaluation; Female; Homemaker Services; Humans; Least-Squares Analysis; Logistic Models; Longitudinal Studies; Male; Nursing homes; Risk Factors; Self-Help Devices

The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits. - Ostermann, Jan; Frank A Sloan (Milbank Q, 2004)
This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alcohol consumption patterns and controls for other characteristics, including smoking. Relative to moderate drinkers, heavy drinkers receive fewer OASI benefits relative to their contributions. Ironically, for each cohort of 25-year-olds, eliminating heavy drinking costs the program an additional $3 billion over the cohort's lifetime. Public health campaigns are designed to improve individual health-relevant behaviors and, in the long run, increase longevity. Therefore, if programs for the elderly are structured as longevity-independent defined benefit programs, their success will reward healthier behaviors but increase these programs' outlays and worsen their financial condition.
RDA 1996-024
Keywords: Accidents, Traffic; Adolescent; Adult; Aged; Aged, 80 and over; Alcoholism; Cost Sharing; Female; Health Behavior; Humans; Insurance Coverage; Life Expectancy; Male; Middle Aged; Old Age Assistance; Social Security; United States

The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans. - Truls Ostbye; Donald H. Taylor Jr. (Health Serv Res, 2004)
OBJECTIVE: To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct. DATA SOURCES/STUDY SETTING: The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons > or =70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000. STUDY DESIGN: Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables. PRINCIPAL FINDINGS: Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers. CONCLUSIONS: Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.
Keywords: Age Distribution; Aged; Aged, 80 and over; Female; Health Surveys; Humans; Longitudinal Studies; Male; Middle Aged; Quality of Life; Quality-Adjusted Life Years; Regression Analysis; Sex Distribution; Smoking; Smoking cessation; United States

The effect of spousal mental and physical health on husbands' and wives' depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey. - Michele J. Siegel; Elizabeth H Bradley; William T Gallo; Stanislav V Kasl (J Aging Health, 2004)
OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents' depressive symptoms in a national sample of older married couples. METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents' depressive symptoms. RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses' physical health was associated with a significant reduction in respondent depressive symptoms (p < .05). DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.
Keywords: Aged; Caregivers; depression; Female; Health Status; Humans; Male; Mental Health; Models, Theoretical; Spouses; United States

The effect of the tobacco settlement and smoking bans on alcohol consumption. - Gabriel A. Picone; Frank A Sloan; Justin G Trogdon (Health Econ, 2004)
In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.
Keywords: Aged; Alcohol Drinking; Behavior, Addictive; Data collection; Female; Humans; Male; Middle Aged; Models, Econometric; Smoking; United States

Elders who delay medication because of cost: health insurance, demographic, health, and financial correlates. - Klein, Dawn; Carolyn L. Turvey; Robert B Wallace (Gerontologist, 2004)
PURPOSE: Prescription medication use is essential to the health and well-being of many elderly persons. However, the cost of medications may be prohibitive and contribute to noncompliance with medical recommendations. This study identifies community-dwelling elders who reported a delay in medication use because of prescription medication cost. DESIGN AND METHODS: This was a cross-sectional study of a nationwide sample of 6,535 elders participating in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Participants reported if they had taken less medication than prescribed or if they had not filled prescriptions because of cost in the past 2 years. This response was then compared with the self-report of multiple variables, including demographic, health status, health insurance coverage, and financial variables. RESULTS: Elders who were most vulnerable to medication delay as a result of cost included those with Medicare coverage only, low income, high out-of-pocket prescription costs, and poor health as well as African American elders and those aged 65-80 years. IMPLICATIONS: This study provides important information about community-dwelling elders that reported a delay in medication use because of cost. As a Medicare prescription benefit has been passed, it will be important to monitor how these changes affect the elders identified at risk for medication delay.
Keywords: Aged; Aged, 80 and over; Cross-Sectional Studies; Drug Therapy; Fees, Pharmaceutical; Female; Health Status; Humans; Insurance, Pharmaceutical Services; Logistic Models; Male; Medicare; Multivariate Analysis; Patient Compliance; Self Administration; Socioeconomic factors; United States

Extent and cost of informal caregiving for older Americans with symptoms of depression. - Kenneth M. Langa; Marcia A. Valenstein; A. Mark Fendrick; Mohammed U Kabeto; Sandeep Vijan (Am J Psychiatry, 2004)
OBJECTIVE: The purpose of this study was to obtain nationally representative estimates of the additional time and cost associated with informal caregiving for older Americans with depressive symptoms. METHOD: Data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people age 70 years or older (N=6,649), were used to determine the weekly hours and imputed costs of informal caregiving for elderly people with no depressive symptoms in the last week, one to three depressive symptoms in the last week, and four to eight depressive symptoms in the last week. RESULTS: Forty-four percent of survey respondents reported one to three depressive symptoms, and 18% reported four to eight depressive symptoms. In multivariate regression analyses that adjusted for sociodemographics, caregiver network, and coexisting chronic health conditions, respondents with no depressive symptoms received an average of 2.9 hours per week of informal care, compared with 4.3 hours per week for those with one to three symptoms and 6.0 hours per week for those with four to eight symptoms. Caregiving associated with depressive symptoms in elderly Americans represented a yearly cost of about $9 billion. CONCLUSIONS: Depressive symptoms in elderly persons are independently associated with significantly higher levels of informal caregiving, even after the effects of major coexisting chronic conditions are adjusted. The additional hours of care attributable to depressive symptoms represent a significant time commitment for family members and, therefore, a significant societal economic cost. Further research should evaluate the causal pathways by which depressive symptoms lead to high levels of caregiving and should examine whether successful treatment of depression reduces the need for informal care.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Caregivers; Comorbidity; Costs and Cost Analysis; Depressive Disorder; Fees and Charges; Female; Health Care Costs; Home Nursing; Humans; Longitudinal Studies; Male; Personality Inventory; Workload

The health effects of restricting prescription medication use because of cost. - Michele M Heisler; Kenneth M. Langa; Eby, Elizabeth L.; A. Mark Fendrick; Mohammed U Kabeto; John D Piette (Med Care, 2004)
BACKGROUND: High out-of-pocket expenditures for prescription medications could lead people with chronic illnesses to restrict their use of these medications. Whether adults experience adverse health outcomes after having restricted medication use because of cost is not known. METHODS: We analyzed data from 2 prospective cohort studies of adults who reported regularly taking prescription medications using 2 waves of the Health and Retirement Study (HRS), a national survey of adults aged 51 to 61 in 1992, and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a national survey of adults aged 70 or older in 1993 (n = 7991). We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2 to 3 years of follow up of reporting in 1995-1996 having taken less medicine than prescribed because of cost during the prior 2 years. After adjusting for differences in sociodemographic characteristics, health status, smoking, alcohol consumption, body mass index (BMI), and comorbid chronic conditions, we determined the risk of a significant decline in overall health among respondents in good to excellent health at baseline and of developing new disease-related adverse outcomes among respondents with cardiovascular disease, diabetes, arthritis, and depression. RESULTS: In adjusted analyses, 32.1% of those who had restricted medications because of cost reported a significant decline in their health status compared with 21.2% of those who had not (adjusted odds ratio [AOR], 1.76; confidence interval [CI], 1.27-2.44). Respondents with cardiovascular disease who restricted medications reported higher rates of angina (11.9% vs. 8.2%; AOR, 1.50; CI, 1.09-2.07) and experienced higher rates of nonfatal heart attacks or strokes (7.8% vs. 5.3%; AOR, 1.51; CI, 1.02-2.25). After adjusting for potential confounders, we found no differences in disease-specific complications among respondents with arthritis and diabetes, and increased rates of depression only among the older cohort. CONCLUSIONS: Cost-related medication restriction among middle-aged and elderly Americans is associated with an increased risk of a subsequent decline in their self-reported health status, and among those with preexisting cardiovascular disease with higher rates of angina and nonfatal heart attacks or strokes. Such cost-related medication restriction could be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage.
Comment in: Med Care. 2004 Jul;42(7):623-5 AN=15213485
Keywords: Aged; Chronic disease; Female; Financing, Personal; Health Services Accessibility; Health Status; Humans; Male; Middle Aged; Multivariate Analysis; Patient Compliance; Prospective Studies; Risk; United States

Health insurance coverage and mortality among the near-elderly. - J. Michael McWilliams; Alan M. Zaslavsky; Meara, Ellen; John Z. Ayanian (Health Aff (Millwood), 2004)
Uninsured near-elderly people may be particularly at risk for adverse health outcomes. We compared mortality of a nationally representative cohort of insured and uninsured near-elderly people with stratification by race; income; and the presence of diabetes, hypertension, or heart disease, using propensity-score methods to adjust for numerous characteristics. Lacking health insurance was associated with substantially higher adjusted mortality among adults who were white; had low incomes; or had diabetes, hypertension, or heart disease. Expanding coverage to the near-elderly uninsured may greatly improve health outcomes for these groups.
Keywords: Cohort Studies; Female; health policy; Humans; Insurance Coverage; Insurance, Health; Longitudinal Studies; Male; Medically Uninsured; Middle Aged; Mortality; United States

Heart disease, comorbidity, and activity limitation in community-dwelling elderly. - Oldrige, Neil B.; Timothy E. Stump (Eur J Cardiovasc Prev Rehabil, 2004)
PURPOSE: The purpose of this study was to describe the impact of self-report heart disease, other chronic comorbidities, and perceived health status on activity limitation among community dwelling persons older than 50 years of age. METHODS: Odds ratios for activity limitation in activities of daily living, mobility, and other activities were estimated for respondents with self-report heart disease, eight other chronic comorbid conditions, and perceived health status using data generated in two nationally representative cross-sectional surveys, the Health and Retirement Survey (HRS; respondents aged 51 to 60 years) and the Assets and Health Dynamics of the Oldest Old study (AHEAD; respondents aged 70 years and older). RESULTS: The prevalence of activity limitation increased significantly across the spectrum from activities of daily living to mobility to other activities in both surveys in respondents with and without heart disease. There was a significantly increased likelihood of mobility and other activity limitation among those with heart disease. Among the HRS respondents with heart disease, five or more of the eight comorbid conditions plus poor or fair perceived health were associated with a significantly increased limitation in each activity category. Among the AHEAD respondents with heart disease, three comorbid conditions plus perceived health were associated with a significantly increased limitation in activities of daily living whereas six comorbid conditions plus perceived health were associated with a significantly increased limitation in mobility and in other activities. CONCLUSIONS: As a prime objective of cardiac rehabilitation is to reduce activity limitation, the strong associations between comorbidity and activity limitation observed in this study among persons older than 50 years with heart disease suggest that the burden of comorbidity-associated is considerable but should not be an automatic exclusion criterion for referral to cardiac rehabilitation. The lack of rigorous scientific information on how these associations may influence clinicians who refer patients to rehabilitation and those who manage these programs strongly reinforces the need for more research to explore the real-world spectrum of comorbidity among persons with heart disease and the impact on activity limitation.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Chronic disease; Cross-Sectional Studies; Female; Health Status; Heart Diseases; Humans; Male; Middle Aged; Motor Activity; Residence Characteristics; Self Concept; Socioeconomic factors

Honeymoons and joint lunches: effects of retirement and spouse's employment on depressive symptoms. - Maximiliane E Szinovacz; Adam Davey (J Gerontol B Psychol Sci Soc Sci, 2004)
With hypotheses derived from a life course perspective in conjunction with life event stress and role theories, we examine whether a spouse's employment and length of retirement affect a person's postretirement depressive symptoms and whether such effects differ by gender. Analyses use pooled data from Waves 1-4 of the Health and Retirement Survey, using a subsample of married individuals who either remained continuously employed over time or completely retired since the Wave 1 interviews (N = 2,695). Recently retired men seem to be negatively affected by their spouses' continuous employment when compared with men whose wives were continuously not employed. In contrast, spouses' joint retirement has a beneficial influence on both recently retired and longer-retired men. However, for recently retired men, the positive effect of wives' retirement seems to be contingent on spouses' enjoyment of joint activities. Among women, effects of spouses' employment occur only among very recently retired wives (0-6 months). These wives report more depressive symptoms if their spouses were already nonemployed prior to wives' retirement. These results demonstrate the complexity of retirement adaptation processes and suggest that marital context plays an important role in retirement well-being.
Keywords: Adaptation, Psychological; Aged; Aging; Data collection; depression; Employment; Female; Humans; Life Change Events; Longitudinal Studies; Male; Mental Health; Middle Aged; Retirement; Sex Factors; Spouses

The impact of diabetes on workforce participation: results from a national household sample. - Sandeep Vijan; Rodney A. Hayward; Kenneth M. Langa (Health Serv Res, 2004)
OBJECTIVE: Diabetes is a highly prevalent condition that results in substantial morbidity and premature mortality. We investigated how diabetes-associated mortality, disability, early retirement, and work absenteeism impacts workforce participation. DATA SOURCE: We used the Health and Retirement Study (HRS), a national household sample of adults aged 51-61 in 1992, as a data source. STUDY DESIGN: We conducted cross-sectional analyses on the baseline HRS data, and longitudinal analyses using data from eight years of follow-up. We used two-part regression models to estimate the adjusted impact of diabetes on workforce participation, and then estimated the economic impact of diabetes-related losses in productivity. PRINCIPAL FINDINGS: Diabetes is a significant predictor of lost productivity. The incremental lost income due to diabetes by 1992 was 60.0 billion US dollars over an average diabetes duration of 9.7 years. From 1992 to 2000, diabetes was responsible for 4.4 billion US dollars in lost income due to early retirement, 0.5 billion US dollars due to increased sick days, 31.7 billion US dollars due to disability, and 22.0 US dollars billion in lost income due to premature mortality, for a total of 58.6 billion dollars in lost productivity, or 7.3 billion US dollars per year. CONCLUSIONS: In the U.S. population of adults born between 1931 and 1941, diabetes is associated with a profound negative impact on economic productivity. By 1992, an estimated 60 billion US dollars in lost productivity was associated with diabetes; additional annual losses averaged 7.3 billion US dollars over the next eight years, totaling about 120 billion US dollars by the year 2000. Given the rising prevalence of diabetes, these costs are likely to increase substantially unless countered by better public health or medical interventions.
Social Security Administration/Michigan Retirement Research Center Grant UM01-11
Keywords: Chronic disease; Cohort Studies; Cost of Illness; Cross-Sectional Studies; Diabetes Mellitus; Disabled Persons; Efficiency; Employment; Female; Health Services Research; Health Status Indicators; Humans; Longitudinal Studies; Male; Middle Aged; United States

Increasing obesity rates and disability trends. - Sturm, Roland; Ringel, Jeanne S.; Andreyeva, Tatiana (Health Aff (Millwood), 2004)
Are older Americans becoming more or less disabled? Unhealthy body weight has increased dramatically, but other data show that disability rates have declined. We use data from the Health and Retirement Study to estimate the association between obesity and disability, and we combine these data with trend estimates of obesity rates from the Behavioral Risk Factor Surveillance Survey. If current trends in obesity continue, disability rates will increase by 1 percent per year more in the 50-69 age group than if there were no further weight gain.
Keywords: Aged; Disabled Persons; Female; Humans; Male; Middle Aged; Obesity; Population Surveillance; United States

Informal care and health care use of older adults. - Courtney Harold Van Houtven; Edward C Norton (J Health Econ, 2004)
Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.
Keywords: Aged; Female; Health Care Surveys; health policy; Health Services for the Aged; Home Care Services; Home Nursing; Homes for the Aged; Humans; Male; Nursing homes; United States

Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: findings from the Health and Retirement Survey. - William T Gallo; Elizabeth H Bradley; Tracy Falba; J. A. Dubin; Cramer, L.; Stanislav V Kasl (Am J Ind Med, 2004)
BACKGROUND: The role of stress in the development of cardiovascular disease is well established. Previous research has demonstrated that involuntary job loss in the years immediately preceding retirement can be a stressful life event shown to produce adverse changes in physical and affective health. The objective of this study was to estimate the risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers nearing retirement in the United States. METHODS: We used multivariable survival analysis to analyze data from the first four waves of the Health and Retirement Survey (HRS), a nationally representative sample of older individuals in the US. The analytic sample includes 457 workers who experienced job loss and a comparison group of 3,763 employed individuals. RESULTS: The results indicate that involuntary job loss is not associated with subsequent risk of MI (adjusted HR = 1.89; 95% CI = 0.91, 3.93); the risk of subsequent stroke associated with involuntary job loss is more than double (adjusted HR = 2.64; 95% CI = 1.01, 6.94). CONCLUSIONS: Our findings present new data to suggest that involuntary job loss should be considered as a plausible risk factor for subsequent cardiovascular and cerebrovascular illness among older workers.
Keywords: Female; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Retirement; Risk Factors; Stress, Psychological; Stroke; Unemployment; United States

Life course transitions and depressive symptoms among women in midlife. - M Jean Turner; Timothy S Killian; Rebekah Cain (Int J Aging Hum Dev, 2004)
This study examined the relationship between three midlife transitions and depressive symptoms among 952 women 50 to 59 years of age. Using longitudinal data from women interviewed for the 1992 and 2000 Health and Retirement Study, the study described changes in marital status, change to a parental caregiving role, and changes in perceived health across the eight years. Further, it examined the impact of these changes on mental health. The findings indicate that becoming widowed, becoming a caregiver, and perceiving health declines significantly increased depressive symptoms in the year 2000, even when controlling for pre-transition levels of depressive symptoms. The findings are consistent with the lifecourse perspective that individual development occurs in context and across the lifespan. The findings confirm and add to current midlife research literature.
Keywords: Caregivers; depression; Female; Health Status; Humans; Interviews as Topic; Life Change Events; Longitudinal Studies; Marital Status; Middle Aged; Quality of Life

Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. - Ramin Mojtabai; Mark Olfson (Psychol Med, 2004)
BACKGROUND: Although major depression is a common condition across the age range, there is some evidence from clinical studies that it may be more persistent and disabling in older adults. This study examined the demographic, socio-economic and clinical factors associated with major depression and with persistence of depressive symptoms at 2- and 4-year follow-ups in a large population sample of middle-aged and older adults. METHOD: In a sample of 9747 participants aged over 50 in the 1996 wave of the US Health and Retirement Study, the authors assessed the 12-month prevalence of major depression using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Significant depressive symptoms at the time of 1996, 1998 and 2000 interviews were assessed using a short form of the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: The 12-month prevalence of CIDI-SF major depression was 6.6%. With age, prevalence declined, but the likelihood of significant depressive symptoms at follow-ups increased. Both prevalence and persistence of significant depressive symptoms at follow-ups were associated with socio-economic disadvantage and physical illness. Persistence of depressive symptoms at follow-ups was also associated with symptoms of anhedonia, feelings of worthlessness, and thoughts of death at baseline. CONCLUSIONS: Sociodemographic, physical health and a specific profile of depressive symptoms are associated with a poorer course of major depression in the middle-aged and older adults. These indicators may identify a subgroup of patients in need of more careful follow-up and intensive treatment.
Keywords: Age Factors; Aged; Depressive Disorder, Major; Female; Follow-Up Studies; Health Status; Humans; Logistic Models; Male; Middle Aged; Prevalence; Residence Characteristics; Sex Factors; Socioeconomic factors; Time Factors; United States

Moderate and severe obesity have large differences in health care costs. - Andreyeva, Tatiana; Sturm, Roland; Ringel, Jeanne S. (Obes Res, 2004)
OBJECTIVE: To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old. RESEARCH METHODS AND PROCEDURES: Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days. RESULTS: The results indicated that there were large differences in obesity-related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50% increase) than a BMI of 30 to 35 (about a 25% increase); a BMI of over 40 doubled health care costs (approximately 100% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services. DISCUSSION: Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.
Keywords: Aged; Ambulatory Care; Body Mass Index; Body Weight; Female; Health Care Costs; Hospitalization; Humans; Male; Middle Aged; Obesity; Sex Characteristics

Nonmetro residence, hearing loss, and its accommodation among elderly people. - Nan E. Johnson (J Rural Health, 2004)
BACKGROUND: No previous studies compare the prevalence of physiological hearing loss among older adults by nonmetro/metro residence. Also, there is little information on their relative successes in accommodating hearing loss with a hearing aid. PURPOSE: This study sought to bridge these gaps by analyzing the 8,222 respondents to Wave 1 (1993-1994) of the national Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey. METHODS: Respondents were classified into 4 categories of hearing status: (1) physiologically normal hearing; and physiologically abnormal hearing with (2) full accommodation of lost hearing with a hearing aid, (3) partial accommodation, and (4) no hearing aid. A multinomial logistic regression was used to predict the odds of having any of the 3 statuses of physiologically abnormal hearing rather than normal hearing. FINDINGS: Nonmetro residents had the same odds as metro residents of having no residual hearing loss when a hearing aid was worn (versus having physiologically normal hearing). But nonmetro residents had a much greater risk than their metro counterparts of having a hearing loss but no hearing aid or a residual hearing loss even when wearing an aid. The association of nonmetro residence with either of these latter hearing-loss statuses was greater than that of age, a more traditionally acknowledged hearing-risk factor. CONCLUSION: Future studies should add nonmetro residence to the list of risk factors for negative hearing outcomes, especially since the percentage of elderly nonmetro residents is expected to grow over the next 2 decades.
Keywords: Aged; Aged, 80 and over; Comorbidity; Female; Health Surveys; Hearing aids; Hearing loss; Humans; Male; Memory Disorders; Odds Ratio; Rural Health; United States; Urban Population

Number of children associated with obesity in middle-aged women and men: results from the health and retirement study. - Weng, Haoling H.; Bastian, Lori A.; Donald H. Taylor Jr.; Truls Ostbye (J Womens Health (Larchmt), 2004)
OBJECTIVE: To study associations between number of children and obesity in middle-aged women and men. METHODS: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples). RESULTS: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women. Men (n = 4523) who were obese were younger, were more frequently African American, and were more frequently less educated and poorer compared with nonobese men. Among women, a 7% increase in risk of obesity was noted for each additional child, adjusting for age, race, household income, work status, physical activity, tobacco use, and alcohol use. Among men, a 4% increase in risk of obesity was noted for each additional child, adjusting for the same covariates. These sex differences were not significantly different. CONCLUSIONS: Previous research has demonstrated an association between number of children and obesity among women. These results suggest a similar association among men. Public health interventions focused on obesity prevention should target both parents, especially those parents with several children.
Keywords: Adult; Aged; Body Mass Index; Family Characteristics; Female; Health Behavior; Health Surveys; Humans; Male; Middle Aged; Obesity; Parity; Risk Assessment; United States

Obesity's effects on the onset of functional impairment among older adults. - Kristi Rahrig Jenkins (Gerontologist, 2004)
PURPOSE: This study has two purposes. First, it determines if there is a relationship between body weight and the onset of functional impairment across time among this sample of older adults. More specifically, it examines if obese older adults are more likely to experience the onset of functional impairment. Second, it explores how health behaviors and health conditions may explain the relationship between body weight and the onset of functional impairment. DESIGN AND METHODS: With the use of longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, logistic regression models on the onset of functional impairment over two time points are estimated for older adults. RESULTS: Results indicate that body weight (more specifically being overweight or obese) makes one more likely to experience the onset of functional impairment across various domains of impairment. Outside of health behaviors and health conditions, obesity has an independent effect on the onset of impairment in strength, lower body mobility, and activities of daily living. IMPLICATIONS: Study findings support the active treatment of weight problems in older adults. Future directions for research in this area should address effective weight management interventions targeting issues related to older individuals.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Body Weight; Chronic disease; Disabled Persons; Exercise; Female; Humans; Longitudinal Studies; Male; Motor Activity; Movement; Obesity; Risk-Taking; United States

Out-of-pocket health care expenditures among older Americans with dementia. - Kenneth M. Langa; Eric B Larson; Robert B Wallace; A. Mark Fendrick; Norman L Foster; Mohammed U Kabeto; David R Weir; Robert J. Willis; A. Regula Herzog (Alzheimer Dis Assoc Disord, 2004)
The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was 1,350 US dollars for those without dementia, 2,150 US dollars for those with mild/moderate dementia, and 3,010 US dollars for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care (1,770 per year US dollars) and prescription medications (800 per year US dollars) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.
Keywords: Aged; Aged, 80 and over; Alzheimer disease; Costs and Cost Analysis; Data Interpretation, Statistical; Female; Financing, Personal; Health Care Costs; Health Expenditures; Health Surveys; Humans; Insurance Coverage; Longitudinal Studies; Male

Out-of-pocket health-care expenditures among older Americans with cancer. - Kenneth M. Langa; A. Mark Fendrick; M.E. Chernew; Mohammed U Kabeto; Paisley, Kerry L.; Hayman, James A. (Value Health, 2004)
OBJECTIVE: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx). METHODS: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated. RESULTS: Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01). CONCLUSIONS: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.
Keywords: Aged; Aged, 80 and over; Cost of Illness; Family Characteristics; Female; Financing, Personal; Health Expenditures; Health Services Research; Humans; Insurance, Health; Longitudinal Studies; Male; Medicaid; Medicare; Michigan; Neoplasms

Physical activity and mortality across cardiovascular disease risk groups. - Richardson, Caroline R.; Kriska, Andrea M.; Lantz, Paula M.; Rodney A. Hayward (Med Sci Sports Exerc, 2004)
PURPOSE: Several cohort studies suggest that sedentary individuals have an increased risk of death compared with individuals who are physically active. Most of these studies have been conducted in highly selected patient populations who tend to be healthier and are from higher socioeconomic status (SES) groups. We examined the impact of a sedentary lifestyle on mortality by cardiovascular disease (CVD) risk group in a national sample of U.S. adults who represent a wide range of activity levels, health conditions, and SES groups. METHODS: Using data from the HRS, a nationally representative, observational study of 9824 U.S. adults aged 51-61 yr in 1992, we estimated the relative risk of death comparing sedentary individuals with those who are physically active by CVD risk group in a multivariate logistic regression model. RESULTS: Even after adjusting for confounders, regular moderate to vigorous physical activity was associated with substantially lower overall mortality (odds ratio (OR) = 0.62 (95% CI 0.44-0.86)) compared with sedentary individuals. High CVD risk individuals (21% of the population) accounted for 64% of deaths attributable to a sedentary lifestyle. Those with high CVD risk had the most significant benefit from being active (regular moderate to vigorous exercisers OR = 0.55 (95% CI 0.31-0.97) and occasional or light exercisers OR 0.55 (95% CI 0.41-0.74)) compared with high CVD risk individuals who were sedentary. CONCLUSION: A sedentary lifestyle is associated with a higher risk of death in preretirement-aged U.S. adults. Individuals with high CVD risk appear to get the largest benefit from being physically active. Physical activity interventions targeting high CVD risk individuals should be a medical and public health priority.
Keywords: Cardiovascular Diseases; Cohort Studies; Female; Follow-Up Studies; Humans; Life Style; Logistic Models; Male; Middle Aged; Motor Activity; Multivariate Analysis; Odds Ratio; Prospective Studies; Risk Assessment; Risk Factors; Socioeconomic factors; Survival Analysis; United States

Quality of preventive clinical services among caregivers in the health and retirement study. - Kim, Catherine; Mohammed U Kabeto; Robert B Wallace; Kenneth M. Langa (J Gen Intern Med, 2004)
We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.
Keywords: Aged; Caregivers; Cohort Studies; Cross-Sectional Studies; Female; Health Care Surveys; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Preventive Health Services; Quality of Health Care; Time Factors; United States

Race, gender, and the retirement decisions of people ages 60 to 80: prospects for age integration in employment. - Tay K. McNamara; Williamson, John B. (Int J Aging Hum Dev, 2004)
UNLABELLED: Demographic projections have prompted concerns about the potential economic burden of an aging population. This article, drawing on the 1998 Health and Retirement Study, explores ways in which race, gender, and age moderate the effects of various factors on labor force participation among people ages 60 to 80. Key findings center on health, education, and non-wage income. First, the effect of low non-wage income is weaker at older ages due to higher levels of functional disability. Second, the effect of low education is stronger for women, who perceive their chances of finding employment as low. Third, the effect of health is weaker for blacks, as they are less likely to find steady employment regardless of health. POLICY IMPLICATIONS: Employer flexibility in number of hours worked might make sense for workers close to retirement age, while job search and training programs might be preferable for workers past the typical retirement age.
Keywords: Age Distribution; Aged; Aged, 80 and over; Black People; Educational Status; Employment; Female; Health Status; Humans; Income; Logistic Models; Male; Middle Aged; Retirement; Sex Distribution; White People

Religion and preventative health care utilization among the elderly. - Benjamins, Maureen Reindl; Brown, Carolyn (Soc Sci Med, 2004)
Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Catholicism; Diagnostic Tests, Routine; Female; Health Services for the Aged; Health Status; Humans; Interviews as Topic; Jews; Logistic Models; Longitudinal Studies; Male; Patient Acceptance of Health Care; Preventive Health Services; Primary Health Care; Protestantism; Religion and Psychology; Socioeconomic factors; United States

Resolving inconsistencies in trends in old-age disability: report from a technical working group. - Vicki A Freedman; Eileen M. Crimmins; Robert F. Schoeni; Brenda C Spillman; Aykan, Hakan; Kramarow, Ellen; Land, Kenneth; Lubitz, James; Kenneth G. Manton; Linda G Martin; Shinberg, Diane; Timothy A Waidmann (Demography, 2004)
In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Chronic disease; Disabled Persons; Female; Health Surveys; Homemaker Services; Humans; Male; Models, Statistical; Self-Help Devices; United States

Retirement transitions and spouse disability: effects on depressive symptoms. - Maximiliane E Szinovacz; Adam Davey (J Gerontol B Psychol Sci Soc Sci, 2004)
OBJECTIVES: The purpose of this study was to investigate the effects of type of retirement (forced, early, abrupt) and spouse's disability on longitudinal change in depressive symptoms. METHODS: The analyses rely on Waves 1-4 of the Health and Retirement Survey (N = 2,649). Generalized estimating equations models with bootstrapped standard errors and adjustment for survey design and non-independence of dyad members estimate effects of retirement, type of retirement, and spouse's disability on depressive symptoms, controlling for relevant covariates. RESULTS: The results suggest that depressive symptoms increase when retirement is abrupt and perceived as too early or forced. Women retirees who stopped employment and were either forced into retirement or perceived their retirement as too early report significantly more depressive symptoms with increasing spouse activities of daily living (ADLs) limitations. There is no similar effect for men. In contrast, for working retirees who retired on time, depressive symptoms decrease with increasing spouse ADLs. DISCUSSION: These results highlight the importance of retirement context on postretirement well-being. They suggest that both type of retirement transition and marital contexts such as spouse's disability influence postretirement well-being, and these effects differ by gender.
Keywords: Activities of Daily Living; Adaptation, Psychological; Aged; Caregivers; Demography; depression; Disabled Persons; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retirement; Spouses; Surveys and Questionnaires

Urinary incontinence and its association with death, nursing home admission, and functional decline. - Holroyd-Leduc, Jayna M.; Kala M. Mehta; Kenneth E Covinsky (J Am Geriatr Soc, 2004)
OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN: A population-based prospective cohort study from 1993 to 1995. SETTING: Community-dwelling within the United States. PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline. MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status. RESULTS: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association. CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Body Mass Index; Female; Follow-Up Studies; Frail Elderly; Health Status; Humans; Male; Nursing homes; Outcome Assessment, Health Care; Risk Factors; Smoking; Socioeconomic factors; Time Factors; Urinary incontinence

Use of an IRT-based latent variable model to link different forms of the CES-D from the Health and Retirement Study. - Richard N Jones; Stephanie J. Fonda (Soc Psychiatry Psychiatr Epidemiol, 2004)
BACKGROUND: The goal of this study was to calibrate depressive symptoms collected using different versions of the Centers for Epidemiologic Studies - Depression (CES-D) instrument in different waves of the Health and Retirement Study (HRS). METHOD: The HRS is a prospective and nationally representative cohort study. This analysis included a sample of HRS participants, adults aged 23-85 years in 1992 who had complete data on depressive symptoms at initial 2- and 4-year follow-up interviews (N= 5,734). Depressive symptoms were assessed with the CES-D. Symptom coverage and response categories varied across study wave. The first wave (1992) used a four-category response, whereas subsequent waves (1994 and 1996) used a two-category response. A structural equations model (SEM) based in Item Response Theory (IRT) was used to calibrate symptoms and generate linked depressive symptom burden scores. RESULTS: Linked depressive symptom burden scores, derived from calibrated symptoms, were distributed similarly across HRS wave. CONCLUSION: Our results demonstrate the applicability of an IRT-based SEM to address a common challenge in prospective studies: changes in the content and context of symptom assessment. Future investigations may make use of our linked syndrome scores to further explore other aspects of depression from a longitudinal perspective.
Keywords: Adult; Aged; Aging; Calibration; Depressive Disorder; Female; Humans; Longitudinal Studies; Male; Middle Aged; Models, Psychological; Psychological Tests; Psychometrics; United States

Workplace characteristics and work disability onset for men and women. - Eileen M. Crimmins; Mark D Hayward (Soz Praventivmed, 2004)
OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits. METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview. RESULTS: Women's disability onset and health problems appear less related to job characteristics than men's. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions. CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.
Keywords: Disabled Persons; Female; Humans; Logistic Models; Male; Middle Aged; Occupational Diseases; Proportional Hazards Models; Retirement; Risk; Sex Factors; Sick Leave; Stress, Psychological; United States; Workers' compensation; Workload; Workplace

Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. - Kala M. Mehta; Kristine Yaffe; Kenneth M. Langa; Laura Sands; Whooley, Mary; Kenneth E Covinsky (J Gerontol A Biol Sci Med Sci, 2003)
BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults. METHODS: We studied 6301 elderly adults (mean age, 77 years; 62% women; 81% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment. RESULTS: During 2 years of follow-up, 9% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3% in those with the best function on both measures to 16% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3%, 5%, and 9% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6%, 7%, and 12% in participants with the middle level of cognitive function (p <.001 for trend), and 10%, 13%, and 16% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95% confidence interval, 2.0-4.7). CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner.
Keywords: Aged; Cognition; depression; Female; Humans; Male; Mortality; Proportional Hazards Models; Risk Factors

Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity. - Amirkhanyan, Anna A.; Douglas A. Wolf (Gerontologist, 2003)
PURPOSE: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members. DESIGN AND METHODS: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings. RESULTS: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers. IMPLICATIONS: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.
Keywords: Caregivers; depression; Female; Humans; Male; Middle Aged; Regression Analysis; Risk Factors; Stress, Psychological

Cognitive function and acute care utilization. - Walsh, Edith G.; Bei Wu; Mitchell, Janet B.; Lisa F Berkman (J Gerontol B Psychol Sci Soc Sci, 2003)
OBJECTIVES: Little is known about variation in cognitive function across the aged population, or how use and costs of health care vary with cognitive impairment. This study was designed to create a typology of cognitive function in a nationally representative sample, and evaluate acute care use in relation to cognitive function, holding constant confounding factors. By including proxy assessments of cognitive function, this is the first study to include individuals unable to respond themselves. METHODS: We analyzed the baseline year of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, sponsored by the National Institute on Aging, to create three levels of cognitive function, using direct measures for self-respondents (n = 6,651) and proxy evaluations for the others (n = 792). We used a two-part model to predict the likelihood of using various health services and to evaluate intensity of care among users. RESULTS: Sixteen percent, 64%, and 20% of the sample fell into the low, moderate, and high cognitive function groups, respectively, that differed significantly on almost all demographic and health status measures, and some utilization measures. Controlling for other health and functional status measures, lower cognitive function had a significant and negative effect on outpatient services, but did not affect hospital use directly. DISCUSSION: Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.
Keywords: Aged; Cognition Disorders; Female; Geriatric Assessment; Health Behavior; Health Status; Hospitalization; Hospitals; Humans; Length of Stay; Male; Neuropsychological tests; Outpatient Clinics, Hospital; Severity of Illness Index; United States

County-level income inequality and depression among older Americans. - Muramatsu, Naoko (Health Serv Res, 2003)
OBJECTIVES: To examine (1) whether county-level income inequality is associated with depression among Americans aged 70 and older, taking into consideration county-level mean household income and individual-level socioeconomic status (SES), demographic characteristics, and physical health, and (2) whether income inequality effects are stronger among people with lower SES and physical health. DATA SOURCES: The individual-level data from the first wave of the Assets and Health Dynamics among the Oldest Old survey (1993-1994) were linked with the county-level income inequality and mean household income data from the 1990 Census. STUDY DESIGN: Multilevel analysis was conducted to examine the association between income inequality (the Gini coefficient) and depression. PRINCIPAL FINDINGS: Income inequality was significantly associated with depression among older Americans. Those living in counties with higher income inequality were more depressed, independent of their demographic characteristics, SES, and physical health. The association was stronger among those with more illnesses. CONCLUSIONS: While previous empirical research on income inequality and physical health is equivocal, evidence for income inequality effects on mental health seems to be strong.
Keywords: Age Factors; Aged; Aged, 80 and over; depression; Female; Health Status Indicators; Humans; Income; Male; Socioeconomic factors; United States

Determinants of self-perceived changes in health status among pre- and early-retirement populations. - Namkee G Choi (Int J Aging Hum Dev, 2003)
Using data from the 1992 and 1994 waves of the Health and Retirement Study (HRS), this study described reasons reported by pre- and early-retirement populations for perceived changes in global health status over a 2-year period. It then analyzed the association between self-perceptions of change and the actual changes in objective health conditions, controlling for demographics, emotional health status, and the changes in work status and health-affecting habits. The results were compared to the determinants of self-ratings of health at wave 2. Existing or increasing impairments in functional abilities were found to contribute to self-perceptions of decline. However, a diagnosis of new chronic disease and the experience of a major medical event per se did not universally contribute to self-perception of decline. The relationship between cross-sectional self-ratings of health and objective health conditions was more straightforward. Self-perception of improvement among people with serious health problems most likely owed to medical interventions and improvement in symptoms, the most frequently mentioned reasons for perceived improvement, and reflected the subjects' selective optimization and resiliency.
Keywords: Activities of Daily Living; Age Factors; Female; Health Behavior; Health Status; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Retirement; Self Concept; United States

Determinants of stability and changes in self-reported work disability among older working-age populations. - Namkee G Choi (J Aging Soc Policy, 2003)
Data from the Health and Retirement Study, 1992-1994, were used to analyze (1) the prevalence and incidence of self-reported work disability among older working-age populations over a two-year period, and (2) the effect of the stability/changes in physical and functional health conditions, controlling for socioeconomic and occupational characteristics, on the stability/changes in self-reported work ability/disability. Findings show a high rate of transitions into and out of work-disabled status over the two-year period. Findings also show that, although objective physical and functional health problems and low self-ratings of health at wave 1 were significant determinants of self-reported work disability at wave 1, most subsequent changes in objective physical and functional health conditions over the two-year period were not significantly associated with the changes in self-report of work disability between wave 1 and wave 2. Especially, improved health conditions were not significantly associated with regained work ability between the two waves. Of the demographic variables, female gender significantly increased the likelihood of reporting work disability at wave 2, and being Black or Hispanic significantly decreased the likelihood of reporting regained work ability at wave 2. Research and policy implications of the findings are discussed.
Keywords: Disabled Persons; Employment; Female; Humans; Male; Middle Aged; Self Disclosure; Surveys and Questionnaires

Health care utilization among older adults with arthritis. - Dorothy D Dunlop; Larry M Manheim; Song, Jing; Rowland W Chang (Arthritis Rheum, 2003)
OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect. METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician's visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources. RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis. CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.
Keywords: Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Arthritis; Comorbidity; Cost of Illness; Female; Health Services; Home Care Services; Hospitals; Humans; Insurance, Health; Longitudinal Studies; Male; Nursing homes; Physicians' Offices; Social Class

Immigrant status, living arrangements, and depressive symptoms among middle-aged and older adults. - Janet M Wilmoth; Pei-Chun Chen (J Gerontol B Psychol Sci Soc Sci, 2003)
OBJECTIVES: This research draws from social integration theory to explain the relationship between living arrangements and depressive symptoms among middle-aged and older adults. Particular attention is given to identifying differences between nonimmigrants and immigrants. METHODS: The data come from the baseline and first 2-year follow-up of the Health and Retirement Study, which were collected in 1992 and 1994. The analysis is based on 6,391 primary respondents who were aged 51 to 61 at the baseline. Descriptive statistics, cross-sectional ordinary least squares regression models, and longitudinal residualized regression models are estimated for the entire sample and by immigrant status. RESULTS: Living arrangements and immigrant status interact to influence depressive symptoms. The results confirm that depressive symptoms are higher among those who live alone, particularly among immigrants. Living with family or others is related to higher cross-sectional levels of depressive symptoms, especially for immigrants, and greater longitudinal increases in depressive symptoms among nonimmigrants. DISCUSSION: The results highlight the important influence of social integration on mental health while demonstrating that context shapes the effect of social integration. They suggest that interventions should promote social integration, particularly among older adults living alone or with family or others. However, those programs should be sensitive to the unique needs of native-born and immigrant populations.
Keywords: Acculturation; Aged; Cross-Sectional Studies; depression; Emigration and Immigration; Female; Follow-Up Studies; Humans; Male; Middle Aged; Quality of Life; Residence Characteristics

Intermittent lack of health insurance coverage and use of preventive services. - Joseph J Sudano; David W. Baker (Am J Public Health, 2003)
OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services. METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study. RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services. CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.
Keywords: Episode of Care; Female; Health Behavior; Health Status; Humans; Insurance Coverage; Logistic Models; Longitudinal Studies; Male; Medically Uninsured; Middle Aged; Outcome Assessment, Health Care; Patient Acceptance of Health Care; Preventive Health Services; Socioeconomic factors; United States

The labor market consequences of race differences in health. - John Bound; Timothy A Waidmann; Michael Schoenbaum; Bingenheimer,Jeffrey B. (Milbank Q, 2003)
Keywords: Adult; Age Distribution; Age Factors; Attitude to Health; Black or African American; Cross-Cultural Comparison; Data Interpretation, Statistical; Employment; Female; Health Services Needs and Demand; Health Status Indicators; Humans; Indians, North American; Male; Middle Aged; Sex Distribution; Sex Factors; Socioeconomic factors; United States; White People

Life expectancy with cognitive impairment in the older population of the United States. - Suthers, Kristen; Jung K Kim; Eileen M. Crimmins (J Gerontol B Psychol Sci Soc Sci, 2003)
OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated. METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment. RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy. DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.
Keywords: Aged; Aged, 80 and over; Alzheimer disease; Cross-Sectional Studies; Female; Humans; Life Expectancy; Male; Neuropsychological tests; Probability; Psychometrics; Sex Factors; Survival Analysis; United States

Medication costs, adherence, and health outcomes among Medicare beneficiaries. - Ramin Mojtabai; Mark Olfson (Health Aff (Millwood), 2003)
In a two-year period more than two million elderly Medicare beneficiaries did not adhere to drug treatment regimens because of cost. This poor adherence tended to be more common among beneficiaries with no or partial medication coverage and was associated with poorer health and higher rates of hospitalization. The risk for cost-related poor adherence was especially pronounced among lower-income beneficiaries with high out-of-pocket drug spending. We argue that this pattern of cost-related poor medication adherence should inform the design of Medicare prescription drug benefit legislation.
Keywords: Aged; Aged, 80 and over; Chronic disease; Continuity of Patient Care; Family Characteristics; Female; Financing, Personal; Health Services Research; Humans; Income; Insurance, Pharmaceutical Services; Longitudinal Studies; Male; Medicare; Patient Compliance; Prevalence; Probability; Self Administration; Treatment Outcome; United States

Racial/ethnic differences in rates of depression among preretirement adults. - Dorothy D Dunlop; Song, Jing; Lyons, J.S.; Larry M Manheim; Rowland W Chang (Am J Public Health, 2003)
OBJECTIVES: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators. METHODS: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders. RESULTS: African Americans (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites. CONCLUSIONS: Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.
Keywords: Aged; Black or African American; Cohort Studies; Comorbidity; Demography; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Hispanic or Latino; Humans; Male; Middle Aged; Minority Groups; Probability; Risk Factors; Socioeconomic factors; United States; White People

Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD). - Truls Ostbye; Gary N. Greenberg; Donald H. Taylor Jr.; Lee, Ann Marie M. (Ann Fam Med, 2003)
BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998. RESULTS: Receipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt. CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.
Keywords: Age Factors; Aged; Aged, 80 and over; Breast Neoplasms; Cost-Benefit Analysis; Female; Health Services for the Aged; Humans; Longitudinal Studies; Mammography; Middle Aged; Multivariate Analysis; Papanicolaou Test; Patient Acceptance of Health Care; Risk; United States; Uterine Cervical Neoplasms; Vaginal Smears

Self-rated life expectancy as a predictor of mortality: evidence from the HRS and AHEAD surveys. - Michele J. Siegel; Elizabeth H Bradley; Stanislav V Kasl (Gerontology, 2003)
BACKGROUND: An extensive literature has demonstrated that self-ratings of health predict mortality, even after controlling for more objective measures of health, health habits and sociodemographic characteristics. We examine the role of a related concept, self-rated life expectancy, in predicting mortality. OBJECTIVE: To assess whether self-rated life expectancy predicts mortality after controlling for measures of health, self-rated health, and sociodemographic characteristics. METHODS: Using data from the 1992 Health and Retirement Survey (HRS), the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, and the second Tracker file (2.0), Cox proportional hazard models were estimated to assess whether self-rated life expectancy predicts mortality, after adjusting for self-rated health and several potential confounders that might otherwise explain this relationship. The AHEAD sample included 2,102 men and 3,160 women. During the 2 years of follow-up, 9% (n = 185) of the men died and 5% (n = 166) of the women died. The HRS sample was comprised of 4,090 men and 4,885 women. Four percent (n = 164) of the men died and 2% (n = 99) of the women died in the 3 years of follow-up. RESULTS: In the older, AHEAD sample, both self-rated life expectancy (p < 0.01) and self-rated health (p < 0.05) predicted mortality for both men and women, even when the two measures were included in the model together. In the younger, HRS sample, self-rated life expectancy was not significantly associated with mortality when self-rated health was included in the model. CONCLUSION: Our findings suggest that, although self-rated life expectancy and self-rated health may be conceptually related, they have independent empirical effects on mortality.
Keywords: Aged; Female; Health Status; Health Surveys; Humans; Life Expectancy; Male; Mortality; Prognosis; Proportional Hazards Models; Self Concept; Sex Distribution; Survival Analysis

Sickness and preventive medical behavior. - Stephen Wu (J Health Econ, 2003)
Using data from two sources, the Health and Retirement Study (HRS) and the Medical Expenditure Panel Survey (MEPS), I analyze the relationship between health status and the likelihood of engaging in medical screening and other preventive behavior. The results show that individuals who are in poorer health are more likely to get flu shots and cholesterol checks, but less likely to have mammograms, pap smears, breast examinations and prostate checks. There is some evidence that suggests that psychological factors such as fear and anxiety may be important reasons why sicker people are less likely to get cancer screens.
Keywords: Aged; Anxiety; Breast Self-Examination; Cholesterol; Female; Health Behavior; Health Expenditures; Health Status; Humans; Influenza Vaccines; Male; Mammography; Mass Screening; Middle Aged; Papanicolaou Test; Patient Acceptance of Health Care; Preventive Health Services; Primary Prevention; Prostatic Neoplasms; Retirement; Risk Factors; Vaginal Smears

Urinary incontinence and depression in middle-aged United States women. - Ingrid E Nygaard; Carolyn L. Turvey; Burns, Trudy L.; Elizabeth A Chrischilles; Robert B Wallace (Obstet Gynecol, 2003)
OBJECTIVE: To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression. METHODS: This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50-69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders. RESULTS: Approximately 16% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80% (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.26, 2.63) and 40% (OR 1.41; 95% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates. CONCLUSION: Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression.
Keywords: Activities of Daily Living; Aged; Comorbidity; Cross-Sectional Studies; depression; Female; Humans; Logistic Models; Middle Aged; United States; Urinary incontinence

Body-mass index and 4-year change in health-related quality of life. - Damush, T.M.; Timothy E. Stump; Daniel O. Clark (J Aging Health, 2002)
OBJECTIVE: To determine the effect of body-mass index (BMI) categories (a proxy for adiposity) on 4-year changes in health-related quality of life (HRQL) independent of baseline disease severity. DESIGN: Secondary analyses of a prospective, longitudinal study. PARTICIPANTS: Data on 7,895 adults ages 51 to 61 years who responded to the Health and Retirement Surveys in 1992, 1994, and 1996 were included. RESULTS: Estimates of the effect of BMI on changes in HRQL were adjusted by disease severity. Each BMI category was associated with an increasing risk of decline in perceived health, with the highest risk in the higher categories. A BMI of between 30 and 35 was associated with a risk of decline in mobility. CONCLUSIONS: The findings suggest a significant impact of BMI on changes in HRQL that is independent of disease severity and baseline HRQL.
Keywords: Body Mass Index; Disabled Persons; Female; Health Status; Humans; Male; Middle Aged; Obesity; Quality of Life; United States

Breast cancer and women's labor supply. - Cathy J. Bradley; Bednarek, Heather; David Neumark (Health Serv Res, 2002)
OBJECTIVE: To investigate the effect of breast cancer on women's labor supply. DATE SOURCE/STUDY SETTING: Using the 1992 Health and Retirement Study, we estimate the probability of working using probit regression and then, for women who are employed, we estimate regressions for average weekly hours worked using ordinary least squares (OLS). We control for health status by using responses to perceived health status and comorbidities. For a sample of married women, we control for spouses' employer-based health insurance. We also perform additional analyses to detect selection bias in our sample. PRINCIPAL FINDINGS: We find that the probability of breast cancer survivors working is 10 percentage points less than that for women without breast cancer. Among women who work, breast cancer survivors work approximately three more hours per week than women who do not have cancer. Results of similar magnitude persist after health status is controlled in the analysis, and although we could not definitively rule out selection bias, we could not find evidence that our results are attributable to selection bias. CONCLUSIONS: For some women, breast cancer may impose an economic hardship because it causes them to leave theirjobs. However, for women who survive and remain working, this study failed to show a negative effect on hours worked associated with breast cancer. Perhaps the morbidity associated with certain types and stages of breast cancer and its treatment does not interfere with work.
Keywords: Breast Neoplasms; Comorbidity; Cost of Illness; Decision making; Employment; Family Characteristics; Female; Health Benefit Plans, Employee; Health Status; Humans; Marital Status; Middle Aged; Probability; Selection Bias; Survivors; United States; Women, Working

Breast cancer survival, work, and earnings. - Cathy J. Bradley; Bednarek, Heather; David Neumark (J Health Econ, 2002)
Relying on data from the Health and Retirement Study (HRS) linked to longitudinal social security earnings data, we examine differences between breast cancer survivors and a non-cancer control group in employment, hours worked, wages, and earnings. Overall, breast cancer has a negative impact on employment. However, among survivors who work, hours of work, wages, and earnings are higher compared to women in the control group. We explore possible biases underlying these estimates, focusing on selection, but cannot rule out a causal interpretation. Our research points to heterogeneous labor market responses to breast cancer, and shows that breast cancer does not appear to be debilitating for women who remain in the work force.
Keywords: Breast Neoplasms; Cohort Studies; Diagnostic Tests, Routine; Efficiency; Employment; Female; Humans; Longitudinal Studies; Mammography; Middle Aged; Models, Econometric; Probability; Research Design; Retirement; Salaries and Fringe Benefits; Social Security; Survivors; United States; Women, Working

Can patient self-management help explain the SES health gradient? - Dana P Goldman; James P Smith (Proc Natl Acad Sci U S A, 2002)
There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation-better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys-one cohort study and one randomized clinical trial-that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.
Keywords: Adolescent; Adult; Antiretroviral Therapy, Highly Active; Diabetes Mellitus, Type 1; Educational Status; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Insulin; Longitudinal Studies; Male; Patient Compliance; Population Surveillance; Prospective Studies; Randomized Controlled Trials as Topic; Self Care; Social Class

Driving life expectancy of persons aged 70 years and older in the United States. - Foley, Daniel J.; Heimovitz, Harley K.; Jack M. Guralnik; Brock, Dwight B. (Am J Public Health, 2002)
OBJECTIVES: We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older. METHODS: Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey. RESULTS: Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies. CONCLUSIONS: Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.
Keywords: Accidents, Traffic; Activities of Daily Living; Aged; Aged, 80 and over; Automobile Driving; Decision making; Family Characteristics; Female; Frail Elderly; Humans; Interviews as Topic; Licensure; Life Expectancy; Logistic Models; Male; Risk Factors; Transportation; United States

The health capital of families: an investigation of the inter-spousal correlation in health status. - Sven E. Wilson (Soc Sci Med, 2002)
This study documents and analyzes the inter-spousal correlation in health status (ISCIHS) among married couples in later life. A simple economic theory is developed that integrates standard theories of marriage markets and health capital formation. This theory implies that several causal factors will lead to a positive correlation in the health status of spouses. These include assortative matching in the marriage market along dimensions related to health (such as education); a tendency to share common life-style behaviors such as diet, smoking and exercise; shared environmental risk factors for disease; and a potential for direct effects of the health of one spouse on the health of the other. Empirical estimates using the 1992 Health and Retirement study in the USA demonstrate that ISCIHS is large in magnitude, highly statistically significant, and robust to alternative measures of health status. ISCIHS exists even after controlling for age, education, income, and other socioeconomic and demographic determinants of health status, including behavioral risk factors. These covariates reduce the overall correlation coefficient by 33% to 57%, depending on the health measure, which suggests both that marriage formation and decision making processes systematically affect health in later life and that heretofore unidentified risk factors for disease and disability exist at the household level.
Keywords: Activities of Daily Living; Chronic disease; Decision making; Female; Health Behavior; Health Status Indicators; Humans; Interviews as Topic; Life Style; Male; Marital Status; Middle Aged; Regression Analysis; Risk Factors; Risk-Taking; Self Efficacy; Sociology, Medical; Spouses; United States

Health in household context: living arrangements and health in late middle age. - Mary Elizabeth Hughes; Linda J. Waite (J Health Soc Behav, 2002)
People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.
Keywords: Activities of Daily Living; Depressive Disorder; Family Characteristics; Family Health; Female; Health Status Indicators; Humans; Longitudinal Studies; Male; Marital Status; Middle Aged; Self Efficacy; United States

Individual consequences of volunteer and paid work in old age: health and mortality. - Luoh, M.; A. Regula Herzog (J Health Soc Behav, 2002)
The impacts of the productive social activities of volunteer and paid work on health have rarely been investigated among the oldest Americans despite a recent claim for their beneficial effect (Rowe and Kahn 1998). This paper used data from Waves 3 and 4 of the Asset and Health Dynamics among the Oldest Old (AHEAD) Study to (1) investigate the impact of these activities on health measured as self-reported health and activities of daily living (ADL) functioning limitations and to (2) explore possible causal mechanisms. Using multinomial logistic regression analysis, amounts of volunteer and paid work over a minimum of 100 annual hours self-reported at Wave 3 were related to poor health and death as competing risks measured at Wave 4, controlling for health measured at Wave 2 and for other predictors of poor health and death. Findings suggest that performing more than 100 annual hours of volunteer work and of paid work have independent and significant protective effects against subsequent poor health and death. Additional analyses suggest that the quantity of volunteer and paid work beyond 100 annual hours is not related to health outcomes and that physical exercise and mental health measured as cognitive functioning and depressive symptoms explain not entirely overlapping parts of the relationship between productive activities and health.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Employment; Female; Health Status; Humans; Male; Mortality; Multivariate Analysis; Prospective Studies; United States; Volunteers

Informal caregiving for diabetes and diabetic complications among elderly americans. - Kenneth M. Langa; Sandeep Vijan; Rodney A. Hayward; M.E. Chernew; Caroline S Blaum; Mohammed U Kabeto; David R Weir; Steven J. Katz; Robert J. Willis; A. Mark Fendrick (J Gerontol B Psychol Sci Soc Sci, 2002)
OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care. METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM. RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM. DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.
Keywords: Aged; Aged, 80 and over; Caregivers; Cost of Illness; Costs and Cost Analysis; Diabetes Complications; Diabetes Mellitus; Disabled Persons; Female; Health Surveys; Humans; Hypoglycemic Agents; Insulin; Male; Time Factors

Informal caregiving time and costs for urinary incontinence in older individuals in the United States. - Kenneth M. Langa; Fultz, Nancy H.; Sanjay Saint; Mohammed U Kabeto; A. Regula Herzog (J Am Geriatr Soc, 2002)
OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals. DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443). SETTING: Community-dwelling older people. PARTICIPANTS: National population-based sample of community-dwelling older people. MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads. RESULTS: Thirteen percent of men and 24% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P <.001). Women in these groups received 5.9, 7.6, and 10.7 hours (P <.001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care. CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition.
Keywords: Aged; Caregivers; Comorbidity; Confounding Factors, Epidemiologic; Female; Humans; Incontinence Pads; Male; Regression Analysis; Time Factors; United States; Urinary incontinence

It takes two: marriage and smoking cessation in the middle years. - Melissa M Franks; Pienta, Amy M.; Linda A. Wray (J Aging Health, 2002)
OBJECTIVES: In this prospective study of smoking cessation among married individuals in midlife we examine correspondence in the change of each partner's smoking status with that of the other, independent of established psychosocial correlates of smoking cessation. METHODS: Using longitudinal data from the first two waves of the Health and Retirement Study, 1992-1994, hierarchical logistic regression models were estimated for married male and female smokers separately. RESULTS: Findings support our hypothesis of correspondence in the smoking cessation of married male and female smokers net of other sociodemographic, health, and health behavior characteristics. DISCUSSION: These findings suggest that initiation and maintenance of this positive lifestyle change may be more easily achieved when both marital partners are given information and support to quit smoking at the same time.
Keywords: Female; Health Behavior; Humans; Male; Marital Status; Marriage; Middle Aged; Smoking cessation; Social Support; Spouses

Linking clinical variables to health-related quality of life in Parkinson's disease. - Elizabeth A Chrischilles; Linda M. Rubenstein; Voelker, Margaret D.; Robert B Wallace; Rodnitzky, Robert L. (Parkinsonism Relat Disord, 2002)
OBJECTIVE: Identify the point-in-time relationship between Parkinson's disease (PD) signs and symptoms and measures of health-related quality of life (HRQL). BACKGROUND: Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms. DESIGN/METHODS: A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews. RESULTS: The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures. CONCLUSION: PD patients' well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.
Keywords: Aged; Cross-Sectional Studies; Female; Health Status; Humans; Male; Mental Health; Middle Aged; Parkinson Disease; Quality of Life

A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey. - Truls Ostbye; Donald H. Taylor Jr.; Sang-Hyuk Jung (Prev Med, 2002)
BACKGROUND: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health). METHODS: The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998). RESULTS: Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health. CONCLUSIONS: Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.
Keywords: Age Distribution; Aged; Aged, 80 and over; Alcohol Drinking; Attitude to Health; Chi-Square Distribution; Exercise; Female; Health Behavior; Health Status; Health Surveys; Humans; Life Style; Logistic Models; Longitudinal Studies; Male; Middle Aged; Risk Assessment; Risk Factors; Sex Distribution; Smoking; Socioeconomic factors; Survival Rate; United States

Loss of health insurance and the risk for a decline in self-reported health and physical functioning. - David W. Baker; Joseph J Sudano; Jeffrey M. Albert; Elaine A Borawski; Avi Dor (Med Care, 2002)
BACKGROUND: Millions of Americans are intermittently uninsured. The health consequences of this are not known. SETTING: National survey. PARTICIPANTS: Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992. MEASUREMENTS: Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996. RESULTS: In 1994, 5768 (95.0%) people continued to have private insurance, 229 (3.8%) reported having lost all insurance, and 75 (1.2%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6% for those who lost all insurance versus 7.2% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5% vs. 20.4%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95% CI, 0.90-1.68). CONCLUSIONS: Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.
Keywords: Female; Health Services Accessibility; Health Status; Humans; Insurance, Health; Male; Medically Uninsured; Middle Aged; Regression Analysis; Risk; Self Efficacy

A national study of the quantity and cost of informal caregiving for the elderly with stroke. - Hickenbottom, S.L.; A. Mark Fendrick; Kutcher, J.S.; Mohammed U Kabeto; Steven J. Katz; Kenneth M. Langa (Neurology, 2002)
BACKGROUND: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. Although estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients. OBJECTIVE: To determine a nationally representative estimate of the quantity and cost of informal caregiving for stroke. METHODS: The authors used data from the first wave of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70, to determine average weekly hours of informal caregiving. Two-part multivariable regression analyses were used to determine the likelihood of receiving informal care and the quantity of caregiving hours for those with stroke, after adjusting for important covariates. Average annual cost for informal caregiving was calculated. RESULTS: Of 7,443 respondents, 656 (8.8%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, potential caregiver networks, and sociodemographics, the proportion of persons receiving informal care increased with stroke severity, and there was an association of weekly caregiving hours with stroke +/- SRHP (p < 0.01). Using the median 1999 home health aide wage (8.20 dollars/hour) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from 3,500 dollars to 8,200 dollars. Using conservative prevalence estimates from the AHEAD sample (750,000 US elderly patients with stroke but no SRHP and 1 million with stroke and SRHP), this would result in an annual cost of up to 6.1 billion dollars for stroke-related informal caregiving in the United States. CONCLUSIONS: Informal caregiving-associated costs are substantial and should be considered when estimating the cost of stroke treatment.
Keywords: Aged; Aged, 80 and over; Caregivers; Confidence Intervals; Female; Humans; Longitudinal Studies; Male; Multivariate Analysis; Stroke; United States

Prevalence and correlates of depressive symptoms in a community sample of people suffering from heart failure. - Carolyn L. Turvey; Schultz, K.; Arndt, Stephan; Robert B Wallace; A. Regula Herzog (J Am Geriatr Soc, 2002)
OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older. DESIGN: Cross-sectional. SETTING: Community-based epidemiological study of older people from the continental United States. PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier. MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies-Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070). RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses. CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.
Keywords: Aged; depression; Female; Heart Failure; Humans; Longitudinal Studies; Male; Prevalence; United States

The role of smoking and other modifiable lifestyle risk factors in maintaining and restoring lower body mobility in middle-aged and older Americans: results from the HRS and AHEAD. Health and Retirement Study. Asset and Health Dynamics Among the Oldest Ol - Truls Ostbye; Donald H. Taylor Jr.; Katrina M. Krause; Scoyoc, L.V. (J Am Geriatr Soc, 2002)
OBJECTIVES: To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle-aged and older Americans. DESIGN: Panel study; secondary data analysis. SETTING: United States (national sample). PARTICIPANTS: The Health and Retirement Study (HRS) includes data on 12,652 Americans aged 50 to 61 in four waves (1992-1998). The Asset and Health Dynamics Among the Oldest Old (AHEAD) survey followed 8,124 community-dwelling people aged 70 years and older in three waves (1993-1998). MEASUREMENTS: The relationships between the primary outcome measure, lower body mobility (ability to walk several blocks and walk up one flight of stairs without difficulty), and smoking, exercise (HRS only), body mass index (BMI), and alcohol use were estimated in bivariate and multivariate analyses. RESULTS: Not smoking was strongly positively related to mobility, and the relative effects were similar in both panels. Among those with impaired mobility at baseline, not smoking was also strongly related to recovery. In the middle aged, there were consistent dose-response relationships between amount smoked and impaired mobility. Fifteen years after quitting, the risk of impaired mobility returned to that of never smokers. There was also a strong dose-response relationship between level of exercise and mobility. Inverted U-shaped relationships with mobility were observed for BMI and alcohol consumption. CONCLUSIONS: The relationships between not smoking and lower body mobility in middle-aged and older Americans are strong and consistent. Interventions aimed at reducing smoking have the potential to preserve mobility and thereby prolong health and independence in later life.
Keywords: Age Distribution; Aged; Aged, 80 and over; Alcohol Drinking; Body Mass Index; Exercise; Female; Humans; Leg; Logistic Models; Longitudinal Studies; Male; Marital Status; Middle Aged; Risk Factors; Sex Distribution; Smoking; Smoking cessation; United States; Walking

State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. - Muramatsu, Naoko; Richard T. Campbell (J Health Soc Behav, 2002)
Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults' strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals' demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.
RDA 1996-025
Keywords: Aged; Aged, 80 and over; Community Health Services; Female; Financing, Government; Frail Elderly; Health Care Surveys; Health Expenditures; Home Care Services; Humans; Logistic Models; Male; State Government

Caregiver report of hallucinations and paranoid delusions in elders aged 70 or older. - Carolyn L. Turvey; Schultz, Susan K.; Arndt, Stephan; Ellingrod, Vicki; Robert B Wallace; A. Regula Herzog (Int Psychogeriatr, 2001)
This study examined the demographic, medical, and psychiatric correlates of hallucinations and paranoid delusions reported by proxy informants for 822 elders aged 70 or older. This sample comprised people who were deemed unable to complete a direct interview in a large nationwide study of aging. Marital status, trouble with vision, and cognitive impairment were associated with report of both paranoid delusions and hallucinations. Depressive symptoms and stroke were associated with hallucinations only. These results suggest that inadequate external stimulation in the elderly leads to psychotic experiences.
Keywords: Aged; Aged, 80 and over; Aging; Caregivers; Cognition Disorders; Cohort Studies; Delusions; depression; Female; Follow-Up Studies; Hallucinations; Humans; Male; Marital Status; Paranoid Disorders; Risk Factors; Stroke; Surveys and Questionnaires; United States; Vision Disorders

Changes in driving patterns and worsening depressive symptoms among older adults. - Stephanie J. Fonda; Robert B Wallace; A. Regula Herzog (J Gerontol B Psychol Sci Soc Sci, 2001)
OBJECTIVES: This study examined whether changes in driving patterns-driving cessation and reduction-have negative consequences for the depressive symptoms of older Americans and whether these consequences are mitigated for people with a spouse who drives. METHODS: The project used data from 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Depressive symptoms were assessed with an abbreviated Center for Epidemiologic Studies-Depression scale. Using 2 models, the project examined how driving cessation and reduction that occurred between Waves 1 and 2 contributed to increases in depressive symptoms between Waves 2 and 3. The first model included the entire sample (N = 5,239), and the second model focused on drivers only (n = 3,543). A third model added interaction terms to the analysis to consider whether respondents who stopped driving but had a spouse who drove were less at risk of worsening depressive symptoms. RESULTS: Respondents who stopped driving had greater risk of worsening depressive symptoms. Drivers who restricted their driving distances before the study began also had greater risk of worsening depressive symptoms, but seemingly less so than the respondents who stopped driving altogether. For respondents who stopped driving, having a spouse available to drive them did not mitigate the risk of worsening symptoms. DISCUSSION: Changes in driving patterns can be deleterious for older people's depressive symptoms. Initiatives for assisting older people should focus on strategies that help them retain driving skills, that prepare them for the possible transition from driver to ex-driver, and that ensure that they have access to mental health therapies if driving changes are imminent.
Keywords: Activities of Daily Living; Adaptation, Psychological; Aged; Aged, 80 and over; Automobile Driving; depression; Female; Humans; Male; Quality of Life; Risk Factors; Social Environment

Childlessness and the psychological well-being of older persons. - Zhang, Zhenmei; Mark D Hayward (J Gerontol B Psychol Sci Soc Sci, 2001)
OBJECTIVES: Rapid growth in the size of the childless elderly population has prompted concerns about the negative effects of childlessness on psychological well-being. This study adds to this line of inquiry by examining the effects of childlessness on two important dimensions of elderly persons' psychological well-being: loneliness and depression. METHODS: Using the 1993 Asset and Health Dynamics Among the Oldest Old data set, the authors estimated logistic and ordinary least squares regression models of psychological well-being for a nationally representative sample of people aged 70 and older (N = 6,517). RESULTS: Childlessness per se did not significantly increase the prevalence of loneliness and depression at advanced ages, net of other factors. There also was no statistical evidence for the hypothesis that childlessness increases loneliness and depression for divorced, widowed, and never married elderly persons. Sex, however, altered how childlessness and marital status influenced psychological well-being. Divorced, widowed, and never married men who were childless had significantly higher rates of loneliness compared with women in comparable circumstances; divorced and widowed men who were childless also had significantly higher rates of depression than divorced and widowed women. DISCUSSION: The findings suggest that it is important to understand the consequences of childlessness in the context of marital status and sex.
Keywords: Aged; Aged, 80 and over; depression; Family Planning Services; Female; Geriatric Assessment; Humans; Loneliness; Male; Marital Status; Risk Factors; Sex Factors

Estimating the cost of informal caregiving for elderly patients with cancer. - Hayman, James A.; Kenneth M. Langa; Mohammed U Kabeto; Steven J. Katz; DeMonner, Sonya M.; M.E. Chernew; Slavin, Mitchell B.; A. Mark Fendrick (J Clin Oncol, 2001)
PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients. MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT). RESULTS: Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally. CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Caregivers; Cost of Illness; Family; Female; Home Nursing; Humans; Male; Multivariate Analysis; Neoplasms; Regression Analysis; United States

The explosion in paid home health care in the 1990s: who received the additional services? - Kenneth M. Langa; M.E. Chernew; Mohammed U Kabeto; Steven J. Katz (Med Care, 2001)
OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services. METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members. RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05). CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Chronic disease; Family Characteristics; Female; Financing, Government; Frail Elderly; Geriatric Assessment; Health Care Surveys; Health Expenditures; health policy; Home Care Services; Home Nursing; Humans; Longitudinal Studies; Male; Marital Status; Multivariate Analysis; Social Support; Socioeconomic factors; Surveys and Questionnaires; United States; Utilization Review

Long-term care and nursing home coverage: are adult children substitutes for insurance policies? - Jennifer M Mellor (J Health Econ, 2001)
Recent theoretical work suggests that in some cases, parents will forego the purchase of long-term care insurance and rely on child-provided care in old age. This paper uses data from the Asset and Health Dynamics survey and the Panel Study of Income Dynamics to examine whether the availability of children and other potential caregivers explains why so few elderly persons have long-term care insurance. In contrast to the notion that family members serve as substitutes for long-term care insurance, variables measuring the availability of informal caregivers have no statistically significant effect in models of insurance ownership and models of intentions to purchase insurance.
RDA 1999-001
Keywords: Adult; Aged; Caregivers; Family; Female; Home Nursing; Humans; Insurance Coverage; Insurance, Long-Term Care; Intergenerational Relations; Long-term Care; Male; Models, Statistical; Nursing homes

National estimates of the quantity and cost of informal caregiving for the elderly with dementia. - Kenneth M. Langa; M.E. Chernew; Mohammed U Kabeto; A. Regula Herzog; Mary Beth Ofstedal; Robert J. Willis; Robert B Wallace; Mucha, L.M.; Walter L. Straus; A. Mark Fendrick (J Gen Intern Med, 2001)
OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia. DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443). SETTING: National population-based sample of the community-dwelling elderly. MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status. RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars. CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.
Keywords: Aged; Aged, 80 and over; Caregivers; Cost of Illness; Dementia; Female; Health Care Costs; Humans; Male; Multivariate Analysis; Regression Analysis; Severity of Illness Index; Time Factors; United States

Patterns and risk factors of change in somatic and mood symptoms among older adults. - Stephanie J. Fonda; A. Regula Herzog (Ann Epidemiol, 2001)
PURPOSE: This paper was concerned with patterns of individual-level, longitudinal change in depressive symptoms and factors related to those patterns among Americans 70+ years of age. Two types of depressive symptoms were considered, somatic and mood symptoms. The paper focused on whether the patterns of change and the risk factors for these two types of symptoms differed, as we might expect among old and oldest-old adults. METHODS: The analytic sample included self-respondents of the 1993--1995 Asset and Health Dynamics among the Oldest Old (AHEAD) study who were born in 1923 or earlier. Depressive symptoms were assessed using an abbreviated Center for Epidemiologic Studies-Depression (CES-D) Scale. The analyses involved examination of respondents' change scores in depressive symptoms and multivariate models using ordinary least squares (OLS) and seemingly unrelated regressions (SUR). RESULTS: In aggregate, somatic symptoms were more common than mood symptoms initially and over time. Despite differences in aggregate rates, AHEAD respondents' individual-level patterns of change for the two types of symptoms were similar; i.e., stability was the principal trend (53--60%), followed by improvement (21--26%). A number of factors related to change in one aspect of depressive symptoms and not the other, or had greater effects on one aspect of depressive symptoms than the other; e.g., physical health had greater effects on somatic than mood symptoms. CONCLUSIONS: This study suggests that, in investigations of the course and risk factors for depressive symptoms among people 70+ years of age, it is important to separate somatic symptoms from mood symptoms; their etiology may differ. In general, factors reflecting respondents' social milieu (e.g., bereavement, residential relocation) may have greater effects on mood than somatic symptoms, whereas certain factors representing physical health may have greater effects on somatic symptoms.
Keywords: Age Factors; Aged; Depressive Disorder; Female; Follow-Up Studies; Geriatric Assessment; Humans; Least-Squares Analysis; Longitudinal Studies; Male; Mood Disorders; Regression Analysis; Risk Factors; Severity of Illness Index; Somatoform Disorders; United States

Predictors of transitions in disease and disability in pre- and early-retirement populations. - Namkee G Choi; Schlichting-Ray, L. (J Aging Health, 2001)
OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period. METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses. RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes. DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups.
Keywords: Activities of Daily Living; Aged; Black or African American; Chronic disease; Disabled Persons; Female; Health Status; Hispanic or Latino; Humans; Male; Middle Aged; Retirement; Risk Factors; Sex Factors; Socioeconomic factors; United States; White People

Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults. - Oldrige, Neil B.; Timothy E. Stump; Nothwehr, F.; Daniel O. Clark (J Clin Epidemiol, 2001)
UNLABELLED: To estimate age group differences in the prevalence and outcomes of three common and often comorbid metabolic conditions (i.e., obesity, hypertension, and diabetes) and heart disease. DESIGN: Nationally representative prospective cohort study. SETTING: PARTICIPANTS' homes. PARTICIPANTS: 9825 adults aged 51 to 61 years (middle-age) in 1992, and 7370 adults aged 70 years and over (older-age) in 1993. MEASUREMENTS: Two-year dichotomous outcomes included: doctor visits, hospitalization, mobility difficulty, activity of daily living limitation, poor perceived health, and mortality. Odds ratios (OR) were adjusted for sociodemographic characteristics and history of cancer or lung disease. RESULTS: Those with one condition represented 80% and 70% of the middle- and older-age groups, respectively, while just 1-2% of each age group reported all three metabolic conditions. Thirteen percent and 32%, respectively, reported heart disease with or without metabolic conditions. Diabetes comorbid with other metabolic conditions, and particularly with heart disease, substantially elevated the risk of adverse outcomes such as health-related quality of life deficits, health services use, and mortality in both middle- and older-age adults. In the middle-age group, the OR was 6.81 for mortality in patients with a combination of obesity and diabetes and 6.10 in those with a combination of heart disease and diabetes. There also were significant ORs for mortality in middle-aged patients with heart disease (OR = 2.40), diabetes (OR = 2.63) and for those with a combination of obesity, hypertension, and diabetes (OR = 3.26). CONCLUSION: The impact of these often comorbid conditions underscores the importance of targeted and aggressive prevention, particularly among middle-age adults.
Keywords: Age Distribution; Aged; Aged, 80 and over; Cardiovascular Diseases; Cohort Studies; Diabetes Complications; Diabetes Mellitus; Female; Health Services for the Aged; Humans; Hypertension; Male; Middle Aged; Obesity; Odds Ratio; Outcome Assessment, Health Care; Prevalence; Prospective Studies; Quality of Life; United States

Proportional treatment effects for count response panel data: effects of binary exercise on health care demand. - Lee, Myoung Jae; Satoru Kobayashi (Health Econ, 2001)
We define conditional and marginal treatment effects appropriate for count data, and then conduct an empirical analysis for the effects of exercise on health care demand using panel data from the Health Retirement Study. The response variables are office visits to doctors and hospitalization days, and the treatments of interest are light and vigorous exercises. We found that short-run light exercise increases health care demand by 3-5%, whereas long-run light exercise decreases it by 3-6%. We also found that short-run vigorous exercise decreases health care demand by 1-2%, whereas long-run vigorous exercise decreases it by 1-3%. However, many of these numbers are not statistically significantly different from zero. These findings suggest that it will be difficult to reduce health care cost much by encouraging people to do more exercise--at least in the short-run.
ProCite field 3 : Sungkyunkwan U; Mitsubishi Trust and Banking Corp, Tokyo
Keywords: Adult; Aged; Aged, 80 and over; Bias; Cost Control; Cross-Sectional Studies; Data Interpretation, Statistical; Effect Modifier, Epidemiologic; Exercise Therapy; Female; Health Promotion; Health Status; Humans; Longitudinal Studies; Male; Middle Aged; Needs Assessment; Regression Analysis; Research Design; Treatment Outcome; United States

The role of job-related rewards in retirement planning. - Karl Kosloski; David J Ekerdt; Stanley DeViney (J Gerontol B Psychol Sci Soc Sci, 2001)
The authors used data from the first wave of the Health and Retirement Study ( F. Juster and R. Suzman 1995) to evaluate whether certain job-related gratifications might reduce retirement planning. Three definitions of retirement planning were evaluated and then regressed separately on a set of variables that included 3 types of job-related satisfactions (intrinsic gratification, positive social relations, and ascendance in the workplace) and 7 covariates: education, age, sex, health, marital status, race, and pension eligibility. Findings indicated that jobs high in ascendance were related to an increase in certain types of retirement planning, but jobs high in intrinsic rewards and positive social relations were related to less planning, regardless of how planning was defined. The findings suggest that information about work-related rewards may be useful in targeting individuals who might benefit from retirement planning programs, in developing planning programs to help workers realize more complex retirement plans, and in assisting employers who hope to retain older workers.
Keywords: Career Mobility; Decision making; Employment; Factor Analysis, Statistical; Female; Florida; Health Surveys; Humans; Interpersonal Relations; Job Satisfaction; Male; Middle Aged; Models, Psychological; Planning Techniques; Regression Analysis; Retirement; Reward; Salaries and Fringe Benefits; Sampling Studies

Self-restriction of medications due to cost in seniors without prescription coverage. - Michael A Steinman; Laura Sands; Kenneth E Covinsky (J Gen Intern Med, 2001)
OBJECTIVE: Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk. DESIGN AND PARTICIPANTS: Cross-sectional study from the 1995-1996 wave of the Survey of Asset and Health Dynamics Among the Oldest Old, a population-based survey of Americans age 70 years and older. MEASUREMENTS: Subjects were asked the extent of their prescription coverage, and whether they had taken less medicine than prescribed for them because of cost over the prior 2 years. We used bivariate and multivariate analyses to identify risk factors for medication restriction in subjects who lacked prescription coverage. Among these high-risk groups, we then examined the effect of prescription coverage on rates of medication restriction. MAIN RESULTS: Of 4,896 seniors who regularly used prescription medications, medication restriction because of cost was reported by 8% of subjects with no prescription coverage, 3% with partial coverage, and 2% with full coverage (P <.01 for trend). Among subjects with no prescription coverage, the strongest independent predictors of medication restriction were minority ethnicity (odds ratio [OR], 2.9 compared with white ethnicity; 95% confidence interval [95% CI], 2.0 to 4.2), annual income <$10,000 (OR, 3.8 compared with income > or =$20,000; 95% CI, 2.4 to 6.1), and out-of-pocket prescription drug costs >$100 per month (OR, 3.3 compared to costs < or =$20; 95% CI, 1.5 to 7.2). The prevalence of medication restriction in members of these 3 risk groups was 21%, 16%, and 13%, respectively. Almost half (43%) of subjects with all 3 risk factors and no prescription coverage reported restricting their use of medications. After multivariable adjustment, high-risk subjects with no coverage had 3 to 15 times higher odds of medication restriction than subjects with partial or full coverage (P <.01). CONCLUSIONS: Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications.
Keywords: Aged; Aged, 80 and over; Cohort Studies; Cross-Sectional Studies; Female; Humans; Insurance, Pharmaceutical Services; Male; Prescription Fees; Risk Factors; Socioeconomic factors; Treatment Refusal; United States

Socioeconomic status and the prevalence of health problems among married couples in late midlife. - Sven E. Wilson (Am J Public Health, 2001)
OBJECTIVES: This study analyzed the association between socioeconomic status (SES) and the prevalence of mutually occurring health problems among married couples in late midlife. METHODS: Data consisted of 4746 married couples aged 51 to 61 years from the 1992 US Health and Retirement Study. Two health measures were used: (1) self-assessed health status and (2) an index of functional limitations and activity restrictions. SES indicators were household income, education, and insurance coverage. RESULTS: In general, after adjustment for age cohort, a strong association was found between the health of a married individual and the health of his or her spouse. SES was highly associated with the joint occurrence of health problems among marriage partners. CONCLUSIONS: Public health policy should pay particular attention to the interaction between health, SES, and interpersonal relationships.
Keywords: Activities of Daily Living; Cohort Studies; Female; Health Status; Humans; Male; Marital Status; Middle Aged; Odds Ratio; Risk Factors; Socioeconomic factors; Spouses; United States

Expectations among the elderly about nursing home entry. - Richard C Lindrooth; Hoerger, Thomas J.; Edward C Norton (Health Serv Res, 2000)
OBJECTIVE: To assess whether the covariates that explain expectations of nursing home entry are consistent with the characteristics of those who enter nursing homes. DATA SOURCES: Waves 1 and 2 of the Assets and Health Dynamics Among the Oldest Old (AHEAD) survey. STUDY DESIGN: We model expectations about nursing home entry as a function of expectations about leaving a bequest, living at least ten years, health condition, and other observed characteristics. We use an instrumental variables and generalized least squares (IV-GLS) method based on Hausman and Taylor (1981) to obtain more efficient estimates than fixed effects, without the restrictive assumptions of random effects. PRINCIPAL FINDINGS: Expectations about nursing home entry are reasonably close to the actual probability of nursing home entry. Most of the variables that affect actual entry also have significant effects on expectations about entry. Medicaid subsidies for nursing home care may have little effect on expectations about nursing home entry; individuals in the lowest asset quartile, who are most likely to receive these subsidies, report probabilities not significantly different from those in other quartiles. Application of the IV-GLS approach is supported by a series of specification tests. CONCLUSIONS: We find that expectations about future nursing home entry are consistent with the characteristics of actual entrants. Underestimation of risk of nursing home entry as a reason for low levels of long-term care insurance is not supported by this analysis.
Keywords: Activities of Daily Living; Aged; Attitude to Health; Data Interpretation, Statistical; Effect Modifier, Epidemiologic; Female; Geriatric Assessment; Health Care Surveys; Health Services Research; Health Status; Homes for the Aged; Humans; Least-Squares Analysis; Longevity; Male; Medicaid; Nursing homes; Patient Admission; Probability; Risk Factors; Surveys and Questionnaires; United States

Gender disparities in the receipt of home care for elderly people with disability in the United States. - Steven J. Katz; Mohammed U Kabeto; Kenneth M. Langa (JAMA, 2000)
CONTEXT: Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources. OBJECTIVE: To address gender differences in receipt of informal and formal home care. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older. MAIN OUTCOME MEASURE: Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors. RESULTS: Compared with disabled men, disabled women were much more likely to be living alone (45.4% vs 16.8%, P<.001) and much less likely to be living with a spouse (27.8% vs 73.6%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95% CI, 19. 7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95% CI, 13.7-15.8 vs 26.2 hours; 95% CI, 24.6-27.9). Children (>80% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95% CI, 2.5-3.1 vs 2.1 hours for men; 95% CI, 1.7-2.4). CONCLUSION: Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.
Keywords: Activities of Daily Living; Aged; Disabled Persons; Family; Female; Geriatrics; Home Care Services; Home Nursing; Humans; Male; Regression Analysis; Sex Distribution; United States

Health effects of involuntary job loss among older workers: findings from the health and retirement survey. - William T Gallo; Elizabeth H Bradley; Michele J. Siegel; Stanislav V Kasl (J Gerontol B Psychol Sci Soc Sci, 2000)
OBJECTIVES: To estimate the health consequences of involuntary job loss among older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, multivariate regression models were estimated to assess the impact of involuntary job loss on both physical functioning and mental health. Our analysis sample included 209 workers who experienced involuntary job loss between survey dates and a comparison group of 2,907 continuously employed workers. RESULTS: The effects of late-life involuntary job loss on both follow-up physical functioning and mental health were negative and statistically significant (p < .05), even after baseline health status and sociodemographic factors were controlled for. Among displaced workers, reemployment was positively associated with both follow-up physical functioning and mental health, whereas the duration of joblessness was not significantly associated with either outcome. DISCUSSION: The findings provide evidence of a causal relationship between job loss and morbidity among older workers. This relationship is reflected in both poorer physical functioning and mental health for workers who experience involuntary job loss. In addition to the economic consequences of worker displacement, there may be important health consequences of job loss, especially among older workers.
Keywords: Activities of Daily Living; Adaptation, Psychological; Aging; Female; Geriatric Assessment; Health Status; Humans; Longitudinal Studies; Male; Middle Aged; Retirement; Unemployment; United States

Health-promoting behaviors among adults with type 2 diabetes: findings from the Health and Retirement Study. - Nothwehr, F.; Timothy E. Stump (Prev Med, 2000)
BACKGROUND: Type 2 diabetes has an enormous impact on the health care system and individuals. Dietary habits, exercise, weight management, and smoking status are critical to management and prevention of complications. This study describes the prevalence of these behaviors and their change over time in a national sample of adults with type 2 diabetes. The relationships between behavior change and sociodemographic and health status measures are explored. METHODS: Data are from the first and third longitudinal waves of the Health and Retirement Study. Surveys were conducted face-to-face or via telephone in 1992 and 1996. RESULTS: The sample consisted of 733 persons with type 2 diabetes, ages 50-62. The most common behaviors were being on a special diet (79.6%), and not smoking (76.6%). Sixty-six percent were engaged in some physical activity, and 58.4% were trying to lose weight. Reports of being on a special diet, trying to lose weight, and exercising all diminished over time. CONCLUSIONS: The prevalence of these behaviors is disappointing. Worse, they declined over the 4-year period. A better understanding of factors contributing to a person's decision to begin or discontinue health-promoting behaviors is needed to plan effective supportive or preemptive interventions.
Keywords: Adult; Behavior Therapy; Black or African American; Data collection; Diabetes Mellitus, Type 2; Diet, Diabetic; Exercise; Female; Health Behavior; Hispanic or Latino; Humans; Longitudinal Studies; Male; Middle Aged; Retirement; White People

Implications of asking "ambiguous" difficulty questions: an analysis of the second wave of the asset and health dynamics of the oldest old study. - Vicki A Freedman (J Gerontol B Psychol Sci Soc Sci, 2000)
OBJECTIVES: This study explores the analytic implications of using questions about difficulty with daily activities that do not specify whether to consider assistance. METHODS: For 1,054 Asset and Health Dynamics of the Oldest Old Study Wave 2 respondents, we compared responses to questions about difficulty without reference to assistance (ambiguous difficulty) to those about difficulty without help or equipment (underlying difficulty) and difficulty with help or equipment, if used (residual difficulty). We modelled predictors of discordance by means of logistic regression. RESULTS: Discordance exists for 15% of respondents between summary variables indicating underlying and ambiguous difficulty with one or more activities. Discrepancies are evenly split between respondents reporting (a) underlying but no ambiguous difficulty and (b) ambiguous but no underlying difficulty. Discordance also exists for 15% of respondents between summary variables indicating residual and ambiguous difficulty with one or more activities: most of these discrepancies involve reports of ambiguous but no residual difficulty. Most respondent characteristics investigated are not significant predictors of discrepancies. DISCUSSION: Analysts should be aware that (a) ambiguously worded questions appear to be a better proxy for underlying than for residual difficulty, (b) discrepancies seem to be lower for separate activities than for summary variables indicating difficulty with one or more activities, and (c) being Hispanic and receiving help may affect reporting discrepancies.
Keywords: Activities of Daily Living; Aged; Cognition; Female; Health Status; Humans; Male; Prospective Studies; Surveys and Questionnaires

Job characteristics and leisure physical activity. - Bei Wu; Frank Porell (J Aging Health, 2000)
OBJECTIVES: This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relating work and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically. METHODS: Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one's job. RESULTS: Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise. DISCUSSION: The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.
Keywords: Demography; Exercise; Female; Humans; Job Description; Job Satisfaction; Leisure activities; Male; Middle Aged; Stress, Psychological; United States

Measuring morbidity: disease counts, binary variables, and statistical power. - Kenneth F Ferraro; Janet M Wilmoth (J Gerontol B Psychol Sci Soc Sci, 2000)
OBJECTIVES: This study compares the use of the binary disease variables with counts of the same conditions in models of self-rated health to better understand the advantages and disadvantages of each approach. In particular, the analysis seeks to determine if statistical power is adequate for the binary variable approach. METHODS: Morbidity measures from adults in 2 large national surveys were used in both cross-sectional and longitudinal analyses. RESULTS: Although differences across the approaches are modest, the binary variable approach offers greater explanatory power and slightly higher R2 values. Despite these advantages, statistical power is insufficient in some cases, especially for conditions that are relatively rare and/or that manifest modest differences on the outcome variable. DISCUSSION: Statistical power estimates are advisable when using the binary variable approach, especially if the list of diseases and health conditions is extensive. Although a simple count of diseases may be useful in some research applications, separate counts for serious and nonserious conditions should be more useful in many research projects while avoiding the risk of inadequate statistical power.
Keywords: Adult; Aged; Chronic disease; Cross-Sectional Studies; Female; Geriatric Assessment; Health Surveys; Humans; Longitudinal Studies; Male; Middle Aged; Models, Statistical; United States

Memory complaint in a community sample aged 70 and older. - Carolyn L. Turvey; Schultz, Susan K.; Arndt, Stephan; Robert B Wallace; A. Regula Herzog (J Am Geriatr Soc, 2000)
OBJECTIVES: The ability of older people to estimate their own memory, often referred to as "metamemory," has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged > or = 70. DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart. SETTING: A nationwide random sample of community-dwelling older persons. PARTICIPANTS: A total of 5,444 community-dwelling persons aged > or = 70 and their spouses. MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini-Mental Status Exam. RESULTS: In general, people's assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures. CONCLUSIONS: The conditions that skew people's self-assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Cognition; Depressive Disorder; Educational Status; Female; Geriatric Assessment; Humans; Longitudinal Studies; Male; Marital Status; Memory; Self-Assessment

Nativity and older women's health: constructed reliance in the health and retirement study. - Cynthia J. Buckley; Jacqueline L. Angel; Donahue, Dennis (J Women Aging, 2000)
Gender and nativity are known risk factors for physical and economic dependency. Immigrant women are particularly disadvantaged because of their greater lack of social and economic resources. In this study, we investigate how women immigrants coordinate and utilize various support systems as they approach retirement age, as well as how choices and constraints affect their physical wellbeing. Experiences throughout the life course play a role in the maintenance of health, but the pre-retirement years are particularly crucial to the establishment of patterns of reliance to be used in later life. We examine the effects of economic resources, social support, and family ties (as well as several exogenous variables) on women's physical health using data from the Health and Retirement Survey. For the women in this study, demographic characteristics, such as Hispanic ethnicity and low education are strong risk factors for poor health. Findings also indicate that reliance patterns across resource domains do not differ significantly by nativity and that both economic and familial resource access significantly lessens the risk of poor health for both native and foreign born women.
Keywords: Aged; Emigration and Immigration; ethnicity; Female; Florida; Health Status; Humans; Middle Aged; Retirement; Social Support; Socioeconomic factors; Women's Health

Older adults and financial bequests. - Goetting, Marsha A.; Peter Martin; Johnson, Christine (Int J Aging Hum Dev, 2000)
Using data from Aging and Health Dynamics (AHEAD), this research investigated a model predicting an older adult's assessment regarding the chances (from 0 to 100) of leaving a financial bequest. Structural equation modeling analyses revealed three significant predictors of a high assessment (i.e., older age, high sense of control, and high socioeconomic status) and three predictors of a low assessment (i.e., race, physical health problems, and assessment of the chances of medical expenses depleting savings). Whites had higher financial bequests assessments than non-Whites. Physical health problems and the depleting savings assessment exerted negative effects on the financial bequest assessment. Marital status and negative psychological functioning exerted indirect effects through sense of control and through the depleting savings assessment.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Aging; Attitude; Female; Health Care Costs; Health Status; Humans; Male; Mental Health; Michigan; Models, Economic; Sampling Studies; Sex Factors; Socioeconomic factors; Spouses; Surveys and Questionnaires; Wills

Pathways to retirement: patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex. - Chenoa Flippen; Tienda, Marta (J Gerontol B Psychol Sci Soc Sci, 2000)
OBJECTIVES: This study examines the pre-retirement labor force participation behavior of Black, White, and Hispanic men and women to determine how patterns of labor market exit differ among groups. METHODS: We combine data from the first and second waves of the Health and Retirement Study and apply multinomial logit regression techniques to model labor force status in the first wave of the HRS and change over time. RESULTS: Black, Hispanic, and female elderly persons experience more involuntary job separation in the years immediately prior to retirement, and the resulting periods of joblessness often eventuate in "retirement" or labor force withdrawal. Minority disadvantage in human capital, health, and employment characteristics accounts for a large part of racial and ethnic differences in labor force withdrawal. Nevertheless, Black men and Hispanic women experience more involuntary labor market exits than Whites with similar socioeconomic and demographic characteristics. DISCUSSION: Workers most vulnerable to labor market difficulties during their youth confront formidable obstacles maintaining their desired level of labor force attachment as they approach their golden years. This has significant policy implications for the contours of gender and race/ethnic inequality among elderly persons, particularly as life expectancy and the size of the minority elderly population continue to increase.
Keywords: Aged; Black or African American; Cross-Cultural Comparison; Employment; Female; Hispanic or Latino; Humans; Logistic Models; Male; Middle Aged; Personnel Downsizing; Regression Analysis; Retirement; Sex Factors; Socioeconomic factors; United States; White People

Pension decisions in a changing economy: gender, structure, and choice. - Melissa A. Hardy; Kim Shuey (J Gerontol B Psychol Sci Soc Sci, 2000)
OBJECTIVES: As responsibility for financial security in retirement becomes more individualized, understanding the distribution and determinants of savings behavior grows in importance. Employed men and women often gain access to their pension assets when they change jobs. In this study gender differences in pre-retirement access to and disposition of accumulated pension assets are examined. METHODS: The authors used data from the Health and Retirement Study to model pension participation, disposition of pension assets, and use of cash settlements derived from a pension plan in a previous job. Logit models provided estimates of gender differences in access to pensions and the preservation of pension funds for retirement. RESULTS: Women were less likely to have participated in employer-sponsored pension plans; more likely to cash out accumulated pension assets when they changed jobs; and, when job changes occurred at relatively young ages, equally likely to spend the settlement. However, by their late 40s, women were more likely to save the settlement, a net gender difference that increased with age at which the settlement was received. DISCUSSION: The structure of employment compensation continues to place women at a disadvantage. Gender differences in earnings and fringe benefits not only affect current financial status, but also cast a shadow over future financial security. Although the gender gap in pension coverage has been reduced, women with pensions have access to lower benefits and less in accumulated assets. As these continuing deficits are addressed, enhancing women's tendency to save pension assets for retirement can help them build financial security.
Keywords: Age Factors; Choice Behavior; Decision making; Female; Humans; Male; Middle Aged; Models, Economic; Pensions; United States

Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: results from a national study. - Faith P. Hopp (Gerontologist, 2000)
This study, drawing on a nationally representative sample of community-dwelling adults aged 70 and older from the second wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, addresses the need for greater information on advance care planning among older adults. Older persons expect to draw on a diverse array of persons to make health care decisions for them when they are unable to do so, including spouses, when available, as well as younger generation members such as children and grandchildren. Completion of advance directives such as living wills and durable powers of attorney for health care was more common among White respondents than among African American respondents, and among high school- and college-educated respondents compared with those with less than a high school education. The results suggest the need to develop interventions aimed at strengthening knowledge and understanding of advance directives, particularly for African Americans and persons with lower levels of educational attainment. They further suggest the need for more research on the factors related to informal communication between older adults and their family members on issues related to advance care planning.
Keywords: Advance directives; Aged; Aged, 80 and over; Black or African American; Choice Behavior; Communication; Educational Status; Family; Female; Health education; Health Status; Humans; Logistic Models; Male; Needs Assessment; Surveys and Questionnaires; United States; White People

The prevalence and impact of accommodations on the employment of persons 51-61 years of age with musculoskeletal conditions. - Yelin, Edward; Sonneborn, Dean; Laura S. Trupin (Arthritis Care Res, 2000)
OBJECTIVE: To provide estimates of the frequency with which persons 51 to 61 years of age with musculoskeletal conditions receive workplace accommodations from their employers and to determine if the receipt of such accommodations is associated with higher rates of employment two years later. METHODS: The estimates derive from the Health and Retirement Survey, a national probability sample of 8,781 respondents who were interviewed both in 1992 and 1994 and who were between the ages of 51 and 61 years, of whom 5,495 reported one or more musculoskeletal conditions. We tabulated the frequency of accommodations provided in 1992 and then estimated the impact of accommodations and demographic and medical characteristics on 1994 employment status, using logistic regression. RESULTS: In 1992, about 14.40 million persons aged 51-61 years reported a musculoskeletal condition. Of these, 1.32 million (9.2%) reported a disability and were employed, the target population for accommodations. Overall, fewer than 1 in 5 persons with musculoskeletal conditions who had a disability and were employed indicated that they had received any form of accommodation on their current jobs. Although no form of accommodation was reported with great frequency, the most commonly used ones included getting someone to help do one's job (12.1%), scheduling more breaks during the work day (9.5%), changing the time that the work day started and stopped (6.3%), having a shorter work day (5.6%), getting special equipment (5.3%), and changing the work tasks (5.3%). Persons with one or more accommodations in 1992, however, were no more likely to be working in 1994 than those with none. Only one specific accommodation--getting someone to help do one's job--was associated with a higher rate of employment in 1994. CONCLUSIONS: Receipt of employment accommodations occurred infrequently, and was not generally associated with an improvement in the employment rate of persons with musculoskeletal conditions and disabilities.
Keywords: Disabled Persons; Employment, Supported; Female; Health Status; Health Surveys; Humans; Logistic Models; Longitudinal Studies; Male; Middle Aged; Morbidity; Musculoskeletal Diseases; Personnel Turnover; Program Evaluation; Surveys and Questionnaires; United States; Workload; Workplace

The racial crossover in comorbidity, disability, and mortality. - Nan E. Johnson (Demography, 2000)
This study analyzed one respondent per household who was age 70 or more at the time of the household's inclusion in Wave 1 (1993-1994) and whose survival status was determinable at Wave 2 (1995-1996) of the Survey on Asset and Health Dynamics Among the Oldest Old (AHEAD Survey). At age 76 at Wave 1, there was a racial crossover in the cumulative number of six potentially fatal diagnoses (chronic lung disease, cancer, heart disease, hypertension, diabetes, and stroke) from a higher cumulative average number for blacks to a higher average number for whites. Also, there was a racial crossover at age 86 in the cumulative average number of disabilities in the Advanced Activities of Daily Living (AADLs), from a higher average for blacks to a higher average for whites. Between Waves 1 and 2, there was a racial crossover in the odds of mortality from higher odds for blacks to higher odds for whites; this occurred at about age 81. The results are consistent with the interpretation that the racial crossover in comorbidity (but not the crossover in AADL disability) propelled the racial crossover in mortality.
RDA 2002-016
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Birth Certificates; Black People; Chronic disease; Comorbidity; Cross-Over Studies; Death Certificates; Disabled Persons; Female; Humans; Male; United States; White People

Racial variations in end-of-life care. - Faith P. Hopp; Sonia A. Duffy (J Am Geriatr Soc, 2000)
OBJECTIVES: To identify differences in advanced care planning and end-of-life decision-making between whites and blacks aged 70 and older. DESIGN: The Asset and Health Dynamics Among the Oldest Old (AHEAD) study is a nationally representative survey of adults who were aged 70 and older in 1993. Relatives (proxy respondents) for 540 persons who died between the first (1993) and second (1995) waves of the study were surveyed about advanced care planning and end-of-life decisions that were made for their family member who died. SETTING: Respondents were interviewed at home by telephone (n = 444) or in person (n = 95). PARTICIPANTS: The 540 proxy respondents included 454 whites and 86 blacks. MEASUREMENTS: Questions were asked about advance care planning and end-of-life decisions. RESULTS: Whites were significantly more likely than blacks to discuss treatment preferences before death (P = .002), to complete a living will (P = .001), and to designate a Durable Power of Attorney for Health Care (DPAHC) (P = .032). The treatment decisions for whites were more likely to involve limiting care in certain situations (P = .007) and withholding treatment before death (P = .034). In contrast, the treatment decisions for blacks were more likely to be based on the desire to provide all care possible in order to prolong life (P = .013). Logistic regression models revealed that race continued to be a significant predictor of advance care planning and treatment decisions even after controlling for sociodemographic factors. CONCLUSIONS: These findings suggest that there are important differences between blacks and whites regarding advanced care planning and end-of-life decision-making. Health professionals need to understand the diverse array of end-of-life preferences among various racial and ethnic groups and to develop greater awareness and sensitivity to these preferences when helping patients with end-of-life decision-making.
Keywords: Advance care planning; Advance directives; Aged; Aged, 80 and over; Attitude to Health; Black or African American; Cross-Cultural Comparison; Decision making; Female; Follow-Up Studies; Humans; Logistic Models; Male; Patient Care Planning; Terminal Care; United States; White People

Uninsured status and out-of-pocket costs at midlife. - Richard W. Johnson; Crystal, Stephen (Health Serv Res, 2000)
OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period. DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline. STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage. PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance. CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.
Keywords: Age Factors; Female; Financing, Personal; Health Care Surveys; Health Services; Health Status; Humans; Insurance Coverage; Insurance, Health; Longitudinal Studies; Male; Medically Uninsured; Middle Aged; Models, Econometric; Multivariate Analysis; Surveys and Questionnaires; United States

The associations between self-rated vision and hearing and functional status in middle age. - Paul P Lee; James P Smith; Raynard Kington (Ophthalmology, 1999)
OBJECTIVES: To describe the associations between self-reported visual and hearing impairment and an index of global functional status among community-dwelling, middle-aged Americans. DESIGN: Cross-sectional. PARTICIPANTS: A total of 9744 U.S. community-dwelling persons 51 to 61 years of age participated. METHODS: Multivariate analyses of functional status based on cross-sectional data from Wave I (1992) of the Health and Retirement Study (HRS), controlling for demographic and socioeconomic status, common chronic medical conditions, and general health status, were performed. MAIN OUTCOME MEASURE: A global index of functional status based on self-reported limitations in 17 activities was measured. RESULTS: Approximately 3% of respondents in the HRS rated their vision or hearing as poor. Even after controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. In addition, controlling for income, wealth, and education reduced the strength of the associations between vision and hearing impairment and function, but did not eliminate them. The magnitude of effect of poor vision exceeded all medical conditions except stroke. CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship with overall functional status, among even community-dwelling, middle-aged Americans and even after controlling for general health status, medical comorbidities, and socioeconomic status.
Keywords: Cross-Sectional Studies; Female; health; Health Status; Health Surveys; Hearing Disorders; Humans; Male; Middle Aged; Outcome and Process Assessment, Health Care; Quality of Life; Self Disclosure; Vision Disorders

At risk on the cusp of old age: living arrangements and functional status among black, white and Hispanic adults. - Linda J. Waite; Mary Elizabeth Hughes (J Gerontol B Psychol Sci Soc Sci, 1999)
OBJECTIVES: We examine the relationship between living arrangements and multiple measures of physical, cognitive, and emotional functioning in late midlife. METHODS: Using cross-sectional data from the Health and Retirement Study, we first assess the bivariate relationship between living arrangements and functioning; we then take into account demographic characteristics and measures of household resources and demands. RESULTS: We find evidence of differential functioning among individuals in various living arrangements. Married couples living alone or with children show the highest levels of functioning, whereas single adults living in complex households show the lowest levels. Functional deficits for those in complex households are reduced but not eliminated when we take demographic characteristics and household resources and demands into account. We find few differences by gender and race/ethnicity in the relationship between living arrangements and functioning. DISCUSSION: We show a pattern of poorer functioning among those in arguably the most demanding and least supportive household environments. This points to a vulnerable and risk-filled transition from middle to old age for these persons. Because Blacks and Hispanics show lower levels of functioning than Whites and are more likely to live in complex households, they may be particularly disadvantaged.
Keywords: Activities of Daily Living; Aging; Black or African American; Cultural Characteristics; Family Relations; Female; Hispanic or Latino; Housing; Humans; Male; Middle Aged; Quality of Life; Retirement; Risk Factors; White People

Characteristics of individuals with integrated pensions. - Bender, K A (Soc Secur Bull, 1999)
Employer pensions that integrate benefits with Social Security have been the focus of relatively little research. Since changes in Social Security benefit levels and other program characteristics can affect the benefit levels and other features of integrated pension plans, it is important to know who is covered by these plans. This article examines the characteristics of workers covered by integrated pension plans, compared to those with nonintegrated plans and those with no pension coverage. Integrated pension plans are those that explicitly adjust their benefit structure to help compensate for the employer's contributions to the Social Security program. There are two basic integration methods used by defined benefit (DB) plans. The offset method causes a reduction in employer pension benefits by up to half of the Social Security retirement benefit; the excess rate method is characterized by an accrual rate that is lower for earnings below the Social Security taxable maximum than above it. Defined contribution (DC) pension plans can be integrated along the lines of the excess rate method. To date, research on integrated pensions has focused on plan characteristics, as reported to the Bureau of Labor Statistics (BLS) through its Employee Benefits Survey (EBS). This research has examined the prevalence of integration among full-time, private sector workers by industry, firm size, and broad occupational categories. However, because the EBS provides virtually no data on worker characteristics, analyses of the effects of pension integration on retirement benefits have used hypothetical workers, varying according to assumed levels of earnings and job tenure. This kind of analysis is not particularly helpful in examining the potential effects of changes in the Social Security program on workers' pension benefits. However, data on pension integration at the individual level are available, most recently from the Health and Retirement Study (HRS), a nationally representative survey of individuals aged 51-61 in 1992. This dataset provides the basis for the analysis presented here. The following are some of the major findings from this analysis. The incidence of pension integration in the HRS sample is 32 percent of all workers with a pension (14 percent of all workers). The HRS can also identify integrated DC plans, a statistic that is not available from BLS data. The rate of integration for workers with only DC plans is 8 percent. After controlling for other variables, several socio-demographic characteristics are significantly related to the incidence of integration. The probability of having an integrated pension is 4.6 percentage points less for men compared to women. Non-Hispanic blacks are 6.4 percentage points less likely than non-Hispanic whites to have integrated pensions. Union members are 14 percentage points less likely to have integrated pensions, while workers with less than a graduate level education are at least 15 percentage points more likely to have a pension that is integrated. Some earnings and pension characteristics are also significantly correlated with pension integration. Earnings are positively related, with the probability of having an integrated pension increasing by 2 percentage points for an increase of $1,000 in annual pay. An even larger effect comes from earning at or above the Social Security taxable maximum. Workers at or above this income level are 10 percentage points more likely to have an integrated plan, but for those with more than one plan the probability of pension integration goes up by 13 percentage points.
Keywords: Bias; Data collection; Educational Status; ethnicity; Female; Humans; Income; Labor Unions; Male; Middle Aged; Occupations; Pensions; Regression Analysis; Reproducibility of Results; Retirement; Sex Factors; Social Security; Socioeconomic factors; United States

A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States. - Mary Beth Ofstedal; Zachary Zimmer; Hui-Sheng Lin (J Gerontol B Psychol Sci Soc Sci, 1999)
OBJECTIVES: This article compares patterns of association between cognitive functioning and a number of sociodemographic and health correlates among older persons in Taiwan and the United States. METHODS: The study uses data from the 1993 Survey of Health and Living Status of the Elderly in Taiwan and the 1993 Study of Asset and Health Dynamics Among the Oldest Old in the United States. Separate multivariate regression models are employed for each country to examine the effects of sociodemographic and health factors on cognitive functioning, and to examine the marginal impact of cognitive functioning on activities of daily living (ADL) and instrumental ADL (IADL) functioning. RESULTS: Results of the multivariate analyses show similar patterns of association across the two countries and replicate findings from previous studies. Increasing age, female gender, lower education, depression, and selected health conditions are associated with lower cognitive functioning. In addition, although a significant predictor of both ADL and IADL impairments, cognitive functioning is more powerful with respect to explaining IADL impairments. DISCUSSION: Study findings suggest that the cognitive measures are capturing similar dimensions in Taiwan and the United States, and that factors associated with cognitive functioning and its consequences with respect to physical functioning are similar in the two countries.
Keywords: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Cognition; Cross-Cultural Comparison; depression; Educational Status; Female; Geriatric Assessment; Health Status; Humans; Male; Multivariate Analysis; Regression Analysis; Sex Factors; Socioeconomic factors; Surveys and Questionnaires; Taiwan; United States

Conjugal loss and syndromal depression in a sample of elders aged 70 years or older. - Carolyn L. Turvey; Carney, C.; Arndt, Stephan; Robert B Wallace; A. Regula Herzog (Am J Psychiatry, 1999)
OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older. METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment. RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects. CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse's death predicted bereavement-related depression.
Keywords: Age Factors; Aged; Aged, 80 and over; Bereavement; Cohort Studies; depression; Depressive Disorder; Female; Humans; Logistic Models; Longitudinal Studies; Male; Marital Status; Odds Ratio; Psychiatric Status Rating Scales; Risk Factors; Sex Factors; Widowhood

Financial assistance from middle-aged couples to parents and children: racial-ethnic differences. - Rebeca Wong; Capoferro, C.; Beth J Soldo (J Gerontol B Psychol Sci Soc Sci, 1999)
OBJECTIVES: To examine racial-ethnic differences in the allocation of financial transfers to parents, children, and others by middle-aged couples. METHODS: Multinomial specification of alternative recipients of financial transfers, using data from the 1992 Health and Retirement Survey. RESULTS: Transfer patterns are sensitive to parental health and wealth, to children being young or in school, as well as to the donors' health and wealth. Controlling for these and other factors, including family size and structure, Blacks and Whites are the most likely, and Hispanics the least likely, to financially help their parents compared to assisting offspring. Black couples are the most likely to sacrifice their own consumption to assist parents financially. DISCUSSION: Future research on transfers should attempt to capture unmeasured noneconomic sources of variation proxied by the race-ethnicity indicator.
Keywords: Aged; Child; ethnicity; Family Relations; Female; Financing, Personal; Humans; Intergenerational Relations; Male; Middle Aged; Parent-Child Relations; Racial Groups

Gender differences in pension wealth: estimates using provider data. - Richard W. Johnson; Sambamoorthi, Usha; Crystal, Stephen (Gerontologist, 1999)
Information from pension providers was examined to investigate gender differences in pension wealth at midlife. For full-time wage and salary workers approaching retirement age who had pension coverage, median pension wealth on the current job was 76% greater for men than women. Differences in wages, years of job tenure, and industry between men and women accounted for most of the gender gap in pension wealth on the current job. Less than one third of the wealth difference could not be explained by gender differences in education, demographics, or job characteristics. The less-advantaged employment situation of working women currently in midlife carries over into worse retirement income prospects. However, the gender gap in pensions is likely to narrow in the future as married women's employment experiences increasingly resemble those of men.
Keywords: Female; Humans; Male; Occupations; Pensions; Sex Factors; United States; Women, Working

The influence of personal care and assistive devices on the measurement of disability. - Agree, E M (Soc Sci Med, 1999)
The goal of all long-term care arrangements is to reduce the disabling effects of physical impairments and functional limitations. However, the means with which individuals cope with disability may not be equivalent and these differences may influence self-reports of disability in surveys. This paper examines assistive devices and personal care as factors in the measurement of disability among persons aged 70 and older in the community using the 1994 Survey of Asset and Health Dynamics of the Oldest Old (AHEAD) in the US. The use of assistive technology differs from personal care on a fundamental level. It does not require the ongoing cooperation or coordination of other people and therefore increases the sense of independence with which a disabled individual can meet their long-term care needs. Results indicate that older individuals can expect to spend most of their remaining years in good functional health, but up to two-thirds of disabled years will be spent with unmet ADL needs. Among those who are disabled, those who use only equipment and no personal care report less residual difficulty with mobility than those who use personal assistance (either alone or in combination with equipment) but the use of equipment alone is most effective for those with the least severe limitations.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Disability Evaluation; Female; Humans; Life Expectancy; Logistic Models; Long-term Care; Male; Self-Help Devices

Multiple roles and well-being among midlife women: testing role strain and role enhancement theories. - Reid, Jennifer; Melissa A. Hardy (J Gerontol B Psychol Sci Soc Sci, 1999)
OBJECTIVE: Research on women's multiple roles frequently adopts one of two perspectives: role strain, which argues that assuming multiple roles is detrimental to mental well-being, or role enhancement, which argues that engaging in multiple roles enhances mental well-being. We argue that the relationship between role occupancy and well-being is manifested through multiple dimensions of role experiences. We investigate the association between depressive symptomatology and various dimensions of the roles of wife, mother, paid worker, and informal caregiver to aging parents. METHODS: Data are from the 1992 wave of the Health and Retirement Study. Depressive symptomatology, measured by a subset of the CES-D scale, is the dependent variable. To assess the robustness of findings relative to different functional forms of the dependent variable, we estimate multiple regression, log-linear regression, and multinomial logit models. Independent variables include demographic characteristics, measures of role occupancy, role demands, and role satisfaction. RESULTS: Although the number of roles women assume affects their reports of depressive symptoms, once the demand and satisfaction associated with these roles is controlled, number has no effect; that is, the effect of the number of roles is indirect. DISCUSSION: Our results highlight the importance of women's perceptions of the quality of their roles in relation to their overall well-being. Future investigations of women's multiple roles should examine how roles may provide rewards, impose constraints, or generate conflict, as well as the extent to which the willingness to assume multiple roles and the reported levels of role satisfaction and mental well-being may be jointly endogenous.
Keywords: Caregivers; depression; Employment; Female; Humans; Marriage; Middle Aged; Personal Satisfaction; Psychological Theory; Role; Women's Health

Parental marital disruption and intergenerational transfers: an analysis of lone elderly parents and their children. - Liliana E Pezzin; Barbara Steinberg Schone (Demography, 1999)
Although one of the most marked demographic trends observed over the twentieth century is the increased rate of divorce, relatively little research has explored the effects of these changing marital patterns in the context of an aging society. Using a sample of lone elderly parents and their adult children, we analyze the direct and indirect effects of marital disruption on four important dimensions of intergenerational transfers: coresidence, financial assistance, adult children's provision of informal care, and parental purchase of paid care. Our findings suggest that divorce has deleterious effects on intergenerational transfers, particularly for elderly fathers. Remarriage further reduces exchange. Our results reveal that parents engage in lower levels of transfers with stepchildren relative to biological children. Moreover, intergenerational transfers are sensitive to characteristics of biological children but not to those of stepchildren. Taken together, these results suggest that exchange at the end of the life course continues to be adversely affected by marital disruption.
ProCite field 3 : Johns Hopkins U; Agency for Health Care Policy and Research
Keywords: Activities of Daily Living; Adult; Aged; Analysis of Variance; Caregivers; Chi-Square Distribution; Divorce; Family; Father-Child Relations; Female; Financial Support; Frail Elderly; Home Nursing; Humans; Intergenerational Relations; Loneliness; Male; Marriage; Parent-Child Relations; Parents; Sample Size; Sampling Studies; Socioeconomic factors

Prevalence and severity of urinary incontinence in older African American and Caucasian women. - Fultz, Nancy H.; A. Regula Herzog; Trivellore E. Raghunathan; Robert B Wallace; Diokno, A.C. (J Gerontol A Biol Sci Med Sci, 1999)
BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services. METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups. RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women. CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.
Keywords: Aged; Aged, 80 and over; Black or African American; Female; Humans; Prevalence; Risk Factors; United States; Urinary incontinence; White People

Racial differences in education, obesity, and health in later life. - Christine L Himes (Ann N Y Acad Sci, 1999)
Keywords: Age Distribution; Aged; Arthritis; Black or African American; Diabetes Mellitus; Educational Status; Female; Health Status; Health Surveys; Humans; Logistic Models; Male; Obesity; Prevalence; Social Class; United States; White People

Racial differences in the multiple social roles of older women: implications for depressive symptoms. - Cochran, Donna; Brown, Diane R.; McGregor, Karl C. (Gerontologist, 1999)
The relationship between multiple role participation and depressive symptoms experienced by African American (n = 547) and White (n = 2,152) women aged 55-61 was explored. Data were obtained from the Health and Retirement Study (HRS). Racial differences in the social roles of marriage, employment, grandmother, care provider, and volunteer and their influence on level of depressive symptoms were examined. African Americans reported higher levels of depressive symptoms than Whites. Additionally, marriage, employment, and total number of social roles were the most powerful predictors of depressive symptoms for both African American and White women. However, employment was more important in diminishing depressive symptoms among African American than White women occupying multiple social roles.
Keywords: Analysis of Variance; Black or African American; Chi-Square Distribution; Cross-Sectional Studies; Demography; depression; Female; Humans; Middle Aged; Regression Analysis; Self Concept; Social Environment; Social Support; White People; women

The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older. - Paul P Lee; James P Smith; Raynard Kington (Am J Ophthalmol, 1999)
PURPOSE: To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older. METHODS: A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision. RESULTS: Of the respondents, 27% rated their vision as fair or poor, whereas 25% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function. CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.
Keywords: Aged; Aged, 80 and over; Female; Health Status; hearing; Hearing Disorders; Humans; Male; Multivariate Analysis; Quality of Life; Self Disclosure; Surveys and Questionnaires; Vision Disorders; Vision, Ocular; Visual Acuity

Retirement patterns and bridge jobs in the 1990s. - Joseph F. Quinn (EBRI Issue Brief, 1999)
During most of the post-World War II period, American men have been leaving the labor force at earlier and earlier ages. Evidence suggests that this trend has been under way for more than a century. However, in the mid-1980s, this trend came to an abrupt halt. Male labor force participation rates have been flat since 1985, and have actually increased over the past several years. Understanding these issues is especially important given the looming increase in the Social Security normal retirement age to 67 and the possibility of even more increases in the ages of eligibility under Social Security and Medicare reform. Because of the influx of married women into the labor market in the post-World War II period, older women's participation rates did not decline as men's did. In contrast, their rates were relatively steady, rising or falling very slowly. Since the mid-1980s, however, older women's participation rates have increased significantly. Many more older men and women are working today than the pre-1986 trends would have suggested. Many older Americans leave the labor force gradually, utilizing "bridge jobs" between employment on a full-time career job and complete labor force withdrawal. These bridge jobs are often part-time, often in a new line of work, and sometimes involve a switch from wage and salary work to self-employment. Estimates suggest that between one-third and one-half of older Americans will work on a bridge job before retiring completely, and for these workers retirement is best viewed as a process, not as a single event. These changes in retirement behavior are consistent with societal changes that have altered the relative attractiveness of work and leisure late in life. Mandatory retirement has been outlawed for most American workers. Social Security has become more age-neutral, no longer penalizing the average worker who wants to continue working after age 65. An increasing proportion of employer pension coverage has been in defined contribution plans, which do not contain the age-specific retirement incentives that many defined benefit plans do. The composition of jobs has shifted from manufacturing to service occupations. Americans are living longer and healthier lives, and many look forward to years to productive activity after age 65. These structural changes have been accompanied by an important cyclical factor: the strength of the American economy over the past decade. This has increased the demand for all types of labor, including older workers. Evidence suggests that there is more than this cyclical factor at work, however, and that new attitudes about work late in life are developing. Labor supply decisions late in life are correlated in expected ways with the individual's health (measured in several ways), age, and pension and health insurance status. Retirement patterns in America are much richer and more varied than the stereotypical one-step view of retirement suggests. Public policy is changing in ways that make continued work late in life more likely. If employers are willing to provide flexible job opportunities to meet the needs of these potential employees, then society can tap a growing pool of older, experienced, and willing workers for years to come.
Keywords: Aged; Attitude; Career Mobility; Data collection; Employment; Female; Humans; Male; Middle Aged; Multivariate Analysis; Retirement; United States

A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. - Carolyn L. Turvey; Robert B Wallace; A. Regula Herzog (Int Psychogeriatr, 1999)
This study examines the psychometric properties of two new abbreviated versions of standard measures of depression, a revised eight-item Center for Epidemiological Studies-Depression Scale (CES-D) and a short-form Composite International Diagnostic Interview (short-form CIDI). A sample of 6,133 elders, age 70 years or older, completed both measures as part of the Asset and Health Dynamics Study of the Oldest Old. The revised CES-D had an internal consistency and factor structure comparable to that of prior versions of the CES-D. The sources of discordance between the two measures were examined and the two measures were compared on self-report of four clinical variables: medical illness, physician diagnosis, psychiatric treatment, and antidepressant or tranquilizer use. Both measures were associated with self-report of physician diagnosis and psychiatric treatment. Respondents positive for depression on the CES-D reported higher rates of antidepressant use. Respondents positive on the short-form CIDI only did not report more antidepressant use than nondepressed respondents.
Keywords: Aged; Antidepressive Agents; depression; Depressive Disorder, Major; Diagnosis, Differential; Female; Humans; Male; Prospective Studies; Psychiatric Status Rating Scales; Psychometrics; Severity of Illness Index; Surveys and Questionnaires

Transitions in employment, morbidity, and disability among persons ages 51-61 with musculoskeletal and non-musculoskeletal conditions in the US, 1992-1994. - Yelin, Edward; Laura S. Trupin; Sebesta, D.S. (Arthritis Rheum, 1999)
OBJECTIVE: To provide estimates of the prevalence of musculoskeletal conditions in a sample of persons ages 51-61 living in the community in the US in 1992, to indicate the incidence of such conditions between 1992 and 1994, and to describe the proportion of individuals with these conditions who developed or recovered from disability and who left and entered employment during this time. METHODS: The estimates were derived from the Health and Retirement Survey, consisting of data on a national probability sample of 8,739 persons, ages 51-61, who were interviewed in the community in 1992 and reinterviewed in 1994. RESULTS: In 1992, 62.4% of persons (14.4 million) between the ages of 51 and 61 years reported at least 1 musculoskeletal condition; the rate increased to 70.5% by 1994. More than 40% of persons with musculoskeletal conditions reported disability, which was almost 90% of all persons with disability in this age group. Persons with musculoskeletal conditions had lower employment rates, were less likely to enter employment, and were more likely to leave employment compared with persons without these conditions. High rates of disability account for much of these differences. CONCLUSION: Musculoskeletal conditions affected more than two-thirds of persons ages 51-61 and accounted for all but 10% of those with disabilities. The prevention of disability among such persons should improve their employment prospects.
Keywords: Chronic disease; Disability Evaluation; Disabled Persons; Employment; Female; Humans; Incidence; Male; Middle Aged; Morbidity; Musculoskeletal Diseases; Prevalence; Retirement; United States

Do medical conditions affect cognition in older adults? - Elizabeth Zelinski; Eileen M. Crimmins; Sandra L Reynolds; Teresa Seeman (Health Psychol, 1998)
Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.
Keywords: Aged; Aged, 80 and over; Aging; Cerebrovascular Disorders; Cognition; Diabetes Complications; Diabetes Mellitus; Female; Health Status; Humans; Hypertension; Male; Mental Health

Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994. - Zwerling, Craig; Nancy L. Sprince; Charles S. Davis; Paul S. Whitten; Robert B Wallace; Steven G Heeringa (Am J Public Health, 1998)
OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries. METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers. RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios. CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.
Keywords: Accidents, Occupational; Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Cross-Sectional Studies; Disabled Persons; Female; Health Surveys; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Prospective Studies; Retirement; Risk Factors; United States

Occupational injuries among older workers with visual, auditory, and other impairments. A validation study. - Zwerling, Craig; Paul S. Whitten; Charles S. Davis; Nancy L. Sprince (J Occup Environ Med, 1998)
This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.
Keywords: Accidents, Occupational; Aged; Cohort Studies; Disabled Persons; Female; Health Surveys; Humans; Logistic Models; Male; Middle Aged; Persons With Hearing Impairments; Risk Factors; Visually Impaired Persons

Women, marital status, and symptoms of depression in a midlife national sample. - J R Earle; M H Smith; C.T. Harris; Charles F Longino (J Women Aging, 1998)
Previous studies of the correlates of depression among women have not generally been based on adequate midlife samples or precision in the specification of marital status categories. The present analysis is designed to address these deficiencies and is based on data from the Health and Retirement Survey-Wave 1 (i.e., respondents 51 to 61 years old). Results indicate that married women are less likely to report symptoms of depression than their unmarried counterparts. The mental health benefits of marriage are greater for men than for women. Moreover, other variables, such as marital satisfaction, self-rated health, and employment status are more powerful predictors of emotional well-being in midlife than marital status per se. The quality of marriage affects depressive symptoms more strongly for women than men.
Keywords: Age Factors; Depressive Disorder; Female; Humans; Male; Marital Status; Marriage; Middle Aged; Surveys and Questionnaires

Demographic and economic correlates of health in old age. - James P Smith; Raynard Kington (Demography, 1997)
In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (1) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.
ProCite field 3 : RAND; UCLA and RAND
Keywords: Activities of Daily Living; Aged; Cohort Studies; Demography; Disabled Persons; ethnicity; Female; Health Status; Humans; Income; Male; Models, Econometric; Racial Groups; Socioeconomic factors; United States

Distribution and association of chronic disease and mobility difficulty across four body mass index categories of African-American women. - Daniel O. Clark; Mungai, S.M. (Am J Epidemiol, 1997)
A majority of African-American women over the age of 50 are obese, have at least one chronic disease, and experience mobility difficulty. Using self-reported data from the 1992 Health and Retirement Study of 1,150 African-American women aged 30-70 years, this report first compares chronic disease prevalence and severity, pain, sensory deficits, and mobility difficulty across four categories of body mass index and, second, investigates whether body mass index affects the association of chronic disease with mobility difficulty. Body mass index was categorized as low, medium, high, and severe, being equal to 19-24 (20%), 25-29 (38%), 30-34 (24%), and 35 or over (18%), respectively. There were few differences when comparing the medium category with either the low or high category. Those in the severe body mass index category, however, reported significantly more frequent and severe hypertension, diabetes, cancer, heart disease, arthritis, pain, sensory deficits, and mobility difficulty than did those in the medium body mass index category. Obesity did not appear to affect the association between chronic disease and mobility difficulty. The relatively high rates of mobility difficulty observed among the severe body mass index group appear to be more likely a result of relatively high chronic disease prevalence and severity than to a disproportionate impact of these on mobility.
Keywords: Activities of Daily Living; Black People; Body Mass Index; Chronic disease; Comorbidity; Cross-Sectional Studies; Female; Health Behavior; Humans; Michigan; Middle Aged; Obesity; Prevalence; Regression Analysis; Severity of Illness Index; Socioeconomic factors

Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey. - Michael Schoenbaum (Am J Public Health, 1997)
OBJECTIVES: This study examined whether smokers recognize that smoking is likely to shorten their lives and, if so, whether they understand the magnitude of this effect. METHODS: People's expectations about their chances of reaching age 75 were compared with epidemiological predictions from life tables for never, former, current light, and current heavy smokers. Data on expectations of reaching age 75 came from the Health and Retirement Survey, a national probability sample of adults aged 50 through 62 years. Predictions came from smoking-specific life tables constituted from the 1986 National Mortality Followback Survey and the 1985 and 1987 National Health Interview Surveys. RESULTS: Among men and women, the survival expectations of never, former, and current light smokers were close to actual predictions. However, among current heavy smokers, expectations of reaching age 75 were nearly twice as high as actuarial predictions. CONCLUSIONS: These findings suggest that at least heavy smokers significantly underestimate their risk of premature mortality.
Keywords: Cognition; Female; Health Surveys; Humans; Life Tables; Longevity; Male; Middle Aged; Retirement; Risk; Sex Factors; Smoking; Survival Analysis

The earnings, income, and assets of persons aged 51-61 with and without musculoskeletal conditions. - Yelin, Edward (J Rheumatol, 1997)
OBJECTIVE: To describe the personal and family earnings, income, and assets of persons with musculoskeletal conditions. METHODS: This study uses the Health and Retirement Survey, a national, community based probability sample of persons 51-61 years of age and their spouses in 1992 to estimate earnings, income, and assets (by kind) in the years immediately prior to the normal age of retirement. RESULTS: Fifty-nine percent of persons 51-61 years of age (13.76 million) report one or more musculoskeletal condition; of these 38% (8.74 million) also report at least one comorbid condition and 21% (5.02 million) report no such comorbidity. Persons with musculoskeletal conditions and comorbidity report 18% lower family earnings, 15% lower family income, and 35% fewer assets than the average among all persons these ages. Persons with musculoskeletal conditions and no comorbidity have earnings, incomes, and assets closer to the average among their peers. CONCLUSION: Persons with musculoskeletal conditions and comorbidity have lower earnings and incomes now and fewer assets with which to face the future than the remainder of their peers.
Keywords: Comorbidity; Data collection; Disabled Persons; Economics; Female; Health Services Research; Humans; Income; Male; Middle Aged; Musculoskeletal Diseases; Retirement

Employee benefits, retirement patterns, and implications for increased work life. - Fronstin, Paul (EBRI Issue Brief, 1997)
This Issue Brief examines why policymakers are concerned about the trend toward early retirement and how it relates to Social Security, Medicare, and employee health and retirement benefits. It reviews the rationale for the effects of economic incentives on early retirement decisions and includes a summary of empirical literature on the retirement process. It presents data on how employee benefits influence workers' expected retirement patterns. Finally, it examines the implications of public policies to reverse early-retirement trends and raise the eligibility age for Social Security and Medicare. An employee Benefit Research Institute/Gallup survey indicates that there is a direct link between a worker's decision to retire early and the availability of retiree health benefits. In 1993, 61 percent of workers reported that they would not retire before becoming eligible for Medicare if their employer did not provide retiree health benefits. Participation in a pension plan can be an important determinant of retirement. Twenty-one percent of pension plan participants planned to stop working before age 65, compared with 12 percent among nonparticipants. Workers whose primary pension plan was a defined benefit plan were more likely to expect to stop working before age 65 (23 percent) than workers whose primary plan was a defined contribution plan (18 percent). Expected income replacement rates effect retirement patterns, indicating that as the expected replacement increases, the probability of expecting to stop working before age 65 increases. Twenty-two percent of workers with an expected income replacement rate below 60 percent expected to stop working before age 65, compared with 29 percent for those in the 60-69 percent replacement range, and 30 percent for those in the 70-79 percent replacement range. Workers expecting to receive retiree health insurance are more likely to expect to stop working before age 65 than workers who do not expect to have retiree health insurance. Twenty-one percent of workers with retiree health insurance expected to stop working before age 65, compared with 12 percent of workers not expecting to receive retiree health insurance. The Social Security Old-Age and Survivors Insurance (OASI) program depends on obtaining sufficient revenue from active workers' payroll taxes to fund the benefits received by retired beneficiaries. Funding the program in the past was in large part effortless because of the relatively large number of workers per retiree. Today, funding the program is a greater challenge because the ratio of workers to retirees has fallen. Policymakers have been able to agree that reform of the program is necessary for its survival; however, the debate over options to reform the program is just beginning, and it is likely to be a long time before a consensus emerges.
Keywords: Age Factors; Aged; Employment; Female; Health Benefit Plans, Employee; Health Status Indicators; Humans; Male; Medicare; Middle Aged; Pensions; Private Sector; Retirement; Social Security; United States

Expectations of nursing home use in the Health and Retirement Study: the role of gender, health, and family characteristics. - Karen C. Holden; Timothy D McBride; Maria Perozek (J Gerontol B Psychol Sci Soc Sci, 1997)
Economic models of life cycle behavior suggest that expectations about future events may affect savings, insurance, and retirement planning. This article uses data from the first wave of the Health and Retirement Survey (HRS) to examine how personal characteristics and health conditions influence expectations of nursing home use. Subjective expectations of nursing home use are quite close to known probabilities of lifetime use. There are marked differences in the determinants of expectations for women and men that also conform to actual behavior. There is strong evidence that women and men incorporate what is known about nursing home risk into their own expectations, even many years prior to the time when they are most likely to need long-term care.
Keywords: Aged; Black or African American; Female; Humans; Male; Middle Aged; Nursing homes; Patient Satisfaction; Retirement; Sex Characteristics; White People

Health insurance coverage at midlife: characteristics, costs, and dynamics. - Richard W. Johnson; Crystal, Stephen (Health Care Financ Rev, 1997)
Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.
Keywords: Age Factors; Costs and Cost Analysis; Demography; Female; Health Benefit Plans, Employee; Health Care Surveys; Humans; Insurance Coverage; Insurance, Health; Logistic Models; Longitudinal Studies; Male; Middle Aged; United States

Patterns of in-home care among elderly black and white Americans. - Norgard, T.M.; Willard L Rodgers (J Gerontol B Psychol Sci Soc Sci, 1997)
This study examines the use of informal and formal sources of care by elderly Black and White Americans (n = 2,847) who are functionally impaired and noninstitutionalized. The data are from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Detailed baseline characteristics are provided and logistic regressions are used to assess the likelihood of (a) receiving in-home assistance from any source, (b) using any informal sources of in-home care, (c) using any formal sources, and (d) using formal sources of in-home care with informal sources of home care. Results of the logistic regressions indicate that, compared to Whites, Black elders were less likely to receive assistance and to use informal sources of home care.
Keywords: Aged; Aged, 80 and over; Black or African American; Caregivers; Female; Home Care Services; Humans; Male; Socioeconomic factors; United States; White People

Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites. - Daniel O. Clark; Mungai, S.M.; Timothy E. Stump; Frederic D Wolinsky (J Gerontol A Biol Sci Med Sci, 1997)
BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites. METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups. RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group. CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.
Keywords: Aged; Aged, 80 and over; Black or African American; Chronic disease; Cohort Studies; Disabled Persons; Disease; Female; Health Behavior; Humans; Male; Memory Disorders; Mexican Americans; Middle Aged; Prevalence; Risk Factors; Socioeconomic factors; White People

Complex marital histories and economic well-being: the continuing legacy of divorce and widowhood as the HRS cohort approaches retirement. - Karen C. Holden; Kuo, H.H. (Gerontologist, 1996)
We use data from the first wave of the Health and Retirement Survey (HRS) to examine the marital histories of this cohort of women and men on the verge of retirement. The legacy of past increases in divorce rates is evident in the complex marital histories of HRS households and the relationship between those histories and current economic status. Couples in a first marriage now make up only one-quarter of black households and fewer than half of all white and Hispanic households. In over one-third of all married-couple households, at least one spouse had a previous marriage that ended in divorce or widowhood. These couples have significantly lower incomes and assets than couples in first marriages. Contrary to the popular notion that private and public insurance better provide for the security of widows than divorced persons, currently widowed households and couples in which the prior marriage of one spouse had ended in widowhood are no better off than are their divorced peers. This holds true for both black and white households. From a single cross-section, one cannot tell what caused these differences in income and wealth across marital status groups although it is clear that women and blacks spend a higher percentage of their lifetime outside of marriage than do men and whites. We also speculate from estimates of widowhood expectations for a subset of married respondents that underestimating the chances of widowhood--because both men and women overestimate their chances of joint survival--may be a factor in the relatively low economic status of widows. Because couples in life-long marriages have been the traditional standard upon which marital property reform and the survivorship rules of private and public programs are based, their diminishing importance among all households raises concern about the protection provided by these institutions against the long-term economic consequences of past and future marital dissolution.
Keywords: Cross-Sectional Studies; Divorce; Female; Humans; Life Tables; Male; Middle Aged; Poverty; Retirement; United States; Widowhood