TY - JOUR T1 - Association between BMI trajectories in late-middle age and subsequent dementia risk in older age: a 26-year population-based cohort study. JF - BMC Geriatrics Y1 - 2023 A1 - Qin, Zijian A1 - Liu, Zheran A1 - Li, Ruidan A1 - Luo, Yaxin A1 - Wei, Zhigong A1 - He, Ling A1 - Pei, Yiyan A1 - Su, Yonglin A1 - Hu, Xiaolin A1 - Peng, Xingchen KW - Aged KW - Body Mass Index KW - Cognition KW - Cohort Studies KW - Dementia KW - Humans KW - Risk Factors AB -

BACKGROUND: The association between body mass index (BMI) and dementia risk differs depending on follow-up time and age at BMI measurement. The relationship between BMI trajectories in late-middle age (50-65 years old) and the risk of dementia in older age (> 65 years old) has not been revealed.

METHODS: In the present study, participants from the Health and Retirement Study were included. BMI trajectories were constructed by combining BMI trend and variation information. The association between BMI trajectories at the age of 50-65 years and dementia risk after the age of 65 years was investigated. Participants with European ancestry and information on polygenic scores for cognitive performance were pooled to examine whether genetic predisposition could modify the association.

RESULTS: A total of 10,847 participants were included in the main analyses. A declining BMI trend and high variation in late-middle age were associated with the highest subsequent dementia risk in older age compared with an ascending BMI trend and low variation (RR = 1.76, 95% CI = 1.45-2.13). Specifically, in stratified analyses on BMI trajectories and dementia risk based on each individual's mean BMI, the strongest association between a declining BMI trend with high variation and elevated dementia risk was observed in normal BMI group (RR = 2.66, 95% CI = 1.72-4.1). Similar associations were found when participants were stratified by their genetic performance for cognition function without interaction.

CONCLUSIONS: A declining BMI trend and high variation in late-middle age were associated with a higher risk of dementia. Early monitoring of these individuals is needed to prevent dementia in older individuals.

VL - 23 IS - 1 ER - TY - JOUR T1 - Associations of Food Insecurity and Memory Function Among Middle to Older-Aged Adults in the Health and Retirement Study. JF - JAMA Netw Open Y1 - 2023 A1 - Lu, Peiyi A1 - Kezios, Katrina A1 - Jawadekar, Neal A1 - Swift, Samuel A1 - Vable, Anusha A1 - Zeki Al Hazzouri, Adina KW - Adult KW - Aged KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Food insecurity KW - Food Supply KW - Humans KW - Male KW - Memory Disorders KW - Middle Aged KW - Retirement AB -

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

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

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

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

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

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

VL - 6 IS - 7 ER - TY - JOUR T1 - Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study. JF - JAMA Netw Open Y1 - 2023 A1 - Gao, Qian A1 - Bone, Jessica K A1 - Bu, Feifei A1 - Paul, Elise A1 - Sonke, Jill K A1 - Fancourt, Daisy KW - Aged KW - Cohort Studies KW - Delivery of Health Care KW - Female KW - Hospitalization KW - Humans KW - Male KW - Middle Aged KW - Patient Acceptance of Health Care KW - Retirement AB -

IMPORTANCE: There is growing evidence for the health benefits associated with social, cultural, and community engagement (SCCE), including for supporting healthy behaviors. However, health care utilization is an important health behavior that has not been investigated in association with SCCE.

OBJECTIVE: To examine the associations between SCCE and health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the 2008 to 2016 waves of the Health and Retirement Study (HRS), a longitudinal panel study using a nationally representative sample of the US population aged 50 years and older. Participants were eligible if they reported SCCE and health care utilization in the relevant HRS waves. Data were analyzed from July to September 2022.

EXPOSURES: SCCE was measured with a 15-item Social Engagement scale (including community, cognitive, creative, or physical activities) at baseline (frequency) and longitudinally over 4 years (no, consistent, increased, or decreased engagement).

MAIN OUTCOMES AND MEASURES: Health care utilization was assessed in association with SCCE within 4 overarching categories: inpatient care (ie, hospital stays, hospital readmissions, length of hospital stays), outpatient care (ie, outpatient surgery, physician visits, number of physician visits), dental care (including dentures), and community health care (ie, home health care, nursing home stays, nights in a nursing home).

RESULTS: A total of 12 412 older adults (mean [SE] age, 65.0 [0.1] years; 6740 [54.3%] women) were included in short-term analyses with 2 years of follow-up. Independent of confounders, more SCCE was associated with shorter hospital stays (incidence rate ratio [IRR], 0.75; 95% CI, 0.58-0.98), greater odds of outpatient surgery (odds ratio [OR], 1.34; 95% CI, 1.12-1.60) and dental care (OR, 1.73; 95% CI, 1.46-2.05), and lower odds of home health care (OR, 0.75; 95% CI, 0.57-0.99) and nursing home stays (OR, 0.46; 95% CI, 0.29-0.71). Longitudinal analysis included 8635 older adults (mean [SE] age, 63.7 [0.1] years; 4784 [55.4%] women) with data on health care utilization 6 years after baseline. Compared with consistent SCCE, reduced SCCE or consistent nonparticipation in SCCE was associated with more inpatient care utilization, such as hospital stays (decreased SCCE: IRR, 1.29; 95% CI, 1.00-1.67; consistent nonparticipation: IRR, 1.32; 95% CI, 1.04-1.68) but lower levels of subsequent outpatient care, such as physician visits (decreased SCCE: OR, 0.68; 95% CI, 0.50-0.93; consistent nonparticipation: OR, 0.62; 95% CI, 0.46-0.82) and dental care utilization (decreased SCCE: OR, 0.68; 95% CI, 0.57-0.81; consistent nonparticipation: OR, 0.51; 95% CI, 0.44-0.60).

CONCLUSIONS AND RELEVANCE: These findings suggest that more SCCE was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE might be associated with shaping beneficial early and preventive health-seeking behaviors, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

VL - 6 IS - 4 ER - TY - JOUR T1 - Change in Purpose in Life Before and After Onset of Cognitive Impairment. JF - JAMA Network Open Y1 - 2023 A1 - Sutin, Angelina R A1 - Luchetti, Martina A1 - Stephan, Yannick A1 - Terracciano, Antonio KW - Aged KW - Aging KW - Awareness KW - Cognitive Dysfunction KW - Cohort Studies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Retirement AB -

IMPORTANCE: Purpose in life is a critical aspect of psychological well-being that is associated with better cognitive outcomes across the continuum of dementia. To our knowledge, the natural history of purpose with onset of cognitive impairment has yet to be evaluated.

OBJECTIVE: To evaluate changes in purpose in life prior to and after onset of cognitive impairment.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used assessments of purpose in life and cognitive status from March 2006 to May 2021 in the Health and Retirement Study (HRS) and from May 2011 to November 2021 in the National Health and Aging Trends Study (NHATS).

EXPOSURE: Cognitive impairment at each wave based on established thresholds in HRS and NHATS.

MAIN OUTCOMES AND MEASURES: The main outcome was purpose in life, measured with the Ryff Measures of Psychological Well-Being in HRS and a validated item in NHATS.

RESULTS: In HRS, 22 668 participants provided 50 985 assessments of purpose across all waves. In NHATS, 10 786 participants provided 53 880 assessments of purpose across all waves. In HRS, 58.3% of participants were female, with mean (SD) age of 64.76 (10.41) years at baseline; in NHATS, 57.4% were female, with mean (SD) age of 76.82 (7.71) years at baseline. Across waves, 6794 HRS participants (30%) and 4446 NHATS participants (41.2%) were in the cognitive impairment range. Accounting for demographic covariates and normative change in purpose, multilevel modeling indicated that standardized purpose in life declined significantly prior to onset of cognitive impairment (estimate for 10 years) in both HRS (b = -0.12; 95% CI, -0.17 to -0.07; P < .001) and NHATS (b = -0.10; 95% CI, -0.20 to -0.01; P = .03). Purpose declined significantly more rapidly following onset of cognitive impairment, with a standardized decline nearly 3 times larger compared with prior to impairment in HRS (b = -0.35; 95% CI, -0.41 to -0.29; P < .001) and 4 times larger in NHATS (b = -0.44; 95% CI, -0.53 to -0.34; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study, purpose in life declined with emergence of cognitive impairment. The decline before onset was too small to be useful to detect impending impairment in clinical settings. The steeper decline following impairment suggests that individuals are aware that their purpose is declining. Purpose may be an intervention target following cognitive impairment to maintain well-being and to reduce or slow emergence of behavioral symptoms associated with low purpose.

VL - 6 IS - 9 ER - TY - JOUR T1 - CogDrisk, ANU-ADRI, CAIDE, and LIBRA Risk Scores for Estimating Dementia Risk. JF - JAMA Netw Open Y1 - 2023 A1 - Huque, Md Hamidul A1 - Kootar, Scherazad A1 - Eramudugolla, Ranmalee A1 - Han, S Duke A1 - Carlson, Michelle C A1 - Lopez, Oscar L A1 - Bennett, David A A1 - Peters, Ruth A1 - Anstey, Kaarin J KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Australia KW - Cohort Studies KW - Female KW - Heart Disease Risk Factors KW - Humans KW - Male KW - Risk Factors AB -

IMPORTANCE: While the Australian National University-Alzheimer Disease Risk Index (ANU-ADRI), Cardiovascular Risk Factors, Aging, and Dementia (CAIDE), and Lifestyle for Brain Health (LIBRA) dementia risk tools have been widely used, a large body of new evidence has emerged since their publication. Recently, Cognitive Health and Dementia Risk Index (CogDrisk) and CogDrisk for Alzheimer disease (CogDrisk-AD) risk tools have been developed for the assessment of dementia and AD risk, respectively, using contemporary evidence; comparison of the relative performance of these risk tools is limited.

OBJECTIVE: To evaluate the performance of CogDrisk, ANU-ADRI, CAIDE, LIBRA, and modified LIBRA (LIBRA with age and sex estimates from ANU-ADRI) in estimating dementia and AD risks (with CogDrisk-AD and ANU-ADRI).

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study obtained data from the Rush Memory and Aging Project (MAP), the Cardiovascular Health Study Cognition Study (CHS-CS), and the Health and Retirement Study-Aging, Demographics and Memory Study (HRS-ADAMS). Participants who were free of dementia at baseline were included. The factors were component variables in the risk tools that included self-reported baseline demographics, medical risk factors, and lifestyle habits. The study was conducted between November 2021 and March 2023, and statistical analysis was performed from January to June 2023.

MAIN OUTCOMES AND MEASURES: Risk scores were calculated based on available factors in each of these cohorts. Area under the receiver operating characteristic curve (AUC) was calculated to measure the performance of each risk score. Multiple imputation was used to assess whether missing data may have affected estimates for dementia risk.

RESULTS: Among the 6107 participants in 3 validation cohorts included for this study, 2184 participants without dementia at baseline were available from MAP (mean [SD] age, 80.0 [7.6] years; 1606 [73.5%] female), 548 participants without dementia at baseline were available from HRS-ADAMS (mean [SD] age, 79.5 [6.3] years; 288 [52.5%] female), and 3375 participants without dementia at baseline were available from CHS-CS (mean [SD] age, 74.8 [4.9] years; 1994 [59.1%] female). In all 3 cohorts, a similar AUC for dementia was obtained using CogDrisk, ANU-ADRI, and modified LIBRA (MAP cohort: CogDrisk AUC, 0.65 [95% CI, 0.61-0.69]; ANU-ADRI AUC, 0.65 [95% CI, 0.61-0.69]; modified LIBRA AUC, 0.65 [95% CI, 0.61-0.69]; HRS-ADAMS cohort: CogDrisk AUC, 0.75 [95% CI, 0.71-0.79]; ANU-ADRI AUC, 0.74 [95% CI, 0.70-0.78]; modified LIBRA AUC, 0.75 [95% CI, 0.71-0.79]; CHS-CS cohort: CogDrisk AUC, 0.70 [95% CI, 0.67-0.72]; ANU-ADRI AUC, 0.69 [95% CI, 0.66-0.72]; modified LIBRA AUC, 0.70 [95% CI, 0.68-0.73]). The CAIDE and LIBRA also provided similar but lower AUCs than the 3 aforementioned tools (eg, MAP cohort: CAIDE AUC, 0.50 [95% CI, 0.46-0.54]; LIBRA AUC, 0.53 [95% CI, 0.48-0.57]). The performance of CogDrisk-AD and ANU-ADRI in estimating AD risks was also similar.

CONCLUSIONS AND RELEVANCE: CogDrisk and CogDrisk-AD performed similarly to ANU-ADRI in estimating dementia and AD risks. These results suggest that CogDrisk and CogDrisk-AD, with a greater range of modifiable risk factors compared with other risk tools in this study, may be more informative for risk reduction.

VL - 6 IS - 8 ER - TY - JOUR T1 - Cumulative exposure to extreme heat and trajectories of cognitive decline among older adults in the USA. JF - J Epidemiol Community Health Y1 - 2023 A1 - Choi, Eun Young A1 - Lee, Haena A1 - Chang, Virginia W KW - Aging KW - Climate Change KW - Cognition KW - Cohort Studies AB -

BACKGROUND: The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status.

METHODS: Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older.

RESULTS: We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods.

CONCLUSION: Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.

ER - TY - JOUR T1 - The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies. JF - J of the American Geriatric Society Y1 - 2023 A1 - Ankuda, Claire K A1 - Covinsky, Kenneth A1 - Freedman, Vicki A A1 - Kenneth M. Langa A1 - Aldridge, Melissa D A1 - Yee, Cynthia A1 - Kelley, Amy S KW - Activities of Daily Living KW - Cohort Studies KW - Disabled Persons KW - Medicare KW - Self Care AB -

BACKGROUND: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS).

METHODS: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing.

RESULTS: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%-13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%-7.2%] and MCBS 5.3% [95% CI 4.7%-5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability.

CONCLUSIONS: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

VL - 71 IS - 3 ER - TY - JOUR T1 - Examining racial and ethnic differences in disability among older adults: A polysocial score approach. JF - Maturitas Y1 - 2023 A1 - Tang, Junhan A1 - Chen, Ying A1 - Liu, Hua A1 - Wu, Chenkai KW - Activities of Daily Living KW - Aged KW - Cohort Studies KW - Disabled Persons KW - ethnicity KW - Health Status Disparities KW - Humans KW - Racial Groups KW - United States AB -

OBJECTIVES: Racial and ethnic disparities in disability in activities of daily living (ADL) continue to be a public concern. We evaluated whether the polysocial score approach could provide a more comprehensive method for modifying racial and ethnic differences in such disability.

STUDY DESIGN: Cohort study.

MAIN OUTCOME MEASURES: We included 5833 participants from the Health and Retirement Study, who were aged 65 years or more and were initially free of ADL disability. We considered six ADLs: bathing, eating, using the toilet, dressing, walking across a room, and getting in/out of bed. We included 20 social factors spanning economic stability, neighborhood and physical environment, education, community and social context, and health system. We used forward stepwise logistic regression to derive a polysocial score for ADL disability. We created a polysocial score using 12 social factors and categorized the score as low (0-19), intermediate (20-30), and high (31+). We used multivariable logistic regression to estimate the incident risk of ADL disability and examine additive interactions between race/ethnicity and polysocial score.

RESULTS: A higher polysocial score is associated with a lower incidence of ADL disability among older adults in the United States. We found additive interactions between race/ethnicity and polysocial score categories. In the low polysocial score category, White and Black/Hispanic participants had a 18.5 % and 24.4 % risk of ADL disability, respectively. Among White participants, the risk of ADL disability decreased to 14.1 % and 12.1 % in the intermediate and high polysocial score categories, respectively; among Black/Hispanic participants, those in the intermediate and high categories had a 11.9 % and 8.7 % risk of ADL disability, respectively.

CONCLUSIONS: The polysocial score approach provides a new opportunity for explaining racial/ethnic disparities in functional capacity among older adults.

VL - 172 ER - TY - JOUR T1 - Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life. JF - Journal of Alzheimer's Disease : JAD Y1 - 2023 A1 - Zhu, Yingying A1 - Olchanski, Natalia A1 - Cohen, Joshua T A1 - Freund, Karen M A1 - Jessica Faul A1 - Fillit, Howard M A1 - Neumann, Peter J A1 - Lin, Pei-Jung KW - Aged KW - Alzheimer disease KW - Cohort Studies KW - Death KW - Humans KW - Medicare KW - Terminal Care KW - United States AB -

BACKGROUND: Older adults with dementia including Alzheimer's disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits.

OBJECTIVE: This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia.

METHODS: This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions.

RESULTS: Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42-2.35]; non-advanced dementia: OR = 1.16 [1.01-1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74-0.96]) and in nursing homes (OR = 0.68 [0.53-0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences.

CONCLUSIONS: Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.

VL - 96 IS - 3 ER - TY - JOUR T1 - Neighborhood Characteristics and Elevated Blood Pressure in Older Adults. JF - JAMA Network Open Y1 - 2023 A1 - Sims, Kendra D A1 - Willis, Mary D A1 - Hystad, Perry W A1 - Batty, G David A1 - Bibbins-Domingo, Kirsten A1 - Smit, Ellen A1 - Odden, Michelle C KW - Aged KW - Blood pressure KW - Cohort Studies KW - ethnicity KW - Female KW - Humans KW - Hypertension KW - Male KW - Neighborhood characteristics AB -

IMPORTANCE: The local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities.

OBJECTIVE: To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021.

EXPOSURES: Fifty-one standardized American Community Survey census tract variables (2005-2009).

MAIN OUTCOMES AND MEASURES: Elevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P ≤ .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure.

RESULTS: Of 12 946 participants, 4565 (35%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50%] male; 228 [5%] Hispanic or Latino, 502 [11%] non-Hispanic Black, and 3761 [82%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95% CI, 0.65-1.09; P = .78 for interaction).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control.

IS - 9 ER - TY - JOUR T1 - Sex differences in cognitive aging and the role of socioeconomic status: Evidence from multi-cohort studies. JF - Psychiatry Res Y1 - 2023 A1 - Jin, Yinzi A1 - Hong, Chenlu A1 - Luo, Yanan KW - Aged, 80 and over KW - Aging KW - cognitive aging KW - Cohort Studies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Sex Characteristics KW - Social Class KW - Socioeconomic factors AB -

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

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

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

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

VL - 321 ER - TY - JOUR T1 - Association Between Long-Term HbA1c Variability and Functional Limitation in Individuals Aged Over 50 Years: A Retrospective Cohort Study. JF - Front Endocrinol Y1 - 2022 A1 - Shao, Di A1 - Wang, Shuang-Shuang A1 - Sun, Ji-Wei A1 - Wang, Hai-Peng A1 - Sun, Qiang KW - Activities of Daily Living KW - Blood Glucose KW - Cohort Studies KW - Diabetes Mellitus KW - Glycated Hemoglobin A KW - Retrospective Studies KW - Type 2 AB -

Background: As mean HbA1c provides incomplete information regarding glycemic variability, there has been considerable interest in the emerging association between glycemic variability and macrovascular events and with microvascular complications and mortality in adults with and without diabetes. However, the association between long-term glycemic variability, represented by visit-to-visit HbA1c variability, and functional limitations has not been clarified in previous literature. The present study aimed to explore the longitudinal association between long-term glycemic variability, represented by visit-to-visit HbA1c variability and functional limitations.

Methods: This cohort study included adults aged over 50 years who participated in the 2006 to 2016 waves of the Health and Retirement Study. Physical functions, including mobility, large muscle function, activities of daily living (ADLs), and instrumental ADLs (IADLs), were assessed at baseline and every 2 years, and HbA1c levels were assessed at baseline and every 4 years. Visit-to-visit HbA1c variability was calculated using the HbA1c variability score (HVS) during the follow-up period. Generalized estimating equation models were used to evaluate the longitudinal association between HbA1c variability and functional limitations with adjustment for a series of confounders.

Results: A total of 5,544 participants having three HbA1c measurements from 2006 to 2016, having two or more physical function measures (including one at baseline), and age over 50 years were included in this analysis. The mean age at baseline was 66.13 ± 8.39 years. A total of 916 (16.5%) participants had an HVS = 100, and 35.1% had an HVS = 50. The highest HVS category (HVS =100) was associated with increased functional status score (β = 0.093, 95% CI: 0.021-0.165) in comparison with the lowest HVS category (HVS = 0). Sensitivity analyses using the CV and SD of HbA1c as measures of variability showed similar associations between HbA1c variability and functional limitation. An incremental increase in HbA1c-CV (β = 0.630, 95% CI: 0.127-1.132) or HbA1c-SD (β = 0.078, 95% CI: 0.006-0.150) was associated with an increase in functional limitation in the fully adjusted model.

Conclusions: HbA1c variability was associated with heightened difficulty in performing functional activities over time after adjusting for mean HbA1c levels and multiple demographics and comorbidities. This study provides further evidence regarding the detrimental effect of HbA1c variability and highlights the significance of steady glycemic control.

VL - 13 ER - TY - JOUR T1 - Association of plasma cystatin C with all-cause and cause-specific mortality among middle-aged and elderly individuals: a prospective community-based cohort study. JF - Scientific Reports Y1 - 2022 A1 - Wu, Jinhua A1 - Liang, Yuemei A1 - Chen, Rong A1 - Xu, Linli A1 - Ou, Zejin A1 - Liang, Haiying A1 - Zhao, Lina KW - Cardiovascular Diseases KW - Cause of Death KW - Cohort Studies KW - Cystatin C KW - Mortality KW - Neoplasms KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors AB -

We investigated the associations of plasma cystatin C with all-cause and cause-specific mortality risk and identified potential modifying factors affecting these associations in middle-aged and elderly people (≥ 50 years). This community-based prospective cohort study included 13,913 individuals aged ≥ 50 years from the Health and Retirement Study. Cox proportional hazard models were used to estimate the associations between cystatin C concentrations and the risk of all-cause and cardiovascular and cancer mortality after adjustment for sociodemographic characteristics, lifestyle factors, self-reported medical history, and other potential confounding factors. During a total of 71,988 person-years of follow-up (median: 5.8 years; interquartile range 3.3-7.6 years), 1893 all-cause deaths were documented, including 714 cardiovascular-related and 406 cancer-related deaths. The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) cystatin C concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.92 (1.62-2.28) for all-cause mortality, 1.98 (1.48-2.65) for cardiovascular mortality, and 1.62 (1.13-2.32) for cancer mortality. The associations of cystatin C concentrations with all-cause, cardiovascular and cancer mortality did not differ substantially when participants were stratified by sex, age, BMI, current smoking status, current alcohol consumption, and regular exercise (all P for interactions > 0.05). Our study indicates that an elevated plasma cystatin C concentration is associated with an increased risk of all-cause, cardiovascular and cancer mortality both men and women among the middle-aged and elderly individuals.

VL - 12 IS - 1 ER - TY - JOUR T1 - Association of Playing College American Football With Long-term Health Outcomes and Mortality. JF - JAMA Network Open Y1 - 2022 A1 - Phelps, Alyssa A1 - Alosco, Michael L A1 - Baucom, Zachary A1 - Hartlage, Kaitlin A1 - Palmisano, Joseph N A1 - Weuve, Jennifer A1 - Mez, Jesse A1 - Tripodis, Yorghos A1 - Stern, Robert A KW - Aged KW - Brain Concussion KW - Cohort Studies KW - Female KW - Football KW - Health Care KW - Humans KW - Male KW - Neurodegenerative Diseases KW - Outcome Assessment AB -

Importance: Exposure to repetitive head impacts from playing American football (including impacts resulting in symptomatic concussions and subconcussive trauma) is associated with increased risk for later-life health problems, including cognitive and neuropsychiatric decline and neurodegenerative disease. Most research on long-term health consequences of playing football has focused on former professional athletes, with limited studies of former college players.

Objectives: To estimate the prevalence of self-reported health conditions among former college football players compared with a sample of men in the general population as well as standardized mortality ratios (SMRs) among former college football players.

Design, Setting, and Participants: This cohort study included data from 447 former University of Notre Dame (ND) football players aged 59 to 75 years who were seniors on the rosters from 1964 to 1980. A health outcomes survey was distributed to living players and next of kin of deceased players for whom contact information was available. The survey was completed from December 2018 to May 2019.

Exposure: Participation in football at ND.

Main Outcomes and Measures: Prevalence of health outcomes was compared between living former players who completed the survey and propensity score-matched participants in the Health and Retirement Study (HRS). Standardized mortality ratios of all causes and specific causes of death among all former players were compared with those among men in the general US population.

Results: A total of 216 living players completed the health survey (median age, 67 years; IQR, 63-70 years) and were compared with 638 participants in the HRS (median age, 66 years; IQR, 63-70 years). Former players reported a higher prevalence of cognitive impairment (10 [5%] vs 8 [1%]; P = .02), headaches (22 [10%] vs 22 [4%]; P = .001), cardiovascular disease (70 [33%] vs 128 [20%]; P = .001), hypercholesterolemia (111 [52%] vs 182 [29%]; P = .001), and alcohol use (185 [86%] vs 489 [77%]; P = .02) and a lower prevalence of diabetes (24 [11%] vs 146 [23%]; P = .001). All-cause mortality (SMR, 0.54; 95% CI, 0.42-0.67) and mortality from heart (SMR, 0.64; 95% CI, 0.39-0.99), circulatory (SMR, 0.23; 95% CI, 0.03-0.83), respiratory (SMR, 0.13; 95% CI, 0.00-0.70), and digestive system (SMR, 0.13; 95% CI, 0.00-0.74) disorders; lung cancer (SMR, 0.26; 95% CI, 0.05-0.77); and violence (SMR, 0.10; 95% CI, 0.00-0.58) were significantly lower in the ND cohort than in the general population. Mortality from brain and other nervous system cancers was significantly higher in the ND cohort (SMR, 3.82; 95% CI, 1.04-9.77). Whereas point estimates were greater for all neurodegenerative causes (SMR, 1.42; 95% CI, 0.29-4.18), amyotrophic lateral sclerosis (SMR, 2.93; 95% CI, 0.36-10.59), and Parkinson disease (SMR, 2.07; 95% CI, 0.05-11.55), the difference did not reach statistical significance.

Conclusions and Relevance: In this cohort study of former college football players, both positive and negative health outcomes were observed. With more than 800 000 former college players living in the US, additional research appears to be needed to provide stakeholders with guidance to maximize factors that improve health outcomes and minimize factors that may increase risk for later-life morbidity and mortality.

VL - 5 IS - 4 ER - TY - JOUR T1 - Purpose in life and 8-year mortality by gender and race/ethnicity among older adults in the U.S. JF - Preventive Medicine Y1 - 2022 A1 - Shiba, Koichiro A1 - Kubzansky, Laura D A1 - Williams, David R A1 - VanderWeele, Tyler J A1 - Kim, Eric S KW - Cohort Studies KW - ethnicity KW - Mortality KW - Odds Ratio KW - Retirement AB -

We examined the associations between a sense of purpose and all-cause mortality by gender and race/ethnicity groups. Data were from the Health and Retirement Study, a nationally representative cohort study of U.S. adults aged >50 (n = 13,159). Sense of purpose was self-reported at baseline (2006/2008), and risk of all-cause mortality was assessed over an 8-year follow-up period. We also formally tested for potential effect modification by gender and race/ethnicity. We observed the associations between higher purpose and lower all-cause mortality risk across all gender and race/ethnicity groups. There was modest evidence that the highest level of purpose (versus lowest quartile) was associated with even lower risk of all-cause mortality among women (risk ratio = 0.66, 95% confidence interval: 0.56, 0.77) compared to men (risk ratio = 0.80, 95% confidence interval: 0.69, 0.93; p-value for multiplicative effect modification =0.07). However, we observed no evidence of effect modification by race/ethnicity. Having a higher sense of purpose appears protective against all-cause mortality regardless of gender and race/ethnicity. Purpose, a potentially modifiable factor, might be a health asset across diverse populations.

VL - 164 ER - TY - JOUR T1 - The Relationship Between Fertility History and Incident Dementia in the U.S. Health and Retirement Study. JF - The Journals of Gerontology, Series B Y1 - 2022 A1 - Gemmill, Alison A1 - Weiss, Jordan KW - Cohort Studies KW - Dementia KW - Fertility KW - Pregnancy KW - Prospective Studies KW - Retirement KW - Risk Factors AB -

OBJECTIVES: An emerging literature suggests that fertility history, which includes measures of parity and birth timing, may influence cognitive health in older ages, especially among women given their differential exposure to pregnancy and sex hormones. Yet, few studies have examined associations between measures of fertility history and incident dementia in population-based samples.

METHOD: We examined the associations between parity, younger age at first birth, and older age at last birth with incident dementia over a 16-year period in a prospective sample of 15,361 men and women aged 51-100 years at baseline drawn from the Health and Retirement Study. We used Cox regression and the Fine and Gray model to obtain cause-specific hazard ratios (csHRs) and subdistribution hazard ratios for incident dementia from gender-stratified models, with the latter method accounting for the semicompeting risk of death.

RESULTS: During the follow-up period (median 13.0 years), the crude incidence rate for dementia was 16.6 and 19.9 per 1,000 person-years for men and women, respectively. In crude models estimating csHRs, higher parity (vs parity 2) and younger age at first birth were associated with increased risk of dementia for both genders. These associations did not persist after adjusting for sociodemographic characteristics, smoking status, and health conditions, with much of the attenuation in estimates occurring after adjustment for sociodemographic characteristics.

DISCUSSION: In this population-based, multiethnic cohort, we observed limited evidence for an association between measures of fertility history and incident dementia among men and women after adjusting for potential confounders.

VL - 77 IS - 6 ER - TY - JOUR T1 - Trends in prevalence, health disparities, and early detection of dementia: A 10-year nationally representative serial cross-sectional and cohort study. JF - Front Public Health Y1 - 2022 A1 - Lu, Kevin A1 - Xiong, Xiaomo A1 - Li, Minghui A1 - Yuan, Jing A1 - Luo, Ye A1 - Friedman, Daniela B KW - Aged KW - Cognitive Dysfunction KW - Cohort Studies KW - Cross-Sectional Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Middle Aged KW - Prevalence AB -

OBJECTIVE: To identify trends in the prevalence of mild cognitive impairment (MCI) and dementia, and to determine risk factors associated with the early detection of dementia among U.S. middle-aged and older adults.

METHODS: We used 10-year nationally representative longitudinal data from the Health and Retirement Study (HRS) (2006-2016). Adults aged 55 years or older were included to examine the trend. To identify the associated factors, adults aged 55 years or older in 2006 who developed MCI or dementia in subsequent waves until the 2016 wave were included. Early and late detection of dementia were identified using the Langa-Weir classification of cognitive function. Multivariate logistic regression models were used to identify factors associated with the early detection of dementia.

RESULTS: The sample size for the analysis of the prevalence of MCI and dementia ranged from 14,935 to 16,115 in the six survey years, and 3,729 individuals were identified to determine associated factors of the early detection of dementia. Among them, participants aged 65 years or older accounted for 77.9%, and male participants accounted for 37.2%. The 10-year prevalence of MCI and dementia was 14.5 and 6.6%, respectively. We also found decreasing prevalence trends in MCI (from 14.9 to 13.6%) and dementia (from 7.4 to 6.0%) overall in the past decade. Using logistic regression controlling for the year, non-Hispanic black (MCI: OR = 2.83, < 0.001; dementia: OR = 2.53, < 0.001) and Hispanic (MCI: OR = 2.52, < 0.001; dementia: OR = 2.62, < 0.001) had a higher prevalence of both MCI and dementia than non-Hispanic white participants. In addition, men had a lower prevalence of MCI (OR = 0.94, = 0.035) and dementia (OR = 0.84, < 0.001) compared to women. Associated factors of the early detection of dementia include age, gender, race, educational attainment, stroke, arthritis diseases, heart problems, and pensions.

CONCLUSION: This study found a decreasing trend in the prevalence of MCI and dementia in the past decade and associated racial/ethnic and gender disparities among U.S. middle-aged and older adults. Healthcare policies and strategies may be needed to address health disparities in the prevalence and take the associated factors of the early detection of dementia into account in clinical settings.

VL - 10 ER - TY - JOUR T1 - Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium. JF - International Journal of Epidemiology Y1 - 2021 A1 - Sanchez-Niubo, Albert A1 - Forero, Carlos G A1 - Wu, Yu-Tzu A1 - Giné-Vázquez, Iago A1 - Prina, Matthew A1 - de la Fuente, Javier A1 - Daskalopoulou, Christina A1 - Critselis, Elena A1 - De La Torre-Luque, Alejandro A1 - Panagiotakos, Demosthenes A1 - Arndt, Holger A1 - Ayuso-Mateos, José Luis A1 - Bayes-Marin, Ivet A1 - Bickenbach, Jerome A1 - Bobak, Martin A1 - Caballero, Francisco Félix A1 - Chatterji, Somnath A1 - Egea-Cortés, Laia A1 - García-Esquinas, Esther A1 - Leonardi, Matilde A1 - Koskinen, Seppo A1 - Koupil, Ilona A1 - Mellor-Marsá, Blanca A1 - Olaya, Beatriz A1 - Pająk, Andrzej A1 - Prince, Martin A1 - Raggi, Alberto A1 - Rodríguez-Artalejo, Fernando A1 - Sanderson, Warren A1 - Scherbov, Sergei A1 - Tamosiunas, Abdonas A1 - Tobias-Adamczyk, Beata A1 - Tyrovolas, Stefanos A1 - Haro, Josep Maria KW - Aging KW - Cohort Studies KW - Health Status KW - healthy aging KW - Humans KW - Reproducibility of Results AB -

BACKGROUND: Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts.

METHODS: In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10.

RESULTS: A common scale was created for 343 915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality.

CONCLUSIONS: The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing.

VL - 50 IS - 3 ER - TY - JOUR T1 - Cohort Trends in the Gender Distribution of Household Tasks in the United States and the Implications for Understanding Disability JF - Journal of Aging and Health Y1 - 2019 A1 - Connor M Sheehan A1 - Benjamin W Domingue A1 - Eileen M. Crimmins KW - Cohort Studies KW - Disabilities KW - Gender Differences KW - Household KW - Women and Minorities AB - Objectives: Measures of disability depend on health and social roles in a given environment. Yet, social roles can change over time as they have by gender. We document how engagement in Instrumental Activities of Daily Living (IADLs) is shifting by gender and birth cohort among older adults, and the challenges these shifts can create for population-level estimates of disability. Method: We used the Health and Retirement Study (N = 25,047) and multinomial logistic regression models with an interaction term between gender and birth cohort to predict limitation and nonperformance relative to no difficulty conducting IADLs. Results: Nonperformance of IADLs have significantly decreased among younger cohorts. Women in younger cohorts were more likely to use a map, whereas men in younger cohorts were more likely to prepare meals and shop. Discussion: Failing to account for gender and cohort changes in IADL, performance may lead to systematic bias in estimates of population-level disability. JO - J Aging Health ER - TY - JOUR T1 - Genetic heterogeneity of Alzheimer's disease in subjects with and without hypertension. JF - Geroscience Y1 - 2019 A1 - Nazarian, Alireza A1 - Konstantin G Arbeev A1 - Arseniy P Yashkin A1 - Alexander M Kulminski KW - Aged KW - Aged, 80 and over KW - Aging KW - Alzheimer disease KW - Cohort Studies KW - disease progression KW - Female KW - Genetic Heterogeneity KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Hypertension KW - Male KW - Polymorphism, Single Nucleotide KW - Prognosis KW - Prospective Studies KW - Risk Assessment AB -

Alzheimer's disease (AD) is a progressive neurodegenerative disorder caused by the interplay of multiple genetic and non-genetic factors. Hypertension is one of the AD risk factors that has been linked to underlying pathological changes like senile plaques and neurofibrillary tangles formation as well as hippocampal atrophy. In this study, we investigated the differences in the genetic architecture of AD between hypertensive and non-hypertensive subjects in four independent cohorts. Our genome-wide association analyses revealed significant associations of 15 novel potentially AD-associated polymorphisms (P < 5E-06) that were located outside the chromosome 19q13 region and were significant either in hypertensive or non-hypertensive groups. The closest genes to 14 polymorphisms were not associated with AD at P < 5E-06 in previous genome-wide association studies (GWAS). Also, four of them were located within two chromosomal regions (i.e., 3q13.11 and 17q21.2) that were not associated with AD at P < 5E-06 before. In addition, 30 genes demonstrated evidence of group-specific associations with AD at the false discovery rates (FDR) < 0.05 in our gene-based and transcriptome-wide association analyses. The chromosomal regions corresponding to four genes (i.e., 2p13.1, 9p13.3, 17q12, and 18q21.1) were not associated with AD at P < 5E-06 in previous GWAS. These genes may serve as a list of prioritized candidates for future functional studies. Our pathway-enrichment analyses revealed the associations of 11 non-group-specific and four group-specific pathways with AD at FDR < 0.05. These findings provided novel insights into the potential genetic heterogeneity of AD among subjects with and without hypertension.

VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31055733?dopt=Abstract ER - TY - JOUR T1 - The Longitudinal Associations of Perceived Neighborhood Disorder and Lack of Social Cohesion With Depression Among Adults Aged 50 Years or Older: An Individual-Participant-Data Meta-Analysis From 16 High-Income Countries JF - American Journal of Epidemiology Y1 - 2019 A1 - Baranyi, Gergő A1 - Sieber, Stefan A1 - Cullati, Stéphane A1 - Pearce, Jamie A1 - Chris J.L. Dibben A1 - Courvoisier, Delphine S KW - Cohort Studies KW - depression KW - Mental Health KW - meta-analysis KW - multicenter studies KW - Residence Characteristics AB - Although residential environment might be an important predictor of depression among older adults, systematic reviews point to a lack of longitudinal investigations, and the generalizability of the findings is limited to a few countries. We used longitudinal data collected between 2012 and 2017 in 3 surveys including 15 European countries and the United States and comprising 32,531 adults aged 50 years or older. The risk of depression according to perceived neighborhood disorder and lack of social cohesion was estimated using 2-stage individualparticipant-data meta-analysis; country-specific parameters were analyzed by meta-regression. We conducted additional analyses on retired individuals. Neighborhood disorder (odds ratio (OR) = 1.25) and lack of social cohesion (OR = 1.76) were significantly associated with depression in the fully adjusted models. In retirement, the risk of depression was even higher (neighborhood disorder: OR = 1.35; lack of social cohesion: OR = 1.93). Heterogeneity across countries was low and was significantly reduced by the addition of country-level data on income inequality and population density. Perceived neighborhood problems increased the overall risk of depression among adults aged 50 years or older. Policies, especially in countries with stronger links between neighborhood and depression, should focus on improving the physical environment and supporting social ties in communities, which can reduce depression and contribute to healthy aging. UR - https://www.researchgate.net/profile/Gergo_Baranyi/publication/336217860_The_Longitudinal_Association_of_Perceived_Neighborhood_Disorder_and_Lack_of_Social_Cohesion_With_Depression_Among_Adults_Aged_50_and_Over_An_Individual_Participant_Data_Meta-Analysis ER - TY - JOUR T1 - Cohort Differences in Parental Financial Help to Adult Children. JF - Demography Y1 - 2018 A1 - John C Henretta A1 - Matthew F. Van Voorhis A1 - Beth J Soldo KW - Adult children KW - Cohort Studies KW - Financial aid KW - Intergenerational transfers AB - In this article, we examine birth cohort differences in parents' provision of monetary help to adult children with particular focus on the extent to which cohort differences in family structure and the transition to adulthood influence these changes. Using data from the Health and Retirement Study from 1994 to 2010, we compare financial help to children of three respondent cohorts as the parents in these birth cohorts from ages 53-58 to 57-62. We find that transfers to children have increased among more recent cohorts. Two trends-declining family size and children's delay in marriage-account for part of the increase across cohorts. However, other trends, such as the increase in the number of stepchildren and increasing child's income level, tend to decrease the observed cohort trend. VL - 55 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29907922?dopt=Abstract ER - TY - JOUR T1 - Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals. JF - Nature Genetics Y1 - 2018 A1 - Lee, James J A1 - Wedow, Robbee A1 - Okbay, Aysu A1 - Kong, Edward A1 - Maghzian, Omeed A1 - Zacher, Meghan A1 - Nguyen-Viet, Tuan Anh A1 - Bowers, Peter A1 - Sidorenko, Julia A1 - Richard Karlsson Linnér A1 - Mark Alan Fontana A1 - Kundu, Tushar A1 - Lee, Chanwook A1 - Hui Liu A1 - Li, Ruoxi A1 - Royer, Rebecca A1 - Pascal N Timshel A1 - Walters, Raymond K A1 - Willoughby, Emily A A1 - Yengo, Loic A1 - Alver, Maris A1 - Bao, Yanchun A1 - Clark, David W A1 - Day, Felix R A1 - Furlotte, Nicholas A A1 - Joshi, Peter K A1 - Kathryn E Kemper A1 - Kleinman, Aaron A1 - Langenberg, Claudia A1 - Mägi, Reedik A1 - Joey W Trampush A1 - Verma, Shefali Setia A1 - Wu, Yang A1 - Lam, Max A1 - Jing Hua Zhao A1 - Zheng, Zhili A1 - Jason D Boardman A1 - Campbell, Harry A1 - Freese, Jeremy A1 - Kathleen Mullan Harris A1 - Caroline Hayward A1 - Herd, Pamela A1 - Kumari, Meena A1 - Lencz, Todd A1 - Luan, Jian'an A1 - Anil K. Malhotra A1 - Andres Metspalu A1 - Lili Milani A1 - Ong, Ken K A1 - Perry, John R B A1 - David J Porteous A1 - Ritchie, Marylyn D A1 - Smart, Melissa C A1 - Smith, Blair H A1 - Tung, Joyce Y A1 - Wareham, Nicholas J A1 - James F Wilson A1 - Jonathan P. Beauchamp A1 - Dalton C Conley A1 - Tõnu Esko A1 - Lehrer, Steven F A1 - Patrik K E Magnusson A1 - Oskarsson, Sven A1 - Pers, Tune H A1 - Matthew R Robinson A1 - Thom, Kevin A1 - Watson, Chelsea A1 - Chabris, Christopher F A1 - Meyer, Michelle N A1 - David I Laibson A1 - Yang, Jian A1 - Johannesson, Magnus A1 - Philipp D Koellinger A1 - Turley, Patrick A1 - Peter M Visscher A1 - Daniel J. Benjamin A1 - Cesarini, David KW - Adult KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Educational Status KW - Female KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Phenotype KW - Polymorphism, Single Nucleotide AB -

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

VL - 50 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30038396?dopt=Abstract ER - TY - JOUR T1 - Associations between community-level disaster exposure and individual-level changes in disability and risk of death for older Americans. JF - Soc Sci Med Y1 - 2017 A1 - Samuel L. Brilleman A1 - Wolfe, Rory A1 - Moreno-Betancur, Margarita A1 - Anne E Sales A1 - Kenneth M. Langa A1 - Yun Li A1 - Elizabeth L. Daugher Biddison A1 - Rubinson, Lewis A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Community Participation KW - Continental Population Groups KW - Disabled Persons KW - Disaster Planning KW - Disasters KW - Female KW - Humans KW - Income KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - United States AB -

Disasters occur frequently in the United States (US) and their impact on acute morbidity, mortality and short-term increased health needs has been well described. However, barring mental health, little is known about the medium or longer-term health impacts of disasters. This study sought to determine if there is an association between community-level disaster exposure and individual-level changes in disability and/or the risk of death for older Americans. Using the US Federal Emergency Management Agency's database of disaster declarations, 602 disasters occurred between August 1998 and December 2010 and were characterized by their presence, intensity, duration and type. Repeated measurements of a disability score (based on activities of daily living) and dates of death were observed between January 2000 and November 2010 for 18,102 American individuals aged 50-89 years, who were participating in the national longitudinal Health and Retirement Study. Longitudinal (disability) and time-to-event (death) data were modelled simultaneously using a 'joint modelling' approach. There was no evidence of an association between community-level disaster exposure and individual-level changes in disability or the risk of death. Our results suggest that future research should focus on individual-level disaster exposures, moderate to severe disaster events, or higher-risk groups of individuals.

VL - 173 UR - https://www.sciencedirect.com/science/article/abs/pii/S0277953616306785?via%3Dihub U1 - http://www.ncbi.nlm.nih.gov/pubmed/27960126?dopt=Abstract JO - Social Science & Medicine ER - TY - JOUR T1 - Association of a Genetic Risk Score With Body Mass Index Across Different Birth Cohorts. JF - JAMA Y1 - 2016 A1 - Stefan Walter A1 - Mejía-Guevara, Iván A1 - Estrada, Karol A1 - Sze Y Liu A1 - M. Maria Glymour KW - African Continental Ancestry Group KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alleles KW - Body Mass Index KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Multilocus Sequence Typing KW - Obesity KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - United States AB -

IMPORTANCE: Many genetic variants are associated with body mass index (BMI). Associations may have changed with the 20th century obesity epidemic and may differ for black vs white individuals.

OBJECTIVE: Using birth cohort as an indicator for exposure to obesogenic environment, to evaluate whether genetic predisposition to higher BMI has a larger magnitude of association among adults from more recent birth cohorts, who were exposed to the obesity epidemic at younger ages.

DESIGN, SETTING, AND PARTICIPANTS: Observational study of 8788 adults in the US national Health and Retirement Study who were aged 50 years and older, born between 1900 and 1958, with as many as 12 BMI assessments from 1992 to 2014.

EXPOSURES: A multilocus genetic risk score for BMI (GRS-BMI), calculated as the weighted sum of alleles of 29 single nucleotide polymorphisms associated with BMI, with weights equal to the published per-allele effects. The GRS-BMI represents how much each person's BMI is expected to differ, based on genetic background (with respect to these 29 loci), from the BMI of a sample member with median genetic risk. The median-centered GRS-BMI ranged from -1.68 to 2.01.

MAIN OUTCOMES AND MEASURES: BMI based on self-reported height and weight.

RESULTS: GRS-BMI was significantly associated with BMI among white participants (n = 7482; mean age at first assessment, 59 years; 3373 [45%] were men; P <.001) and among black participants (n = 1306; mean age at first assessment, 57 years; 505 [39%] were men; P <.001) but accounted for 0.99% of variation in BMI among white participants and 1.37% among black participants. In multilevel models accounting for age, the magnitude of associations of GRS-BMI with BMI were larger for more recent birth cohorts. For example, among white participants, each unit higher GRS-BMI was associated with a difference in BMI of 1.37 (95% CI, 0.93 to 1.80) if born after 1943, and 0.17 (95% CI, -0.55 to 0.89) if born before 1924 (P = .006). For black participants, each unit higher GRS-BMI was associated with a difference in BMI of 3.70 (95% CI, 2.42 to 4.97) if born after 1943, and 1.44 (95% CI, -1.40 to 4.29) if born before 1924.

CONCLUSIONS AND RELEVANCE: For participants born between 1900 and 1958, the magnitude of association between BMI and a genetic risk score for BMI was larger among persons born in later cohorts. This suggests that associations of known genetic variants with BMI may be modified by obesogenic environments.

VL - 316 UR - http://www.ncbi.nlm.nih.gov/pubmed/27380344 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27380344?dopt=Abstract ER - TY - JOUR T1 - A chapter a day: Association of book reading with longevity. JF - Soc Sci Med Y1 - 2016 A1 - Bavishi, Avni A1 - Martin D Slade A1 - Becca R Levy KW - Aged KW - Aged, 80 and over KW - Books KW - Chi-Square Distribution KW - Cohort Studies KW - Female KW - Humans KW - Longevity KW - Male KW - Michigan KW - Middle Aged KW - Reading KW - Survival Analysis AB -

Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline. Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2 = 0.83, p < 0.001, HRT3 = 0.77, p < 0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression. Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2 = 90.6, p < 0.001; tT3 = 67.9, p < 0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage (p = 0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.

VL - 164 UR - http://www.sciencedirect.com/science/article/pii/S0277953616303689 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27471129?dopt=Abstract ER - TY - JOUR T1 - GWAS analysis of handgrip and lower body strength in older adults in the CHARGE consortium. JF - Aging Cell Y1 - 2016 A1 - Amy M Matteini A1 - Toshiko Tanaka A1 - Karasik, David A1 - Atzmon, Gil A1 - Chou, Wen-Chi A1 - John D Eicher A1 - Andrew D Johnson A1 - Alice M. Arnold A1 - Michele L Callisaya A1 - Gail Davies A1 - Daniel S Evans A1 - Holtfreter, Birte A1 - Kurt Lohman A1 - Kathryn L Lunetta A1 - Mangino, Massimo A1 - Albert Vernon Smith A1 - Jennifer A Smith A1 - Teumer, Alexander A1 - Lei Yu A1 - Dan E Arking A1 - Aron S Buchman A1 - Chibinik, Lori B A1 - Philip L de Jager A1 - Jessica Faul A1 - Melissa E Garcia A1 - Gillham-Nasenya, Irina A1 - Gudnason, Vilmundur A1 - Hofman, Albert A1 - Hsu, Yi-Hsiang A1 - Ittermann, Till A1 - Lahousse, Lies A1 - David C Liewald A1 - Yongmei Liu A1 - Lopez, Lorna A1 - Fernando Rivadeneira A1 - Rotter, Jerome I A1 - Siggeirsdottir, Kristin A1 - John M Starr A1 - Thomson, Russell A1 - Tranah, Gregory J A1 - André G Uitterlinden A1 - Völker, Uwe A1 - Völzke, Henry A1 - David R Weir A1 - Kristine Yaffe A1 - Wei Zhao A1 - Wei Vivian Zhuang A1 - Zmuda, Joseph M A1 - David A Bennett A1 - Steven R Cummings A1 - Ian J Deary A1 - Luigi Ferrucci A1 - Tamara B Harris A1 - Sharon L R Kardia A1 - Kocher, Thomas A1 - Stephen B Kritchevsky A1 - Psaty, Bruce M A1 - Seshadri, Sudha A1 - Timothy Spector A1 - Velandai K Srikanth A1 - Beverly G Windham A1 - Zillikens, M Carola A1 - Anne B Newman A1 - Jeremy D Walston A1 - Douglas P Kiel A1 - Joanne M Murabito KW - Adult KW - Aged KW - Chromatin Immunoprecipitation KW - Cohort Studies KW - Epigenesis, Genetic KW - Genome-Wide Association Study KW - Hand Strength KW - Humans KW - Molecular Sequence Annotation KW - Muscle Strength KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Reproducibility of Results AB -

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

VL - 15 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27325353?dopt=Abstract ER - TY - JOUR T1 - Marital history and survival after a heart attack. JF - Soc Sci Med Y1 - 2016 A1 - Matthew E Dupre A1 - Nelson, Alicia KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Divorce KW - Female KW - Humans KW - Male KW - Marital Status KW - Myocardial Infarction KW - Prospective Studies KW - Retrospective Studies KW - Single Person KW - Spouses KW - Survivors KW - United States KW - Widowhood AB -

Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n = 2197). We found that adults who were never married (odds ratio [OR] = 1.73), currently divorced (OR = 1.70), or widowed (OR = 1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12% for every additional marital loss and decreased by 7% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.

VL - 170 UR - http://www.sciencedirect.com/science/article/pii/S0277953616305810 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27770749?dopt=Abstract ER - TY - JOUR T1 - Motoric cognitive risk syndrome and risk of mortality in older adults. JF - Alzheimers Dement Y1 - 2016 A1 - Emmeline Ayers A1 - Joe Verghese KW - Age Factors KW - Aged KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Early Diagnosis KW - Female KW - Gait KW - Humans KW - Male KW - Mortality KW - Risk Factors AB -

INTRODUCTION: Cognitive impairment is associated with increased mortality. We examined the association between motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and cognitive complaints, and survival.

METHODS: A total of 11,867 nondemented participants aged >65 years from three established cohort studies in the United States and Europe were screened for MCR. Mortality risk of MCR was assessed with Cox and logistic regression models.

RESULTS: At baseline, 836 (7.0%) participants had MCR. Over a median follow-up of 28 months, 1603 participants died (758 in first 2 years). MCR was associated with increased mortality overall (adjusted hazard ratio, 1.69; 95% confidence interval [CI], 1.46-1.96) and 2-year mortality (adjusted odds ratio, 1.89; 95% CI, 1.50-2.38). The association remained after accounting for established mortality risk factors as well as baseline gait speed and memory performance.

DISCUSSION: MCR is associated with increased mortality. Older adults should be screened for MCR to identify at-risk individuals for dementia and death.

VL - 12 UR - https://www.ncbi.nlm.nih.gov/pubmed/26545790 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26545790?dopt=Abstract ER - TY - JOUR T1 - Neuroimaging overuse is more common in Medicare compared with the VA. JF - Neurology Y1 - 2016 A1 - James F. Burke A1 - Eve A Kerr A1 - Ryan J McCammon A1 - Holleman, Rob A1 - Kenneth M. Langa A1 - Brian C. Callaghan KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Female KW - Headache Disorders, Primary KW - Humans KW - Male KW - Medicare KW - Neuroimaging KW - Peripheral Nervous System Diseases KW - United States KW - United States Department of Veterans Affairs KW - Unnecessary Procedures AB -

OBJECTIVE: To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.

METHODS: Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n = 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n = 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.

RESULTS: For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1% in the VA (p < 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0% in the VA (p < 0.001), and the difference persisted after excluding nontarget conditions.

CONCLUSIONS: Overuse of neuroimaging is likely less common in the VA than in a Medicare population. Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing.

VL - 87 UR - http://www.ncbi.nlm.nih.gov/pubmed/27402889 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27402889?dopt=Abstract ER - TY - JOUR T1 - One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. JF - J Am Geriatr Soc Y1 - 2016 A1 - Irena Cenzer A1 - Victoria L. Tang A1 - W John Boscardin A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Espaldon, Roxanne A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cause of Death KW - Cohort Studies KW - Comorbidity KW - Disability Evaluation KW - Female KW - Hip Fractures KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Prognosis KW - Retrospective Studies KW - Risk Assessment KW - Survival Analysis KW - United States AB -

OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains.

DESIGN: Retrospective cohort study.

SETTINGS: Health and Retirement Study (HRS).

PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).

MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.

RESULTS: Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.

CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27295578 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27295578?dopt=Abstract ER - TY - JOUR T1 - Racial and Ethnic Differences in End-of-Life Medicare Expenditures. JF - Journal of the American Geriatrics Society Y1 - 2016 A1 - Byhoff, Elena A1 - Tamara B Harris A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - African Continental Ancestry Group KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Comorbidity KW - Cross-Cultural Comparison KW - Ethnic Groups KW - European Continental Ancestry Group KW - Female KW - Health Care Surveys KW - Health Expenditures KW - Hispanic Americans KW - Humans KW - Life Support Care KW - Longitudinal Studies KW - Male KW - Medicare KW - Rate Setting and Review KW - Social Support KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

OBJECTIVES: To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life (EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6 months of life.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Decedents who participated in HRS between 1998 and 2012 and previously consented to survey linkage with Medicare claims (N = 7,105).

MEASUREMENTS: Total Medicare expenditures in the last 180 days of life according to race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors, including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected.

RESULTS: The analysis included 5,548 (78.1%) non-Hispanic white, 1,030 (14.5%) non-Hispanic black, and 331 (4.7%) Hispanic adults and 196 (2.8%) adults of other race or ethnicity. Unadjusted results suggest that average EOL Medicare expenditures were $13,522 (35%, P < .001) more for black decedents and $16,341 (42%, P < .001) more for Hispanics than for whites. Controlling for demographic, socioeconomic, geographic, medical, and EOL-specific factors, the Medicare expenditure difference between groups fell to $8,047 (22%, P < .001) more for black and $6,855 (19%, P < .001) more for Hispanic decedents than expenditures for non-Hispanic whites. The expenditure differences between groups remained statistically significant in all models.

CONCLUSION: Individuals-level factors, including EOL planning factors do not fully explain racial and ethnic differences in Medicare spending in the last 6 months of life. Future research should focus on broader systemic, organizational, and provider-level factors to explain these differences.

VL - 64 IS - 9 ER - TY - JOUR T1 - The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects. JF - Mol Psychiatry Y1 - 2015 A1 - Wouter J Peyrot A1 - Lee, S H A1 - Milaneschi, Y A1 - Abdel Abdellaoui A1 - Byrne, E M A1 - Tõnu Esko A1 - Eco J. C. de Geus A1 - Hemani, G A1 - Jouke-Jan Hottenga A1 - Kloiber, S A1 - Douglas F Levinson A1 - Lucae, S A1 - Nicholas G Martin A1 - Sarah E Medland A1 - Andres Metspalu A1 - Lili Milani A1 - Markus M Nöthen A1 - Potash, J B A1 - Rietschel, M A1 - Cornelius A Rietveld A1 - Ripke, S A1 - Jianxin Shi A1 - Gonneke Willemsen A1 - Zhihong Zhu A1 - Dorret I Boomsma A1 - Naomi R. Wray A1 - Brenda W J H Penninx KW - Adult KW - Aged KW - Cohort Studies KW - Depressive Disorder, Major KW - Educational Status KW - Estonia KW - Female KW - Gene-Environment Interaction KW - Genetic Association Studies KW - Genotype KW - Humans KW - Likelihood Functions KW - Male KW - Middle Aged KW - Netherlands KW - Odds Ratio KW - Polymorphism, Single Nucleotide KW - Psychiatric Status Rating Scales KW - Regression Analysis AB -

An association between lower educational attainment (EA) and an increased risk for depression has been confirmed in various western countries. This study examines whether pleiotropic genetic effects contribute to this association. Therefore, data were analyzed from a total of 9662 major depressive disorder (MDD) cases and 14,949 controls (with no lifetime MDD diagnosis) from the Psychiatric Genomics Consortium with additional Dutch and Estonian data. The association of EA and MDD was assessed with logistic regression in 15,138 individuals indicating a significantly negative association in our sample with an odds ratio for MDD 0.78 (0.75-0.82) per standard deviation increase in EA. With data of 884,105 autosomal common single-nucleotide polymorphisms (SNPs), three methods were applied to test for pleiotropy between MDD and EA: (i) genetic profile risk scores (GPRS) derived from training data for EA (independent meta-analysis on ~120,000 subjects) and MDD (using a 10-fold leave-one-out procedure in the current sample), (ii) bivariate genomic-relationship-matrix restricted maximum likelihood (GREML) and (iii) SNP effect concordance analysis (SECA). With these methods, we found (i) that the EA-GPRS did not predict MDD status, and MDD-GPRS did not predict EA, (ii) a weak negative genetic correlation with bivariate GREML analyses, but this correlation was not consistently significant, (iii) no evidence for concordance of MDD and EA SNP effects with SECA analysis. To conclude, our study confirms an association of lower EA and MDD risk, but this association was not because of measurable pleiotropic genetic effects, which suggests that environmental factors could be involved, for example, socioeconomic status.

VL - 20 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25917368?dopt=Abstract ER - TY - JOUR T1 - The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: a cohort study. JF - Psychosom Med Y1 - 2015 A1 - Dimitry S Davydow A1 - Deborah A Levine A1 - Zivin, Kara A1 - Wayne J Katon A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Cohort Studies KW - Dementia KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - Psychiatric Status Rating Scales KW - Retrospective Studies KW - Risk Factors KW - Stroke KW - United States AB -

OBJECTIVE: To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations.

METHODS: This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to their Medicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses.

RESULTS: After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics.

CONCLUSIONS: CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.

PB - 77 VL - 77 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25647752?dopt=Abstract ER - TY - JOUR T1 - Comprehensive gene- and pathway-based analysis of depressive symptoms in older adults. JF - J Alzheimers Dis Y1 - 2015 A1 - Nho, Kwangsik A1 - Vijay K Ramanan A1 - Horgusluoglu, Emrin A1 - Sungeun Kim A1 - Mark H Inlow A1 - Shannon L Risacher A1 - Brenna C McDonald A1 - Martin R Farlow A1 - Tatiana Foroud A1 - Gao, Sujuan A1 - Christopher M. Callahan A1 - Hugh C Hendrie A1 - Alexander B Niculescu A1 - Andrew J Saykin KW - Aged KW - Cohort Studies KW - depression KW - European Continental Ancestry Group KW - Female KW - Genotyping Techniques KW - Humans KW - Male KW - Psychiatric Status Rating Scales AB -

Depressive symptoms are common in older adults and are particularly prevalent in those with or at elevated risk for dementia. Although the heritability of depression is estimated to be substantial, single nucleotide polymorphism-based genome-wide association studies of depressive symptoms have had limited success. In this study, we performed genome-wide gene- and pathway-based analyses of depressive symptom burden. Study participants included non-Hispanic Caucasian subjects (n = 6,884) from three independent cohorts, the Alzheimer's Disease Neuroimaging Initiative (ADNI), the Health and Retirement Study (HRS), and the Indiana Memory and Aging Study (IMAS). Gene-based meta-analysis identified genome-wide significant associations (ANGPT4 and FAM110A, q-value = 0.026; GRM7-AS3 and LRFN5, q-value = 0.042). Pathway analysis revealed enrichment of association in 105 pathways, including multiple pathways related to ERK/MAPK signaling, GSK3 signaling in bipolar disorder, cell development, and immune activation and inflammation. GRM7, ANGPT4, and LRFN5 have been previously implicated in psychiatric disorders, including the GRM7 region displaying association with major depressive disorder. The ERK/MAPK signaling pathway is a known target of antidepressant drugs and has important roles in neuronal plasticity, and GSK3 signaling has been previously implicated in Alzheimer's disease and as a promising therapeutic target for depression. Our results warrant further investigation in independent and larger cohorts and add to the growing understanding of the genetics and pathobiology of depressive symptoms in aging and neurodegenerative disorders. In particular, the genes and pathways demonstrating association with depressive symptoms may be potential therapeutic targets for these symptoms in older adults.

VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25690665?dopt=Abstract ER - TY - JOUR T1 - Depressive symptoms, psychiatric medication use, and risk of type 2 diabetes: results from the Health and Retirement Study. JF - Gen Hosp Psychiatry Y1 - 2015 A1 - Scott M Ratliff A1 - Briana Mezuk KW - Antidepressive Agents KW - Cohort Studies KW - depression KW - Diabetes Mellitus, Type 2 KW - Female KW - Humans KW - Male KW - Middle Aged KW - Risk Assessment KW - Surveys and Questionnaires AB -

OBJECTIVE: This prospective study investigates the relationships between depressive symptoms, psychiatric medication use, and their interaction on risk of developing type 2 diabetes.

METHOD: Data come from the 1998-2010 waves of the Health and Retirement Study, a US nationally representative cohort of adults aged 51 years and older. Analysis is restricted to participants <65 years old who did not have diabetes in 1998 (N=8704). Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies-Depression Scale. Risk of diabetes over the 12-year follow-up period was assessed using Cox proportional hazard models with time-varying covariates.

RESULTS: After adjusting for covariates, both depressive symptoms [hazard ratio (HR): 1.06, 95% confidence interval (CI): 1.02-1.09] and psychiatric medication use (HR: 1.57, 95% CI: 1.25-1.96) were associated with development of diabetes. The interaction between depressive symptoms and medication use was significant (beta=-0.240, P=.049), indicating that the association between elevated depressive symptoms and diabetes was higher among respondents not taking medications. The associations between depressive symptoms and medication use were also attenuated by increasing body mass index.

CONCLUSION: Findings highlight the complex relationship between depressive symptoms and psychiatric medications on diabetes risk and the need for a nuanced understanding of these factors.

PB - 37 VL - 37 UR - http://www.sciencedirect.com/science/article/pii/S0163834315001334 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26094130?dopt=Abstract U2 - PMC4558325 U4 - Depression/Antidepressants/Type 2 diabetes/Longitudinal/Epidemiology ER - TY - JOUR T1 - Directional dominance on stature and cognition in diverse human populations. JF - Nature Y1 - 2015 A1 - Joshi, Peter K A1 - Tõnu Esko A1 - Mattsson, Hannele A1 - Eklund, Niina A1 - Gandin, Ilaria A1 - Nutile, Teresa A1 - Jackson, Anne U A1 - Schurmann, Claudia A1 - Albert Vernon Smith A1 - Zhang, Weihua A1 - Okada, Yukinori A1 - Stančáková, Alena A1 - Jessica Faul A1 - Wei Zhao A1 - Traci M Bartz A1 - Maria Pina Concas A1 - Franceschini, Nora A1 - Enroth, Stefan A1 - Vitart, Veronique A1 - Trompet, Stella A1 - Guo, Xiuqing A1 - Daniel I Chasman A1 - Jeff O'Connell A1 - Corre, Tanguy A1 - Nongmaithem, Suraj S A1 - Chen, Yuning A1 - Mangino, Massimo A1 - Ruggiero, Daniela A1 - Traglia, Michela A1 - Farmaki, Aliki-Eleni A1 - Kacprowski, Tim A1 - Bjonnes, Andrew A1 - van der Spek, Ashley A1 - Wu, Ying A1 - Giri, Anil K A1 - Yanek, Lisa R A1 - Wang, Lihua A1 - Edith Hofer A1 - Cornelius A Rietveld A1 - McLeod, Olga A1 - Marilyn C Cornelis A1 - Pattaro, Cristian A1 - Verweij, Niek A1 - Baumbach, Clemens A1 - Abdel Abdellaoui A1 - Warren, Helen R A1 - Vuckovic, Dragana A1 - Mei, Hao A1 - Bouchard, Claude A1 - Perry, John R B A1 - Cappellani, Stefania A1 - Saira S Mirza A1 - Benton, Miles C A1 - Broeckel, Ulrich A1 - Sarah E Medland A1 - Penelope A Lind A1 - Malerba, Giovanni A1 - Alexander W Drong A1 - Yengo, Loic A1 - Bielak, Lawrence F A1 - Zhi, Degui A1 - van der Most, Peter J A1 - Daniel Shriner A1 - Mägi, Reedik A1 - Hemani, Gibran A1 - Karaderi, Tugce A1 - Wang, Zhaoming A1 - Tian Liu A1 - Demuth, Ilja A1 - Jing Hua Zhao A1 - Meng, Weihua A1 - Lataniotis, Lazaros A1 - van der Laan, Sander W A1 - Bradfield, Jonathan P A1 - Andrew R Wood A1 - Bonnefond, Amelie A1 - Ahluwalia, Tarunveer S A1 - Hall, Leanne M A1 - Salvi, Erika A1 - Yazar, Seyhan A1 - Carstensen, Lisbeth A1 - de Haan, Hugoline G A1 - Abney, Mark A1 - Afzal, Uzma A1 - Matthew A. Allison A1 - Amin, Najaf A1 - Asselbergs, Folkert W A1 - Bakker, Stephan J L A1 - Barr, R Graham A1 - Baumeister, Sebastian E A1 - Daniel J. Benjamin A1 - Bergmann, Sven A1 - Boerwinkle, Eric A1 - Erwin P Bottinger A1 - Campbell, Archie A1 - Chakravarti, Aravinda A1 - Chan, Yingleong A1 - Chanock, Stephen J A1 - Chen, Constance A1 - Yii-Der I Chen A1 - Collins, Francis S A1 - Connell, John A1 - Correa, Adolfo A1 - Cupples, L Adrienne A1 - Gail Davies A1 - Dörr, Marcus A1 - Georg B Ehret A1 - Ellis, Stephen B A1 - Feenstra, Bjarke A1 - Feitosa, Mary F A1 - Ford, Ian A1 - Caroline S Fox A1 - Timothy M Frayling A1 - Friedrich, Nele A1 - Geller, Frank A1 - Scotland, Generation A1 - Gillham-Nasenya, Irina A1 - Gottesman, Omri A1 - Graff, Misa A1 - Grodstein, Francine A1 - Gu, Charles A1 - Haley, Chris A1 - Hammond, Christopher J A1 - Sarah E Harris A1 - Tamara B Harris A1 - Nicholas D Hastie A1 - Heard-Costa, Nancy L A1 - Heikkilä, Kauko A1 - Lynne J Hocking A1 - Homuth, Georg A1 - Jouke-Jan Hottenga A1 - Huang, Jinyan A1 - Huffman, Jennifer E A1 - Hysi, Pirro G A1 - Mohammed Arfan Ikram A1 - Ingelsson, Erik A1 - Joensuu, Anni A1 - Johansson, Åsa A1 - Jousilahti, Pekka A1 - Jukema, J Wouter A1 - Kähönen, Mika A1 - Kamatani, Yoichiro A1 - Kanoni, Stavroula A1 - Kerr, Shona M A1 - Khan, Nazir M A1 - Philipp D Koellinger A1 - Koistinen, Heikki A A1 - Kooner, Manraj K A1 - Kubo, Michiaki A1 - Kuusisto, Johanna A1 - Lahti, Jari A1 - Lenore J Launer A1 - Lea, Rodney A A1 - Lehne, Benjamin A1 - Lehtimäki, Terho A1 - David C Liewald A1 - Lars Lind A1 - Loh, Marie A1 - Lokki, Marja-Liisa A1 - London, Stephanie J A1 - Loomis, Stephanie J A1 - Loukola, Anu A1 - Lu, Yingchang A1 - Lumley, Thomas A1 - Lundqvist, Annamari A1 - Männistö, Satu A1 - Marques-Vidal, Pedro A1 - Masciullo, Corrado A1 - Matchan, Angela A1 - Mathias, Rasika A A1 - Matsuda, Koichi A1 - Meigs, James B A1 - Meisinger, Christa A1 - Meitinger, Thomas A1 - Menni, Cristina A1 - Mentch, Frank D A1 - Mihailov, Evelin A1 - Lili Milani A1 - Montasser, May E A1 - Grant W Montgomery A1 - Alanna C Morrison A1 - Myers, Richard H A1 - Nadukuru, Rajiv A1 - Navarro, Pau A1 - Nelis, Mari A1 - Nieminen, Markku S A1 - Ilja M Nolte A1 - O'Connor, George T A1 - Ogunniyi, Adesola A1 - Padmanabhan, Sandosh A1 - Walter R Palmas A1 - Pankow, James S A1 - Patarcic, Inga A1 - Pavani, Francesca A1 - Peyser, Patricia A A1 - Pietilainen, Kirsi A1 - Neil Poulter A1 - Prokopenko, Inga A1 - Ralhan, Sarju A1 - Redmond, Paul A1 - Rich, Stephen S A1 - Rissanen, Harri A1 - Robino, Antonietta A1 - Rose, Lynda M A1 - Rose, Richard A1 - Cinzia Felicita Sala A1 - Babatunde Salako A1 - Veikko Salomaa A1 - Sarin, Antti-Pekka A1 - Saxena, Richa A1 - Schmidt, Helena A1 - Scott, Laura J A1 - Scott, William R A1 - Sennblad, Bengt A1 - Seshadri, Sudha A1 - Peter Sever A1 - Shrestha, Smeeta A1 - Smith, Blair H A1 - Jennifer A Smith A1 - Soranzo, Nicole A1 - Sotoodehnia, Nona A1 - Southam, Lorraine A1 - Stanton, Alice V A1 - Stathopoulou, Maria G A1 - Strauch, Konstantin A1 - Strawbridge, Rona J A1 - Suderman, Matthew J A1 - Tandon, Nikhil A1 - Tang, Sian-Tsun A1 - Kent D Taylor A1 - Bamidele O Tayo A1 - Töglhofer, Anna Maria A1 - Tomaszewski, Maciej A1 - Tšernikova, Natalia A1 - Tuomilehto, Jaakko A1 - André G Uitterlinden A1 - Vaidya, Dhananjay A1 - van Hylckama Vlieg, Astrid A1 - van Setten, Jessica A1 - Vasankari, Tuula A1 - Vedantam, Sailaja A1 - Vlachopoulou, Efthymia A1 - Vozzi, Diego A1 - Vuoksimaa, Eero A1 - Waldenberger, Melanie A1 - Erin B Ware A1 - Wentworth-Shields, William A1 - Whitfield, John B A1 - Sarah Wild A1 - Gonneke Willemsen A1 - Yajnik, Chittaranjan S A1 - Yao, Jie A1 - Zaza, Gianluigi A1 - Zhu, Xiaofeng A1 - Salem, Rany M A1 - Melbye, Mads A1 - Bisgaard, Hans A1 - Nilesh J Samani A1 - Cusi, Daniele A1 - Mackey, David A A1 - Cooper, Richard S A1 - Froguel, Philippe A1 - Pasterkamp, Gerard A1 - Grant, Struan F A A1 - Hakonarson, Hakon A1 - Luigi Ferrucci A1 - Scott, Robert A A1 - Morris, Andrew D A1 - Palmer, Colin N A A1 - George Dedoussis A1 - Deloukas, Panos A1 - Bertram, Lars A1 - Lindenberger, Ulman A1 - Berndt, Sonja I A1 - Lindgren, Cecilia M A1 - Nicholas J Timpson A1 - Tönjes, Anke A1 - Munroe, Patricia B A1 - Thorkild I. A. Sørensen A1 - Charles N Rotimi A1 - Donna K Arnett A1 - Oldehinkel, Albertine J A1 - Sharon L R Kardia A1 - Balkau, Beverley A1 - Gambaro, Giovanni A1 - Morris, Andrew P A1 - Johan G Eriksson A1 - Margaret J Wright A1 - Nicholas G Martin A1 - Hunt, Steven C A1 - John M Starr A1 - Ian J Deary A1 - Griffiths, Lyn R A1 - Henning Tiemeier A1 - Nicola Pirastu A1 - Kaprio, Jaakko A1 - Wareham, Nicholas J A1 - Pérusse, Louis A1 - Wilson, James G A1 - Giorgia G Girotto A1 - Caulfield, Mark J A1 - Olli T Raitakari A1 - Dorret I Boomsma A1 - Gieger, Christian A1 - van der Harst, Pim A1 - Hicks, Andrew A A1 - Kraft, Peter A1 - Sinisalo, Juha A1 - Knekt, Paul A1 - Johannesson, Magnus A1 - Patrik K E Magnusson A1 - Hamsten, Anders A1 - Schmidt, Reinhold A1 - Ingrid B Borecki A1 - Vartiainen, Erkki A1 - Becker, Diane M A1 - Bharadwaj, Dwaipayan A1 - Mohlke, Karen L A1 - Boehnke, Michael A1 - Cornelia M van Duijn A1 - Sanghera, Dharambir K A1 - Teumer, Alexander A1 - Zeggini, Eleftheria A1 - Andres Metspalu A1 - Paolo P. Gasparini A1 - Ulivi, Sheila A1 - Ober, Carole A1 - Toniolo, Daniela A1 - Rudan, Igor A1 - David J Porteous A1 - Ciullo, Marina A1 - Timothy Spector A1 - Caroline Hayward A1 - Dupuis, Josée A1 - Ruth J F Loos A1 - Alan F Wright A1 - Chandak, Giriraj R A1 - Vollenweider, Peter A1 - Alan R Shuldiner A1 - Ridker, Paul M A1 - Rotter, Jerome I A1 - Sattar, Naveed A1 - Gyllensten, Ulf A1 - Kari E North A1 - Pirastu, Mario A1 - Psaty, Bruce M A1 - David R Weir A1 - Laakso, Markku A1 - Gudnason, Vilmundur A1 - Takahashi, Atsushi A1 - Chambers, John C A1 - Kooner, Jaspal S A1 - David P Strachan A1 - Campbell, Harry A1 - Joel N Hirschhron A1 - Markus Perola A1 - Polasek, Ozren A1 - James F Wilson KW - Biological Evolution KW - Blood pressure KW - Body Height KW - Cholesterol KW - Cognitive Ability KW - Cohort Studies KW - Education KW - Female KW - Forced Expiratory Volume KW - Genome KW - Homozygote KW - Humans KW - Lung Volume Measurements KW - Male KW - Phenotype AB -

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

VL - 523 IS - 7561 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26131930?dopt=Abstract ER - TY - JOUR T1 - Factors associated with cognitive evaluations in the United States. JF - Neurology Y1 - 2015 A1 - Vikas Kotagal A1 - Kenneth M. Langa A1 - Brenda L Plassman A1 - Gwenith G Fisher A1 - Bruno J Giordani A1 - Robert B Wallace A1 - James F. Burke A1 - David C Steffens A1 - Mohammed U Kabeto A1 - Roger L. Albin A1 - Norman L Foster KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Logistic Models KW - Male KW - Marital Status KW - Multivariate Analysis KW - Neuropsychological tests KW - Severity of Illness Index KW - United States AB -

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

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

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

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

VL - 84 UR - http://www.neurology.org/cgi/doi/10.1212/WNL.0000000000001096 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25428689?dopt=Abstract JO - Neurology ER - TY - JOUR T1 - Functional impairment and hospital readmission in Medicare seniors. JF - JAMA Intern Med Y1 - 2015 A1 - S. Ryan Greysen A1 - Irena Cenzer A1 - Andrew D. Auerbach A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Comorbidity KW - Female KW - Heart Failure KW - Humans KW - Income KW - Logistic Models KW - Male KW - Medicare KW - Myocardial Infarction KW - Patient Readmission KW - Pneumonia KW - Risk Assessment KW - Risk Factors KW - Sex Factors KW - United States AB -

IMPORTANCE: Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment.

OBJECTIVE: To assess the effects of functional impairment on Medicare hospital readmissions given the high prevalence of functional impairments in community-dwelling seniors.

DESIGN, SETTING, AND PARTICIPANTS: We created a nationally representative cohort of 7854 community-dwelling seniors in the Health and Retirement Study, with 22,289 Medicare hospitalizations from January 1, 2000, through December 31, 2010.

MAIN OUTCOMES AND MEASURES: Outcome was 30-day readmission assessed by Medicare claims. The main predictor was functional impairment determined from the Health and Retirement Study interview preceding hospitalization, stratified into the following 5 levels: no functional impairments, difficulty with 1 or more instrumental activities of daily living, difficulty with 1 or more activities of daily living (ADL), dependency (need for help) in 1 to 2 ADLs, and dependency in 3 or more ADLs. Adjustment variables included age, race/ethnicity, sex, annual income, net worth, comorbid conditions (Elixhauser score from Medicare claims), and prior admission. We performed multivariable logistic regression to adjust for clustering at the patient level to characterize the association of functional impairments and readmission.

RESULTS: Patients had a mean (SD) age of 78.5 (7.7) years (range, 65-105 years); 58.4% were female, 84.9% were white, 89.6% reported 3 or more comorbidities, and 86.0% had 1 or more hospitalizations in the previous year. Overall, 48.3% had some level of functional impairment before admission, and 15.5% of hospitalizations were followed by readmission within 30 days. We found a progressive increase in the adjusted risk of readmission as the degree of functional impairment increased: 13.5% with no functional impairment, 14.3% with difficulty with 1 or more instrumental activities of daily living (odds ratio [OR], 1.06; 95% CI, 0.94-1.20), 14.4% with difficulty with 1 or more ADL (OR, 1.08; 95% CI, 0.96-1.21), 16.5% with dependency in 1 to 2 ADLs (OR, 1.26; 95% CI, 1.11-1.44), and 18.2% with dependency in 3 or more ADLs (OR, 1.42; 95% CI, 1.20-1.69). Subanalysis restricted to patients admitted with conditions targeted by Medicare (ie, heart failure, myocardial infarction, and pneumonia) revealed a parallel trend with larger effects for the most impaired (16.9% readmission rate for no impairment vs 25.7% for dependency in 3 or more ADLs [OR, 1.70; 95% CI, 1.04-2.78]).

CONCLUSIONS AND RELEVANCE: Functional impairment is associated with increased risk of 30-day all-cause hospital readmission in Medicare seniors, especially those admitted for heart failure, myocardial infarction, or pneumonia. Functional impairment may be an important but underaddressed factor in preventing readmissions for Medicare seniors.

PB - 175 VL - 175 IS - 4 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25642907?dopt=Abstract U2 - PMC4388787 U4 - Medicare/Functional impairment/hospital readmission/ADL and IADL Impairments ER - TY - JOUR T1 - Genetic contributions to variation in general cognitive function: a meta-analysis of genome-wide association studies in the CHARGE consortium (N=53949). JF - Mol Psychiatry Y1 - 2015 A1 - Gail Davies A1 - Armstrong, N. A1 - Joshua C. Bis A1 - Bressler, J. A1 - Chouraki, V. A1 - Giddaluru, S. A1 - Edith Hofer A1 - Carla A Ibrahim-Verbaas A1 - Kirin, M. A1 - J. Lahti A1 - Sven J van der Lee A1 - Stephanie Le Hellard A1 - Tian Liu A1 - Riccardo E Marioni A1 - Christopher J Oldmeadow A1 - Postmus, I. A1 - Albert Vernon Smith KW - Aged KW - Aged, 80 and over KW - Atherosclerosis KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - HMGN1 Protein KW - Humans KW - Male KW - Middle Aged KW - Neuropsychological tests KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Scotland AB -

General cognitive function is substantially heritable across the human life course from adolescence to old age. We investigated the genetic contribution to variation in this important, health- and well-being-related trait in middle-aged and older adults. We conducted a meta-analysis of genome-wide association studies of 31 cohorts (N=53,949) in which the participants had undertaken multiple, diverse cognitive tests. A general cognitive function phenotype was tested for, and created in each cohort by principal component analysis. We report 13 genome-wide significant single-nucleotide polymorphism (SNP) associations in three genomic regions, 6q16.1, 14q12 and 19q13.32 (best SNP and closest gene, respectively: rs10457441, P=3.93 × 10(-9), MIR2113; rs17522122, P=2.55 × 10(-8), AKAP6; rs10119, P=5.67 × 10(-9), APOE/TOMM40). We report one gene-based significant association with the HMGN1 gene located on chromosome 21 (P=1 × 10(-6)). These genes have previously been associated with neuropsychiatric phenotypes. Meta-analysis results are consistent with a polygenic model of inheritance. To estimate SNP-based heritability, the genome-wide complex trait analysis procedure was applied to two large cohorts, the Atherosclerosis Risk in Communities Study (N=6617) and the Health and Retirement Study (N=5976). The proportion of phenotypic variation accounted for by all genotyped common SNPs was 29% (s.e.=5%) and 28% (s.e.=7%), respectively. Using polygenic prediction analysis, ~1.2% of the variance in general cognitive function was predicted in the Generation Scotland cohort (N=5487; P=1.5 × 10(-17)). In hypothesis-driven tests, there was significant association between general cognitive function and four genes previously associated with Alzheimer's disease: TOMM40, APOE, ABCG1 and MEF2C.

PB - 20 VL - 20 IS - 2 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25644384?dopt=Abstract U2 - PMC4356746 U4 - genetics/genetics/GENOME-WIDE ASSOCIATION/TOMM40/ABCG1/MEF2C/complex train anaysis/Atherosclerosis Risk in Communities Study/cross-national study ER - TY - JOUR T1 - GWAS of longevity in CHARGE consortium confirms APOE and FOXO3 candidacy. JF - J Gerontol A Biol Sci Med Sci Y1 - 2015 A1 - Broer, Linda A1 - Aron S Buchman A1 - Deelen, Joris A1 - Daniel S Evans A1 - Jessica Faul A1 - Kathryn L Lunetta A1 - Sebastiani, Paola A1 - Jennifer A Smith A1 - Albert Vernon Smith A1 - Toshiko Tanaka A1 - Lei Yu A1 - Alice M. Arnold A1 - Aspelund, Thor A1 - Emelia J Benjamin A1 - Philip L de Jager A1 - Guðny Eiríksdóttir A1 - Melissa E Garcia A1 - Hofman, Albert A1 - Kaplan, Robert C A1 - Sharon L R Kardia A1 - Douglas P Kiel A1 - Ben A Oostra A1 - Orwoll, Eric S A1 - Parimi, Neeta A1 - Psaty, Bruce M A1 - Fernando Rivadeneira A1 - Rotter, Jerome I A1 - Seshadri, Sudha A1 - Andrew B Singleton A1 - Henning Tiemeier A1 - André G Uitterlinden A1 - Wei Zhao A1 - Bandinelli, Stefania A1 - David A Bennett A1 - Luigi Ferrucci A1 - Gudnason, Vilmundur A1 - Tamara B Harris A1 - Karasik, David A1 - Lenore J Launer A1 - Thomas T Perls A1 - Eline P Slagboom A1 - Tranah, Gregory J A1 - David R Weir A1 - Anne B Newman A1 - Cornelia M van Duijn A1 - Joanne M Murabito KW - Aged KW - Aged, 80 and over KW - Apolipoproteins E KW - Cell Adhesion Molecules KW - Cohort Studies KW - Female KW - Forkhead Box Protein O3 KW - Forkhead Transcription Factors KW - Genome-Wide Association Study KW - Humans KW - Longevity KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Receptors, Kainic Acid AB -

BACKGROUND: The genetic contribution to longevity in humans has been estimated to range from 15% to 25%. Only two genes, APOE and FOXO3, have shown association with longevity in multiple independent studies.

METHODS: We conducted a meta-analysis of genome-wide association studies including 6,036 longevity cases, age ≥90 years, and 3,757 controls that died between ages 55 and 80 years. We additionally attempted to replicate earlier identified single nucleotide polymorphism (SNP) associations with longevity.

RESULTS: In our meta-analysis, we found suggestive evidence for the association of SNPs near CADM2 (odds ratio [OR] = 0.81; p value = 9.66 × 10(-7)) and GRIK2 (odds ratio = 1.24; p value = 5.09 × 10(-8)) with longevity. When attempting to replicate findings earlier identified in genome-wide association studies, only the APOE locus consistently replicated. In an additional look-up of the candidate gene FOXO3, we found that an earlier identified variant shows a highly significant association with longevity when including published data with our meta-analysis (odds ratio = 1.17; p value = 1.85×10(-10)).

CONCLUSIONS: We did not identify new genome-wide significant associations with longevity and did not replicate earlier findings except for APOE and FOXO3. Our inability to find new associations with survival to ages ≥90 years because longevity represents multiple complex traits with heterogeneous genetic underpinnings, or alternatively, that longevity may be regulated by rare variants that are not captured by standard genome-wide genotyping and imputation of common variants.

VL - 70 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296168/ IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25199915?dopt=Abstract ER - TY - JOUR T1 - Health literacy and the digital divide among older Americans. JF - J Gen Intern Med Y1 - 2015 A1 - Helen G Levy A1 - Alexander T Janke A1 - Kenneth M. Langa KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Digital Divide KW - Female KW - Health Literacy KW - Humans KW - Internet KW - Male KW - Prospective Studies KW - Retrospective Studies KW - Surveys and Questionnaires KW - United States AB -

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

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

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

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

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

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

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

VL - 30 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84914171477andpartnerID=40andmd5=41b0823f4329aba89308dad7c476949a IS - 3 N1 - Export Date: 20 January 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25387437?dopt=Abstract U4 - health literacy/health literacy/electronic health records/internet use/sociodemographic characteristics/sociodemographic characteristics ER - TY - JOUR T1 - Social Relationships, Gender, and Recovery From Mobility Limitation Among Older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Kenzie Latham A1 - Philippa J Clarke A1 - Gregory Pavela KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Family KW - Female KW - Humans KW - Interpersonal Relations KW - Male KW - Middle Aged KW - Mobility Limitation KW - Peer Group KW - Recovery of Function KW - Residence Characteristics KW - Sex Factors KW - Social Support KW - United States AB -

OBJECTIVES: Evidence suggests social relationships may be important facilitators for recovery from functional impairment, but the extant literature is limited in its measurement of social relationships including an over emphasis on filial social support and a paucity of nationally representative data.

METHODS: Using data from Waves 4-9 (1998-2008) of the Health and Retirement Study (HRS), this research examines the association between social relationships and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room) among older Americans. Using a more nuanced measure of recovery that includes complete and partial recovery, a series of discrete-time event history models with multiple competing recovery outcomes were estimated using multinomial logistic regression.

RESULTS: Providing instrumental support to peers increased the odds of complete and partial recovery from severe mobility limitation, net of numerous social, and health factors. Having relatives living nearby decreased the odds of complete recovery, while being engaged in one's neighborhood increased the odds of partial recovery. The influence of partner status on partial and complete recovery varied by gender, whereby partnered men were more likely to experience recovery relative to partnered women. The effect of neighborhood engagement on partial recovery also varied by gender. Disengaged women were the least likely to experience partial recovery compared with any other group.

DISCUSSION: The rehabilitative potential of social relationships has important policy implications. Interventions aimed at encouraging older adults with mobility limitation to be engaged in their neighborhoods and/or provide instrumental support to peers may improve functional health outcomes.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/11/geronb.gbu181.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25583597?dopt=Abstract U2 - PMC4635643 U4 - Functional health/Gender/Mobility/Recovery/neighborhood effects/Social relationships/Social support ER - TY - JOUR T1 - Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort. JF - BMC Public Health Y1 - 2015 A1 - Hui Zheng A1 - Dmitry Tumin KW - Aged KW - Aged, 80 and over KW - Body Weight KW - Cohort Studies KW - ethnicity KW - Family Characteristics KW - Female KW - Health Behavior KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Male KW - Middle Aged KW - Obesity KW - Prospective Studies KW - Qualitative Research KW - Retirement KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Studies have identified prenatal and early childhood conditions as important contributors to weight status in later life. To date, however, few studies have considered how weight status in adulthood is shaped by regional variation in early-life conditions, rather than the characteristics of the individual or their family. Furthermore, gender and life course differences in the salience of early life conditions to weight status remain unclear. This study investigates whether the effect of family background and birth region on adult obesity status varies by gender and over the life course.

METHODS: We used data from a population-based cohort of 6,453 adults from the Health and Retirement Study, 1992-2008. Early life conditions were measured retrospectively at and after the baseline. Obesity was calculated from self-reported height and weight. Logistic models were used to estimate the net effects of family background and birth region on adulthood obesity risk after adjusting for socioeconomic factors and health behaviors measured in adulthood. Four economic and demographic data sets were used to further test the birthplace effect.

RESULTS: At ages 50-61, mother's education and birth region were associated with women's obesity risk, but not men's. Each year's increase in mother's education significantly reduces the odds of being obese by 6% (OR = 0.94; 95% CI: 0.92, 0.97) among women, and this pattern persisted at ages 66-77. Women born in the Mountain region were least likely to be obese in late-middle age and late-life. Measures of per capita income and infant mortality rate in the birth region were also associated with the odds of obesity among women.

CONCLUSIONS: Women's obesity status in adulthood is influenced by early childhood conditions, including regional conditions, while adulthood health risk factors may be more important for men's obesity risk. Biological and social mechanisms may account for the gender difference.

PB - 15 VL - 15 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84934903370andpartnerID=40andmd5=b19c15d412d4437881f0111906f49570 N1 - Export Date: 9 September 2015 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26088317?dopt=Abstract U2 - PMC4474348 U4 - Birth place/Early-life conditions/Gender/Life course/Mothers education/Obesity ER - TY - JOUR T1 - Cohort differences in the marriage-health relationship for midlife women. JF - Soc Sci Med Y1 - 2014 A1 - Nicky J Newton A1 - Lindsay H Ryan A1 - Rachel T King A1 - Jacqui Smith KW - Age Factors KW - Aged KW - Chronic disease KW - Cohort Studies KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Marital Status KW - Marriage KW - Middle Aged KW - Mobility Limitation KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

The present study aimed to identify potential cohort differences in midlife women's self-reported functional limitations and chronic diseases. Additionally, we examined the relationship between marital status and health, comparing the health of divorced, widowed, and never married women with married women, and how this relationship differs by cohort. Using data from the Health and Retirement Study (HRS), we examined potential differences in the level of functional limitations and six chronic diseases in two age-matched cohorts of midlife women in the United States: Pre-Baby Boomers, born 1933-1942, N = 4574; and Early Baby Boomers, born 1947-1956, N = 2098. Linear and logistic regressions tested the marital status/health relationship, as well as cohort differences in this relationship, controlling for age, education, race, number of marriages, length of time in marital status, physical activity, and smoking status. We found that Early Baby Boom women had fewer functional limitations but higher risk of chronic disease diagnosis compared to Pre-Baby Boom women. In both cohorts, marriage was associated with lower disease risk and fewer functional limitations; however, never-married Early Baby Boom women had more functional limitations, as well as greater likelihood of lung disease than their Pre-Baby Boom counterparts (OR = 0.28). Results are discussed in terms of the stress model of marriage, and the association between historical context and cohort health (e.g., the influence of economic hardship vs. economic prosperity). Additionally, we discuss cohort differences in selection into marital status, particularly as they pertain to never-married women, and the relative impact of marital dissolution on physical health for the two cohorts of women.

PB - 116 VL - 116 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24983699?dopt=Abstract U2 - PMC4625785 U4 - Midlife women/Health/Cohort/Marital status/LIFE EXPECTANCY/MENOPAUSE/divorce/functional limitations/regression Analysis/cohort differences ER - TY - JOUR T1 - Depression and risk of hospitalization for pneumonia in a cohort study of older Americans. JF - J Psychosom Res Y1 - 2014 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Zivin, Kara A1 - Kenneth M. Langa A1 - Wayne J Katon KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Comorbidity KW - depression KW - Depressive Disorder KW - Female KW - Hospitalization KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - Pneumonia KW - Risk Assessment KW - Risk Factors KW - United States AB -

OBJECTIVE: The aim of this study is to determine if depression is independently associated with risk of hospitalization for pneumonia after adjusting for demographics, medical comorbidity, health-risk behaviors, baseline cognition and functional impairments.

METHODS: This secondary analysis of prospectively collected data examined a population-based sample of 6704 Health and Retirement Study (HRS) (1998-2008) participants>50years old who consented to have their interviews linked to their Medicare claims and were without a dementia diagnosis. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. ICD-9-CM diagnoses were used to identify hospitalizations for which the principal discharge diagnosis was for bacterial or viral pneumonia. The odds of hospitalization for pneumonia for participants with depression relative to those without depression were estimated using logistic regression models. Population attributable fractions were calculated to determine the extent that hospitalizations for pneumonia could be attributable to depression.

RESULTS: After adjusting for demographic characteristics, clinical factors, and health-risk behaviors, depression was independently associated with increased odds of hospitalization for pneumonia (odds ratio [OR]: 1.28, 95% confidence interval [95%CI]: 1.08, 1.53). This association persisted after adjusting for baseline cognition and functional impairments (OR: 1.24, 95%CI: 1.03, 1.50). In this cohort, 6% (95%CI: 2%, 10%) of hospitalizations for pneumonia were potentially attributable to depression.

CONCLUSION: Depression is independently associated with increased odds of hospitalization for pneumonia. This study provides additional rationale for integrating mental health care into medical settings in order to improve outcomes for older adults.

PB - 77 VL - 77 IS - 6 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25139125?dopt=Abstract U2 - PMC4259844 U4 - Depression/Pneumonia/Hospitalization/Outcome assessment (health care)/health Care Utilization/mental Health ER - TY - JOUR T1 - Development and validation of a brief dementia screening indicator for primary care. JF - Alzheimers Dement Y1 - 2014 A1 - Deborah E Barnes A1 - Alexa S. Beiser A1 - Anne Lee A1 - Kenneth M. Langa A1 - Alain Koyama A1 - Sarah R Preis A1 - John Neuhaus A1 - Ryan J McCammon A1 - Kristine Yaffe A1 - Seshadri, Sudha A1 - Mary Haan A1 - David R Weir KW - Aged KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Mass Screening KW - Predictive Value of Tests KW - Primary Health Care KW - Proportional Hazards Models KW - Risk Assessment AB -

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

PB - 10 VL - 10 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1 IS - 6 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24491321?dopt=Abstract U2 - PMC4119094 U4 - Dementia/Primary care/Risk prediction modeling/Screening/Cognitive Impairment ER - TY - JOUR T1 - The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort. JF - J Gerontol A Biol Sci Med Sci Y1 - 2014 A1 - Benjamin D Capistrant A1 - Nicte I Mejia A1 - Sze Y Liu A1 - Qianyi Wang A1 - M. Maria Glymour KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Cohort Studies KW - Disabled Persons KW - Female KW - Humans KW - Male KW - Prospective Studies KW - Stroke KW - United States KW - White People AB -

BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace.

METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace.

RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke.

CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

PB - 69 VL - 69 UR - http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24444610?dopt=Abstract U2 - PMC4067116 U4 - Minority aging/Disablement process/Stroke/Cardiovascular/Epidemiology. ER - TY - JOUR T1 - Geographic variation in out-of-pocket expenditures of elderly Medicare beneficiaries. JF - J Am Geriatr Soc Y1 - 2014 A1 - Lena M. Chen A1 - Edward C Norton A1 - Kenneth M. Langa A1 - Le, Sidney A1 - Arnold M. Epstein KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Female KW - Geography KW - Health Care Costs KW - Health Expenditures KW - Humans KW - Male KW - Medicare KW - Retrospective Studies KW - United States AB -

OBJECTIVES: To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans.

DESIGN: Retrospective cohort study.

SETTING: Data from the Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008.

MEASUREMENTS: The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums.

RESULTS: Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001).

CONCLUSION: Medicare payments vary widely between high- and low-cost regions, but OOPEs do not.

PB - 62 VL - 62 IS - 6 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24852182?dopt=Abstract U4 - Medicare/geographic variation/out-of-pocket expenditures ER - TY - JOUR T1 - An investigation of activity profiles of older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2014 A1 - Morrow-Howell, Nancy A1 - Putnam, Michelle A1 - Lee, Yung Soo A1 - Jennifer C. Greenfield A1 - Inoue, Megumi A1 - Chen, Huajuan KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Cohort Studies KW - Cross-Sectional Studies KW - Employment KW - Female KW - Florida KW - Health Surveys KW - Hispanic or Latino KW - Human Activities KW - Humans KW - Male KW - Middle Aged KW - Models, Psychological KW - Motor Activity KW - Prospective Studies KW - Regression Analysis KW - United States AB -

OBJECTIVES: In this study, we advance knowledge about activity engagement by considering many activities simultaneously to identify profiles of activity among older adults. Further, we use cross-sectional data to explore factors associated with activity profiles and prospective data to explore activity profiles and well-being outcomes.

METHOD: We used the core survey data from the years 2008 and 2010, as well as the 2009 Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS). The HRS CAMS includes information on types and amounts of activities. We used factor analysis and latent class analysis to identify activity profiles and regression analyses to assess antecedents and outcomes associated with activity profiles.

RESULTS: We identified 5 activity profiles: Low Activity, Moderate Activity, High Activity, Working, and Physically Active. These profiles varied in amount and type of activities. Demographic and health factors were related to profiles. Activity profiles were subsequently associated with self-rated health and depression symptoms.

DISCUSSION: The use of a 5-level categorical activity profile variable may allow more complex analyses of activity that capture the "whole person." There is clearly a vulnerable group of low-activity individuals as well as a High Activity group that may represent the "active ageing" vision.

PB - 69 VL - 69 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/12/geronb.gbu002.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24526690?dopt=Abstract U2 - PMC4189653 U4 - Activity/Activity patterns/Engagement/Time use ER - TY - JOUR T1 - Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans. JF - J Gen Intern Med Y1 - 2014 A1 - Dimitry S Davydow A1 - Zivin, Kara A1 - Wayne J Katon A1 - Gregory M Pontone A1 - Lydia Chwastiak A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - depression KW - Female KW - Hospitalization KW - Humans KW - Male KW - Mental Disorders KW - Prospective Studies KW - Risk Factors KW - United States AB -

BACKGROUND: The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.

OBJECTIVE(S): To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).

DESIGN: Prospective cohort study.

PARTICIPANTS: Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).

MAIN MEASURES: The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

KEY RESULTS: All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95% Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

CONCLUSIONS: Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.

PB - 29 VL - 29 IS - 10 N1 - Export Date: 6 August 2014 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24939712?dopt=Abstract U2 - PMC4175651 U4 - depression/dementia/ambulatory care-sensitive/condition/hospitalization/rehospitalization/cognitive impairment ER - TY - JOUR T1 - Obesity and 1-year outcomes in older Americans with severe sepsis. JF - Crit Care Med Y1 - 2014 A1 - Hallie C Prescott A1 - Virginia W Chang A1 - James M. O'Brien Jr A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Cohort Studies KW - Comorbidity KW - Critical Illness KW - Delivery of Health Care KW - Female KW - Health Expenditures KW - Hospitalization KW - Humans KW - Male KW - Medicare KW - Middle Aged KW - Obesity KW - Sepsis KW - Survival Rate KW - Survivors KW - United States AB -

OBJECTIVES: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.

DESIGN: Observational cohort study.

SETTING: U.S. hospitals.

PATIENTS: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).

CONCLUSIONS: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.

PB - 42 VL - 42 IS - 8 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/24717466?dopt=Abstract U2 - PMC4205159 U4 - body mass index/critical care/outcomes assessment/prognosis/sepsis/utilization ER - TY - JOUR T1 - Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study. JF - J Manipulative Physiol Ther Y1 - 2013 A1 - Paula A Weigel A1 - Jason Hockenberry A1 - Suzanne E Bentler A1 - Frederic D Wolinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Databases, Factual KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Humans KW - Low Back Pain KW - Male KW - Manipulation, Chiropractic KW - Medicare KW - Mobility Limitation KW - Musculoskeletal Diseases KW - Patient Satisfaction KW - Quality of Life KW - Risk Assessment KW - Sex Factors KW - Treatment Outcome KW - United States AB -

OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

VL - 36 UR - https://www.ncbi.nlm.nih.gov/pubmed/24636108 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24144425?dopt=Abstract ER - TY - JOUR T1 - Genome-wide association analysis of blood-pressure traits in African-ancestry individuals reveals common associated genes in African and non-African populations. JF - Am J Hum Genet Y1 - 2013 A1 - Franceschini, Nora A1 - Fox, Ervin A1 - Zhang, Zhaogong A1 - Edwards, Todd L A1 - Michael A Nalls A1 - Yun Ju Sung A1 - Bamidele O Tayo A1 - Yan V Sun A1 - Gottesman, Omri A1 - Adebawole Adeyemo A1 - Andrew D Johnson A1 - Young, J Hunter A1 - Kenneth Rice A1 - Duan, Qing A1 - Chen, Fang A1 - Yun Li A1 - Tang, Hua A1 - Myriam Fornage A1 - Keene, Keith L A1 - Andrews, Jeanette S A1 - Jennifer A Smith A1 - Jessica Faul A1 - Guangfa, Zhang A1 - Guo, Wei A1 - Liu, Yu A1 - Murray, Sarah S A1 - Musani, Solomon K A1 - Srinivasan, Sathanur A1 - Digna R Velez Edwards A1 - Wang, Heming A1 - Becker, Lewis C A1 - Bovet, Pascal A1 - Bochud, Murielle A1 - Broeckel, Ulrich A1 - Burnier, Michel A1 - Carty, Cara A1 - Daniel I Chasman A1 - Georg B Ehret A1 - Chen, Wei-Min A1 - Chen, Guanjie A1 - Wei Chen A1 - Ding, Jingzhong A1 - Dreisbach, Albert W A1 - Michele K Evans A1 - Guo, Xiuqing A1 - Melissa E Garcia A1 - Jensen, Rich A1 - Keller, Margaux F A1 - Lettre, Guillaume A1 - Lotay, Vaneet A1 - Martin, Lisa W A1 - Moore, Jason H A1 - Alanna C Morrison A1 - Thomas H Mosley A1 - Ogunniyi, Adesola A1 - Walter R Palmas A1 - George J Papanicolaou A1 - Alan Penman A1 - Polak, Joseph F A1 - Ridker, Paul M A1 - Babatunde Salako A1 - Andrew B Singleton A1 - Daniel Shriner A1 - Kent D Taylor A1 - Ramachandran S Vasan A1 - Kerri Wiggins A1 - Williams, Scott M A1 - Yanek, Lisa R A1 - Wei Zhao A1 - Alan B Zonderman A1 - Becker, Diane M A1 - Berenson, Gerald A1 - Boerwinkle, Eric A1 - Erwin P Bottinger A1 - Cushman, Mary A1 - Charles B Eaton A1 - Nyberg, Fredrik A1 - Gerardo Heiss A1 - Joel N Hirschhron A1 - Howard, Virginia J A1 - Karczewsk, Konrad J A1 - Lanktree, Matthew B A1 - Liu, Kiang A1 - Yongmei Liu A1 - Ruth J F Loos A1 - Margolis, Karen A1 - Snyder, Michael A1 - Psaty, Bruce M A1 - Schork, Nicholas J A1 - David R Weir A1 - Charles N Rotimi A1 - Sale, Michele M A1 - Tamara B Harris A1 - Sharon L R Kardia A1 - Hunt, Steven C A1 - Donna K Arnett A1 - Redline, Susan A1 - Cooper, Richard S A1 - Neil Risch A1 - Rao, D C A1 - Rotter, Jerome I A1 - Chakravarti, Aravinda A1 - Reiner, Alex P A1 - Levy, Daniel A1 - Keating, Brendan J A1 - Zhu, Xiaofeng KW - Africa KW - African Continental Ancestry Group KW - Blood pressure KW - Cohort Studies KW - Databases, Genetic KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Polymorphism, Single Nucleotide KW - Quantitative Trait, Heritable KW - Reproducibility of Results AB -

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

VL - 93 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23972371?dopt=Abstract ER - TY - JOUR T1 - Pain as a risk factor for disability or death. JF - J Am Geriatr Soc Y1 - 2013 A1 - James S Andrews A1 - Irena Cenzer A1 - Yelin, Edward A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Disabled Persons KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Life Style KW - Male KW - Middle Aged KW - pain KW - Prevalence KW - Prognosis KW - Prospective Studies KW - Severity of Illness Index KW - Sex Distribution KW - Sex Factors KW - United States AB -

OBJECTIVES: To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.

DESIGN: Prospective cohort study.

SETTING: The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.

PARTICIPANTS: Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.

MEASUREMENTS: Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).

RESULTS: At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.

CONCLUSION: Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.

PB - 61 VL - 61 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1356928876?accountid=14667 IS - 4 N1 - Date revised - 2013-05-01 Last updated - 2013-05-31 DOI - 0b2ff290-e53b-4073-a3d7csamfg102v; 17944301; 0002-8614; 1532-5415 SubjectsTermNotLitGenreText - Demography; Mortality; Mobility; Risk factors; Disabilities; Survival; Pain U1 - http://www.ncbi.nlm.nih.gov/pubmed/23521614?dopt=Abstract U2 - PMC3628294 U4 - Demography/Risk Abstracts/Mortality/Mobility/Risk factors/Disabilities/Survival ER - TY - JOUR T1 - Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults. JF - Am J Epidemiol Y1 - 2013 A1 - Markus Jokela A1 - G David Batty A1 - Solja T. Nyberg A1 - Virtanen, Marianna A1 - Nabi, Hermann A1 - Archana Singh-Manoux A1 - Mika Kivimäki KW - Age Factors KW - Anxiety Disorders KW - Cohort Studies KW - Extraversion, Psychological KW - Female KW - Humans KW - Male KW - Middle Aged KW - Mortality KW - Neuroticism KW - Personality KW - Prospective Studies KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors AB -

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

PB - 178 VL - 178 UR - http://www.ncbi.nlm.nih.gov/pubmed/23911610 IS - 5 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23911610?dopt=Abstract U2 - PMC3755650 U4 - Meta-analysis/Mortality/Personality/Personality/Psychology/Survival analysis/cross-national comparison/Death ER - TY - JOUR T1 - Predicting 10-year mortality for older adults. JF - JAMA Y1 - 2013 A1 - Cruz, Marisa A1 - Kenneth E Covinsky A1 - Eric W Widera A1 - Stijacic-Cenzer, Irena A1 - Sei J. Lee KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Female KW - Forecasting KW - Humans KW - Kaplan-Meier Estimate KW - Life Expectancy KW - Male KW - Middle Aged KW - Mortality KW - Risk Assessment KW - United States PB - 309 VL - 309 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23462780?dopt=Abstract U2 - PMC3760279 U4 - mortality/cancer screening/Diabetes/glycemic control/glycemic control/preventive interventions ER - TY - JOUR T1 - Self-rated health and morbidity onset among late midlife U.S. adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2013 A1 - Kenzie Latham A1 - Chuck W Peek KW - Chronic disease KW - Cohort Studies KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Morbidity KW - Predictive Value of Tests KW - Self Concept KW - Self Report KW - United States AB -

OBJECTIVES: Although self-rated health (SRH) is recognized as a strong and consistent predictor of mortality and functional health decline, there are relatively few studies examining SRH as a predictor of morbidity. This study examines the capacity of SRH to predict the onset of chronic disease among the late midlife population (ages 51-61 years).

METHOD: Utilizing the first 9 waves (1992-2008) of the Health and Retirement Study, event history analysis was used to estimate the effect of SRH on incidence of 6 major chronic diseases (coronary heart disease, diabetes, stroke, lung disease, arthritis, and cancer) among those who reported none of these conditions at baseline (N = 4,770).

RESULTS: SRH was a significant predictor of onset of any chronic condition and all specific chronic conditions excluding cancer. The effect was particularly pronounced for stroke.

DISCUSSION: This research provides the strongest and most comprehensive evidence to date of the relationship between SRH and incident morbidity.

PB - 68 VL - 68 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23197340?dopt=Abstract U2 - PMC3605944 U4 - Middle age/Mortality/Chronic illnesses/Morbidity/Self assessed health/Chronic Disease/Stroke ER - TY - JOUR T1 - Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. JF - Am J Geriatr Psychiatry Y1 - 2013 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - depression KW - Female KW - Hospitalization KW - Humans KW - Longitudinal Studies KW - Male KW - Poisson Distribution KW - Prospective Studies KW - Regression Analysis KW - Risk Factors KW - Sepsis KW - Severity of Illness Index KW - Survivors KW - United States AB -

OBJECTIVES: To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006).

PARTICIPANTS: A total of 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview.

MEASUREMENTS: Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims.

RESULTS: The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.73, 1.34) nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, presepsis substantial depressive symptoms (RR: 2.20; 95% CI: 1.66, 2.90) and worse postsepsis functional impairment (RR: 1.08 per new limitation; 95% CI: 1.03, 1.13) were independently associated with substantial depressive symptoms after sepsis.

CONCLUSIONS: The prevalence of substantial depressive symptoms in severe sepsis survivors is high but is not increased relative to their presepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions before hospital discharge, may improve outcomes.

PB - 21 VL - 21 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23567391?dopt=Abstract U2 - PMC3462893 U4 - Critical care/Depression/Outcome assessment (healthcare)/Sepsis/health Care Utilization/HOSPITALIZATION ER - TY - JOUR T1 - Trends in depressive symptom burden among older adults in the United States from 1998 to 2008. JF - J Gen Intern Med Y1 - 2013 A1 - Zivin, Kara A1 - Paul A Pirraglia A1 - Ryan J McCammon A1 - Kenneth M. Langa A1 - Sandeep Vijan KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Cost of Illness KW - Cross-Sectional Studies KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States AB -

CONTEXT: Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown.

OBJECTIVE: To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.

DESIGN: Serial cross-sectional analysis of six biennial assessments.

SETTING: Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N = 16,184 in 1998).

MAIN OUTCOME MEASURE: The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics.

RESULTS: Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13-1.19), with significant increases in those aged ≥ 60 relative to those aged 55-59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60.

CONCLUSIONS: Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.

PB - 28 VL - 28 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23835787?dopt=Abstract U2 - PMC3832736 U4 - Depression/Risk-Factors/Retirement/Older Adults/Depressive Symptoms ER - TY - JOUR T1 - What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline. JF - Neuroepidemiology Y1 - 2013 A1 - Hector M González A1 - Wassim Tarraf A1 - Mary E Bowen A1 - Michelle D Johnson-Jennings A1 - Gwenith G Fisher KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cognitive Reserve KW - Cohort Studies KW - Female KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Parents KW - Prospective Studies KW - Socioeconomic factors KW - United States AB -

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

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

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

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

PB - 41 VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23860477?dopt=Abstract U2 - PMC3811933 U4 - Cognitive reserve/Older adults/Life course/Development/CHILDHOOD/Socioeconomic Status ER - TY - JOUR T1 - The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study. JF - J Gerontol A Biol Sci Med Sci Y1 - 2012 A1 - Anda Botoseneanu A1 - Jersey Liang KW - Aged KW - Aging KW - Alcohol Drinking KW - Body Mass Index KW - Cohort Studies KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Motor Activity KW - Smoking KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group.

METHODS: We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI.

RESULTS: Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory.

CONCLUSIONS: In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.

VL - 67 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22459621?dopt=Abstract U2 - PMC3437967 U4 - Obesity/body Mass Index/smoking/alcohol use ER - TY - JOUR T1 - The growth in Social Security benefits among the retirement-age population from increases in the cap on covered earnings. JF - Soc Secur Bull Y1 - 2012 A1 - Alan L Gustman A1 - Thomas L. Steinmeier A1 - N. Tabatabai KW - Aged KW - Cohort Studies KW - Female KW - Humans KW - Insurance Benefits KW - Male KW - Middle Aged KW - Models, Econometric KW - Public Policy KW - Salaries and Fringe Benefits KW - Social Security KW - Taxes KW - United States AB -

Analysts have proposed raising the maximum level of earnings subject to the Social Security payroll tax (the "tax max") to improve long-term Social Security Trust Fund solvency. This article investigates how raising the tax max leads to the "leakage" of portions of the additional revenue into higher benefit payments. Using Health and Retirement Study data matched to Social Security earnings records, we compare historical payroll tax payments and benefit amounts for Early Boomers (born 1948-1953) with tax and benefit simulations had they been subject to the tax max (adjusted for wage growth) faced by cohorts 12 and 24 years older. We find that 43.2 percent of the additional payroll tax revenue attributable to tax max increases affecting Early Boomers relative to taxes paid by the cohort 12 years older leaked into higher benefits. For Early Boomers relative to those 24 years older, we find 53.5 percent leakage.

PB - 72 VL - 72 UR - https://www.ssa.gov/policy/docs/ssb/v72n2/v72n2p49.html IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22799138?dopt=Abstract U4 - Social security/payroll tax/Public policy/retirement planning/taxation ER - TY - JOUR T1 - Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults. JF - Am J Epidemiol Y1 - 2012 A1 - Melissa H. Roberts A1 - Douglas W Mapel KW - Activities of Daily Living KW - Aged KW - Chronic disease KW - Cohort Studies KW - Comorbidity KW - Diabetes Mellitus KW - Female KW - Health Services KW - Health Status KW - Heart Diseases KW - Hospitalization KW - Humans KW - Incidence KW - Logistic Models KW - Longitudinal Studies KW - Lung Diseases KW - Male KW - Middle Aged KW - Neoplasms KW - Odds Ratio KW - Peak Expiratory Flow Rate KW - Population Surveillance KW - Stroke KW - United States AB -

The authors examined whether peak expiratory flow (PEF) is a valid measure of health status in older adults. Survey and test data from the 2006 and 2008 cycles of the Health and Retirement Study, a longitudinal study of US adults over age 50 years (with biennial surveys initiated in 1992), were used to develop predicted PEF regression models and to examine relations between low PEF values and other clinical factors. Low PEF (<80% of predicted value) was prevalent among persons with chronic conditions, including frequent pain, obstructive lung disease, heart disease, diabetes, and psychological distress. Persons with higher physical disability scores had substantially higher adjusted odds of having low PEF, on par with those for conditions known to be associated with poor health (cancer, heart disease, and stroke). In a multivariate regression model for difficulty with mobility, PEF remained an independent factor (odds ratio (OR) = 1.69, 95% confidence interval (CI): 1.53, 1.86). Persons with low PEF in 2006 were more likely to be hospitalized (OR = 1.26, 95% CI: 1.10, 1.43) within the subsequent 2 years and to estimate their chances of surviving for 10 or more years at less than 50% (OR = 1.69, 95% CI: 1.24, 2.30). PEF is a valid measure of health status in older persons, and low PEF is an independent predictor of hospitalization and poor subjective mortality assessment.

PB - 176 VL - 176 IS - 2 N1 - Roberts, Melissa H Mapel, Douglas W United States Am J Epidemiol. 2012 Jul 15;176(2):127-34. Epub 2012 Jun 28. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22759722?dopt=Abstract U2 - PMC3493194 U4 - peak expiratory flow/disability/disability/hospitalization/physical fitness ER - TY - JOUR T1 - Loneliness, health, and mortality in old age: a national longitudinal study. JF - Soc Sci Med Y1 - 2012 A1 - Ye Luo A1 - Louise C Hawkley A1 - Linda J. Waite A1 - John T. Cacioppo KW - Aged KW - Aged, 80 and over KW - Aging KW - Cohort Studies KW - depression KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Interpersonal Relations KW - Loneliness KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - Social Support KW - Socioeconomic factors KW - United States AB -

This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works.

PB - 74 VL - 74 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2601961601andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22326307?dopt=Abstract U2 - PMC3303190 U4 - Emotions/Emotions/Mortality/Clinical outcomes/Health behavior/Risk factors/Personal health/Older people ER - TY - JOUR T1 - Long-term rate of change in memory functioning before and after stroke onset. JF - Stroke Y1 - 2012 A1 - Qianyi Wang A1 - Benjamin D Capistrant A1 - Amy Ehntholt A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - disease progression KW - Female KW - Follow-Up Studies KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Memory KW - Memory Disorders KW - Middle Aged KW - Stroke KW - Survivors KW - Time Factors AB -

BACKGROUND AND PURPOSE: Memory impairment is a predictor and a consequence of stroke, but memory decline is common even in healthy elderly individuals. We compared the long-term trajectory of memory functioning before and after stroke with memory change in stroke-free elderly individuals.

METHODS: Health and Retirement Study participants aged 50 years and older (n=17 340) with no stroke history at baseline were interviewed biennially up to 10 years for first self-reported or proxy-reported stroke (n=1574). Age-, sex-, and race-adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among 3 groups: 1189 stroke survivors; 385 stroke decedents; and 15 766 cohort members who remained stroke-free.

RESULTS: Before stroke onset, individuals who later survived stroke had significantly (P<0.001) faster average annual rates of memory decline (-0.143 points per year) than those who remained stroke-free throughout follow-up (-0.101 points per year). Stroke decedents had even faster prestroke memory decline (-0.212 points per year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable with 3.7 years of age-related decline in stroke-free cohort members. After stroke, memory in stroke survivors continued to decline at -0.142 points per year, similar to their prestroke rates (P=0.93). Approximately 50% of the memory difference between stroke survivors soon after stroke and age-matched stroke-free individuals was attributable to prestroke memory.

CONCLUSIONS: Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults.

VL - 43 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22935399?dopt=Abstract U2 - PMC3675175 U4 - Cognition/Cognitive impairment/memory impairment/cognitive decline/stroke ER - TY - JOUR T1 - Presepsis depressive symptoms are associated with incident cognitive impairment in survivors of severe sepsis: a prospective cohort study of older Americans. JF - J Am Geriatr Soc Y1 - 2012 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - depression KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Sepsis KW - Survivors AB -

OBJECTIVES: To test the hypothesis that presepsis depressive symptoms are associated with risk of new cognitive impairment in survivors of severe sepsis.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006).

PARTICIPANTS: Four hundred forty-seven individuals with normal presepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview.

MEASUREMENTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively using a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status (TICS). Logistic regression with robust standard errors was used to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (mild or moderate to severe cognitive impairment) at any interview after sepsis.

RESULTS: The prevalence of substantial depressive symptoms in participants with normal cognition before sepsis was 38% (95% confidence interval (CI) = 34-42%). After severe sepsis, 18% (95% CI = 15-20%) of survivors had incident cognitive impairment. In unadjusted analyses, presepsis substantial depressive symptoms were associated with postsepsis incident cognitive impairment (odds ratio (OR) = 2.56, 95% CI = 1.53-4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and presepsis TICS scores, substantial presepsis depressive symptoms remained the strongest factor associated with postsepsis incident cognitive impairment (OR = 2.58, 95% CI = 1.45-4.59).

CONCLUSION: Substantial presepsis depressive symptoms are independently associated with incident postsepsis cognitive impairment. Depressed older adults may be particularly at risk of developing cognitive impairment after a serious medical illness.

PB - 60 VL - 60 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23176643?dopt=Abstract U2 - PMC3521098 U4 - Depression/sepsis/Cognition/Cognitive Impairment/CES Depression Scale/CES Depression Scale/TICS Scale/Older Adults ER - TY - JOUR T1 - Racial and ethnic differences in hypertension risk: new diagnoses after age 50. JF - Ethn Dis Y1 - 2012 A1 - A. R. Quinones A1 - Jersey Liang A1 - Wen Ye KW - Age Factors KW - Aged KW - Black or African American KW - Cohort Studies KW - Female KW - Health Status Disparities KW - Humans KW - Hypertension KW - Incidence KW - Male KW - Mexican Americans KW - Middle Aged KW - Risk Factors KW - Socioeconomic factors KW - White People AB -

OBJECTIVES: Our study examines the differences in estimated risk of developing hypertension in Whites, Blacks, and Mexican-Americans aged > or = 50 for a period of 11 years.

DESIGN, SETTING, AND PARTICIPANTS: Data came from 9,259 respondents who reported being hypertension-free at the baseline in the Health and Retirement Study (HRS) with up to five time intervals (1998-2006). Discrete-time survival models were used to analyze ethnic variations in the probability of developing hypertension.

MAIN OUTCOME MEASURE: Estimated odds of developing hypertension.

RESULTS: The risk of newly diagnosed hypertension increased between 1995 and 2006 for HRS participants aged > or = 50. After adjusting for demographic and health status, the probability of incident hypertension among Black Americans was .10 during the period of 1995/96-1998, which increased steadily to .17 in 2004-2006, with cumulative incidence over the 11-year period at 51%. In contrast, among White Americans the risk was .07 during 1995/96-1998 and .13 in 2004-2006, with cumulative incidence at 43%. For Mexican-Americans, the probability also increased from .08 during 1995/ 96-1998 to .14 during 2004-2006, with cumulative incidence at 42%.

CONCLUSIONS: Relative to White and Mexican-Americans, Black Americans had an elevated risk of incident hypertension throughout the 11-year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics were accounted for.

PB - 22 VL - 22 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22764639?dopt=Abstract U3 - 22764639 U4 - Hypertension/minorities/socioeconomic factors/african-americans/mexican Americans/Hispanic/morbidity ER - TY - JOUR T1 - Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions. JF - Am J Respir Crit Care Med Y1 - 2012 A1 - Theodore J Iwashyna A1 - Netzer, Giora A1 - Kenneth M. Langa A1 - Christine T Cigolle KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Chronic pain KW - Cohort Studies KW - Comorbidity KW - Critical Illness KW - Disabled Persons KW - disease progression KW - Female KW - Geriatric Assessment KW - Hearing Disorders KW - Hospitalization KW - Humans KW - Incidence KW - Male KW - Musculoskeletal Diseases KW - Prognosis KW - Retrospective Studies KW - Risk Assessment KW - Sepsis KW - Survival Analysis KW - Survivors KW - Thinness KW - Time KW - Treatment Outcome KW - Urinary incontinence KW - Vision Disorders AB -

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

PB - 185 VL - 185 IS - 8 N1 - Iwashyna, Theodore J Netzer, Giora Langa, Kenneth M Cigolle, Christine K08 AG031837/AG/NIA NIH HHS/ K08 HL091249/HL/NHLBI NIH HHS/ K12 RR023250/RR/NCRR NIH HHS/ P30-AG028747/AG/NIA NIH HHS/ P60 DK-20572/DK/NIDDK NIH HHS/ R01 AG030155/AG/NIA NIH HHS/ U01 AG09740/AG/NIA NIH HHS/ UL1RR024986/RR/NCRR NIH HHS/ Am J Respir Crit Care Med. 2012 Apr 15;185(8):835-41. Epub 2012 Feb 9. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22323301?dopt=Abstract U2 - PMC3360570 U4 - Body Mass Index/Cohort Studies/Comorbidity/DISABILITY/DISABILITY/Geriatric Assessment/Hearing Disorders/Hospitalization/Musculoskeletal Diseases/Risk Assessment/Sepsis/Survival Analysis/body Weight/Treatment Outcome/Urinary Incontinence/Vision Disorders ER - TY - JOUR T1 - Stroke incidence in older US Hispanics: is foreign birth protective? JF - Stroke Y1 - 2012 A1 - J Robin Moon A1 - Benjamin D Capistrant A1 - Ichiro Kawachi A1 - Mauricio Avendano A1 - Subramanian, S V A1 - Lisa M. Bates A1 - M. Maria Glymour KW - Age Factors KW - Aged KW - Cohort Studies KW - Emigration and Immigration KW - Female KW - Hispanic or Latino KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retrospective Studies KW - Risk Factors KW - Socioeconomic factors KW - Stroke KW - United States KW - White People AB -

BACKGROUND AND PURPOSE: Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites.

METHODS: Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites.

RESULTS: In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95% CI, 1.08-1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95% CI, 0.80-1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95% CI, 0.41-0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites.

CONCLUSIONS: In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.

PB - 43 VL - 43 IS - 5 N1 - Moon, J Robin Capistrant, Benjamin D Kawachi, Ichiro Avendano, Mauricio Subramanian, S V Bates, Lisa M Glymour, M Maria T32-HL098048-01/HL/NHLBI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Stroke. 2012 May;43(5):1224-9. Epub 2012 Feb 21. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22357712?dopt=Abstract U3 - 22357712 U4 - Hispanic/stroke/Socioeconomic Factors/survival Analysis ER - TY - JOUR T1 - Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008. JF - Stroke Y1 - 2011 A1 - Afshin A Divani A1 - Shahram Majidi A1 - Anna M Barrett A1 - Noorbaloochi, Siamak A1 - Andreas R Luft KW - Activities of Daily Living KW - Aged KW - Case-Control Studies KW - Cohort Studies KW - Comorbidity KW - Female KW - Geriatrics KW - Humans KW - Male KW - Quality of Life KW - Retirement KW - Risk KW - Social Environment KW - Stroke AB -

BACKGROUND AND PURPOSE: Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke.

METHODS: We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups.

RESULTS: Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95% CI, 1.16 to 2.24), falls (OR, 1.5; 95% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects.

CONCLUSIONS: The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.

PB - 42 VL - 42 IS - 7 N1 - Divani, Afshin A Majidi, Shahram Barrett, Anna M Noorbaloochi, Siamak Luft, Andreas R K24 HD062647-01/HD/NICHD NIH HHS/United States K24 HD062647-02/HD/NICHD NIH HHS/United States K24HD062647/HD/NICHD NIH HHS/United States R01 NS055808/NS/NINDS NIH HHS/United States R01 NS055808-01A2/NS/NINDS NIH HHS/United States R01 NS055808-02/NS/NINDS NIH HHS/United States R01 NS055808-03/NS/NINDS NIH HHS/United States R01 NS055808-04/NS/NINDS NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Stroke; a journal of cerebral circulation Nihms297056 Stroke. 2011 Jul;42(7):1821-5. Epub 2011 May 19. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21597018?dopt=Abstract U2 - PMC3125444 U4 - Activities of Daily Living/Case-Control Studies/Case-Control Studies/Cohort Studies/Comorbidity/Female/Geriatrics/methods/Geriatrics/methods/Humans/Quality of Life/Retirement/Social Environment/Stroke/ complications/ epidemiology/Stroke/ complications/ epidemiology ER - TY - JOUR T1 - Development and validation of a brief cognitive assessment tool: the sweet 16. JF - Arch Intern Med Y1 - 2011 A1 - Tamara G Fong A1 - Richard N Jones A1 - James L Rudolph A1 - Frances Margaret Yang A1 - Tommet, Douglas A1 - Habtemariam, Daniel A1 - Edward R Marcantonio A1 - Kenneth M. Langa A1 - Sharon K Inouye KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Surveys and Questionnaires AB -

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

PB - 171 VL - 171 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21059967?dopt=Abstract U3 - 21059967 U4 - Older people/Cognition/reasoning/Correlation analysis/Medical diagnosis/Dementia/Hospitalization ER - TY - JOUR T1 - Does informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Lin, I-Fen A1 - Wu, Hsueh-Sheng KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cohort Studies KW - Cost of Illness KW - depression KW - Disability Evaluation KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Models, Psychological KW - United States AB -

OBJECTIVE: Prior studies have extensively examined the reciprocal relation between disability and depressive symptoms in late life, but little is known about whether informal care attenuates the reciprocal relation over time. This study examined whether disability and depressive symptoms mobilize informal care and whether informal care, once mobilized, protects older adults against the progression of disability and depressive symptoms.

METHODS: The analysis was based on 6,454 community-dwelling older adults who were interviewed in one or more waves of the Health and Retirement Study between 1998 and 2006. Extending an autoregressive cross-lagged model, we constructed 3 cycles of the relations among disability, depressive symptoms, and informal care. Comparing the relations across 3 cycles informs us about the attenuating effect of informal care on the relation between disability and depressive symptoms over time.

RESULTS: Although older adults' disability and depressive symptoms mobilized informal care initially, worsening disability and depressive symptoms often exhausted support. Receipt of care generally increased, rather than decreased, disability and depressive symptoms, and the detrimental effects remained the same over time.

DISCUSSION: We need to better understand the linkage between disability and depressive symptoms and seek effective interventions to reduce caregiver strain and enhance care receivers' well-being.

PB - 66B VL - 66 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21746870?dopt=Abstract U2 - PMC3155031 U4 - Disability/Disability/Mental depression/Older people/Caregivers/Gerontology/Mobility ER - TY - JOUR T1 - Incidence of dementia and cognitive impairment, not dementia in the United States. JF - Ann Neurol Y1 - 2011 A1 - Brenda L Plassman A1 - Kenneth M. Langa A1 - Ryan J McCammon A1 - Gwenith G Fisher A1 - Guy G Potter A1 - James R Burke A1 - David C Steffens A1 - Norman L Foster A1 - Bruno J Giordani A1 - Frederick W Unverzagt A1 - Kathleen A Welsh-Bohmer A1 - Steven G Heeringa A1 - David R Weir A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Diagnostic and Statistical Manual of Mental Disorders KW - disease progression KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Models, Statistical KW - United States AB -

OBJECTIVE: Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND.

METHODS: Participants in the Aging, Demographic, and Memory Study (ADAMS) were evaluated for cognitive impairment using a comprehensive in-home assessment. A total of 456 individuals aged 72 years and older, who were not demented at baseline, were followed longitudinally from August 2001 to December 2009. An expert consensus panel assigned a diagnosis of normal cognition, CIND, or dementia and its subtypes. Using a population-weighted sample, we estimated the incidence of dementia, Alzheimer disease (AD), vascular dementia (VaD), and CIND by age. We also estimated the incidence of progression from CIND to dementia.

RESULTS: The incidence of dementia was 33.3 (standard error [SE], 4.2) per 1,000 person-years and 22.9 (SE, 2.9) per 1,000 person-years for AD. The incidence of CIND was 60.4 (SE, 7.2) cases per 1,000 person-years. An estimated 120.3 (SE, 16.9) individuals per 1,000 person-years progressed from CIND to dementia. Over a 5.9-year period, about 3.4 million individuals aged 72 and older in the United States developed incident dementia, of whom approximately 2.3 million developed AD, and about 637,000 developed VaD. Over this same period, almost 4.8 million individuals developed incident CIND.

INTERPRETATION: The incidence of CIND is greater than the incidence of dementia, and those with CIND are at high risk of progressing to dementia, making CIND a potentially valuable target for treatments aimed at slowing cognitive decline.

VL - 70 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21425187?dopt=Abstract U2 - PMC3139807 U4 - Dementia/Cognitive Impairment/Alzheimer disease/vascular dementia/incident dementia ER - TY - JOUR T1 - Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval. JF - Int J Environ Res Public Health Y1 - 2011 A1 - Janet Kay Bobo A1 - April A Greek KW - Aged KW - Alcohol Drinking KW - Alcoholic Intoxication KW - Alcoholism KW - Cohort Studies KW - depression KW - Ethanol KW - Female KW - Follow-Up Studies KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - Retirement KW - Risk Factors KW - Smoking KW - Surveys and Questionnaires KW - United States AB -

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

PB - 8 VL - 8 IS - 8 N1 - Bobo, Janet Kay Greek, April A AA016534/AA/NIAAA NIH HHS/United States R24 HD042828-10/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Switzerland International journal of environmental research and public health Int J Environ Res Public Health. 2011 Aug;8(8):3263-76. Epub 2011 Aug 5. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21909305?dopt=Abstract U2 - PMC3166741 U4 - alcohol use/WOMEN/depression/Smoking ER - TY - JOUR T1 - Job strain, depressive symptoms, and drinking behavior among older adults: results from the health and retirement study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Briana Mezuk A1 - Amy S B Bohnert A1 - Scott M Ratliff A1 - Zivin, Kara KW - Age Factors KW - Aged KW - Alcoholism KW - Cohort Studies KW - Depressive Disorder KW - Female KW - Health Behavior KW - Health Surveys KW - Humans KW - Job Satisfaction KW - Logistic Models KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Prospective Studies KW - Retirement KW - Sex Factors KW - Statistics as Topic KW - Stress, Psychological KW - United States AB -

OBJECTIVE: To examine the relationship between job strain and two indicators of mental health, depression and alcohol misuse, among currently employed older adults.

METHOD: Data come from the 2004 and 2006 waves of the Health and Retirement Study (N = 2,902). Multivariable logistic regression modeling was used to determine the association between job strain, indicated by the imbalance of job stress and job satisfaction, with depression and alcohol misuse.

RESULTS: High job strain (indicated by high job stress combined with low job satisfaction) was associated with elevated depressive symptoms (odds ratio [OR] = 2.98, 95% confidence interval [CI]: 1.99-4.45) relative to low job strain after adjusting for sociodemographic characteristics, labor force status, and occupation. High job stress combined with high job satisfaction (OR = 1.93) and low job stress combined with low job satisfaction (OR = 1.94) were also associated with depressive symptoms to a lesser degree. Job strain was unrelated to either moderate or heavy drinking. These associations did not vary by gender or age.

DISCUSSION: Job strain is associated with elevated depressive symptoms among older workers. In contrast to results from investigations of younger workers, job strain was unrelated to alcohol misuse. These findings can inform the development and implementation of workplace health promotion programs that reflect the mental health needs of the aging workforce.

PB - 66B VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21427175?dopt=Abstract U2 - PMC3166196 U4 - Occupational stress/Job satisfaction/Occupational health/Alcohol use/Older people ER - TY - JOUR T1 - Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. JF - BMC Geriatr Y1 - 2011 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Jason Hockenberry A1 - Michael P Jones A1 - Maksym Obrizan A1 - Paula A Weigel A1 - Kaskie, Brian A1 - Robert B Wallace KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Insurance Benefits KW - Longitudinal Studies KW - Male KW - Medicare KW - Mobility Limitation KW - Prospective Studies KW - Time Factors KW - United States AB -

BACKGROUND: Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

PB - 11 VL - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21846400?dopt=Abstract U2 - PMC3167753 U4 - SELF-RATED HEALTH/Medicare/Functional decline/Functional decline/ADL/IADL/risk Factors ER - TY - JOUR T1 - A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. JF - BMC Public Health Y1 - 2011 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Jason Hockenberry A1 - Michael P Jones A1 - Paula A Weigel A1 - Kaskie, Brian A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Medicare KW - Mental Health KW - Outcome Assessment, Health Care KW - Prospective Studies KW - Regression Analysis KW - Risk Factors KW - United States AB -

BACKGROUND: Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function.

METHODS: We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests.

RESULTS: Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status.

CONCLUSIONS: In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

PB - 11 VL - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21933430?dopt=Abstract U2 - PMC3190354 U4 - Cognition/Cognitive decline/public policy/Medicare/cognitive Function/TICS Scale ER - TY - JOUR T1 - Trends in the incidence and prevalence of Alzheimer's disease, dementia, and cognitive impairment in the United States. JF - Alzheimers Dement Y1 - 2011 A1 - Walter A Rocca A1 - Ronald C Petersen A1 - David S Knopman A1 - Liesi Hebert A1 - Denis A Evans A1 - Kathleen S Hall A1 - Gao, Sujuan A1 - Frederick W Unverzagt A1 - Kenneth M. Langa A1 - Eric B Larson A1 - Lon R White KW - Age Factors KW - Alzheimer disease KW - Cognition Disorders KW - Cohort Studies KW - Community Health Planning KW - Dementia KW - Humans KW - Incidence KW - Prevalence KW - Residence Characteristics KW - Retrospective Studies KW - Time Factors KW - United States AB -

Declines in heart disease and stroke mortality rates are conventionally attributed to reductions in cigarette smoking, recognition and treatment of hypertension and diabetes, effective medications to improve serum lipid levels and to reduce clot formation, and general lifestyle improvements. Recent evidence implicates these and other cerebrovascular factors in the development of a substantial proportion of dementia cases. Analyses were undertaken to determine whether corresponding declines in age-specific prevalence and incidence rates for dementia and cognitive impairment have occurred in recent years. Data spanning 1 or 2 decades were examined from community-based epidemiological studies in Minnesota, Illinois, and Indiana, and from the Health and Retirement Study, which is a national survey. Although some decline was observed in the Minnesota cohort, no statistically significant trends were apparent in the community studies. A significant reduction in cognitive impairment measured by neuropsychological testing was identified in the national survey. Cautious optimism appears justified.

PB - 7 VL - 7 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21255746?dopt=Abstract U2 - PMC3026476 U4 - Alzheimers disease/Dementia/Cognitive impairment/Prevalence/Incidence/Time trends ER - TY - JOUR T1 - Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline. JF - J Am Geriatr Soc Y1 - 2010 A1 - Janet Kay Bobo A1 - April A Greek A1 - Daniel H. Klepinger A1 - Jerald R Herting KW - Aged KW - Aging KW - Alcohol Drinking KW - Alcoholism KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - Humans KW - Life Change Events KW - Middle Aged KW - Retirement KW - Risk Factors KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVES: To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up.

DESIGN: Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age.

SETTING: Study data were obtained from detailed interviews conducted in the home or by telephone.

PARTICIPANTS: One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995.

MEASUREMENTS: Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003.

RESULTS: All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9% of cohort), infrequent and nondrinkers (61.8%), consistent drinkers (25.9%), and decreasing drinkers (7.4%). Corresponding NLS values from the drinks per day model were 8.8%, 61.4%, 21.2%, and 8.6%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively.

CONCLUSION: Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.

PB - 58 VL - 58 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21087226?dopt=Abstract U2 - PMC3064493 U4 - WOMEN/Alcohol Abuse/Drinking Behavior ER - TY - JOUR T1 - Childhood socioeconomic position and disability in later life: results of the health and retirement study. JF - Am J Public Health Y1 - 2010 A1 - Mary E Bowen A1 - Hector M González KW - Activities of Daily Living KW - Cohort Studies KW - Disabled Persons KW - Female KW - Humans KW - Male KW - Michigan KW - Middle Aged KW - Prospective Studies KW - Retirement KW - Risk Assessment KW - Social Class AB -

OBJECTIVES: We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life.

METHODS: We used longitudinal data from the nationally representative Health and Retirement Study (1998-2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities.

CONCLUSIONS: Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life.

PB - 100 VL - 100 Suppl 1 IS - Suppl 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19762655?dopt=Abstract U2 - PMC2837439 U4 - ADL and IADL Impairments/Health risk assessment/Children/youth/Tuition/Health behavior/Tobacco smoke/Families/family life/Disease/Retirement/Disability/Disability/Palliative care/Education ER - TY - JOUR T1 - Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries. JF - BMC Health Serv Res Y1 - 2010 A1 - Kaskie, Brian A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Michael P Jones A1 - Li Liu A1 - Suzanne E Bentler A1 - Robert B Wallace A1 - John F Geweke A1 - Kara B Wright A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Frederic D Wolinsky KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Emergency Service, Hospital KW - Humans KW - Insurance Claim Review KW - Medicare KW - Prospective Studies KW - Severity of Illness Index KW - United States AB -

BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.

RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).

CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.

PB - 8 VL - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20565949?dopt=Abstract U2 - PMC2903585 U4 - HOSPITALIZATION/emergency department service use/emergency department service use/medicare/predictive validity/predictive validity ER - TY - JOUR T1 - Dynamics and heterogeneity in the process of human frailty and aging: evidence from the U.S. older adult population. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Yang, Yang A1 - Lee, Linda C KW - Aged KW - Aged, 80 and over KW - Aging KW - Cohort Studies KW - Female KW - Frail Elderly KW - Humans KW - Male KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVES: This study investigated the dynamics and heterogeneity of the frailty index (FI) conceived as a systemic indicator of biological aging in the community-dwelling older adult population in the United States.

METHODS: We used panel data on multiple birth cohorts from the Health and Retirement Survey 1993-2006 and growth curve models to estimate age trajectories of the FI and their differences by sex, race, and socioeconomic status (SES) within cohorts.

RESULTS: The FI for cohorts born before 1942 exhibit quadratic increases with age and accelerated increases in the accumulation of health deficits. More recent cohorts exhibit higher average levels of and rates of increment in the FI than their predecessors do at the same ages. Females, non-Whites, and individuals with low education and income exhibit greater degrees of physiological deregulation than their male, White, and high-SES counterparts at any age. Patterns of sex, race, and SES differentials in rates of aging vary across cohorts.

DISCUSSION: Adjusting for social behavioral factors, the analysis provides evidence for physiological differences in the aging process among recent cohorts of older adults, points to the need for biological explanations of female excess in general system damage, and reveals the insufficiency of any single mechanism for depicting the racial and SES differences in the process of physiological deterioration.

PB - CCCB CCCP VL - 65B IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20007299?dopt=Abstract U2 - PMC2981448 U4 - Frailty index/Deficits accumulation/Biological aging/Heterogeneity of frailty/age trajectories ER - TY - JOUR T1 - Early-life characteristics, psychiatric history, and cognition trajectories in later life. JF - Gerontologist Y1 - 2010 A1 - Maria T. Brown KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Disorders KW - Middle Aged KW - Psychiatric Status Rating Scales KW - Social Environment KW - Socioeconomic factors KW - Time Factors AB -

PURPOSE OF THE STUDY: Although considerable attention has been paid to the relationship between later-life depression and cognitive function, the relationship between a history of psychiatric problems and cognitive function is not very well documented. Few studies of relationships between childhood health, childhood disadvantage, and cognitive function in later life consider both childhood health and disadvantage, include measures for psychiatric history, or use nationally representative longitudinal data.

DESIGN AND METHODS: This study uses growth curve models to analyze the relationships between childhood health and disadvantage, psychiatric history, and cognitive function using 6 waves of the Health and Retirement Study, controlling for demographics, health behavior, and health status.

RESULTS: A history of psychiatric problems is associated with lower cognitive function and steeper declines in cognitive function with age. The influence of childhood health is mediated by later-life health status and behaviors. A combined history of childhood disadvantage and psychiatric problems more strongly affects cognitive function, but cognitive declines remain consistent with those associated with psychiatric history. These effects are partially mediated by later-life demographic, socioeconomic, or health characteristics.

IMPLICATIONS: These findings demonstrate that cumulative disadvantage and a history of psychiatric problems shape later-life cognition and cognitive decline. This evidence can enhance public understanding of the trajectories of cognitive decline experienced by groups living with disadvantage and can enable policy makers and human services providers to better design and implement preventative interventions and support services for affected populations.

PB - 50 VL - 50 IS - 5 N1 - Using Smart Source Parsing pp. Oct Gerontological Society of America, Washington DC U1 - http://www.ncbi.nlm.nih.gov/pubmed/20566836?dopt=Abstract U3 - 20566836 U4 - cognitive Function/Cognitive decline/psychiatric history/Health outcomes/Childhood/Health Behavior/Public Policy/socioeconomic Status/demographics ER - TY - JOUR T1 - Lifetime marital history and mortality after age 50. JF - J Aging Health Y1 - 2010 A1 - John C Henretta KW - Age Factors KW - Aging KW - Cohort Studies KW - Female KW - Health Status KW - Humans KW - Interpersonal Relations KW - Male KW - Marital Status KW - Middle Aged KW - Mortality KW - Multivariate Analysis KW - Proportional Hazards Models KW - Residence Characteristics KW - Risk Assessment KW - Risk-Taking KW - Smoking KW - Time Factors KW - United States AB -

OBJECTIVES: This article examines the relationship between lifetime marital history and mortality after age 50.

METHOD: Data are drawn from the Health and Retirement Study birth cohort of 1931 to 1941. The analysis utilizes three measures of marital history: number of marriages, proportion time married, and age at first marriage.

RESULTS: Three or more marriages and a lower proportion of adult life spent married are each associated with a higher hazard of dying after age 50 for both men and women even after controlling for current marital status and socioeconomic status. Smoking behavior accounts for part of the relationship of marital history and status with mortality.

DISCUSSION: Research on marital status and health should consider marital history as well as current status. Two topics are particularly important: examining the relationship in different cohorts and disentangling the potentially causal role of health behaviors such as smoking.

PB - 22 VL - 22 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20660636?dopt=Abstract U3 - 20660636 U4 - Mortality Rates/Marriage/Marital Status/Smoking/Socioeconomic Status/Health Behavior/Health Problems/Dying/Health Policy ER - TY - JOUR T1 - Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61. JF - J Aging Health Y1 - 2010 A1 - Dianna D Carroll A1 - Heidi M Blanck A1 - Mary K. Serdula A1 - David R Brown KW - Activities of Daily Living KW - Age Factors KW - Aging KW - Chi-Square Distribution KW - Cohort Studies KW - Confidence Intervals KW - depression KW - Female KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Motor Activity KW - Multivariate Analysis KW - Obesity KW - Odds Ratio KW - Psychometrics KW - Self Report KW - Sex Factors KW - United States AB -

OBJECTIVE: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline.

METHOD: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women >/= 4, men >/= 3) on the eight-item Center for Epidemiologic Studies-Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status.

RESULTS: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998.

DISCUSSION: The findings illustrate the importance of examining gender differences in studies of risk factors for depression.

PB - 22 VL - 22 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20164412?dopt=Abstract U3 - 20164412 U4 - Physical Fitness/Health/Problems/Sex Differences/Males/depression/physical activity/obesity/aging/mental and emotional health problems ER - TY - JOUR T1 - Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Brian J Ayotte A1 - Frances Margaret Yang A1 - Richard N Jones KW - Age Factors KW - Aged KW - Chi-Square Distribution KW - Chronic disease KW - Cohort Studies KW - depression KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Least-Squares Analysis KW - Male KW - Marriage KW - Middle Aged KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors KW - Spouses KW - Stroke AB -

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses. Additionally, post hoc analyses indicated that husbands' stroke and high blood pressure were related to increased depressive symptomatology among wives. Beyond the reciprocal relationship, husbands were unaffected by wives' health. These results suggest sex differences underlying psychological distress in the context of physical health among older adults and that older women with husbands who have high levels of depressive symptomatology, high blood pressure, or a history of stroke may be at particular risk of experiencing depressive symptoms.

VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20498455?dopt=Abstract U2 - PMC2883871 U4 - Chronic Disease/depression/Stroke/Stress/Sex Differences ER - TY - JOUR T1 - Surgery as a teachable moment for smoking cessation. JF - Anesthesiology Y1 - 2010 A1 - Yu Shi A1 - David O. Warner KW - Aged KW - Aged, 80 and over KW - Ambulatory Surgical Procedures KW - Analysis of Variance KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - General Surgery KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Patient Education as Topic KW - Regression Analysis KW - Smoking cessation KW - Treatment Outcome KW - United States AB -

BACKGROUND: A "teachable moment" is an event that motivates spontaneous behavior change. Some evidence suggests that major surgery for a smoking-related illness can serve as a teachable moment for smoking cessation. This study tested the hypotheses that surgery increases the likelihood of smoking cessation and that cessation is more likely after major surgical procedures compared with outpatient surgery.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992-2004) from the nationally representative Health and Retirement Study of U.S. adults older than 50 yr, determining the relationship between the incidence of smoking cessation and the occurrence of surgery.

RESULTS: Five thousand four hundred ninety-eight individuals reported current smoking at enrollment, and 2,444 of them (44.5%) quit smoking during the period of examination. The incidence of quitting in smokers undergoing major surgery was 20.6/100 person-years of follow-up and 10.2/100 person-years in those undergoing outpatient surgery. In a multivariate negative binomial regression model, the incidence rate ratio of quitting associated with major surgery was 2.02 (95% CI: 1.67-2.44) and that of those associated with outpatient surgery was 1.28 (95% CI: 1.09-1.50). Estimates derived from national surgical utilization data show that approximately 8% of all quit events in the United States annually can be attributed to the surgical procedures analyzed.

CONCLUSIONS: Undergoing surgery is associated with an increased likelihood of smoking cessation in the older U.S. population. Cessation is more likely in association with major procedures compared with outpatient surgery. These data support the concept that surgery is a teachable moment for smoking cessation.

PB - 112 VL - 112 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19996946?dopt=Abstract U3 - 19996946 U4 - Smoking/Smoking Cessation ER - TY - JOUR T1 - The accuracy of Medicare claims as an epidemiological tool: the case of dementia revisited. JF - J Alzheimers Dis Y1 - 2009 A1 - Donald H. Taylor Jr. A1 - Østbye, Truls A1 - Kenneth M. Langa A1 - David R Weir A1 - Brenda L Plassman KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cohort Studies KW - Dementia KW - Female KW - Health Care Costs KW - Humans KW - Insurance Claim Reporting KW - Male KW - Medicare KW - Prevalence KW - Sensitivity and Specificity KW - United States AB -

Our study estimates the sensitivity and specificity of Medicare claims to identify clinically-diagnosed dementia, and documents how errors in dementia assessment affect dementia cost estimates. We compared Medicare claims from 1993-2005 to clinical dementia assessments carried out in 2001-2003 for the Aging Demographics and Memory Study (ADAMS) cohort (n = 758) of the Health and Retirement Study. The sensitivity and specificity of Medicare claims was 0.85 and 0.89 for dementia (0.64 and 0.95 for AD). Persons with dementia cost the Medicare program (in 2003) $7,135 more than controls (P < 0.001) when using claims to identify dementia, compared to $5,684 more when using ADAMS (P < 0.001). Using Medicare claims to identify dementia results in a 110% increase in costs for those with dementia as compared to a 68% increase when using ADAMS to identify disease, net of other variables. Persons with false positive Medicare claims notations of dementia were the most expensive group of subjects ($11,294 versus $4,065, for true negatives P < 0.001). Medicare claims overcount the true prevalence of dementia, but there are both false positive and negative assessments of disease. The use of Medicare claims to identify dementia results in an overstatement of the increase in Medicare costs that are due to dementia.

PB - 17 VL - 17 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19542620?dopt=Abstract U2 - PMC3697480 U4 - Medicare/dementia/Cost of Illness ER - TY - JOUR T1 - Cancer survivorship, health insurance, and employment transitions among older workers. JF - Inquiry Y1 - 2009 A1 - Tunceli, Kaan A1 - Pamela F. Short A1 - John R. Moran A1 - Tunceli, Ozgur KW - Career Mobility KW - Cohort Studies KW - Female KW - Health Benefit Plans, Employee KW - Health Insurance Portability and Accountability Act KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Neoplasms KW - Retirement KW - Survivors KW - United States AB -

This study examined the effect of job-related health insurance on employment transitions (labor force exits, reductions in hours, and job changes) of older working cancer survivors. Using multivariate models, we compared longitudinal data for the period 1997-2002 from the Penn State Cancer Survivor Study to similar data for workers with no cancer history in the Health and Retirement Study, who were also ages 55 to 64 at follow-up. The interaction of cancer survivorship with health insurance at diagnosis was negative and significant in predicting labor force exits, job changes, and transitions to part-time employment for both genders. The differential effect of job-related health insurance on the labor market dynamics of cancer survivors represents an additional component of the economic and psychosocial burden of cancer on survivors.

PB - 46 VL - 46 IS - 1 N1 - PMID: 19489481 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19489481?dopt=Abstract U3 - 19489481 U4 - Health Insurance/Employment/CANCER/labor market behavior ER - TY - JOUR T1 - Cognitive health among older adults in the United States and in England. JF - BMC Geriatr Y1 - 2009 A1 - Kenneth M. Langa A1 - David J Llewellyn A1 - Iain A Lang A1 - David R Weir A1 - Robert B Wallace A1 - Mohammed U Kabeto A1 - Felicia A Huppert KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Cross-Sectional Studies KW - England KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Neuropsychological tests KW - United States AB -

BACKGROUND: Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries.

METHODS: Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale).

RESULTS: US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment x country interaction).

CONCLUSION: Despite methodological differences in the administration of the surveys in the two countries, US adults aged >/= 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.

PB - 9 VL - 9 N1 - PMID: 19555494 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19555494?dopt=Abstract U2 - PMC2709651 U4 - Cross Cultural Comparison/Cognitive Function/Hypertension/Medicine/ELSA_/cross-national comparison ER - TY - JOUR T1 - Cognitive performance and informant reports in the diagnosis of cognitive impairment and dementia in African Americans and whites. JF - Alzheimers Dement Y1 - 2009 A1 - Guy G Potter A1 - Brenda L Plassman A1 - James R Burke A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - David J Llewellyn A1 - Mary A M Rogers A1 - David C Steffens KW - Activities of Daily Living KW - Age of Onset KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Caregivers KW - Cognition Disorders KW - Cohort Studies KW - Culture KW - Dementia KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Male KW - Neuropsychological tests KW - Observer Variation KW - Population Surveillance KW - Predictive Value of Tests KW - Prevalence KW - Psychiatric Status Rating Scales KW - Psychometrics KW - Registries KW - Sensitivity and Specificity KW - Surveys and Questionnaires KW - White People AB -

BACKGROUND: The diagnosis of cognitive impairment and dementia must reflect an increasingly diverse and aging United States population. This study compared direct testing and informant reports of cognition with clinical diagnoses of cognitive impairment and dementia between African Americans and whites.

METHODS: Participants in the Aging, Demographics, and Memory Study completed in-person dementia evaluations, and were assigned clinical diagnoses (by a consensus panel of dementia experts) of normal; cognitive impairment, not demented (CIND); and dementia. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) total score and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were used to assess cognitive performance and reported cognitive decline.

RESULTS: A higher CERAD total score was associated with lower odds of CIND and dementia, at comparable ratios between African Americans and whites. Higher IQCODE scores were associated with increased odds of dementia in both African Americans and whites. Higher IQCODE scores were associated with increased odds of CIND among whites, but not among African Americans.

CONCLUSIONS: Cultural differences may influence informant reports of prevalent CIND and dementia. Our findings also highlight the need for more comparative research to establish the cultural validity of measures used to diagnose these conditions.

PB - 5 VL - 5 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19896583?dopt=Abstract U2 - PMC2805266 U4 - CERAD/IQCODE/Cognitive decline/Dementia/African American ER - TY - JOUR T1 - Does job loss cause ill health? JF - Health Econ Y1 - 2009 A1 - Salm, Martin KW - Activities of Daily Living KW - Age Factors KW - Cohort Studies KW - Cross-Sectional Studies KW - Employment KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Sex Factors KW - Smoking KW - Socioeconomic factors AB -

This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers' business. I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality.

PB - 18 VL - 18 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19634153?dopt=Abstract U3 - 19634153 U4 - Job Loss/Unemployment/health status ER - TY - JOUR T1 - Is the effect of reported physical activity on disability mediated by cognitive performance in white and african american older adults? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Mihaela A. Popa A1 - Sandra L Reynolds A1 - Brent J. Small KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Cognition Disorders KW - Cohort Studies KW - Disability Evaluation KW - Exercise KW - Female KW - Follow-Up Studies KW - Health Status Disparities KW - Humans KW - Male KW - Motor Activity KW - Neuropsychological tests KW - Socioeconomic factors KW - United States KW - White People AB -

This study examined if reported physical activity has beneficial outcomes on disability through cognitive performance-mediated effects and if these mediation effects are comparable for White and African American elders. Longitudinal data from the Assets and Health Dynamics among the Oldest Old study (N = 4,472) are used to test mediation in multilevel models. During the 7-year follow-up, cognitive performance mediated the effects of reported physical activity on disability in the entire sample and in Whites but not in African Americans. Our results indicate that reported physical activity may delay the disability development through improvement in cognitive performance. Unmeasured education and comorbidity influences may have obscured the mediation effects in African Americans. Reported physical activity plays a key role in the independence of older adults and should be particularly promoted in African Americans and during the entire life course.

PB - 64 VL - 64 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19196688?dopt=Abstract U2 - PMC2654991 U4 - SELF-RATED HEALTH/DISABILITY/DISABILITY/Cognitive Functioning ER - TY - JOUR T1 - The effect of retirement on weight. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Chung, Sukyung A1 - Marisa E Domino A1 - Sally C. Stearns KW - Aged KW - Aging KW - Body Mass Index KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Motor Activity KW - Obesity KW - Overweight KW - Pensions KW - Retirement KW - Social Security KW - Socioeconomic factors KW - United States KW - Weight Gain AB -

OBJECTIVES: People who are close to retirement age show the highest rates of weight gain and obesity. We investigate the effect of retirement on the change in body mass index (BMI) in diverse groups varying by wealth status and occupation type.

METHODS: Six panels of the Health and Retirement Study (1992-2002) on individuals aged 50-71 were used (N = 37,807). We used fixed-effects regression models with instrumental variables method to estimate the causal effect of retirement on change in the BMI.

RESULTS: Retirement leads to modest weight gain, 0.24 BMI on average. Weight gain with retirement was found among people who were already overweight and those with lower wealth retiring from physically demanding occupations. The cumulative effect of aging among people in their 50s, however, outweighs the effect of retirement; the average BMI gain between ages 50 and 60 is 1.30, 5 times the effect of retirement.

CONCLUSIONS: Given the increasing number of people approaching retirement age, the population level impact of the weight gain ascribed to retirement on health outcomes and health care system might be significant. Future research should evaluate programs targeted to older adults who are most likely to gain weight with retirement.

PB - 64B VL - 64 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19357073?dopt=Abstract U3 - 19357073 U4 - RETIREMENT/Obesity/Body Mass Index/Occupations/Wealth ER - TY - JOUR T1 - Financial status, employment, and insurance among older cancer survivors. JF - J Gen Intern Med Y1 - 2009 A1 - Norredam, Marie A1 - Meara, Ellen A1 - Landrum, Mary Beth A1 - Haiden A. Huskamp A1 - Nancy L. Keating KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Data collection KW - Employment KW - Female KW - Financing, Personal KW - Humans KW - Income KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Neoplasms KW - Socioeconomic factors KW - Survivors AB -

BACKGROUND: Few data are available about the socioeconomic impact of cancer for long-term cancer survivors.

OBJECTIVES: To investigate socioeconomic outcomes among older cancer survivors compared to non-cancer patients.

DATA SOURCE: 2002 Health and Retirement Study.

STUDY DESIGN: We studied 964 cancer survivors of > 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans ages >or= 55 years responding to the 2002 Health and Retirement Study.

MEASURES: We compared household income, housing assets, net worth, insurance, employment, and future work expectations.

ANALYSES: Propensity score methods were used to control for baseline differences between cancer survivors and controls.

RESULTS: Female cancer survivors did not differ from non-cancer patients in terms of income, housing assets, net worth, or likelihood of current employment (all P > 0.20); but more were self-employed (25.0% vs. 17.7%; P = 0.03), and fewer were confident that if they lost their job they would find an equally good job in the next few months (38.4% vs. 45.9%; P = 0.03). Among men, cancer survivors and noncancer patients had similar income and housing assets (both P >or= 0.10) but differed somewhat in net worth (P = 0.04). Male cancer survivors were less likely than other men to be currently employed (25.2% vs. 29.7%) and more likely to be retired (66.9% vs. 62.2%), although the P value did not reach statistical significance (P = 0.06). Men were also less optimistic about finding an equally good job in the next few months if they lost their current job (33.5% vs. 46.9%), although this result was not significant (P = 0.11).

CONCLUSIONS: Despite generally similar socioeconomic outcomes for cancer survivors and noncancer patients ages >or=55 years, a better understanding of employment experience and pessimism regarding work prospects may help to shape policies to benefit cancer survivors.

PB - 24 VL - 24 Suppl 2 IS - Suppl 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19838847?dopt=Abstract U2 - PMC2763157 U4 - CANCER/financial resources/insurance/socioeconomic status ER - TY - JOUR T1 - The impact of occupation on self-rated health: cross-sectional and longitudinal evidence from the health and retirement survey. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Ralitza Gueorguieva A1 - Jody L Sindelar A1 - Tracy Falba A1 - Jason M. Fletcher A1 - Patricia S Keenan A1 - Wu, Ran A1 - William T Gallo KW - Aged KW - Attitude to Health KW - Cohort Studies KW - Cross-Sectional Studies KW - Educational Status KW - Female KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - Occupations KW - Odds Ratio KW - Retirement KW - Social Class KW - Socioeconomic factors KW - United States AB -

BACKGROUND: The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals.

METHODS: We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working.

RESULTS: Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout.

CONCLUSIONS: Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

PB - 64 VL - 64 IS - 1 N1 - PMID 19196689 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19196689?dopt=Abstract U2 - PMC2654983 U4 - SELF-RATED HEALTH/Occupations ER - TY - JOUR T1 - Level and change in cognitive test scores predict risk of first stroke. JF - J Am Geriatr Soc Y1 - 2009 A1 - Triveni DeFries A1 - Mauricio Avendano A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Cohort Studies KW - Dementia, Vascular KW - Female KW - Follow-Up Studies KW - Humans KW - Interviews as Topic KW - Kaplan-Meier Estimate KW - Male KW - Mental Status Schedule KW - Middle Aged KW - Predictive Value of Tests KW - Psychometrics KW - Risk KW - Stroke KW - United States AB -

OBJECTIVES: To determine whether cognitive test scores and cognitive decline predict incidence of first diagnosed stroke.

DESIGN: Stroke-free Health and Retirement Study participants were followed on average 7.6 years for self- or proxy-reported first stroke (1,483 events). Predictors included baseline performance on a modified Telephone Interview for Cognitive Status (Mental Status) and Word Recall test and decline between baseline and second assessment in either measure. Hazard ratios (HRs) were estimated using Cox proportional hazards models for the whole sample and stratified according to five major cardiovascular risk factors.

SETTING: National cohort study of noninstitutionalized adults with a mean baseline age of 64+/-9.9.

PARTICIPANTS: Health and Retirement Study participants (n=19,699) aged 50 and older.

RESULTS: Word Recall (HR for 1 standard deviation difference=0.92, 95% confidence interval (CI)=0.86-0.97)) and Mental Status (HR=0.89, 95% CI=0.84-0.95) predicted incident stroke. Mental Status predicted stroke risk in those with (HR=0.93, 95%=0.87-0.99) and without (HR=0.81, 95% CI=0.72-.91) one or more vascular risk factors. Word Recall declines predicted a 16% elevation in subsequent stroke risk (95% CI=1.01-1.34). Declines in Mental Status predicted a 37% elevation in stroke risk (95% CI=1.11-1.70).

CONCLUSION: Cognitive test scores predict future stroke risk, independent of other major vascular risk factors.

PB - 57 VL - 57 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19175440?dopt=Abstract U3 - 19175440 U4 - Stroke/Cognitive Function ER - TY - JOUR T1 - Marital trajectories and mortality among US adults. JF - Am J Epidemiol Y1 - 2009 A1 - Matthew E Dupre A1 - Audrey N Beck A1 - Sarah O. Meadows KW - Age Factors KW - Cohort Studies KW - Female KW - Health Behavior KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Mortality KW - Retirement KW - Retrospective Studies KW - Risk Factors KW - Sex Factors KW - Time Factors KW - United States AB -

More than a century of empirical evidence links marital status to mortality. However, the hazards of dying associated with long-term marital trajectories and contributing risk factors are largely unknown. The authors used 1992-2006 prospective data from a cohort of US adults to investigate the impact of current marital status, marriage timing, divorce and widow transitions, and marital durations on mortality. Multivariate hazard ratios were significantly higher for adults currently divorced and widowed, married at young ages (< or =18 years), who accumulated divorce and widow transitions (among women), and who were divorced for 1-4 years. Results also showed significantly lower risks of mortality for men married after age 25 years compared with on time (ages 19-25 years) and among women experiencing > or =10 years of divorce and > or =5 years of widowhood relative to those without exposure to these statuses. For both sexes, accumulation of marriage duration was the most robust predictor of survival. Results from risk-adjusted models indicated that socioeconomic resources, health behaviors, and health status attenuated the associations in different ways for men and women. The study demonstrates that traditional measures oversimplify the relation between marital status and mortality and that sex differences are related to a nexus of marital experiences and associated health risks.

PB - 170 VL - 170 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19584130?dopt=Abstract U2 - PMC2732990 U4 - Marital Status/Mortality/Marital History/GENDER-DIFFERENCES ER - TY - JOUR T1 - Prevalence of depression among older Americans: the Aging, Demographics and Memory Study. JF - Int Psychogeriatr Y1 - 2009 A1 - David C Steffens A1 - Gwenith G Fisher A1 - Kenneth M. Langa A1 - Guy G Potter A1 - Brenda L Plassman KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Black People KW - Cohort Studies KW - Comorbidity KW - Cross-Sectional Studies KW - Depressive Disorder KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Male KW - Neuropsychological tests KW - Personality Assessment KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

BACKGROUND: Previous studies have attempted to provide estimates of depression prevalence in older adults. The Aging, Demographics and Memory Study (ADAMS) is a population-representative study that included a depression assessment, providing an opportunity to estimate the prevalence of depression in late life in the U.S.A.

METHODS: The ADAMS sample was drawn from the larger Health and Retirement Study. A total of 851 of 856 ADAMS participants aged 71 and older had available depression data. Depression was measured using the Composite International Diagnostic Interview - Short Form (CIDI-SF) and the informant depression section of the Neuropsychiatric Inventory (NPI). We estimated the national prevalence of depression, stratified by age, race, sex, and cognitive status. Logistic regression analyses were performed to examine the association of depression and previously reported risk factors for the condition.

RESULTS: When combining symptoms of major or minor depression with reported treatment for depression, we found an overall depression prevalence of 11.19%. Prevalence was similar for men (10.19%) and women (11.44%). Whites and Hispanics had nearly three times the prevalence of depression found in African-Americans. Dementia diagnosis and pain severity were associated with increased depression prevalence, while black race was associated with lower rates of depression.

CONCLUSIONS: The finding of similar prevalence estimates for depression in men and women was not consistent with prior research that has shown a female predominance. Given the population-representativeness of our sample, similar depression rates between the sexes in ADAMS may result from racial, ethnic and socioeconomic diversity.

PB - 21 VL - 21 IS - 5 N1 - PMID: 19519984 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19519984?dopt=Abstract U2 - PMC2747379 U4 - Depression/PREVALENCE/Elderly ER - TY - JOUR T1 - Recent hospitalization and the risk of hip fracture among older Americans. JF - J Gerontol A Biol Sci Med Sci Y1 - 2009 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - Maksym Obrizan A1 - Elizabeth A Cook A1 - Kara B Wright A1 - John F Geweke A1 - Elizabeth A Chrischilles A1 - Claire E Pavlik A1 - Robert L. Ohsfeldt A1 - Michael P Jones A1 - Kelly K Richardson A1 - Gary E Rosenthal A1 - Robert B Wallace KW - Accidental Falls KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Aging KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Hip Fractures KW - Hospitalization KW - Humans KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Probability KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Sex Distribution KW - Survival Analysis KW - United States AB -

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

PB - 64 VL - 64 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19196641?dopt=Abstract U2 - PMC2655029 U4 - Accidental Falls/Aged, 80 and over/Geriatric Assessment/Hip Fractures/Hospitalization/Prospective Studies/Risk Factors/Sex Distribution/Survival Analysis ER - TY - JOUR T1 - Retirement and physical activity: analyses by occupation and wealth. JF - Am J Prev Med Y1 - 2009 A1 - Chung, Sukyung A1 - Marisa E Domino A1 - Sally C. Stearns A1 - Barry M Popkin KW - Cohort Studies KW - Female KW - Humans KW - Income KW - Life Style KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Motor Activity KW - Occupations KW - Retirement KW - United States AB -

BACKGROUND: Older adults close to retirement age show the lowest level of physical activity. Changes in lifestyle with retirement may alter physical activity levels. This study investigated whether retirement changes physical activity and how the effect differs by occupation type and wealth level.

METHODS: This longitudinal study used the Health and Retirement Study (1996-2002), U.S. population-based data. Analyses were conducted in 2007 and 2008. Physical activity was measured by a composite indicator of participation in either work-related or leisure-time physical activity. Fixed-effects regression models were used to account for confounders and unobserved heterogeneity. The dependent variable was a composite indicator of participation in regular physical activity either at work or during nonworking hours.

RESULTS: Physical activity decreased with retirement from a physically demanding job but increased with retirement from a sedentary job. Occupation type interacted with wealth level, with the negative impact on physical activity of retirement exacerbated by lack of wealth and the positive effect of retirement on physical activity enhanced by wealth.

CONCLUSIONS: Substantial differences in the effect of retirement on physical activity occurred across subgroups. As the number of people approaching retirement age rapidly increases, findings suggest that a growing segment of the nation's population may not sustain an adequate level of physical activity.

PB - 36 VL - 36 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19269129?dopt=Abstract U3 - 19269129 U4 - RETIREMENT/Physical Activity ER - TY - JOUR T1 - Risk factors associated with injury attributable to falling among elderly population with history of stroke. JF - Stroke Y1 - 2009 A1 - Afshin A Divani A1 - Vazquez, Gabriela A1 - Anna M Barrett A1 - Asadollahi, Marjan A1 - Andreas R Luft KW - Accidental Falls KW - Aged KW - Aged, 80 and over KW - Aging KW - Causality KW - Cohort Studies KW - Comorbidity KW - disease progression KW - Female KW - Health Status KW - Humans KW - Male KW - Marital Status KW - Mental Disorders KW - Movement Disorders KW - Prevalence KW - Risk Factors KW - Risk Reduction Behavior KW - Sex Distribution KW - Stroke KW - Urinary incontinence KW - Wounds and Injuries AB -

BACKGROUND AND PURPOSE: Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life.

METHODS: We used 5 biennial waves (1998-2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model.

RESULTS: We identified 1174 stroke survivors (mean age+/-SD, 74.4+/-7.2 years; 53% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46%, 15%, and 2.1% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of > or = 3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of > or = 3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2).

CONCLUSIONS: This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.

PB - 40 VL - 40 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19628798?dopt=Abstract U2 - PMC2929376 U4 - Stroke/Falls/Elderly/risk factors ER - TY - JOUR T1 - Early motherhood and mental health in midlife: a study of British and American cohorts. JF - Aging Ment Health Y1 - 2008 A1 - John C Henretta A1 - Emily M D Grundy A1 - Lucy C Okell A1 - Michael E J Wadsworth KW - Adolescent KW - Birth Order KW - Cohort Studies KW - England KW - Female KW - Humans KW - Interviews as Topic KW - Maternal Age KW - Mental Health KW - Middle Aged KW - Mothers KW - Pregnancy KW - Pregnancy in Adolescence KW - United States AB -

OBJECTIVES: Examine the relationship between early age at first birth and mental health among women in their fifties.

METHODS: Analysis of data on women from a British 1946 birth cohort study and the U.S. Health and Retirement Study birth cohort of 1931-1941.

RESULTS: In both samples a first birth before 21 years, compared to a later first birth, is associated with poorer mental health. The association between early first birth and poorer mental health persists in the British study even after controlling for early socioeconomic status, midlife socioeconomic status and midlife health. In the U.S. sample, the association becomes non-significant after controlling for educational attainment.

CONCLUSIONS: Early age at first birth is associated with poorer mental health among women in their fifties in both studies, though the pattern of associations differs.

PB - 12 VL - 12 IS - 5 N1 - PMID: 18855176 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18855176?dopt=Abstract U2 - PMC3191851 U4 - Women/Mental health/CHILDREN ER - TY - JOUR T1 - Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans. JF - Psychosom Med Y1 - 2008 A1 - Frances Margaret Yang A1 - Richard N Jones KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cohort Studies KW - Comorbidity KW - Confounding Factors, Epidemiologic KW - Culture KW - depression KW - Diabetes Mellitus KW - Educational Status KW - ethnicity KW - Factor Analysis, Statistical KW - Female KW - Heart Diseases KW - Humans KW - Hypertension KW - Interviews as Topic KW - Lung Diseases KW - Male KW - Self-Assessment KW - Sex Factors KW - Stroke KW - United States AB -

OBJECTIVE: To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD: Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS: Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS: The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

PB - 70 VL - 70 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18981269?dopt=Abstract U2 - PMC2746732 U4 - Chronic Disease/Demographics/Depressive Symptoms/Psychology ER - TY - JOUR T1 - Productive activities and psychological well-being among older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Hao, Yanni KW - Activities of Daily Living KW - Aged KW - Cohort Studies KW - depression KW - Employment KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Models, Psychological KW - Psychological Theory KW - Psychomotor Performance KW - Quality of Life KW - Social Environment KW - Volunteers AB -

OBJECTIVES: The purpose of this study was to test whether paid work and formal volunteering reduce the rate of mental health decline in later life.

METHODS: Using four waves of Health and Retirement Study data collected from a sample of 7,830 individuals aged 55 to 66, I estimated growth curve models to assess the effects of productive activities on mental health trajectories. The analytical strategy took into account selection processes when examining the beneficial effects of activities. The analyses also formally attended to the sample attrition problem inherent in longitudinal studies.

RESULTS: The results indicated that activity participants generally had better mental health at the beginning of the study. Full-time employment and low-level volunteering had independent protective effects against decline in psychological well-being. Joint participants of both productive activities enjoyed a slower rate of mental health decline than single-activity participants.

DISCUSSION: The results are consistent with activity theory and further confirm the role accumulation perspective. The finding that full-time work combined with low-level volunteering is protective of mental health reveals the complementary effect of volunteering to formal employment. Methodological and theoretical implications are discussed.

PB - 63B VL - 63 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18441271?dopt=Abstract U3 - 18441271 U4 - Work/Work, volunteer/Mental health ER - TY - JOUR T1 - Stroke disparities in older Americans: is wealth a more powerful indicator of risk than income and education? JF - Stroke Y1 - 2008 A1 - Mauricio Avendano A1 - M. Maria Glymour KW - Age Distribution KW - Age Factors KW - Aged KW - Cohort Studies KW - Educational Status KW - Female KW - Humans KW - Incidence KW - Income KW - Life Style KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Factors KW - Socioeconomic factors KW - Stroke KW - United States AB -

BACKGROUND AND PURPOSE: This study examines the independent effect of wealth, income, and education on stroke and how these disparities evolve throughout middle and old age in a representative cohort of older Americans.

METHODS: Stroke-free participants in the Health and Retirement Study (n=19,565) were followed for an average of 8.5 years. Total wealth, income, and education assessed at baseline were used in Cox proportional hazards models to predict time to stroke. Separate models were estimated for 3 age-strata (50 to 64, 65 to 74, and >or=75), and incorporating risk factor measures (smoking, physical activity, body mass index, hypertension, diabetes, and heart disease).

RESULTS: 1542 subjects developed incident stroke. Higher education predicted reduced stroke risk at ages 50 to 64, but not after adjustment for wealth and income. Wealth and income were independent risk factors for stroke at ages 50 to 64. Adjusted hazard ratios comparing the lowest decile with the 75th-90th percentiles were 2.3 (95% CI 1.6, 3.4) for wealth and 1.8 (95% CI 1.3, 2.6) for income. Risk factor adjustment attenuated these effects by 30% to 50%, but coefficients for both wealth (HR=1.7, 95% CI 1.2, 2.5) and income (HR=1.6, 95% CI 1.2, 2.3) remained significant. Wealth, income, and education did not consistently predict stroke beyond age 65.

CONCLUSIONS: Wealth and income are independent predictors of stroke at ages 50 to 64 but do not predict stroke among the elderly. This age patterning might reflect buffering of the negative effect of low socioeconomic status by improved access to social and health care programs at old ages, but may also be an artifact of selective survival.

PB - 39 VL - 39 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18436891?dopt=Abstract U2 - PMC3079499 U4 - Stroke/Socioeconomic Factors/Education/income ER - TY - JOUR T1 - Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and self-management? JF - J Gen Intern Med Y1 - 2007 A1 - Eve A Kerr A1 - Michele M Heisler A1 - Sarah L. Krein A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - David R Weir A1 - John D Piette KW - Aged KW - Attitude to Health KW - Cohort Studies KW - Comorbidity KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Female KW - Health Priorities KW - Heart Failure KW - Humans KW - Male KW - Middle Aged KW - Self Care KW - Severity of Illness Index KW - United States AB -

BACKGROUND: The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40% have at least three.

OBJECTIVE: We sought to understand how the number, type, and severity of comorbidities influence diabetes patients' self-management and treatment priorities.

DESIGN: Cross-sectional observation study.

PATIENTS: A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.

MEASUREMENTS: We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).

RESULTS: 40% of respondents had at least 1 microvascular comorbidity, 79% at least 1 macrovascular comorbidity, and 61% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.

CONCLUSIONS: The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients' self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.

PB - 22 VL - 22 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17647065?dopt=Abstract U2 - PMC2219819 U4 - diabetes/COMORBIDITY/Chronic Illness ER - TY - JOUR T1 - Early childbearing, marital status, and women's health and mortality after age 50. JF - J Health Soc Behav Y1 - 2007 A1 - John C Henretta KW - Adolescent KW - Cohort Studies KW - Female KW - Humans KW - Marital Status KW - Maternal Age KW - Middle Aged KW - Mortality KW - Parity KW - Pregnancy KW - Pregnancy in Adolescence KW - Prevalence KW - Proportional Hazards Models KW - Social Class KW - United States KW - Women's Health AB -

This article examines the relationship between a woman's childbearing history and her later health and mortality, with primary focus on whether the association between them is due to early and later socioeconomic status. Data are drawn from the Health and Retirement Study birth cohort of 1931-1941. Results indicate that, conditional on reaching midlife and controlling for early and later socioeconomic status, a first birth before age 20 is associated with a higher hazard of dying. In addition, having an early birth is associated with a higher prevalence of reported heart disease, lung disease, and cancer in 1994. Being unmarried at the time of the first birth is associated with earlier mortality, but this association disappears when midlife socioeconomic status is controlled. The number of children ever born does not significantly affect mortality but is associated with prevalence of diabetes.

PB - 48 VL - 48 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17982867?dopt=Abstract U4 - womens health/Mortality/CHILDREN ER - TY - JOUR T1 - Educational disparities in the prevalence and consequence of physical vulnerability. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Daniel O. Clark A1 - Timothy E. Stump A1 - Douglas K Miller A1 - Long, J. Scott KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cohort Studies KW - Cross-Sectional Studies KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Male KW - Mobility Limitation KW - Risk Factors KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States.

METHODS: Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index.

RESULTS: In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53%) of these adults had less than 12 years of education.

DISCUSSION: In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507595?dopt=Abstract U4 - Mortality/Physical Vulnerability/Education/ADULT HEALTH/DISABILITY/DISABILITY ER - TY - JOUR T1 - Longitudinal variable selection by cross-validation in the case of many covariates. JF - Stat Med Y1 - 2007 A1 - Cantoni, E. A1 - Field, C. A1 - Mills Fleming, J. A1 - Ronchetti, E. KW - Cohort Studies KW - Computer Simulation KW - Female KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Markov chains KW - Monte Carlo Method KW - Smoking KW - Socioeconomic factors AB -

Longitudinal models are commonly used for studying data collected on individuals repeatedly through time. While there are now a variety of such models available (marginal models, mixed effects models, etc.), far fewer options exist for the closely related issue of variable selection. In addition, longitudinal data typically derive from medical or other large-scale studies where often large numbers of potential explanatory variables and hence even larger numbers of candidate models must be considered. Cross-validation is a popular method for variable selection based on the predictive ability of the model. Here, we propose a cross-validation Markov chain Monte Carlo procedure as a general variable selection tool which avoids the need to visit all candidate models. Inclusion of a 'one-standard error' rule provides users with a collection of good models as is often desired. We demonstrate the effectiveness of our procedure both in a simulation setting and in a real application.

PB - 26 VL - 26 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16625521?dopt=Abstract U4 - Methodology/LONGITUDINAL DATA ER - TY - JOUR T1 - Prevalence of dementia in the United States: the aging, demographics, and memory study. JF - Neuroepidemiology Y1 - 2007 A1 - Brenda L Plassman A1 - Kenneth M. Langa A1 - Gwenith G Fisher A1 - Steven G Heeringa A1 - David R Weir A1 - Mary Beth Ofstedal A1 - James R Burke A1 - Michael D Hurd A1 - Guy G Potter A1 - Willard L Rodgers A1 - David C Steffens A1 - Robert J. Willis A1 - Robert B Wallace KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Dementia KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Prevalence KW - Sex Distribution KW - United States AB -

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.

PB - 29 VL - 29 IS - 1-2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17975326?dopt=Abstract U4 - aging/Dementia/Epidemiology ER - TY - JOUR T1 - Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Muramatsu, Naoko A1 - yin, Hongjun A1 - Richard T. Campbell A1 - Ruby L Hoyem A1 - Martha A. Jacob A1 - Christopher Ross KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cohort Studies KW - Cost Savings KW - Cost-Benefit Analysis KW - Female KW - Financing, Government KW - Health Expenditures KW - Home Care Services KW - Homes for the Aged KW - Humans KW - Insurance Coverage KW - Long-term Care KW - Male KW - Medicaid KW - Medicare KW - Nursing homes KW - Patient Admission KW - Patient Readmission KW - Risk Assessment KW - Risk Factors KW - State Health Plans KW - United States AB -

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%.

DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507592?dopt=Abstract U4 - Home Care Services/Nursing Homes/Health Policy/Elderly ER - TY - JOUR T1 - Weight and depressive symptoms in older adults: direction of influence? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Valerie L Forman-Hoffman A1 - Jon W. Yankey A1 - Stephen L Hillis A1 - Robert B Wallace KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Cohort Studies KW - Comorbidity KW - Depressive Disorder KW - Female KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Odds Ratio KW - Prospective Studies KW - Sex Factors KW - Statistics as Topic KW - United States KW - Weight Gain KW - Weight Loss AB -

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.

PB - 62 VL - 62 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17284566?dopt=Abstract U4 - Weight/Depressive Symptoms ER - TY - JOUR T1 - Changes in health for the uninsured after reaching age-eligibility for Medicare. JF - J Gen Intern Med Y1 - 2006 A1 - David W. Baker A1 - Joseph Feinglass A1 - Durazo-Arvizu, Ramon A1 - Whitney P. Witt A1 - Joseph J Sudano A1 - Jason A. Thompson KW - Age Factors KW - Aged KW - Cohort Studies KW - Eligibility Determination KW - Female KW - Health Status KW - Humans KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Prospective Studies KW - United States AB -

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.

PB - 21 VL - 21 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16879704?dopt=Abstract ER - TY - JOUR T1 - Explaining US racial/ethnic disparities in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance. JF - Soc Sci Med Y1 - 2006 A1 - Joseph J Sudano A1 - David W. Baker KW - Black or African American KW - Cohort Studies KW - Female KW - Health Behavior KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Insurance, Health KW - Logistic Models KW - Male KW - Medically Uninsured KW - Middle Aged KW - Mortality KW - Poverty KW - Risk Assessment KW - Social Class KW - Sociology, Medical KW - United States KW - White People AB -

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.

PB - 62 VL - 62 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16055252?dopt=Abstract U4 - Racial disparities/Health Behaviors/Health Insurance/Hispanics ER - TY - JOUR T1 - Health insurance coverage during the years preceding medicare eligibility. JF - Arch Intern Med Y1 - 2005 A1 - David W. Baker A1 - Joseph J Sudano KW - Age Factors KW - Black or African American KW - Cohort Studies KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Male KW - Medically Uninsured KW - Middle Aged KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

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.

PB - 165 VL - 165 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15824296?dopt=Abstract U4 - Age Factors/Cohort Studies/Female/Health Status/African-Americans/Health Insurance/Health Insurance Coverage/Sex Factors/Socioeconomic Factors/United States ER - TY - JOUR T1 - The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Ye Luo A1 - Linda J. Waite KW - Aged KW - Aging KW - Black People KW - Child KW - Cognition KW - Cohort Studies KW - Data collection KW - Education KW - ethnicity KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Income KW - Male KW - Mental Health KW - Middle Aged KW - Quality of Life KW - Retirement KW - Sex Factors KW - Social Class KW - White People AB -

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.

PB - 60B VL - 60 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15746030?dopt=Abstract U2 - PMC2505177 U4 - Childhood/Socioeconomic Status/Well Being ER - TY - JOUR T1 - The impact of own and spouse's urinary incontinence on depressive symptoms. JF - Soc Sci Med Y1 - 2005 A1 - Fultz, Nancy H. A1 - Kristi Rahrig Jenkins A1 - Truls Ostbye A1 - Donald H. Taylor Jr. A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Aged KW - Caregivers KW - Cohort Studies KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States KW - Urinary incontinence AB -

This study investigated the impact of own and spouse's urinary incontinence on depressive symptoms. Attention was paid to the possibility that gender and caregiving might be important factors in understanding significant effects. We used negative binomial regression to analyze survey data for 9974 middle-aged and older respondents to the Health and Retirement Study in the USA. Results supported the hypothesis that the respondents' own urinary incontinence was associated with depressive symptoms (unadj. IRR = 1.73, 95% CIs = 1.53, 1.95 for men; unadj. IRR = 1.50, 95% CIs = 1.38, 1.63 for women). Controlling sociodemographic and health variables reduced this relationship, but it remained statistically significant for both men and women. Having an incontinent wife put men at greater risk for depressive symptoms (unadj. IRR = 1.13, 95% CIs = 1.02, 1.25), although this relation became nonsignificant with the addition of control variables. No relation between women's depressive symptoms and husbands' (in)continence status was found. Caregiving was not a significant variable in the adjusted analyses, but spouses' depressive symptoms emerged as a significant predictor of the respondents' own depressive symptoms. Health care providers must be sensitive to the emotional impact of urinary incontinence. Our findings also suggest the importance of considering the patient's mental health within a wider context, particularly including the physical and mental health of the patient's spouse.

PB - 60 VL - 60 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15814179?dopt=Abstract U4 - Depression Symptoms/Incontinence/Health Services/Mental Health ER - TY - JOUR T1 - Physical and mental health status of older long-term cancer survivors. JF - J Am Geriatr Soc Y1 - 2005 A1 - Nancy L. Keating A1 - Norredam, Marie A1 - Landrum, Mary Beth A1 - Haiden A. Huskamp A1 - Meara, Ellen KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Chronic disease KW - Cohort Studies KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Mental Health KW - Middle Aged KW - Neoplasms KW - Survivors KW - United States AB -

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.

PB - 53 VL - 53 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16398900?dopt=Abstract U4 - Survivors/Mental Health/Health Physical ER - TY - JOUR T1 - Health insurance coverage and mortality among the near-elderly. JF - Health Aff (Millwood) Y1 - 2004 A1 - J. Michael McWilliams A1 - Alan M. Zaslavsky A1 - Meara, Ellen A1 - John Z. Ayanian KW - Cohort Studies KW - Female KW - health policy KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Middle Aged KW - Mortality KW - United States AB -

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.

PB - 23 VL - 23 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15318584?dopt=Abstract U4 - Health Insurance Coverage/Elderly/Mortality ER - TY - JOUR T1 - The impact of diabetes on workforce participation: results from a national household sample. JF - Health Serv Res Y1 - 2004 A1 - Sandeep Vijan A1 - Rodney A. Hayward A1 - Kenneth M. Langa KW - Chronic disease KW - Cohort Studies KW - Cost of Illness KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Disabled Persons KW - Efficiency KW - Employment KW - Female KW - Health Services Research KW - Health Status Indicators KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

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.

PB - 39 VL - 39 IS - 6 Pt 1 N1 - Social Security Administration/Michigan Retirement Research Center Grant UM01-11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15533180?dopt=Abstract U4 - diabetes/Labor Supply ER - TY - JOUR T1 - Physical activity and mortality across cardiovascular disease risk groups. JF - Med Sci Sports Exerc Y1 - 2004 A1 - Richardson, Caroline R. A1 - Kriska, Andrea M. A1 - Lantz, Paula M. A1 - Rodney A. Hayward KW - Cardiovascular Diseases KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - Humans KW - Life Style KW - Logistic Models KW - Male KW - Middle Aged KW - Motor Activity KW - Multivariate Analysis KW - Odds Ratio KW - Prospective Studies KW - Risk Assessment KW - Risk Factors KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

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.

VL - 36 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15514508?dopt=Abstract U4 - Exercise/Mortality/Socioeconomic Status ER - TY - JOUR T1 - Quality of preventive clinical services among caregivers in the health and retirement study. JF - J Gen Intern Med Y1 - 2004 A1 - Kim, Catherine A1 - Mohammed U Kabeto A1 - Robert B Wallace A1 - Kenneth M. Langa KW - Aged KW - Caregivers KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Health Care Surveys KW - Humans KW - Male KW - Middle Aged KW - Patient Acceptance of Health Care KW - Preventive Health Services KW - Quality of Health Care KW - Time Factors KW - United States AB -

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.

PB - 19 VL - 19 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15242474?dopt=Abstract U4 - Caregiving/Spouses/Health Care Utilization/Caregivers/Health Services ER - TY - JOUR T1 - Racial disparities in joint replacement use among older adults. JF - Med Care Y1 - 2003 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Song, Jing A1 - Rowland W Chang KW - Aged KW - Aged, 80 and over KW - Arthroplasty, Replacement KW - Black or African American KW - Cohort Studies KW - Data Interpretation, Statistical KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Health Status KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Interviews as Topic KW - Osteoarthritis KW - Sampling Studies KW - United States KW - White People AB -

BACKGROUND: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN: Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING: National probability sample of US community-dwelling older adults.

PATIENT POPULATION: AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS: The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS: Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95).

CONCLUSIONS: These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

PB - 41 VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12555056?dopt=Abstract U4 - Arthritis/Health Care/Racial disparities ER - TY - JOUR T1 - Racial/ethnic differences in rates of depression among preretirement adults. JF - Am J Public Health Y1 - 2003 A1 - Dorothy D Dunlop A1 - Song, Jing A1 - Lyons, J.S. A1 - Larry M Manheim A1 - Rowland W Chang KW - Aged KW - Black or African American KW - Cohort Studies KW - Comorbidity KW - Demography KW - Depressive Disorder, Major KW - Diagnostic and Statistical Manual of Mental Disorders KW - Female KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Minority Groups KW - Probability KW - Risk Factors KW - Socioeconomic factors KW - United States KW - White People AB -

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.

PB - 93 VL - 93 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14600071?dopt=Abstract U4 - Racial Differences/Depression ER - TY - JOUR T1 - Breast cancer survival, work, and earnings. JF - J Health Econ Y1 - 2002 A1 - Cathy J. Bradley A1 - Bednarek, Heather A1 - David Neumark KW - Breast Neoplasms KW - Cohort Studies KW - Diagnostic Tests, Routine KW - Efficiency KW - Employment KW - Female KW - Humans KW - Longitudinal Studies KW - Mammography KW - Middle Aged KW - Models, Econometric KW - Probability KW - Research Design KW - Retirement KW - Salaries and Fringe Benefits KW - Social Security KW - Survivors KW - United States KW - Women, Working AB -

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.

PB - 21 VL - 21 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12349881?dopt=Abstract U4 - Breast Neoplasms/Economics/Mortality/Radiography/Cohort Studies/Diagnostic Tests, Routine/Efficiency/Employment/Economics/Statistics and Numerical Data/Female/Human/Longitudinal Studies/Mammography/Utilization/Middle Age/Models, Econometric/Probability/Research Design/Retirement/Salaries and Fringe Benefits/Statistics and Numerical Data/Social Security/Support, U.S. Government--PHS/Survivors/Statistics and Numerical Data/United States/Epidemiology/Women, Working/Statistics and Numerical Data ER - TY - JOUR T1 - Caregiver report of hallucinations and paranoid delusions in elders aged 70 or older. JF - Int Psychogeriatr Y1 - 2001 A1 - Carolyn L. Turvey A1 - Schultz, Susan K. A1 - Arndt, Stephan A1 - Ellingrod, Vicki A1 - Robert B Wallace A1 - A. Regula Herzog KW - Aged KW - Aged, 80 and over KW - Aging KW - Caregivers KW - Cognition Disorders KW - Cohort Studies KW - Delusions KW - depression KW - Female KW - Follow-Up Studies KW - Hallucinations KW - Humans KW - Male KW - Marital Status KW - Paranoid Disorders KW - Risk Factors KW - Stroke KW - Surveys and Questionnaires KW - United States KW - Vision Disorders AB -

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.

PB - 13 VL - 13 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11495398?dopt=Abstract U4 - Caregivers/Dementia/Elderly ER - TY - JOUR T1 - Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults. JF - J Clin Epidemiol Y1 - 2001 A1 - Oldrige, Neil B. A1 - Timothy E. Stump A1 - Nothwehr, F. A1 - Daniel O. Clark KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Cohort Studies KW - Diabetes Complications KW - Diabetes Mellitus KW - Female KW - Health Services for the Aged KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Obesity KW - Odds Ratio KW - Outcome Assessment, Health Care KW - Prevalence KW - Prospective Studies KW - Quality of Life KW - United States AB -

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.

VL - 54 IS - 9 ER - TY - JOUR T1 - Self-restriction of medications due to cost in seniors without prescription coverage. JF - J Gen Intern Med Y1 - 2001 A1 - Michael A Steinman A1 - Laura Sands A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Cross-Sectional Studies KW - Female KW - Humans KW - Insurance, Pharmaceutical Services KW - Male KW - Prescription Fees KW - Risk Factors KW - Socioeconomic factors KW - Treatment Refusal KW - United States AB -

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.

PB - 16 VL - 16 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11903757?dopt=Abstract U4 - Aged, 80 and Over/Cohort Studies/Cross Sectional Studies/Female/Insurance, Pharmaceutical Services/Prescription Fees/Risk Factors/Socioeconomic Factors/Support, U.S. Government--non PHS/Support, U.S. Government--PHS/Treatment Refusal ER - TY - JOUR T1 - Socioeconomic status and the prevalence of health problems among married couples in late midlife. JF - Am J Public Health Y1 - 2001 A1 - Sven E. Wilson KW - Activities of Daily Living KW - Cohort Studies KW - Female KW - Health Status KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Odds Ratio KW - Risk Factors KW - Socioeconomic factors KW - Spouses KW - United States AB -

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.

PB - 91 VL - 91 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11189807?dopt=Abstract U4 - Cohort Studies/Gender/Health Status/Marital Status/Middle Age/Odds Ratio/Risk Factors/Socioeconomic Status/Spouses/Support, Non U.S. Government/Support, U.S. Government--PHS ER - TY - JOUR T1 - Conjugal loss and syndromal depression in a sample of elders aged 70 years or older. JF - Am J Psychiatry Y1 - 1999 A1 - Carolyn L. Turvey A1 - Carney, C. A1 - Arndt, Stephan A1 - Robert B Wallace A1 - A. Regula Herzog KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Bereavement KW - Cohort Studies KW - depression KW - Depressive Disorder KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Marital Status KW - Odds Ratio KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Sex Factors KW - Widowhood AB -

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.

PB - 156 VL - 156 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10518172?dopt=Abstract U4 - Age Factors/Aged, 80 and Over/Bereavement/Cohort Studies/Depression/Depressive Disorders/Logistic Models/Longitudinal Studies/Marital Status/Odds Ratio/Psychiatric Status Rating Scales/Risk Factors/Sex Factors/Support, U.S. Government--PHS/Widowhood ER - TY - JOUR T1 - Occupational injuries among older workers with visual, auditory, and other impairments. A validation study. JF - J Occup Environ Med Y1 - 1998 A1 - Zwerling, Craig A1 - Paul S. Whitten A1 - Charles S. Davis A1 - Nancy L. Sprince KW - Accidents, Occupational KW - Aged KW - Cohort Studies KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Persons With Hearing Impairments KW - Risk Factors KW - Visually Impaired Persons AB -

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.

PB - 40 VL - 40 UR - https://pubmed.ncbi.nlm.nih.gov/9729756/ IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9729756?dopt=Abstract U4 - Accidents, Occupational/Cohort Studies/Disabled Persons/Gender/Hearing Impaired Persons/Logistic Models/Middle Age/Risk Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Visually Impaired Persons ER - TY - JOUR T1 - Demographic and economic correlates of health in old age. JF - Demography Y1 - 1997 A1 - James P Smith A1 - Raynard Kington KW - Activities of Daily Living KW - Aged KW - Cohort Studies KW - Demography KW - Disabled Persons KW - ethnicity KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Models, Econometric KW - Racial Groups KW - Socioeconomic factors KW - United States AB -

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.

PB - 34 VL - 34 UR - https://www.ncbi.nlm.nih.gov/pubmed/9074837 IS - 1 N1 - ProCite field 3 : RAND; UCLA and RAND U1 - http://www.ncbi.nlm.nih.gov/pubmed/9074837?dopt=Abstract U4 - Economics of the Elderly/Health Status/Socioeconomic Status/Ethnicity/Income/Gender/Old Age ER - TY - JOUR T1 - Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites. JF - J Gerontol A Biol Sci Med Sci Y1 - 1997 A1 - Daniel O. Clark A1 - Mungai, S.M. A1 - Timothy E. Stump A1 - Frederic D Wolinsky KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Chronic disease KW - Cohort Studies KW - Disabled Persons KW - Disease KW - Female KW - Health Behavior KW - Humans KW - Male KW - Memory Disorders KW - Mexican Americans KW - Middle Aged KW - Prevalence KW - Risk Factors KW - Socioeconomic factors KW - White People AB -

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.

PB - 52A VL - 52 UR - http://biomed.gerontologyjournals.org/contents-by-date.0.shtml IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9060977?dopt=Abstract U4 - Aged, 80 and Over/Blacks/Chronic Disease/Cohort Studies/Disabled Persons/Disease/Female/Health Behavior/Human/Memory Disorders/Mexican Americans/Middle Age/Prevalence/Risk Factors/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Whites ER -