TY - JOUR T1 - Factor structure of the Harmonized Cognitive Assessment Protocol neuropsychological battery in the Health and Retirement Study JF - Neuropsychology Y1 - Forthcoming A1 - Richard N Jones A1 - Jennifer J Manly A1 - Kenneth M. Langa A1 - Lindsay H Ryan A1 - Deborah A Levine A1 - Ryan J McCammon A1 - David R Weir KW - Cognitive Ability KW - Confirmatory Factor Analysis KW - HCAP KW - Older Adults AB - Objectives: The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS).Method: The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically-driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data. Results: For the eight domains of cognitive functioning identified theoretically (orientation, memory [immediate, delayed, & recognition], set shifting, attention/speed, language/fluency, andvisuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where good fit is axiomatic. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94). Discussion: The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used as anchors for calibrating cross-national studies of cognitive performance, and to identify persons performing atthe low end as part of an algorithmic classification of probable dementia ER - TY - JOUR T1 - Factors Associated With Psychological Wellbeing in Home Care Older Adults With Alzheimer's Disease: A Longitudinal Analysis. JF - Journal of Applied Gerontology: the official journal of the gerontology society Y1 - Forthcoming A1 - Guo, Yuqi A1 - Shi, Jingyi KW - Alzheimer’s disease and mental health KW - home care KW - Psychosocial AB -

The long-term symptoms associated with Alzheimer's disease pose significant challenges to the psychological wellbeing of patients. This longitudinal study aims to analyze the effects of socioeconomic factors and physical health factors on the psychological wellbeing of older patients diagnosed with Alzheimer's disease (AD) receiving home care, as well as the moderating role of aging and care support in influencing their psychological wellbeing. Data from the Health and Retirement Study ( = 628 older Alzheimer's patients) were analyzed using pooled ordinary least squares fixed-effects models. Findings suggest that Alzheimer's patients' psychological wellbeing was significantly affected by factors including cohabitation, gender, assistance frequency, age, education, and daily activity challenges, with assistance and increasing age mitigating some daily difficulties. The findings underline the multifactorial nature of psychological wellbeing among older Alzheimer's patients in home care and the critical role of social and physical health determinants in shaping these outcomes.

ER - TY - JOUR T1 - Financial strain and loneliness in older adults JF - Applied Economics Letters Y1 - Forthcoming A1 - Madeleine A. Drost A1 - Anastasia R. Snyder A1 - Michael Betz A1 - Cäzilia Loibl KW - Financial strain KW - household income KW - Loneliness KW - personal resources KW - social resources AB - ABSTRACT This study assesses whether changes in older adults’ financial situation after an economic shock are associated with feelings of loneliness. Data come from the 2006 and 2010 waves of the Health and Retirement Study (N = 2,510) which span the 2008 Great Recession. We conduct first-differencing and formal mediation analyses to determine whether change in financial situation is related to change in loneliness in older age and test potential mediation of personal and social resources. Results show that a higher level of loneliness in 2010 is associated with a higher level of subjective financial strain but not with changes in household income and net assets. The findings hold when accounting for personal and social resources. Knowledge of the direct link between financial strain and loneliness in older age provides an important insight for programmes and initiatives aimed at relieving widespread loneliness in later life. ER - TY - ICOMM T1 - Financial hardship drives unhappiness in people living with dementia, study finds Y1 - 2024 A1 - Fischer, Kristen KW - Dementia KW - Finances KW - Healthcare KW - Life Satisfaction PB - McKnights UR - https://www.mcknights.com/news/clinical-news/financial-hardship-drives-unhappiness-in-people-living-with-dementia-study-finds/ ER - TY - JOUR T1 - First-generation college graduates have similar depressive symptoms in midlife as multi-generational college graduates. JF - SSM Population Health Y1 - 2024 A1 - Meza, Erika A1 - Hebert, Jillian A1 - Garcia, Maria E A1 - Torres, Jacqueline M A1 - Glymour, M Maria A1 - Vable, Anusha M KW - First-generation KW - Intergenerational education KW - Midlife depressive symptoms AB -

PURPOSE: Higher education may protect an individual against depressive symptoms, yet, disadvantaged socioeconomic status (SES) during childhood, often measured by lower parental education, may put them at higher risk for depressive symptoms later in life. This study evaluates if midlife depression is similar for first-generation and multi-generation college graduates.

METHODS: For US Health and Retirement Study (HRS) participants ages 55-63 (N = 16,752), we defined a 4-category exposure from parents' (highest of mother or father's) and participant's own years of education, with 16 years indicating college completion: multi-gen (both 16 years: reference); first-gen (parents <16; own 16); only parent(s) (parents 16; own <16); and neither (both <16) college graduates across three birth cohorts. We used linear regressions to evaluate relationships between college completion and depressive symptoms measured by an 8-item Center for Epidemiologic Studies - Depression (CES-D) scale. Models pooled over time evaluated differences by sex, race/ethnicity, and birthplace.

RESULTS: First-gen and multi-gen college graduates averaged similar depressive symptoms in midlife (: 0.01; 95% CI: 0.15, 0.13). Results were similar by sex and race/ethnicity.

CONCLUSION: Consistent with resource substitution theory, college completion may offset the deleterious effects of lower parental education on midlife depressive symptoms for first-generation graduates.

VL - 25 ER - TY - JOUR T1 - Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults. JF - The Journal of Nutrition Y1 - 2024 A1 - Wang, Haowei A1 - El-Abbadi, Naglaa KW - Aged KW - Cognition KW - Cognitive Dysfunction KW - ethnicity KW - Food insecurity KW - Food Supply KW - Humans KW - Middle Aged KW - Minority Groups KW - Racial Groups KW - United States AB -

BACKGROUND: Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics.

OBJECTIVE: This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups.

METHODS: We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status.

RESULTS: Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults.

CONCLUSION: Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

VL - 154 IS - 1 ER - TY - ICOMM T1 - ‘Forgotten middle’ near-retirees worse off than prior generations, will need stronger supports in aging, researchers say Y1 - 2024 A1 - Bonvissuto, Kimberly KW - Finances KW - health KW - near-retiree PB - McKnights UR - https://www.mcknightsseniorliving.com/home/news/forgotten-middle-worse-off-than-prior-generations-will-need-stronger-supports-in-aging-researchers-say/ ER - TY - ICOMM T1 - Facing Financial Ruin as Costs Soar for Elder Care Y1 - 2023 A1 - Reed Abelson A1 - Jordan Rau KW - Finances KW - health costs KW - Long-term Care JF - Dying Broke PB - The New York Times CY - New York, NY UR - https://www.nytimes.com/2023/11/14/health/long-term-care-facilities-costs.html ER - TY - JOUR T1 - Factors Associated with Healthcare Delays Among Adults Over 50 During the COVID-19 Pandemic. JF - The Journals of Gerontology, Series A Y1 - 2023 A1 - Chan, Athena C Y A1 - Sneed, Rodlescia S KW - COVID-19 KW - geographical region KW - healthcare delay KW - Race/ethnicity AB -

BACKGROUND: Adults over 50 have high healthcare needs, but also face high coronavirus disease 2019 (COVID-19)-related vulnerability. This may result in reluctance to enter public spaces, including healthcare settings. Here, we examined factors associated with healthcare delays among adults over 50 early in the COVID-19 pandemic.

METHODS: Using data from the 2020 wave of the Health and Retirement Study (N=7615), we evaluated how race/ethnicity, age, geographic region, and pandemic-related factors were associated with healthcare delays.

RESULTS: In our sample, 3 in 10 participants who were interviewed from March 2020 to June 2021 reported delays in medical or dental care in the early stages of the COVID-19 pandemic. Non-Hispanic Whites (OR: 1.37; 95% CI: 1.19-1.58) and those of other racial/ethnic backgrounds (OR: 1.31; 95% CI: 1.02-1.67) delayed care more than Non-Hispanic Blacks. Other factors associated with delayed care included younger age, living in the Midwest or West, knowing someone diagnosed with or who died from COVID-19, and having high COVID-19-related concerns. There were no differences in care delays among adults aged >70; however, among those ≤70, those who knew someone diagnosed with COVID-19 were more likely to delay care than those who did not. Additionally, among those ≤70, Non-Hispanic Whites and those of other racial/ethnic backgrounds delayed care more than Non-Hispanic Blacks and Hispanics.

CONCLUSIONS: There is considerable heterogeneity in care delays among older adults based on age, race/ethnicity, and pandemic-related factors. As the pandemic continues, future studies should examine whether these patterns persist.

ER - TY - THES T1 - Family Care and Household Production: Implications for Adult Children by Gender, Race and Ethnicity T2 - ProQuest Dissertations and Theses Y1 - 2023 A1 - Byambasuren,Binderiya KW - 0493:Aging KW - 0501:Economics KW - 0510:Labor economics KW - 0769:Health care management KW - Adult children KW - Adult children’s employment KW - Aging KW - Economics KW - Family care KW - gender gap KW - Health care management KW - household production KW - Labor economics KW - labor market KW - Long-term Care AB - My dissertation consists of three chapters on unpaid care work and its implications for adult children by gender, race and ethnicity. The first chapter studies the effect of family care on adult children’s employment and earnings, and its implications for the gender gap in labor market outcomes among adult children. I first provide empirical evidence that caring for an elderly parent results from decision-making within a family rather than at the individual level. Regarding the gender gap in family care, I document that daughters with less attachment to the labor market and lower earnings provide the brunt of family care. The gender gap in family care is most salient in sibling groups with mixed gender composition. Motivated by the empirical evidence, I employ the simulated method of moments to structurally estimate a model of strategic interactions between a daughter and a son sibling pair in mixed-gender sibling groups. Adult children face different opportunity costs in terms of wages and have heterogeneous preferences or perceived care responsibility for family care to a parent with long-term care (LTC) needs. I find that the heterogeneity in preferences for public good explains the gender gap in family care among adult children more substantially than the heterogeneity in opportunity costs. Using life cycle profiles of parents’ LTC needs and adult children’s wages, I simulate the long-run trajectories of employment and family care of adult children. In a counterfactual scenario, I quantify that daughters face a 4.6 percent drop in lifetime earnings due to family caregiving compared to a 1.5 percent drop for sons.The second chapter investigates the effect of family care on adult children’s employment by race and ethnicity. Due to lower access to quality formal care and differences in norms and traditions, minority populations rely more heavily on family care than non-minority populations do. Despite the growing diversity in the demography of the older population and their family caregivers, we know little about the racial and ethnic differences in family care patterns over time and their impact on the economic outcomes of caregivers. My study intends to fill this gap. Using the pooled 1998-2019 Health and Retirement Study, I first provide a descriptive analysis documenting the disability and family care trajectories of elderly individuals aged 50 and over across racial and ethnic groups. I then employ a recursive bivariate probit model to examine how family care affects adult children’s employment by race and ethnicity. I find that non-Hispanic Black and Hispanic elderly individuals have higher levels of LTC needs and rely more on family care provision over their lifespans, compared to non-Hispanic Whites. Family care lowers adult children’s employment by 5 to 9 percentage points depending on care type in the overall sample. The effect is 3.3 to 8.4 percentage points for non-Hispanic Whites and 11 to 13 percentage points for non-Hispanic Blacks. The effect of family care on employment is more pronounced for adult children aged less than 40 and those with non-married parents.The third chapter examines whether the gendered division of household labor persists intergenerationally from parents to children. Suppose an adult child grows up in a household with the mother as the sole provider of housework or the father who shares housework equally with the mother. Do children show a similar division of household labor in their marriages in adulthood? To investigate this question, I draw on social psychology literature on childhood socialization and the development of gender role perceptions by focusing on the ’modeling effect’ of parents during childhood. Using the questionnaire asking two generations of married couples their time spent on housework in the 1969-2019 Panel Study of Income Dynamics, I link the adult children split off from the original cohort of families and examine the intergenerational persistence in the gendered division of household labor. I first use an event-study approach to explore the gender gap in housework hours between adult children and their spouses in response to the arrival of a first child. I then employ a multinomial logit model to show the relationship between childhood socialization and the division of household labor. Having a mother as the sole provider of housework across any childhood period strongly predicts a less egalitarian division of household labor for adult children and their spouses. Being exposed to working mothers or fathers who were more involved in housework does not significantly predict adult daughters’ division of household labor. However, both indicators imply a more egalitarian division of household labor for adult sons and their spouses. JF - ProQuest Dissertations and Theses SN - 9798380110532 UR - https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/family-care-household-production-implications/docview/2850988866/se-2 ER - TY - ICOMM T1 - Family caregivers provide 2 extra ‘shifts’ of care per week per resident in assisted living: study Y1 - 2023 A1 - Bonvissuto, Kimberly KW - Assisted living KW - Informal caregiving PB - McKnights UR - https://www.mcknightsseniorliving.com/home/news/family-caregivers-provide-2-extra-shifts-of-care-per-week-per-resident-in-assisted-living-study/ ER - TY - ICOMM T1 - Family caregiving doesn’t always mean poor mental health, study finds Y1 - 2023 A1 - Fischer, Kristen KW - Caregiving KW - depression KW - Mental Health PB - McKnights UR - https://www.mcknights.com/news/clinical-news/family-caregiving-doesnt-always-mean-poor-mental-health-study-finds/ ER - TY - ICOMM T1 - Feeling a sense of purpose drops after dementia, new study shows Y1 - 2023 A1 - Holcombe, Madeline KW - cognitive impairment KW - Dementia KW - Sense of purpose PB - CNN UR - https://www.cnn.com/2023/09/13/health/dementia-life-purpose-wellness/index.html ER - TY - ICOMM T1 - Feeling lonely can lead to sleepless nights for middle-aged and older adults. Y1 - 2023 A1 - Kirkendoll-Duke, Shantell KW - insomnia symptoms KW - Loneliness PB - Duke University UR - https://medschool.duke.edu/news/loneliness-linked-insomnia-symptoms-middle-aged-and-older-adults ER - TY - JOUR T1 - Female APOE ɛ4 Carriers with Slow Rates of Biological Aging Have Better Memory Performances Compared to Female ɛ4 Carriers with Accelerated Aging. JF - J Alzheimers Dis Y1 - 2023 A1 - O'Shea, Deirdre M A1 - Galvin, James E KW - Aged KW - Aging KW - Apolipoprotein E4 KW - Cognition KW - Dementia KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Memory Disorders AB -

BACKGROUND: Evidence suggests that APOE ɛ4 carriers have worse memory performances compared to APOE ɛ4 non-carriers and effects may vary by sex and age. Estimates of biological age, using DNA methylation may enhance understanding of the associations between sex and APOE ɛ4 on cognition.

OBJECTIVE: To investigate whether associations between APOE ɛ4 status and memory vary according to rates of biological aging, using a DNA methylation age biomarker, in older men and women without dementia.

METHODS: Data were obtained from 1,771 adults enrolled in the 2016 wave of the Health and Retirement Study. A series of ANCOVAs were used to test the interaction effects of APOE ɛ4 status and aging rates (defined as 1 standard deviation below (i.e., slow rate), or above (i.e., fast rate) their sex-specific mean rate of aging on a composite measure of verbal learning and memory.

RESULTS: APOE ɛ4 female carriers with slow rates of GrimAge had significantly better memory performances compared to fast and average aging APOE ɛ4 female carriers. There was no effect of aging group rate on memory in the female non-carriers and no significant differences in memory according to age rate in either male APOE ɛ4 carriers or non-carriers.

CONCLUSION: Slower rates of aging in female APOE ɛ4 carriers may buffer against the negative effects of the ɛ4 allele on memory. However, longitudinal studies with larger sample sizes are needed to evaluate risk of dementia/memory impairment based on rates of aging in female APOE ɛ4 carriers.

VL - 92 IS - 4 ER - TY - ICOMM T1 - Fetal exposure to Great Depression economic hardship linked to accelerated aging Y1 - 2023 A1 - National Institute on Aging KW - aging biology KW - Economics KW - Longevity PB - National Institute on Aging UR - https://www.nia.nih.gov/news/fetal-exposure-great-depression-economic-hardship-linked-accelerated-aging ER - TY - ICOMM T1 - Fewer Retirees Have Wills in Place, Putting Their Families at Risk of Losing Their Inheritance Y1 - 2023 A1 - Gibson, Liam KW - Inheritance KW - Retirees KW - Wills PB - MSN UR - https://www.msn.com/en-us/money/retirement/fewer-retirees-have-wills-in-place-putting-their-families-at-risk-of-losing-their-inheritance/ar-AA1hcL05#image=AA1cANLh|1 ER - TY - JOUR T1 - Financial burden among cancer patients: A national-level perspective. JF - Cancer Medicine Y1 - 2023 A1 - Mudaranthakam, Dinesh Pal A1 - Wick, Jo A1 - Calhoun, Elizabeth A1 - Gurley, Tami KW - cancer treatment KW - Financial burden KW - financial challenges KW - treatment burden AB -

BACKGROUND: This research study aimed to evaluate the financial burden among older cancer patients and its corresponding risk factors. Factors such as increasing treatment costs and work limitations often lead cancer patients to bankruptcy and poor quality of life. These consequences, in turn, can cause higher mortality rates among these patients.

METHODS: This retrospective cohort study utilized data from the Health Retirement Study (HRS), conducted by the University of Michigan (N = 18,109). Eligible participants had responses captured from years 2002 to 2016. Participants were classified according to any self-reported cancer diagnosis (yes or no) and were compared on the basis of financial, work, and health-related outcomes. Propensity score (PS) matching was applied to reduce the effects of potential confounding factors. Also only, individuals with an age ≥50 and ≤85 during Wave 6 were retained.

RESULTS: Multivariate analysis with random effects revealed several indicators of financial burden when comparing participants with a cancer diagnosis to those with no history of cancer. Mean out-of-pocket costs associated with a cancer diagnosis were $1058 higher when compared to participants with no history of cancer, suggesting that even cancer patients with insurance coverage faced out-of-pocket costs. Respondents with cancer patients had higher odds of encountering financial hardship if they are facing Work Limitations (OR = 2.714), Regular use of Medications (OR = 2.518), Hospital Stays (OR = 2.858), Declining Health (OR = 2.349), or were being covered under government health insurance (OR = 5.803) than respondents who did not have cancer, or suffered from mental health issues such as Depression (OR = 0.901).

CONCLUSION: Cancer patients contend with increasing financial costs during their treatment. However, most newly diagnosed patients are not aware of these costs and are given few resources to handle them.

ER - TY - JOUR T1 - Financial hardship and change in emotional well-being before to during COVID-19 pandemic among middle-aged and older Americans: Moderating effects of internal coping resources. JF - Social Science & Medicine Y1 - 2023 A1 - Choi, Shinae L A1 - Lee, Yoon G KW - Adaptation KW - COVID-19 KW - financial stress KW - Leave Behind Questionnaire KW - Pandemics KW - Psychological AB -

OBJECTIVE: The purpose of this study was to investigate associations between financial hardship and change in emotional well-being-positive and negative affect-before to during the COVID-19 pandemic among middle-aged and older Americans and to examine the extent to which associations were moderated by internal coping resources-dispositional mastery and optimism.

METHOD: Data derived from the Leave-Behind Questionnaire in the 2016 and 2020 waves of the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults aged 51 and older (N = 1312). We estimated multivariate ordinary least squares regression models with interaction terms to evaluate prospectively the benefits of mastery and optimism as internal coping resources for middle-aged and older adults.

RESULTS: Dispositional mastery moderated the effects of financial hardship on changes in negative and positive affect, respectively, before to during the COVID-19 pandemic; however, optimism did not significantly moderate the effects of financial hardship on change in negative and positive affect before to during the COVID-19 pandemic.

CONCLUSIONS: Our findings have implications for interventions aimed at improving middle-aged and older adults' emotional well-being by promoting internal coping resources. Specifically, interventions should focus on financial hardship and mastery for vulnerable middle-aged and older adults in the context of public health crises.

VL - 317 ER - TY - ICOMM T1 - Financial Impact on Caregivers of Spouses With Cancer Y1 - 2023 A1 - Stenger, Matthew KW - Cancer KW - Caregivers KW - Spouses PB - The ASCO Post UR - https://ascopost.com/news/april-2023/financial-impact-on-caregivers-of-spouses-with-cancer/ ER - TY - ICOMM T1 - Financial Instability Is Connected to Increased Mortality Rates Y1 - 2023 A1 - Min, Penny KW - Healthcare KW - Mortality rates KW - socio-economic status PB - HealthNews UR - https://healthnews.com/news/financial-instability-connected-to-increased-mortality-rate/ ER - TY - JOUR T1 - FINDING THE MINDS OF OUR ELDERS: TESTING THE MINORITY STRESS AND COGNITION MODEL WITH INDIGENOUS OLDER ADULTS JF - Innovation in Aging Y1 - 2023 A1 - Whetung, Cliff KW - cognitive function KW - Indigenous older adults KW - Minority Stress and Cognition Model AB - This study used data from the Health and Retirement Study (HRS) data to investigate how an understudied group of Indigenous Older Adults (IOAs) in the United States fared over a 14-year period (2006-2020) in the domain of global cognitive function. The number of IOAs, defined here as Native American and Alaska Natives, will more than double in the next 30 years. Concurrently, the number of IOAs living with cognitive impairments will also increase. Guided by the Minority Stress and Cognition Model, we tested the hypothesis that discriminatory stress increases the risk of cognitive impairment in later life. Using a robust set of psychosocial (e.g. educational quality, perceived everyday discrimination experiences), behavioral (e.g. substance use, exercise), and physiological (e.g. diabetes, hypertension, obesity) risk factors, we modeled the cognition trajectories 186 IOAs using mixed growth curves. We found that one third of these IOAs reported experiencing everyday discrimination at least once per month, the highest of any ethnic group. They also reported high rates of other risk factors for cognitive impairment like low education, SES, and physical activity, and high rates of depression and chronic health conditions. Our analysis found that everyday discrimination was negatively associated with total cognition among IOAs but that this relationship was mediated by allostatic loads. On average, the total cognition scores of IOAs declined significantly faster than those of Whites. This study has important implications for the integration of stress as a mechanism for cognitive decline and the health equity of Indigenous older adults. VL - 6 IS - Suppl 1 ER - TY - ICOMM T1 - Food Insecurity a Dementia Risk Factor? Y1 - 2023 A1 - Brooks, Megan KW - dementia risk KW - Food insecurity PB - Medscape UR - https://www.medscape.com/viewarticle/998912?form=fpf ER - TY - JOUR T1 - Food Insecurity Among Older Adults with a History of Incarceration JF - Journal of Applied Gerontology Y1 - 2023 A1 - Jordan, Tamara A1 - Rodlescia S. Sneed KW - Food insecurity KW - incarceration KW - justice involvement AB - Objectives To examine the association between history of incarceration (HOI) and food insecurity (FI) among older adults.Methods This is a secondary analysis utilizing data from 12,702 respondents aged 51+ who participated in the 2012 and 2014 waves of The Health and Retirement Study. Multiple logistic regression was used to estimate the association between HOI and FI, adjusting for demographic variables using odds ratios (OR) and 95% confidence intervals (CI).Results In our sample, 12.8% of participants reported FI. Having a HOI increased odds of FI (OR 1.83; 95% CI 1.52-2.21), especially among Blacks (OR 1.78; 95% CI 1.29-2.46) and Whites (OR 2.27; 95% CI 1.74-2.97), but not Hispanics (OR 1.11; 95% CI 0.69-1.77) or other racial/ethnic groups (OR 1.79; 95% CI 0.71-4.52).Discussion FI is an important issue among older adults with a HOI. Stronger linkages between formerly incarcerated older adults and existing food assistance programs are needed.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis project was funded by Michigan Center for Urban African-American Aging Center through a grant from the National Institutes of Health (grant number P30 AG015281). This analysis uses data from the Health and Retirement Study (2012 HRS Core, 2014 HRS Core, and RAND HRS Longitudinal File 2018), sponsored by the National Institute on Aging (grant number NIA U01AG009740) and conducted by the University of Michigan.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This current study was exempt from Michigan State University IRB review (STUDY00006614).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data are available online at: https://hrsdata.isr.umich.edu/data-products/2012-hrs-core, https://hrsdata.isr.umich.edu/data-products/2014-hrs-core, and https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 VL - 42 IS - 5 ER - TY - JOUR T1 - Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older. JF - JAMA Network Open Y1 - 2023 A1 - Qian, Haobing A1 - Khadka, Aayush A1 - Martinez, Suzanna M A1 - Singh, Sonali A1 - Brenowitz, Willa D A1 - Zeki Al Hazzouri, Adina A1 - Hill-Jarrett, Tanisha G A1 - Glymour, M Maria A1 - Vable, Anusha M KW - agriculture KW - Algorithms KW - Alzheimer disease KW - Food insecurity KW - Memory Disorders AB -

IMPORTANCE: Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association.

OBJECTIVE: To examine whether food insecurity in older adults is associated with later-life cognitive outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023.

EXPOSURE: Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure.

MAIN OUTCOMES AND MEASURES: Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights.

RESULTS: The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline.

CONCLUSIONS AND RELEVANCE: In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

VL - 6 IS - 11 ER - TY - ICOMM T1 - Food Insecurity Tied to Dementia Risk, Memory Decline in Older Adults Y1 - 2023 A1 - Khaja, Hibah KW - Cognition KW - dementia risk KW - Food insecurity PB - Neurology Advisor UR - https://www.neurologyadvisor.com/topics/alzheimers-disease-and-dementia/food-insecurity-dementia-risk-memory-decline-older-adults/ ER - TY - JOUR T1 - Food security status and breast cancer screening among women in the United States: Evidence from Health and Retirement Study and Health Care and Nutrition Study JF - Research Square Y1 - 2023 A1 - Mahmood, Asos A1 - Kedia, Satish A1 - Dillon, Patrick A1 - kim, Hyunmin A1 - Arshad, Hassan A1 - Ray, Meredith KW - breast cancer screening KW - Food security AB - Purpose: To assesses the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast x-ray) among older women in the United States (US). <h4>Methods: </h4> Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 to 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fitted a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening. <h4>Results: </h4>: Food insecurity was significantly associated with failure to obtain a mammogram or breast x-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past two years (OR=0.46; 95% CI: 0.30-0.70, P-value <.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms. <h4>Conclusion: </h4> Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower-income and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity. ER - TY - JOUR T1 - The Forgotten Middle: Worsening Health And Economic Trends Extend To Americans With Modest Resources Nearing Retirement. JF - Health Affairs Y1 - 2023 A1 - Chapel, Jack M A1 - Tysinger, Bryan A1 - Goldman, Dana P A1 - Rowe, John W KW - Future Elderly Model KW - health KW - middle class KW - Retirement AB -

In an aging US society, anticipating the challenges that future seniors will face is essential. This study analyzed the health and economic well-being of five cohorts of Americans in their mid-fifties between 1994 and 2018 using the Future Elderly Model, a dynamic microsimulation based on the Health and Retirement Study. We projected mortality, quality-adjusted life years, health expenditures, and income and benefits. We classified individuals by economic status and focused on the lower middle and upper middle of the economic distribution. Outcome disparities between people in these two groups widened substantially between the 1994 and 2018 cohorts. Quality-adjusted life expectancy increased (5 percent) for the upper-middle economic status group but stagnated for their lower-middle peers. We found that the combined value of the current stock (financial and housing wealth) and the present value of the expected flow of resources (income, health expenditures, and quality-adjusted life-years) after age sixty grew 13 percent for the upper-middle group between cohorts, whereas people in the lower-middle group in 2018 were left scarcely better off (3 percent growth) than their peers two decades earlier. The relatively neglected "forgotten middle" group of near-retirees in the lower-middle group may require stronger supports than are currently available to them.

VL - 42 IS - 9 ER - TY - JOUR T1 - Frailty trajectory predicts subsequent cognitive decline: A 26-year population-based longitudinal cohort study. JF - MedComm (2020) Y1 - 2023 A1 - Li, Ruidan A1 - Liu, Zheran A1 - Huang, Rendong A1 - Chen, Ye A1 - Wei, Zhigong A1 - Wang, Jingjing A1 - He, Ling A1 - Pei, Yiyan A1 - Su, Yonglin A1 - Hu, Xiaolin A1 - Peng, Xingchen AB -

Frailty refers to a decline in the physiological functioning of one or more organ systems. It remained unclear whether variations in the trajectory of frailty over time were associated with subsequent cognitive change. The aim of the current study was to investigate the association between frailty trajectories and subsequent cognitive decline based on the Health and Retirement Study (HRS). A total of 15,454 participants were included. The frailty trajectory was assessed using the Paulson-Lichtenberg Frailty Index, while the cognitive function was evaluated using the Langa-Weir Classification. Results showed that severe frailty was significantly associated with the subsequent decline in cognitive function ( [95% CI] = -0.21 [-0.40, -0.03],  = 0.03). In the five identified frailty trajectories, participants with mild frailty (inverted U-shaped, [95% CI] = -0.22 [-0.43, -0.02],  = 0.04), mild frailty (U-shaped, [95% CI] = -0.22 [-0.39, -0.06],  = 0.01), and frailty (β [95% CI] = -0.34 [-0.62, -0.07],  = 0.01) were all significantly associated with the subsequent cognition decline in the elderly. The current study suggested that monitoring and addressing frailty trajectories in older adults may be a critical approach in preventing or mitigating cognitive decline, which had significant implications for healthcare.

VL - 4 IS - 3 ER - TY - JOUR T1 - Frequency and implications of coexistent manifestations of serious illness in older adults with dementia. JF - J Am Geriatr Soc Y1 - 2023 A1 - Nothelle, Stephanie A1 - Bollens-Lund, Evan A1 - Covinsky, Kenneth E A1 - Kelley, Amy KW - Dementia KW - Older Adults KW - serious illness AB -

BACKGROUND: In older adults, serious illness comprises three manifestations: dementia, activity of daily living (ADL) impairment, and other advanced medical conditions (AMC; e.g., end-stage renal disease). Little is known about how dementia and other manifestations of serious illness co-occur. We aim to describe the prevalence of persons with dementia (PWD) who are living with additional manifestations of serious illness, and the implications on healthcare utilization, Medicare costs, caregiving hours and out-of-pocket expenses.

METHODS: In this cross-sectional study, we use data from the 2016 Health and Retirement Study (HRS) linked to Medicare fee-for-service claims. We limited inclusion to adults >65 years. Dementia was determined using validated methodology that incorporates functional and cognitive test scores from HRS. We classified PWD as having dementia alone, dementia and an AMC (irrespective of ADL impairment) or dementia and ADL impairment (without an AMC). Healthcare utilization and Medicare costs were measured in claims, caregiving hours and out-of-pocket expenses were self-reported.

RESULTS: Most PWD (67%) met criteria for another manifestation of serious illness (24% advanced medical condition, 44% ADL impairment). PWD and an AMC had the highest proportion of hospital use and the highest median total Medicare costs ($17,900 vs. $8962 dementia + ADL impairment vs. $4376 dementia alone). Mean total hours of caregiving per month were similar for PWD and an AMC and PWD and ADL impairment (142.9 and 141.9 h, respectively), while mean hours were much lower for PWD alone (47.7 h). Median out-of-pocket costs were highest for PWD and ADL impairment ($13,261) followed by PWD and an AMC ($10,837) and PWD alone ($7017).

CONCLUSIONS: PWD commonly face another manifestation of serious illness. Dementia and ADL impairment was associated with the highest costs for PWD and families while dementia and an AMC was associated with the highest costs for Medicare.

ER - TY - JOUR T1 - Friendship in Later Life: A Pathway between Volunteering Hours and Depressive Symptoms. JF - The Journals of Gerontology, Series B Y1 - 2023 A1 - Lim, Emily A1 - Peng, Changmin A1 - Burr, Jeffrey A KW - Emotional Health KW - Mental Health KW - pro-social behaviors KW - social engagement KW - Social Relationships AB -

OBJECTIVES: Friendships are essential in the face of social network changes in later life and friendships may be important for reducing depression risk. Social participation through volunteering is also associated with fewer depressive symptoms. What is less well-understood is whether friendships serve as a pathway in the link between volunteering and depression.

METHODS: We used panel data from the Health and Retirement Study (2010, 2014, 2018). Negative binomial regression within the SEM modeling framework was employed to analyze the association between volunteering and friendship, focusing on the indirect effect of friendships for understanding the volunteering and depressive symptoms relationship.

RESULTS: Volunteer hours were positively associated with friendship (1-99 hours: β=0.17, p<.001, 100-199 hours: β=0.15, p<.001, 200 hours and more: β=0.23, p<.001) and negatively associated with number of depressive symptoms (1-99 hours: β=-0.07, p=.06, 100-199 hours: β=-0.14, p<.001, 200 hours and more: β=-0.17, p<.001). Friendship mediated the relationship between volunteer hours and depressive symptoms (indirect effects; 1-99 hours: β=-0.01, (95% CI=[-0.02, -0.00], p=.03), 100-199 hours: β=-0.01, (95% CI=[-0.02, -0.00], p=.03), 200 hours and more: β=-0.02, (95% CI=[-0.03, -0.00], p=.03).

DISCUSSION: Our findings underscored the role of volunteering in generating and maintaining friendships, as well as for friendships as a pathway between volunteer hours and depressive symptoms. Providing opportunities to maintain and grow friendships in later life may be a possible intervention strategy for older adults at risk of depression.

VL - 78 IS - 4 ER - TY - ICOMM T1 - From Breadwinner to Retiree: How to Manage the Transition Y1 - 2023 A1 - Wood, Erin KW - Retirement PB - Kiplinger Personal Finance UR - https://www.kiplinger.com/retirement/new-retiree-how-to-manage-the-transition-from-breadwinner ER - TY - JOUR T1 - From financial wealth shocks to ill-health: Allostatic load and overload. JF - Health Econ Y1 - 2023 A1 - French, Declan KW - Allostasis KW - Cholesterol KW - Humans KW - Retirement KW - Stress, Psychological KW - United States AB -

A number of studies have associated financial wealth changes with health-related outcomes arguing that the effect is due to psychological distress and is immediate. In this paper, I examine this relationship for cumulative shocks to the financial wealth of American retirees using the allostatic load model of pathways from stress to poor health. Wealth shocks are identified from Health and Retirement Study reports of stock ownership along with significant negative discontinuities in high-frequency S&P500 index data. I find that a one standard deviation increase in cumulative shocks over two years increases the probability of elevated blood pressure by 9.5%, increases waist circumference by 1.2% and the cholesterol ratio by 6.1% for those whose wealth is all in shares. My findings suggest that the combined effect of random shocks to financial wealth over time is salient for health outcomes. This is consistent with the allostatic load model in which repeated activation of stress responses leads to cumulative wear and tear on the body.

VL - 32 IS - 4 ER - TY - JOUR T1 - Functional aging trajectories of older cancer survivors: A latent growth analysis of the US Health and Retirement Study. JF - Journal of Cancer Survivorship Y1 - 2023 A1 - Westrick, Ashly C A1 - Kenneth M. Langa A1 - Eastman, Marisa A1 - Ospina-Romero, Monica A1 - Mullins, Megan A A1 - Lindsay C Kobayashi KW - Activities for daily living KW - Aging KW - Cancer KW - Memory AB -

PURPOSE: We aimed to identify prototypical functional aging trajectories of US cancer survivors aged 50 and older, overall and stratified by sociodemographic and health-related characteristics.

METHODS: Data were from 2986 survivors of a first incident cancer diagnosis (except non-melanoma skin cancer) after age 50 in the population representative U.S. Health and Retirement Study from 1998-2016. Cancer diagnoses, episodic memory function, and activity of daily living (ADL) limitations were assessed at biennial study interviews. Using time of cancer diagnosis as the baseline, we used group-based trajectory modeling to identify trajectories of memory function and ADL limitations following diagnosis.

RESULTS: We identified five memory loss trajectories (high: 8.4%; medium-high: 18.3%; medium-low: 21.5%; low: 25.5%; and, very low: 26.2%), and four ADL limitation trajectories (high/increasing limitations: 18.7%; medium limitations: 18.7%; low limitations: 8.14%; no limitations: 60.0). The high memory loss and high/increasing ADL limitation trajectories were both characterized by older age, being female (52% for memory, 58.9% for ADL), having lower pre-cancer memory scores, and a higher prevalence of pre-cancer comorbidities including stroke (30.9% for memory and 29.7% for ADL), hypertension (64.7% for memory and 69.8 for ADL), and depressive symptoms. In joint analyses, we found that generally those with higher memory were more likely to have fewer ADL limitations and vice versa.

CONCLUSION: Older cancer survivors experience heterogeneous trajectories of functional aging that are largely characterized by comorbidities prior to diagnosis.

IMPLICATION FOR CANCER SURVIVORS: Results can help identify older cancer survivors at increased risk for accelerated functional decline.

VL - 17 IS - 5 ER - TY - JOUR T1 - Facets of conscientiousness and motoric cognitive risk syndrome JF - Journal of Psychiatric Research Y1 - 2022 A1 - Yannick Stephan A1 - Angelina R. Sutin A1 - Martina Luchetti A1 - Damaris Aschwanden A1 - Antonio Terracciano KW - cognitive complaint KW - Conscientiousness KW - motoric cognitive risk KW - walking speed AB - Conscientiousness is related to a lower risk of motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by slow gait speed and cognitive complaints. The present study examines which facets of conscientiousness are related to concurrent and incident MCR. Participants were dementia-free older adults aged 65–99 years (N = 6001) from the Health and Retirement Study (HRS). Baseline data on conscientiousness facets and MCR (cognitive complaints and gait speed) were collected in 2008/2010, along with the covariates: demographic factors, cognition, physical activity, disease burden, depressive symptoms, and body mass index (BMI). MCR was assessed again in 2012/2014 and 2016/2018. Controlling for demographic factors, higher industriousness was related to a nearly 30% lower likelihood of concurrent MCR (Odds Ratio [OR] = 0.75, 95%CI: 0.67–0.85, p < .001) and to about 60% reduced risk of incident MCR (Hazard ratio [HR] = 0.63, 95%CI: 0.56–0.71, p < .001). Self-control, order, and responsibility were also associated with a lower likelihood of concurrent (OR range: 0.82–0.88) and incident (HR range: 0.72–0.82) MCR. Traditionalism (HR = 0.84, 95%CI: 0.75–0.93, p < .01) and virtue (HR = 0.84, 95%CI: 0.75–0.93, p < .01) were related to a lower risk of incident MCR. Cognition, physical activity, disease burden, depressive symptoms, and BMI partially accounted for these associations. Industriousness is the facet of conscientiousness with the strongest association with risk of MCR. This facet could be targeted in interventions to reduce MCR and, ultimately, dementia. VL - 151 ER - TY - THES T1 - Factors Contributing to Job Satisfaction Y1 - 2022 A1 - McDonald, Zane KW - Job Satisfaction AB - Job satisfaction is often categorized as the enjoyment or appreciation someone has for the work that they do. Job satisfaction is an important variable to analyze as many individuals spend a significant portion of their lives working. The purpose of the current study was to determine the relationship between five work-related and non-work-related variables and job satisfaction. There were five hypotheses: Life satisfaction is positively associated with job satisfaction (H1), stressful life events are negatively associated with job satisfaction (H2), work environment is positively associated with job satisfaction (H3), coworker support is positively associated with job satisfaction (H4), and supervisor support is positively associated with job satisfaction (H5). Data were analyzed using a multiple regression analysis to determine how the five factors related to job satisfaction from the Institute for Social Research University of Michigan (HRS; a preexisting dataset). Four of the hypotheses were supported. Life satisfaction, work environment, and supervisor support were positively correlated with job satisfaction, and stressful life events were negatively correlated with job satisfaction. Coworker support was not correlated with job satisfaction. The current findings demonstrate support for a variety of factors inside and outside of the workplace impacting job satisfaction. PB - University of Wisconsin-Stout VL - M.S. UR - https://minds.wisconsin.edu/bitstream/handle/1793/83698/2022mcdonaldz.pdf?sequence=1&isAllowed=y ER - TY - JOUR T1 - Factors influencing participation among adults aging with long-term physical disability. JF - Disability and Health Journal Y1 - 2022 A1 - Heeb, Rachel A1 - Putnam, Michelle A1 - Keglovits, Marian A1 - Weber, Courtney A1 - Campbell, Margaret A1 - Stark, Susan A1 - Morgan, Kerri KW - Aging KW - environment KW - Participation KW - Physical disability KW - Qualitative methods AB -

BACKGROUND: People aging with long-term physical disability (AwPD) experience barriers to participation and independent living. There are currently limited evidence-based interventions that address issues regarding participation for people AwPD.

OBJECTIVE: This study examined factors influencing participation in personal and life activities among people AwPD to inform future interventions.

METHODS: A cross-sectional study within an ongoing, community-based cohort study of participation was conducted. A purposive sample of people AwPD aged 45-65, living with a physical disability for at least five years, and who speak English was recruited through disability organizations, aging organizations, and social media. Participants answered open-ended questions about what supports they needed to successfully participate in nine activity categories derived from the Health and Retirement Study participation items (e.g., employment, community leisure). A content analysis was conducted using NVivo to categorize responses, and member checking occurred with four additional people AwPD.

RESULTS: A total of 215 participants completed the survey. Eight categories of factors emerged from the data: physical environment factors, social factors, symptoms, economic factors, policy factors, body structure and functions, mental and emotional state, and temporal factors. Participant responses illuminated a combination of environmental and individual factors. Physical effects of disability and accelerated aging, such as pain and fatigue, paired with environmental factors, such as accessibility of transportation, were reported as influencing participation.

CONCLUSIONS: People AwPD experience a range of factors that substantially impact their ability to remain independent and participate in society. By identifying barriers to participation, new interventions addressing these barriers may be developed, resulting in more effective service provision, enhanced participation in personal and life activities, and improved health and well-being.

VL - 15 IS - 1 ER - TY - THES T1 - FAMILY MATTERS: RELATIONSHIP DYNAMICS SURROUNDING THE DEATH OF A CHILD IN LATER LIFE Y1 - 2022 A1 - Mellencamp, Kagan A. KW - children KW - Death KW - family relationships KW - older parents AB - Despite the ubiquity of bereavement, few are prepared for the traumatic loss of a child. Child death is regarded as the most painful experience of family bereavement because it disturbs the natural order of life, leaving a lasting impression on bereaved parents and their families. Yet, most prior research has focused its attention on individual adjustment to child death with insufficient consideration of the impact of the loss on the family unit. Indeed, families are linked in life and death, so the individual and relational processes surrounding child death should be considered simultaneously. Drawing on data from the Health and Retirement Study, a nationally representative survey of American adults over the age of 50 and their spouses and children, this dissertation attends to this supposition by exploring not only how the death of a child after age 50 impacts family functioning, but also how older parents’ individual adjustment to a child’s death is shaped by their family relationships. The first analytic chapter investigates whether child death in later life affects the risk of gray divorce, paying close attention to the buffering role of marital quality prior to a child’s death and the role of parent-child genetic ties. The second analytic chapter turns the focus to parent-child relationship dynamics by mapping trajectories of older mothers’ and fathers’ relationships with their surviving children before, during, and after the death of a child. The final analytic chapter examines parents’ dementia onset after losing a child in later life and the protective role of family relationships. This dissertation attempts to uncover the complex family processes surrounding the death of a child in later life, and in doing so, aims to impel bereavement theory and research to treat child death as a family-wide trauma with implications for individual family members, their relationships to one another, and the family unit as a whole. PB - Bowling Green State University VL - Ph.D. UR - https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=bgsu1667313906396129&disposition=inline ER - TY - RPRT T1 - Family Proximity and CoResidence in Retirement Heterogeneity in Residential Changes Across Older Adults’ Care Contexts Y1 - 2022 A1 - Megan Doherty Bea A1 - Somalis Chy KW - Grandchild Care KW - residential mobility KW - Retirement AB - Residential changes to live near or with family can facilitate caregiving for children and older adults, along with other supports, but family-based residential changes could also have implications for economic security in retirement, including if changes correspond with earlier receipt of retirement benefits through the Social Security Administration (SSA). This study examines: 1) How often do residential changes to live near or with family coincide with retirement? 2) How do caregiving responsibilities impact the risk of such a residential change? and 3) How do these associations correspond with early SSA claiming around retirement? Using the longitudinal data of the Health and Retirement Study (HRS) from 2000 to 2018, we follow 2,798 households pre- and post-retirement. Results show that the risk of a residential change that puts an older adult household in close proximity to their child is significantly higher at the onset of retirement, compared to pre-retirement years, while the risks of residential changes that result in co-residence with children are less tied to retirement. There is evidence that grandchild-caregiving responsibilities for the older adult increase the risk of these residential changes. Finally, we find little evidence that such changes are tied to earlier Social Security retirement benefits claiming when comparing those who make such changes around retirement to those who do not. Thus, although many older adults are making significant changes to their living arrangements as they manage family-care needs, they are not at disproportionate risk of claiming SSA retirement benefits early when doing so.ability due to economic needs. Findings will reveal social and economic determinants of family-focused residential changes and consequences for benefit receipt. PB - Center for Financial Security, University of Wisconsin-Madison CY - Madison, WI UR - https://cfsrdrc.wisc.edu/project/wi22-03 ER - TY - JOUR T1 - Favourable Lifestyle Protects Cognitive Function in Older Adults With High Genetic Risk of Obesity: A Prospective Cohort Study. JF - Frontiers in Molecular Neuroscience Y1 - 2022 A1 - Liu, Huamin A1 - Wang, Zhenghe A1 - Zou, Lianwu A1 - Gu, Shanyuan A1 - Zhang, Minyi A1 - Hukportie, Daniel Nyarko A1 - Zheng, Jiazhen A1 - Zhou, Rui A1 - Yuan, Zelin A1 - Wu, Keyi A1 - Huang, Zhiwei A1 - Zhong, Qi A1 - Huang, Yining A1 - Wu, Xianbo KW - cognitive function KW - genetic risk KW - lifestyle KW - Obesity AB -

The relationship between body mass index (BMI) and cognitive impairment remains controversial, especially in older people. This study aims to confirm the association of phenotypic and genetic obesity with cognitive impairment and the benefits of adhering to a healthy lifestyle. This prospective study included 10,798 participants (aged ≥ 50 years) with normal cognitive function from the Health and Retirement Study in the United States. Participants were divided into low (lowest quintile), intermediate (quintiles 2-4), and high (highest quintile) groups according to their polygenic risk score (PRS) for BMI. The risk of cognitive impairment was estimated using Cox proportional hazard models. Higher PRS for BMI was associated with an increased risk, whereas phenotypic obesity was related to a decreased risk of cognitive impairment. Never smoking, moderate drinking, and active physical activity were considered favourable and associated with a lower risk of cognitive impairment compared with current smoking, never drinking, and inactive, respectively. A favourable lifestyle was associated with a low risk of cognitive impairment, even in subjects with low BMI and high PRS for BMI. This study suggest that regardless of obesity status, including phenotypic and genetic, adhering to a favourable lifestyle is beneficial to cognitive function.

VL - 15 ER - TY - JOUR T1 - Fertility History and Risk of Cognitive Impairment Among Older Parents in The United States. JF - The Journal of Gerontology, Series B Y1 - 2022 A1 - Zhang, Yan KW - cognitive function KW - Demography KW - family sociology KW - population aging AB -

OBJECTIVES: I work from a gendered life course perspective to examine the association between older parents' fertility history (i.e., timing and parity) and their risk of cognitive impairment in the United States.

METHOD: I analyze nationally representative data from 9 waves over 16 years of the Health and Retirement Study (2000-2016). The sample includes 14,543 respondents (6,108 men and 8,435 women) aged 50 and older at the baseline survey. I examine the relationship between parity, age at first birth, and age at last birth with risk of cognitive impairment using non-linear discrete-time hazard models.

RESULTS: Adjusting for the effects of full covariates, there are U-shaped relationships between women's age at last birth and risk of cognitive impairment, and between women's parity and risk of cognitive impairment. In the sensitivity tests, the relationships remain robust when sampling weights are applied, or mortality selection is corrected.

DISCUSSION: Fertility timing and parity are likely factors associated with the risk of cognitive impairment for older women. Understanding fertility history and its impact on cognition can help identify the most vulnerable subpopulations so that more effective interventions can be made to improve cognitive functioning among older adults.

VL - 77 IS - 12 ER - TY - JOUR T1 - Financial Decision-Making Responsibility and Household Wealth Accumulation Among Older Adults: A Comparative Advantage Perspective JF - Journal of Financial Counseling and Planning Y1 - 2022 A1 - Xu, Yilan A1 - Yao, Rui KW - Cognitive Ability KW - financial decision-making KW - financial responsibility KW - personality wealth AB - This article introduces collective rationality and comparative advantage into understanding household financial decision-making responsibility allocation and its relationship to wealth accumulation. Evidence from the Health and Retirement Study (HRS) shows that conscientiousness, memory, and numeracy are favorable personal attributes for household financial decision-making. Greater relative advantages in these attributes predict a higher probability of assuming financial responsibility. Households that assign the disadvantaged spouse as the financial decision-maker tend to have a lower total net worth and a lower financial net worth. Our results suggest that it is critical for financial planning professionals to engage both spouses in the initial discussion of household finances and to assess the efficiency of the status quo financial decision-making responsibility allocation. VL - 33 IS - 1 ER - TY - JOUR T1 - Financial Hardship and Psychological Resilience during COVID-19: Differences by Race/Ethnicity. JF - The Journals of Gerontology, Series B Y1 - 2022 A1 - Taylor, Miles G A1 - Carr, Dawn C A1 - Jason, Kendra KW - COVID-19 KW - Health Disparities KW - Income KW - Race/ethnicity KW - Successful aging KW - Wellbeing AB -

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

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

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

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

VL - 77 IS - 7 ER - TY - RPRT T1 - Financial Regret at Older Ages and Longevity Awareness Y1 - 2022 A1 - Hurwitz, Abigail A1 - Mitchell, Olivia S KW - Financial decisions KW - financial regret KW - longevity awareness AB - Older people often express regret about financial decisions made earlier in life that left them susceptible to old-age insecurity. Prior work has explored one outcome, saving regret, or peoples’ expressed wish that they had saved more earlier in life. The present paper extends attention to five additional areas regarding financial decisions, examining whether older Americans also regret not having insured better, claimed benefits and quit working too early, and becoming financially dependent on others. Using a controlled randomized experiment conducted on 1,764 respondents age 50+ in the Health and Retirement Study, we show that providing people objective longevity information does alter their self-reported financial regret. Specifically, giving people information about objective survival probabilities more than doubled regret expressed about not having purchased long term care, and it also boosted their regret by 2.4 times for not having purchased lifetime income. We conclude that information provision can be a potent, as well as cost-effective, method of alerting people to retirement risk. JF - NBER Working Paper PB - NBER ER - TY - JOUR T1 - Financial social protection and individual out-of-pocket costs of long-term care in the USA and Europe: An observational study. JF - EClinicalMedicine Y1 - 2022 A1 - Angrisani, Marco A1 - Regalado, José Carlos Ortega A1 - Hashiguchi, Tiago Cravo Oliveira KW - Cross-country analysis KW - Long term care expenditure KW - SHARE KW - Social protection systems AB -

Background: Empirical evidence informing policies aiming at ensuring affordability of long-term care (LTC) costs is limited. Combining system-level with individual-level data, we quantify the burden of out-of-pocket costs of LTC services on households in 13 European countries and the USA and explore how social protection systems impact affordability of care.

Methods: In this observational study, we use harmonised data from the Health and Retirement Study (HRS), collected between 2012 and 2016, and from the Survey of Health, Ageing and Retirement in Europe, collected between 2013 and 2017. We assess the severity of LTC needs of older adults (65+) on the basis of self-reported limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). We classify countries' social protection systems in terms of affordability and progressivity using information obtained from country officials. We examine variation in individual-level out-of-pocket LTC costs by social protection systems' affordability and progressivity.

Findings: Out-of-pocket LTC costs are heterogeneous across countries and increase with individuals' needs. In countries where LTC is more affordable and social protection systems less progressive, older adults incur significantly lower levels of LTC costs. Within Europe, not only are costs lower where systems are characterized by higher affordability and lower progressivity, but they also represent a lower share of households' disposable income.

Interpretation: Our findings indicate that the social protection systems significantly affect the level of out-of-pocket costs faced and reported by older adults with LTC needs as well as the share of their income that is devoted to pay for care.

Funding: We received funding from the National Institute on Aging (grant number R01 AG030153). The OECD programme of work on ageing and long-term care is partly funded by the European Union.

VL - 50 ER - TY - JOUR T1 - Financial social protection and individual out-of-pocket costs of long-term care in the USA and Europe: An observational study JF - eClinicalMedicine Y1 - 2022 A1 - Marco Angrisani A1 - José Carlos Ortega Regalado A1 - Tiago Cravo Oliveira Hashiguchi KW - Cross-country analysis KW - Long term care expenditure KW - SHARE KW - Social protection systems AB - Background Empirical evidence informing policies aiming at ensuring affordability of long-term care (LTC) costs is limited. Combining system-level with individual-level data, we quantify the burden of out-of-pocket costs of LTC services on households in 13 European countries and the USA and explore how social protection systems impact affordability of care. Methods In this observational study, we use harmonised data from the Health and Retirement Study (HRS), collected between 2012 and 2016, and from the Survey of Health, Ageing and Retirement in Europe, collected between 2013 and 2017. We assess the severity of LTC needs of older adults (65+) on the basis of self-reported limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). We classify countries' social protection systems in terms of affordability and progressivity using information obtained from country officials. We examine variation in individual-level out-of-pocket LTC costs by social protection systems' affordability and progressivity. Findings Out-of-pocket LTC costs are heterogeneous across countries and increase with individuals' needs. In countries where LTC is more affordable and social protection systems less progressive, older adults incur significantly lower levels of LTC costs. Within Europe, not only are costs lower where systems are characterized by higher affordability and lower progressivity, but they also represent a lower share of households' disposable income. Interpretation Our findings indicate that the social protection systems significantly affect the level of out-of-pocket costs faced and reported by older adults with LTC needs as well as the share of their income that is devoted to pay for care. Funding We received funding from the National Institute on Aging (grant number R01 AG030153). The OECD programme of work on ageing and long-term care is partly funded by the European Union. VL - 50 ER - TY - RPRT T1 - FINANCIAL TRANSFERS FROM PARENTS TO ADULT CHILDREN Y1 - 2022 A1 - Siqiang Yang A1 - Marla Ripoll KW - Bequests KW - coresidency KW - intervivos transfers KW - parental altruism AB - This paper uses 1996-2014 longitudinal HRS data to establish the relative importance of intervivos transfers, bequests and coresidency in the United States. We Önd that when computing the relative importance of intervivos transfers versus bequests, the aggregate perspective that pools all data into a single cross-section is very di§erent than the parent-level longitudinal perspective, highlighting the special value of panel data. This di§erence reáects the fact that large bequests are highly concentrated and play an ináuential role at the aggregate level, while at the micro parent-level, intervivos transfers constitute the main form of Önancial support for most parents. Regarding coresidency, we Önd that although older children and parents tend to coreside when the child is helping the parent, coresidency tends to be more prevalent among poorer, younger parents and their children. Children who ever coreside with parents also receive larger total intervivos transfers. UR - https://sites.pitt.edu/~ripoll/research/transfers-JEBO-revision-2.pdf ER - TY - JOUR T1 - Five-factor model personality traits and grip strength: Meta-analysis of seven studies JF - Journal of Psychosomatic Research Y1 - 2022 A1 - Yannick Stephan A1 - Angelina R. Sutin A1 - Brice Canada A1 - Maxime Deshayes A1 - Tiia Kekäläinen A1 - Antonio Terracciano KW - five-factor model KW - Grip strength KW - health KW - Neuroticism KW - Personality AB - Objective To examine the association between Five-Factor Model personality traits and grip strength. Method Adults aged 16 to 104 years old (N > 40,000) were from the Health and Retirement Study, the Midlife in the United States Study, The English Longitudinal Study of Aging, the National Health and Aging Trends Survey, the United Kingdom Household Longitudinal Study, and the Wisconsin Longitudinal Study graduate and sibling samples. Participants had data on personality traits, demographic factors, grip strength, and mediators such as depressive symptoms, physical activity, body mass index (BMI), and c-reactive protein (CRP). Results Across all samples and a meta-analysis, higher neuroticism was related to lower grip strength (meta-analytic estimate: -0.07, 95%CI: −0.075; −0.056). Higher extraversion (0.04, 95%CI: 0.022; 0.060), openness (0.05, 95%CI: 0.032; 0.062), and conscientiousness (0.05, 95%CI: 0.04; 0.065) were associated with higher grip strength across most samples and the meta-analysis. Depressive symptoms were the most consistent mediators between neuroticism and grip strength. Depressive symptoms and physical activity partly mediated the associations with extraversion, openness, and conscientiousness. Lower CRP partly mediated the association with conscientiousness. Sex moderated the associations for extraversion, openness, and conscientiousness, with stronger associations among males. Age moderated the neuroticism association, with stronger associations among younger individuals. Conclusion This study provides replicable evidence that personality is related to grip strength and identifies potential moderators and mediators of these associations. Overall, higher neuroticism is a risk factor for low grip strength, whereas high extraversion, openness, and conscientiousness may be protective. VL - 160 ER - TY - ICOMM T1 - Fixed Vial Sizes For Alzheimer’s Drug Could Waste $605M In Medicare Spending Each Year Y1 - 2022 A1 - University of California, Los Angeles KW - Alzheimer's disease KW - drugs KW - Medicare KW - Spending PB - ScienceBlog UR - https://scienceblog.com/531622/fixed-vial-sizes-for-alzheimers-drug-could-waste-605m-in-medicare-spending-each-year/ ER - TY - JOUR T1 - Food insecurity among older adults in the U.S.: The role of mortgage borrowing JF - Applied Economic Perspectives and Policy Y1 - 2022 A1 - Cäzilia Loibl A1 - Rhodes, Alec P. A1 - Stephanie Moulton A1 - Donald Haurin A1 - Edmunds, Chrisse KW - Food insecurity KW - Housing wealth KW - mortgage borrowing AB - Housing wealth is the main source of wealth for many older adults. Using the Health and Retirement Study, we assess the impact of new mortgage borrowing on food insecurity among homeowners aged 65 and older. We find a substantial short-term effect, with each additional \$10,000 borrowed, lowering food insecurity by 2.2 percentage points. In a simulation of the impact of relaxing the debt-to-income borrowing constraint, food insecurity is reduced by 2.1 percentage points for previous nonborrowers and by 1.6 percentage points for borrowers. Results support the importance of access to mortgage borrowing to reduce material hardship in older age. VL - 44 IS - 2 ER - TY - JOUR T1 - Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans. JF - Preventive Medicine Reports Y1 - 2022 A1 - Choi, Yeon Jin A1 - Eileen M. Crimmins A1 - Jennifer A Ailshire KW - diet quality KW - Food access KW - Healthy Eating Index KW - Obesity risk KW - Social and environmental factors AB -

Food insecurity, reflecting a household's low ability to purchase healthy food, is a public health concern that is associated with poor diet and obesity. Poor food environments, characterized as a neighborhood with low access to healthy, affordable food, may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of community-dwelling older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive to investigate the role of household and neighborhood characteristics on diet and obesity. Weighted regression models were estimated to examine the relationship between food insecurity and food environments as well as their interaction with diet quality and obesity. Food insecure respondents had lower Healthy Eating Index scores and were more likely to be obese than food secure respondents. Living in a poor food environment was associated with lower Healthy Eating Index scores, but not with obesity. We did not find any interaction between food insecurity and food environment in determining either healthy eating or obesity. Reducing food insecurity and increasing access to healthy food environments may encourage healthier eating among older adults, while alleviating food-related hardship may also reduce their obesity risk.

VL - 29 ER - TY - ICOMM T1 - For Older Adults, Loneliness Ups Mortality After Nonelective Surgery Y1 - 2022 A1 - Gotkine, Elana KW - Loneliness KW - Mortality KW - nonelective surgery PB - HealthDay UR - https://consumer.healthday.com/for-older-adults-loneliness-ups-mortality-after-nonelective-surgery-2658649038.html ER - TY - CHAP T1 - Forecasting Employment of the Older Population T2 - Overtime: America's Aging Workforce and the Future of Working Longer Y1 - 2022 A1 - Michael D Hurd A1 - Rohwedder, Susann ED - Berkman, Lisa F ED - Truesdale, Beth C. KW - Employment KW - Older workers KW - Retirement JF - Overtime: America's Aging Workforce and the Future of Working Longer PB - Oxford University Press ER - TY - ICOMM T1 - Forget the Stock Market. This Is the Big Risk for Retirees. Y1 - 2022 A1 - O'Brien, Elizabeth KW - Aging KW - Lifespan KW - longevity risk KW - retirement security PB - Barron's UR - https://www.barrons.com/articles/retirement-longevity-risk-stock-market-51657907372?tesla=y ER - TY - RPRT T1 - The Forgotten Middle: Housing and Care Options for Middle-Income Seniors in 2033 Y1 - 2022 A1 - Pearson, Caroline A1 - Loganathan, Sai KW - Health Care KW - Housing KW - middle-income AB - A new NORC analysis updating the groundbreaking “Forgotten Middle” study finds that there will be 16 million middle-income seniors in 2033, many of whom will struggle to pay for the health, personal care, and housing services that they need. For instance, excluding home equity, nearly three-quarters of middle-income seniors in 2033 will have insufficient financial resources to pay for assisted living, if they need and want it. Even with home equity, nearly 40% will not be able to afford assisted living. JF - Projects PB - NORC at the University of Chicago UR - https://www.norc.org/Research/Projects/Pages/forgotten-middle-housing-and-care-options-for-middle-income-seniors-in-2033.aspx ER - TY - ICOMM T1 - Formerly incarcerated women of color face worse health in later life Y1 - 2022 A1 - Latham-Mintus, Kenzie A1 - Deck, Monica M A1 - Nelson, Elizabeth KW - health KW - incarcerated KW - Race/ethnicity KW - women JF - OUPBlog PB - Oxford University Press UR - https://blog.oup.com/2022/09/formerly-incarcerated-women-of-color-face-worse-health-in-later-life/ ER - TY - RPRT T1 - FP-22-18 Marital Status Variation in Religiosity Among Older Women and Men Y1 - 2022 A1 - Marino, Francesca A. A1 - Mellencamp, Kagan A. KW - Couples KW - Divorce KW - Marital quality KW - religiosity AB - Religiosity, feelings of closeness to a God, and involvement in religious activities, are linked to higher levels of couples’ commitment to one another and marital quality (Dollahite & Lambert, 2007). In long-term couples they are associated with a reduced likelihood of divorce (Dollahite & Lambert, 2007; Tuttle & Davis, 2015). A growing number of older adults are currently unmarried due to increasing shares experiencing a gray divorce (Brown & Lin, 2022, 2012) or never marrying (Lin & Brown, 2012), demonstrating the need to explore the heterogeneity in church attendance and religious attitudes among the unmarried. Using the 2016 wave of the Health and Retirement Study (HRS), this family profile examines religious service attendance and religious attitudes by marital status among adults aged 65 and older, distinguishing between women and men. PB - National Center for Family and Marriage Research Family Profiles UR - https://scholarworks.bgsu.edu/ncfmr_family_profiles/287 ER - TY - JOUR T1 - Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes JF - International Journal of Chronic Obstructive Pulmonary Disease Y1 - 2022 A1 - Roberts, Melissa A1 - Mapel, Douglas A1 - Ganvir, Nikhil A1 - Dodd, Melanie KW - Cognition KW - Disability KW - home health KW - peak air flow KW - Survival AB - Rationale: Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population. Objective(s): Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years. Methods: This was an observational cohort study using Health and Retirement Study data (2006– 2018) of community living individuals ages 50– 64 and ≥ 65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, ≥ 1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions. Results: The study included 18,979 survey observations for age 50– 64, and 24,162 age ≥ 65; 7.8% and 12.0% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age ≥ 65 was 23.1% (COPD) and 9.4% (non-COPD), and for the Enhanced FI-CGA, 45.9% (COPD) and 22.4% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50– 64 (95% CI: 3.8– 5.9% vs 0.7– 1.3%) and age ≥ 65 (95% CI: 11.9– 14.3% vs 5.6– 6.6%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions. Conclusion: Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50– 64 years). These measures identify patients with increased risk of poor outcomes. VL - Volume 17 ER - TY - JOUR T1 - Frailty does not cause all frail symptoms: United States Health and Retirement Study. JF - PLoS One Y1 - 2022 A1 - Chao, Yi-Sheng A1 - Wu, Chao-Jung A1 - Po, June Y T A1 - Huang, Shih-Yu A1 - Wu, Hsing-Chien A1 - Hsu, Hui-Ting A1 - Cheng, Yen-Po A1 - Lai, Yi-Chun A1 - Chen, Wei-Chih KW - Frail Elderly KW - Frailty KW - Geriatric Assessment KW - Retirement AB -

BACKGROUND: Frailty is associated with major health outcomes. However, the relationships between frailty and frailty symptoms haven't been well studied. This study aims to show the associations between frailty and frailty symptoms.

METHODS: The Health and Retirement Study (HRS) is an ongoing longitudinal biannual survey in the United States. Three of the most used frailty diagnoses, defined by the Functional Domains Model, the Burden Model, and the Biologic Syndrome Model, were reproduced according to previous studies. The associations between frailty statuses and input symptoms were assessed using odds ratios and correlation coefficients.

RESULTS: The sample sizes, mean ages, and frailty prevalence matched those reported in previous studies. Frailty statuses were weakly correlated with each other (coefficients = 0.19 to 0.38, p < 0.001 for all). There were 49 input symptoms identified by these three models. Frailty statuses defined by the three models were not significantly correlated with one or two symptoms defined by the same models (p > 0.05 for all). One to six symptoms defined by the other two models were not significantly correlated with each of the three frailty statuses (p > 0.05 for all). Frailty statuses were significantly correlated with their own bias variables (p < 0.05 for all).

CONCLUSION: Frailty diagnoses lack significant correlations with some of their own frailty symptoms and some of the frailty symptoms defined by the other two models. This finding raises questions like whether the frailty symptoms lacking significant correlations with frailty statuses could be included to diagnose frailty and whether frailty exists and causes frailty symptoms.

VL - 17 IS - 11 ER - TY - JOUR T1 - Frailty Risks of Prescription Analgesics and Sedatives across Frailty Models: the Health and Retirement Study. JF - Drugs & Aging Y1 - 2022 A1 - Bergen, Andrew W A1 - Cil, Gulcan A1 - Sargent, Lana J A1 - Dave, Chintan V KW - Analgesics KW - Frail Elderly KW - Frailty KW - Humans KW - Hypnotics and Sedatives KW - Opioid KW - prescription drugs KW - Prescriptions KW - Retirement decisions AB -

INTRODUCTION: Limited evidence for incident frailty risks associated with prescription analgesics and sedatives in older (≥ 65 years) community-living adults prompted a more comprehensive investigation.

METHODS: We used data from older Health and Retirement Study respondents and three frailty models (frailty index, functional domain, frailty phenotype with 8803, 10,470, and 6850 non-frail individuals, respectively) and estimated sub-hazard ratios of regular prescription drug use (co-use, analgesic use, and sedative use), by frailty model. We addressed confounding with covariate adjustment and propensity score matching approaches.

RESULTS: The baseline prevalence of analgesic and sedative co-use, analgesic use, and sedative use among non-frail respondents was 1.8%, 12.8%, and 4.7% for the frailty index model, 4.2%, 16.2%, and 5.3% for the functional domain model, and 4.3%, 15.4%, and 6.1% for the frailty phenotype model, respectively. Cumulative frailty incidence over 10 years was 39.3%, 36.1%, and 14.2% for frailty index, functional domain, and frailty phenotype models, respectively; covariate-adjusted sub-hazard ratio estimates were 2.00 (1.63-2.45), 1.83 (1.57-2.13), and 1.68 (1.21-2.33) for co-use; 1.72 (1.56-1.89), 1.38 (1.27-1.51), and 1.51 (1.27-1.79) for analgesic use; and 1.46 (1.24-1.72), 1.25 (1.07-1.46), and 1.31 (0.97-1.76) for sedative use. Frailty risk ranking (co-use > analgesic use > sedative use) persisted across all model sensitivity analyses.

DISCUSSION: Consistently significant frailty risk estimates of regular prescription analgesic and sedative co-use and of prescription analgesic use support existing clinical, public health, and regulatory guidance on opioid and benzodiazepine co-prescription, on opioid prescription, and on NSAID prescription. Frailty phenotype measurement administration limited power to detect significant frailty risks. Research into specific pharmaceutical exposures and comparison of results across cohorts will be required to contribute to the deprescribing evidence base.

VL - 39 IS - 5 ER - TY - RPRT T1 - A Framework for Evaluating the Adequacy of Disability Benefit Programs and Its Application to U.S. Social Security Disability Y1 - 2022 A1 - Morris, Zachary A. KW - Disabilities KW - disability benefits program KW - Social Security Disability Insurance AB - This paper presents a framework for assessing the adequacy of disability benefit programs and then applies that framework to an analysis of two Social Security disability programs in the U.S.: Social Security Disability Insurance and Supplemental Security Income. The paper draws on survey data from the Health and Retirement Study linked to administrative records from the Social Security Administration, and further compares the U.S. estimates to those from 26 other countries using cross-nationally harmonized data from the Survey of Health, Ageing and Retirement in Europe. The paper found that: More than 50 percent of older adults of working-age with work-disabilities in the U.S. do not receive disability benefits, though rates of benefit receipt for older adults with work-disabilities were higher than the average across other high-income countries in 2016.Those that receive disability benefits experienced greater difficulty achieving an adequate standard of living, as measured by an index of financial security, than those with similar characteristics in the U.S. who did not receive disability benefits. The policy implications of the findings are: Policy makers may find the research framework useful for investigating the adequacy of disability benefit programs. The analysis identified the limited availability and generosity of disability benefits in the U.S. indicating that the programs may not be sufficient to provide an adequate standard of living, as defined in the framework, to those with work-disabilities. JF - CRRBC Working Papers PB - Center for Retirement Research at Boston College CY - Chestnut Hill, MA UR - https://crr.bc.edu/working-papers/a-framework-for-evaluating-the-adequacy-of-disability-benefit-programs-and-its-application-to-u-s-social-security-disability/ ER - TY - JOUR T1 - Frequency and Implications of Co-occurring Serious Illness in Older Adults (S544) JF - Journal of Pain and Symptom Management Y1 - 2022 A1 - Stephanie Nothelle A1 - Cynthia Yee A1 - Evan Bollens-Lund A1 - Kenneth Covinsky A1 - Amy Kelley KW - Caregivers KW - Dementia KW - Medicare KW - serious illness AB - Outcomes 1. Describe how frequently the three categories of serious illness (dementia, functional impairment, advanced medical conditions) overlap in older adults 2. List two ways health service use or caregiving needs differ by type of serious illness Original Research Background Serious illness is a condition with high risk of mortality that negatively affects function or quality of life or excessively strains caregivers. In older adults, serious illness predominantly comprises three overlapping categories: dementia, functional impairment, and other advanced medical conditions. Research Objectives We estimate the frequency and co-occurrence of three categories of serious illness in older adults and describe differences in health service use and caregiving hours by category. Methods Using 2016 data from the nationally representative Health and Retirement Study, we selected those with 12 months of linked fee-for-service Medicare claims pre- and post-interview. Dementia status was determined by a survey-based algorithm, functional impairment by self-report of help with ≥1 activity of daily living, and advanced medical condition by claims-based ICD10 codes. Results We included 4,503 adults >65 years. Approximately 27% were seriously ill (9% dementia, 13% functional impairment, 16% advanced medical condition). Approximately 70% of persons with dementia (PWDs) and 65% with functional impairment had another category of serious illness, whereas only 31% with an advanced medical condition did. Functional impairment and advanced medical condition in combination increased prevalence of hospitalization compared to either alone (52% combined, 32% functional impairment, 30% advanced medical condition), but combining dementia with another serious illness category did not meaningfully change hospitalization (39% alone, 33% with functional impairment, 39% with advanced medical condition). PWDs and those with functional impairment reported more than twice the caregiving hours per month (113 and 130 hours, respectively) than those with an advanced medical condition (51 hours). Conclusion Older adults with serious illness due to dementia or functional impairment are more likely than those with an advanced medical condition to have another category of serious illness and have higher caregiving needs. Implications for Research, Policy, or Practice Caregiving policies and interventions for older adults with serious illness may need to be tailored by category of serious illness. VL - 63 UR - https://www.sciencedirect.com/science/article/pii/S088539242200252 IS - 5 ER - TY - JOUR T1 - Functional and Cognitive Decline Among Older Adults After High-risk Surgery. JF - Annals of Surgery Y1 - 2022 A1 - Suwanabol, Pasithorn A A1 - Li, Yun A1 - Abrahamse, Paul A1 - De Roo, Ana C A1 - Vu, Joceline V A1 - Maria J Silveira A1 - Mody, Lona A1 - Dimick, Justin B KW - Cognitive decline KW - functional decline KW - Surgery AB -

OBJECTIVE: The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use.

SUMMARY BACKGROUND DATA: Patient-centered outcomes after surgery are poorly characterized.

METHODS: Using data from the Health and Retirement Study linked with Medicare, we matched older adults (≥65 years) who underwent one of 163 high-risk elective operations (ie, inpatient mortality of ≥1%) with nonsurgical controls between 1992 and 2012. Functional decline was defined as an increase in the number of activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs) requiring assistance from baseline. Cognitive decline was defined by worse response to a test of memory and mental processing from baseline. Using logistic regression, we examined whether surgery was associated with functional and cognitive decline, and whether declines were associated with poorer survival and increased healthcare use.

RESULTS: The matched cohort of patients who did not undergo surgery consisted of 3591 (75%) participants compared to 1197 (25%) who underwent surgery. Patients who underwent surgery were at higher risk of functional and cognitive declines [adjusted odds ratio (aOR) 1.52, 95% confidence interval (CI): 1.23-1.87 and aOR 1.32, 95% CI: 1.03-1.71]. Declines were associated with poorer long-term survival [hazard ratio (HR) 1.67, 95% CI: 1.43-1.94 and HR 1.35, 95% CI: 1.15-1.58], and were significantly associated with nearly all measures of increased healthcare utilization (P < 0.001).

CONCLUSION: Older adults undergoing high-risk surgery are at increased risk of developing lasting functional and cognitive declines.

VL - 275 IS - 1 ER - TY - JOUR T1 - Functional Limitations and Access to Long-Term Services and Supports Among Sexual Minority Older Adults. JF - Journal of Applied Gerontology Y1 - 2022 A1 - Travers, Jasmine L A1 - Shippee, Tetyana P A1 - Flatt, Jason D A1 - Caceres, Billy A KW - Functional limitations KW - long-term support KW - sexual identity KW - sexual minorities AB -

Little is known about sexual minority (SM) older adults' activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations and their subsequent access to long-term services and supports (LTSS). We analyzed cross-sectional data from the 2016 Health and Retirement Study limited to individuals ≥50 years old. Bivariate analyses were performed to examine 1) sexual identity differences in the prevalence of ADL/IADL limitations and 2) associations of sexual identity with having ADL/IADL limitations and having access to help with ADL/IADL limitations. Our sample consisted of 3833 older adults, 6% ( = 213) were SM. Compared to heterosexual participants, bisexual older adults had greater reports of ADL/IADL limitations (20.9% vs. 35.9%, = 0.013). Among those who reported having ADL/IADL limitations ( = 803), there were no sexual identity differences in accessing help for ADL/IADL limitations ( = .901). Our findings contribute to the limited research on LTSS access among SM older adults.

VL - 41 IS - 9 ER - TY - JOUR T1 - Future Directions for the HRS Harmonized Cognitive Assessment Protocol. JF - Forum for Health Economics and Policy Y1 - 2022 A1 - Torres, Jacqueline M A1 - M. Maria Glymour KW - Alzheimer KW - Dementia KW - HCAP KW - Measurement AB -

In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer's disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of the HCAP demonstrated the feasibility and value of the more detailed cognitive assessments in the HCAP compared to the brief cognitive assessments in the core HRS interviews. To achieve its full potential, we provide eight recommendations for improving future iterations of the HCAP. Our highest priority recommendation is to increase the representation of historically marginalized racial/ethnic groups disproportionately affected by ADRDs. Additional recommendations relate to the timing of the HCAP assessments; clinical and biomarker validation data, including to improve cross-national comparisons; dropping lower performing items; enhanced documentation; and the addition of measures related to caregiver impact. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions.

ER - TY - JOUR T1 - Factors associated with healthy ageing: a comparative study between China and the United States JF - China Population and Development Studies Y1 - 2021 A1 - Chu, Lanlan A1 - Chen, Lu KW - CHARLS KW - China KW - health policy KW - healthy aging AB - This study compares the associators of healthy ageing in China and the United States, using the 2005–2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the 2004–2014 Health and Retirement Study (HRS). Health ageing is measured using an overall healthy ageing index (HAI), defined according to five dimensions: no major chronic diseases, free of physical functional impairment, free of cognitive impairment, no depressive symptoms, and socially active engagement. Multilevel logistic regression analysis is adopted to explore the association of demographic characteristics, socioeconomic status, and healthy lifestyles with the odds ratios of healthy ageing in China and the United States. Results indicate that the proportion of individuals experiencing healthy ageing is slightly higher in US than Chinese older adults aged 65–100 (25.67% vs 23.27%). Nevertheless, Chinese oldest-old (80–100) have a higher proportion of healthy ageing than American oldest-old (15.05% vs. 12.19%). Our results indicate that the odds of healthy ageing decrease with age, whereas they increase with education, income, marriage, and health behaviours. The odds of healthy ageing are lower for older Chinese women than men, whereas the odds are higher for older US women. Moreover, non-white elders in the United States have significantly lower odds of healthy ageing than their white counterparts. These findings suggest certain similar patterns of healthy ageing across two countries, but distinct patterns do exist. Promoting gender and racial equalities in healthy ageing are crucial for Chinese and American policymakers, respectively. SN - 2523-8965 ER - TY - ICOMM T1 - Family Care Availability And Implications For Informal And Formal Care Used By Adults With Dementia In The US Y1 - 2021 A1 - National Institute on Aging KW - Alzheimer's disease KW - Behavioral & Social Research KW - Caregiving KW - Chronic conditions KW - Dementias KW - Demography KW - Disability AB - As dementia worsens, people may gradually lose the ability to prepare meals, bathe, get dressed, and otherwise care for themselves. The likelihood that people living with dementia rely on unpaid care rather than paid care depends on whether a spouse or adult children are available to be primary caregivers, according to an NIA-supported study at the University of Michigan. Conversely, people without family members available to care for them are more likely to require paid help from a long-term care facility. As reported recently in Health Affairs, national estimates suggest that available family members and other unpaid caregivers are an important consideration for how people with dementia can remain outside of a nursing home environment when they need help with everyday activities. JF - News & Events PB - National Institute on Aging UR - https://www.nia.nih.gov/news/family-member-availability-predicts-likelihood-unpaid-care-people-living-dementia ER - TY - JOUR T1 - Family Care Availability And Implications For Informal And Formal Care Used By Adults With Dementia In The US. JF - Health Affairs Y1 - 2021 A1 - Choi, Hwajung A1 - Michele M Heisler A1 - Edward C Norton A1 - Kenneth M. Langa A1 - Cho, Tsai-Chin A1 - Cathleen M. Connell KW - Dementia KW - family caregivers KW - formal care KW - Informal care AB -

Despite the important role that family members can play in dementia care, little is known about the association between the availability of family members and the type of care, informal (unpaid) or formal (paid), that is actually delivered to older adults with dementia in the US. Using data about older adults with dementia from the Health and Retirement Study, we found significantly lower spousal availability but greater adult child availability among women versus men, non-Hispanic Blacks versus non-Hispanic Whites, and people with lower versus higher socioeconomic status. Adults with dementia and disability who have greater family availability were significantly more likely to receive informal care and less likely to use formal care. In particular, the predicted probability of a community-dwelling adult moving to a nursing home during the subsequent two years was substantially lower for those who had a co-resident adult child (11 percent) compared with those who did not have a co-resident adult child but had at least one adult child living close (20 percent) and with those who have all children living far (23 percent). Health care policies on dementia should consider potential family availability in predicting the type of care that people with dementia will use and the potential disparities in consequences for them and their families.

VL - 40 IS - 9 ER - TY - JOUR T1 - Family caregiving and place of death: Insights from cross-national analysis of the Harmonized End of Life Data. JF - The Journals of Gerontology: Series B Y1 - 2021 A1 - Jennifer A Ailshire A1 - Osuna, Margarita A1 - Wilkens, Jenny A1 - Jinkook Lee KW - Activities of Daily Living KW - Aging KW - Disability KW - family caregivers KW - Nursing homes KW - SHARE KW - spouse KW - Terminally Ill AB -

OBJECTIVES: Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe.

METHODS: We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home.

RESULTS: Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes.

DISCUSSION: This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.

VL - 76 IS - Supplement_1 ER - TY - JOUR T1 - Family Caregiving for Those With and Without Dementia in the Last 10 Years of Life. JF - JAMA Internal Medicine Y1 - 2021 A1 - Reckrey, Jennifer M A1 - Bollens-Lund, Evan A1 - Husain, Mohammed A1 - Katherine A Ornstein A1 - Amy Kelley KW - Caregiving KW - Dementia AB - Family caregivers of people with dementia (eg, spouses, children, and other unpaid caregivers) provide high levels of care1 and experience substantial caregiver strain at the end of life,2 yet little is known about the trajectory of care as the end of life approaches and how individual family members contribute to total care. We compared the hours of care that family caregivers provide to those with and without dementia during the last 10 years of life. Methods We sampled all decedents in the nationally representative Health and Retirement Study, including interview waves 2006 to 2016, who were 75 years or older at the time of death (n = 5266) and excluded those with significant missing data (n = 1317). Data analysis was conducted between October 2019 and March 2020. We determined each family caregiver’s annual care hours using the decedent’s self-reported hours of help received with self-care and household activities in the preceding month. We estimated caregiving hours between interviews using a weighted average of hours from each interview and assigned annual prorated hours based on the time from interview to death.3 We used a clinically validated algorithm4 to determine dementia status in the interview before death and then stratified results based on marital status. The study was approved by the Mount Sinai School of Medicine institutional review board with a waiver of informed consent due to the retrospective nature of the study. Results Family caregivers of people with dementia provided 3 times as many total hours of care over the last 10 years of life compared with caregivers of those without dementia (Figure). While care hours provided to those with dementia increased steadily in each of the last 10 years (mean annual increase, 17%; range 18%-41%), care hours provided to those without dementia remained low and then nearly tripled in the last year of life (mean [SD] of 8 [23] hours of care per week 1-2 years before death and 22 [35] hours in the last year of life). Adult children of those with dementia provided a larger portion of total care hours (50%) compared with those without dementia (41%). In the last year of life, adult children of those with dementia provided a mean (SD) of 17 (34) hours of care per week, while children of those without dementia provided a mean (SD) of 10 (22) hours. Among those married at the interview before death, spousal caregivers provided most of the care hours over all 10 years before death in the dementia and nondementia groups (81% and 77% of total care hours, respectively). Discussion Our study highlights the high levels of caregiving provided to those with dementia by their family caregivers in general and by adult children in particular. All married individuals relied primarily on spouses to provide care. However, adult children provided the bulk of care for family members with dementia, who were on average older and more likely to be widowed; substantial caregiving responsibilities for this population often began at least 10 years before death. The survey data did not assess the total time caregivers spent with family members; some time reported as caregiving may have replaced time spent in social engagement before needs arose, and our results may therefore overstate the time spent providing care. However, this limitation is unlikely to explain the many hours spent caregiving for individuals with dementia. Moreover, sustained caregiving responsibilities for individuals with dementia likely have financial implications beyond the time spent providing care. Caregivers may work fewer hours, miss opportunities for advancement, or fail to enter or stay in the workforce5; indirect costs of caregiving affect financial security and retirement savings and may even affect opportunities for the next generation. Because of the higher prevalence of dementia among those with lower socioeconomic status, the intergenerational effect of caregiving is particularly concerning for those already struggling to achieve equity. Existing programs that provide short-term, episodic support for caregivers (eg, the US Family Medical Leave Act and paid family leave) do not match the long-term, progressive care needs of those with dementia. VL - 181 IS - 2 ER - TY - ICOMM T1 - Family member availability predicts likelihood of unpaid care for people living with dementia Y1 - 2021 A1 - National Institute on Aging KW - Alzheimer's disease KW - Caregiving KW - Chronic conditions KW - Dementias KW - Demography KW - Disability AB - As dementia worsens, people may gradually lose the ability to prepare meals, bathe, get dressed, and otherwise care for themselves. The likelihood that people living with dementia rely on unpaid care rather than paid care depends on whether a spouse or adult children are available to be primary caregivers, according to an NIA-supported study at the University of Michigan. Conversely, people without family members available to care for them are more likely to require paid help from a long-term care facility. As reported recently in Health Affairs, national estimates suggest that available family members and other unpaid caregivers are an important consideration for how people with dementia can remain outside of a nursing home environment when they need help with everyday activities. JF - Featured Research PB - National Institute on Aging UR - https://www.nia.nih.gov/news/family-member-availability-predicts-likelihood-unpaid-care-people-living-dementia ER - TY - JOUR T1 - Feature selection algorithms enhance the accuracy of frailty indexes as measures of biological age. JF - The Journals of Gerontology, Series A Y1 - 2021 A1 - Kim, Sangkyu A1 - Fuselier, Jessica A1 - Welsh, David A A1 - Cherry, Katie E A1 - Myers, Leann A1 - Jazwinski, S Michal KW - Biological age KW - DNA Methylation KW - frailty index KW - Mortality AB -

Biological age captures some of the variance in life expectancy for which chronological age is not accountable, and it quantifies the heterogeneity in the presentation of the aging phenotype in various individuals. Among the many quantitative measures of biological age, the mathematically uncomplicated frailty/deficit index is simply the proportion of the total health deficits in various health items surveyed in different individuals. We used three different statistical methods that are popular in machine learning to select 17-28 health items that together are highly predictive of survival/mortality, from independent study cohorts. From the selected sets, we calculated frailty indexes and Klemera-Doubal's biological age estimates, and then compared their mortality prediction performance using Cox proportional hazards regression models. Our results indicate that the frailty index outperforms age and Klemera-Doubal's biological age estimates, especially among the oldest old who are most prone to biological aging-caused mortality. We also showed that a DNA methylation index, which was generated by applying the frailty/deficit index calculation method to 38 CpG sites that were selected using the same machine learning algorithms, can predict mortality even better than the best performing frailty index constructed from health, function, and blood chemistry.

VL - 76 IS - 8 ER - TY - CONF T1 - On the Fence of a Family: Dynamics of Inter-generational Transfers in Stepfamilies T2 - Population Association of America Meeting Y1 - 2021 A1 - He, Jingying KW - Adult children KW - intergenerational relationships KW - motivations of transfers KW - stepfamilies AB - The growing prevalence of family complexity in the United States calls into question the notion of family boundaries. Past research has shown weaker stepkin support consistently but has not explored the dynamics of exchanges. This paper studies how stepkin respond to each other’s past signals of help in providing future interpersonal support, financial transfers, and contacts compared to biological kin to sheds light on stepkin’s different motivations of support and relationship norms. I propose an “on-the-fence” theory and three hypotheses suggesting dynamic stepkin relationships subject to their past interactions. Using data of the Health and Retirement Study (HRS) from 1996 to 2014 and within-family fixed effects models, major hypotheses are confirmed. I find that despite the lower transfers among stepkin when no past signals of help are present (low-bar expectation hypothesis), stepkin respond to the other’s signals with a larger increase of parents’ monetary transfers, contacts, and adult children’s interpersonal support compared to biological kin (sensitivity response hypothesis), but not a larger increase in parent’s expectation or parents’ grandchild care support (differential convergence hypothesis). Results also vary depending on specific step status (child-stepmother or child-stepfather). Overall, the study provides a picture of dynamic stepkin relationship and family boundary. JF - Population Association of America Meeting UR - https://submissions2.mirasmart.com/Verify/PAA2021/Submission/Temp/radwd4acozb.pdf ER - TY - JOUR T1 - Financial hardship and depression experienced by pre-retirees during the COVID-19 pandemic: the mitigating role of stimulus payments JF - Applied Economics Letters Y1 - 2021 A1 - Liu, Yingyi A1 - Zhang, Yu A1 - Chatterjee, Swarn KW - COVID-19 KW - depression KW - Financial hardship KW - pre-retirees KW - stimulus checks AB - This study examines the association between financial hardship and depression among pre-retirees (ages 50 to 65) using the Health and Retirement Study (HRS) and its 2020 COVID-19 supplement. We find a negative association between the amount of stimulus received and financial hardship experienced by respondents during the pandemic. Additionally, the results indicate that African American households were less likely to increase spending, Hispanic households were more likely to increase savings, and households with lower educational attainment were more likely to pay down debt using their stimulus money. Financial wealth was negatively associated with the perception of feeling depressed. Overall, the findings from this study underscore the important role that the stimulus checks and other financial resources played in buffering the economic shock experienced by American households during the COVID-19 pandemic. SN - 1350-4851 ER - TY - ICOMM T1 - Financial Hardship and Risk of Incident Diabetic Kidney Disease Y1 - 2021 A1 - Socha, Victoria KW - diabetic kidney disease KW - Financial hardship KW - kidney KW - risk of incident AB - Approximately 30.3 million individuals in the United States are affected by diabetes; since the 1980s, there has been a rise in the prevalence of diabetes, accompanied by a rise in diabetic kidney disease (DKD). DKD affects ~40% of those with diabetes, putting them at increased risk of cardiovascular disease and progression to end-stage kidney disease. There are also associations between DKD and increased healthcare costs and risk of mortality. PB - Nephrology Times UR - https://www.docwirenews.com/nephtimes/nephtimes-features/news/financial-hardship-and-risk-of-incident-diabetic-kidney-disease-2/ ER - TY - RPRT T1 - Finding Needles in Haystacks: Multiple-Imputation Record Linkage Using Machine Learning Y1 - 2021 A1 - Abowd, John M. A1 - Abramowitz, Joelle A1 - Levenstein, Margaret C. A1 - McCue, Kristin A1 - Patiki, Dhiren A1 - Trivellore E. Raghunathan A1 - Rodgers, Ann A1 - Matthew D. Shapiro A1 - Wasi, Nada A1 - Zinsser, Dawn KW - Machine learning KW - record linkage AB - This paper considers the problem of record linkage between a household-level survey and an establishment-level frame in the absence of unique identifiers. Linkage between frames in this setting is challenging because the distribution of employment across establishments is highly skewed. To address these difficulties, this paper develops a probabilistic record linkage methodology that combines machine learning (ML) with multiple imputation (MI). This ML-MI methodology is applied to link survey respondents in the Health and Retirement Study to their workplaces in the Census Business Register. The linked data reveal new evidence that non sampling errors in household survey data are correlated with respondents’ workplace characteristics. JF - Working Paper PB - United State Census Bureau UR - https://www.census.gov/library/working-papers/2021/adrm/CES-WP-21-35.html ER - TY - JOUR T1 - Food and Nutrient Intake and Diet Quality among Older Americans JF - Public Health Nutrition Y1 - 2021 A1 - Choi, Yeon Jin A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Jennifer A Ailshire KW - diet quality KW - food KW - Nutrients AB - A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. For this study, data from a nationally representative sample of 5,614 community-dwelling older adults over age 54 in the Health and Retirement Study – Health Care and Nutrition Survey were used. Descriptive analyses were conducted to assess average intake of 17 food groups and nutrients and the percentage of respondents who consumed an optimal amount of food and nutrients. Differences in diet quality by sociodemographic, psychosocial, environmental, and geographic factors were assessed using chi-square and OLS regression was used to identify risk and protective factors for good quality diet. Overall, only 10.7% of respondents had a good quality diet (HEI score 81 and above); the majority had diets considered poor or needing improvement. Less than 50% of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socioeconomic status, fewer psychosocial resources, and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality. VL - 24 IS - 7 ER - TY - JOUR T1 - Food Insecurity Associated with Higher COVID-19 Infection in Households with Older Adults JF - Public Health Y1 - 2021 A1 - Shinae L. Choi A1 - Fei Men KW - COVID-19 KW - Food insecurity KW - Health Disparities AB - ABSTRACT Objectives As a well-documented social determinant of health, food insecurity may be associated with COVID infection in households with older adults. We examined whether older adults were vulnerable to COVID infection during the early pandemic if they were food insecure versus food secure. Study design Cross-sectional study using a nationally representative population-based survey of US older adults. Methods We used a random subsample of Health and Retirement Study (HRS) drawn in June 2020 (N = 3,212). We compared the odds of reporting COVID infection in a household, COVID infection and mortality among acquaintances, and respondent’s perceived fair or poor health across household food insecurity status resulted from financial or nonfinancial barriers. Baseline health and socioeconomic circumstances were adjusted in the models. Results Results showed higher COVID infection rate among food-insecure households than among their food-secure counterparts during the pandemic. Food insecurity due to nonfinancial obstacles was associated with greater likelihood of COVID infection both within respondents’ households (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.03–2.90) and among their acquaintances (aOR = 1.32, 95% CI: 1.05–1.65). Food insecurity caused by both nonfinancial and financial constraints was associated with twice the likelihood of knowing someone who died from COVID than their food-secure counterparts (aOR = 2.14, 95% CI: 1.27–3.61). Conclusions Food insecurity driven by nonfinancial constraints played an important role in the ongoing pandemic among US older adults. Policies addressing COVID need to recognize the vulnerability of food-insecure older adults beyond lack of monetary resources. VL - 200 ER - TY - ICOMM T1 - For breakthroughs in slowing aging, scientists must look beyond biology Y1 - 2021 A1 - University of Southern California KW - Aging KW - Behavior KW - Demography KW - Gerontology KW - Longevity KW - Mortality AB - A trio of recent studies highlight the need to incorporate behavioral and social science alongside the study of biological mechanisms in order to slow aging. The three papers, published in concert in Ageing Research Reviews, emphasized how behavioral and social factors are intrinsic to aging. This means they are causal drivers of biological aging. In fact, the influence of behavioral and social factors on how fast people age are large and meaningful. However, geroscience--the study of how to slow biological aging to extend healthspan and longevity--has traditionally not incorporated behavioral or social science research. These papers are by three pioneers in aging research and members of the National Academy of Medicine who study different aspects of the intersection of biology and social factors in shaping healthy aging through the lifespan. JF - Research News PB - EurekAlert/AAAS UR - https://www.eurekalert.org/pub_releases/2021-02/uosc-fbi022221.php ER - TY - JOUR T1 - Forecasting Mortality Inequalities in the U.S. Based on Trends in Midlife Health JF - Journal of Health Economics Y1 - 2021 A1 - Péter Hudomiet A1 - Michael D Hurd A1 - Susann Rohwedder KW - differential survival KW - Health Inequality KW - social security wealth KW - socioeconomic status AB - Recent literature has documented a widening gap in mortality between older individuals of high versus low socioeconomic status (SES) in the U.S. This paper investigates whether this trend will continue. We analyze the health status of successive cohorts of 54-60-year-old U.S. individuals born between 1934 and 1959 and use a rich set of health indicators to forecast life expectancies. The detailed health measures come from the longitudinal Health and Retirement Study. We find that many health indicators have worsened recently. For example, rates of obesity, diabetes, and self-reported levels of pain sharply increased between 1992 and 2016. Directly relevant for mortality, recent cohorts report lower subjective survival probabilities. Using Social Security wealth as an SES indicator, we find strong evidence for increasing health inequalities. We predict overall life expectancy to increase further; but the increase will be concentrated among higher SES individuals and mortality inequality will continue to increase. VL - 80 ER - TY - JOUR T1 - The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults JF - The Journals of Gerontology: Series B Y1 - 2021 A1 - Esther M Friedman A1 - Houle, Jason A1 - Kathleen A. Cagney A1 - Mary E Slaughter A1 - Regina A Shih KW - Cognitive decline KW - Community physical disorder KW - Community social cohesion KW - Foreclosures AB - Objectives While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition. Method This paper uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults’ cognitive health and the mechanisms responsible. Results We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship. Discussion This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults VL - 76 IS - 5 ER - TY - JOUR T1 - Frailty Changes Predict Mortality in 4 Longitudinal Studies of Aging JF - The Journals of Gerontology: Series A Y1 - 2021 A1 - Stolz, Erwin A1 - Emiel O Hoogendijk A1 - Mayerl, Hannes A1 - Wolfgang Freidl KW - ELSA KW - Epidemiology KW - Frailty KW - Mortality KW - Public Health KW - SHARE AB - Baseline frailty index (FI) values have been shown to predict mortality among older adults, but little is known about the effects of changes in FI on mortality.In a coordinated approach, we analyzed data from 4 population-based cohorts: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Survey of Ageing (ELSA), and the Longitudinal Aging Study Amsterdam (LASA), comprising a total of 24 961 respondents (65+), 95 897 observations, up to 9 repeated FI assessments, and up to 23 years of mortality follow-up. The effect of time-varying FI on mortality was modeled with joint regression models for longitudinal and time-to-event data.Differences (of 0.01) in current FI levels (hazard ratio [HR] = 1.04, 95% credible interval [CI] = 1.03–1.05) and baseline FI levels (HR = 1.03, 95% CI = 1.03–1.05) were consistently associated with mortality across studies. Importantly, individuals with steeper FI growth also had a higher mortality risk: An increase in annual FI growth by 0.01 was associated with an increased mortality risk of HR = 1.56 (95% CI = 1.49–1.63) in HRS, HR = 1.24 (95% CI = 1.13–1.35) in SHARE, HR = 1.40 (95% CI = 1.25–1.52) in ELSA, and HR = 1.71 (95% CI = 1.46–2.01) in LASA.FI changes predicted mortality independently of baseline FI differences. Repeated assessment of frailty and individual’s frailty trajectory could provide a means to anticipate further health deterioration and mortality and could thus support clinical decision making. VL - 76 SN - 1079-5006 IS - 9 ER - TY - THES T1 - From Housing Assistance to Student Debt: The Effects of Government Aid on Household Behavior and Welfare Y1 - 2021 A1 - Zhang, Ning KW - government aid KW - household behavior KW - Welfare AB - This dissertation consists of three chapters that study the effects of government assistance on household behavior and welfare. The first chapter studies the effect of the Housing Voucher Program (Section 8) on household behavior and welfare. Policymakers and researchers continuously debate the optimal structure and scope of the U.S. Housing Voucher Program. The current program features an inverse relation between subsidies and recipients' income, a high degree of rationing, and a limited scope of voucher usage. This chapter studies the effect of the Housing Voucher Program on low-income household behavior and welfare. Using several household datasets, I specify and estimate a lifecycle model that characterizes the effects of housing vouchers. Then I examine how a set of policy reforms affect household labor supply, marriage, homeownership, and well-being. The second chapter investigates the role of job mismatch, wage dispersion, student debt, family background, and preferences in accounting for the rise in parental coresidence rates over time. Parental coresidence rates for college graduates have risen substantially over the last twenty five years, from 25% average coresidence rate for 23-27 years old for 1996 graduation cohort to over 31% for the 2014 graduation cohort. We develop a structurally estimated model of child parent decisions to study the quantitative effect of job mismatch, wage dispersion, student debt, family background, and preferences on coresidence rates. The third chapter examines the effect student debt on marriage and homeownership among college graduates. Student debt for the current college cohort has increased in terms of number of debtors and average amount, which subsequently impacts family formation and homeownership. Using NLSY 79 and NLSY 97 data, we develop and estimate a lifecycle model to quantify the role of student debt in college graduates' marriage and homeownership patterns. Beyond student debt, we also examine the role of housing prices, wage dispersion, and downpayment rates in accounting for the difference in homeownership and marriage. PB - University of Pittsburgh CY - Pittsburgh, PA VL - Ph.D. UR - www.proquest.com/dissertations-theses/housing-assistance-student-debt-effects/docview/2665129792/se-2?accountid=14667 ER - TY - RPRT T1 - Functional disability with systematic trends and uncertainty: A comparison between China and the U.S. Y1 - 2021 A1 - Fu, Yu A1 - Sherris, Michael A1 - Xu, Mengyi KW - functional disability KW - Life Expectancy KW - multi-state latent factor intensity model KW - systematic trend and uncertainty AB - China and the U.S. are two contrasting countries in terms of functional disability and long-term care. China is experiencing declining family support for long-term care and developing private long-term care insurance. The U.S. has more developed public aged care and private long-term care insurance than in China. Changes in the demand for longterm care are closely related to levels of and trends in mortality and functional disability. To understand future potential demand for long-term care, we compare mortality and functional disability experiences in both China and the U.S. using a multi-state latent factor intensity model to estimate time trends and systematic uncertainty in transition rates. The estimation results show that if trends continue, both countries will experience longevity improvement with morbidity compression and a declining proportion of the older population with a functional disability. Although the elderly Chinese have an estimated shorter life expectancy, they are expected to spend a smaller proportion of that future lifetime functionally disabled in contrast to the U.S. Systematic uncertainty is shown to be significant in future trends in disability rates and our model estimates higher uncertainty in trends for the Chinese elderly, especially for urban residents. JF - CEPAR Working Paper PB - ARC Centre of Excellence in Population Ageing Research UR - https://www.cepar.edu.au/sites/default/files/WP2021_21_Functional_disability.pdf ER - TY - Generic T1 - Future Directions for the HRS Harmonized Cognitive Assessment Protocol Y1 - 2021 A1 - Torres, W. Jackeline A1 - M. Maria Glymour KW - Alzheimer KW - Dementia KW - HCAP AB - In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer’s disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve both our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of HCAP demonstrated feasibility and value of the more detailed cognitive assessments. To achieve its full potential, we recommend that the HCAP: 1) increase the representation of racial/ethnic minority participants disproportionately affected by ADRDs, 2) administer the HCAP repeatedly and with greater frequency to facilitate longitudinal analyses, cross-national harmonization, and precise characterization of practice and period effects, 3) field a clinical dementia assessment for at least a subset of HCAP participants, 4) phase-in a baseline assessment for people under age 60 in order to facilitate research on the earlier stages of cognitive impairment and midlife dementia prevention, 5) consider dropping lower performing items from the HCAP to increase feasibility of scaling the assessment to more participants at more frequent intervals, 6) enhance the documentation, multi-lingual options, training activities, and randomized sub-studies of language effects or other tools to promote the use of the HCAP and cross-national comparisons, 7) incorporate blood-based AD biomarkers, and 8) improve the capacity of the HCAP to understand the consequences of dementia, including for caregivers and for policy-relevant outcomes such as use of home and community-based services. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions. PB - National Institute on Aging CY - Bethesda, MD ER - TY - JOUR T1 - Fact or artefact? Childhood adversity and adulthood trauma in the U.S. population-based Health and Retirement Study JF - European Journal of Psychotraumatology Y1 - 2020 A1 - David Bürgin A1 - Cyril Boonmann A1 - Marc Schmid A1 - Paige Tripp A1 - Aoife O'Donovan KW - Childhood adversity KW - Trauma AB - Background: Despite the well-known deleterious health effects of childhood adversity (CA) and adulthood trauma (AT) and ageing of the global population, little is known about self-reported CA and AT in older populations. Existing findings are mixed due to methodological and sampling artefacts, in particular, recall and selection biases, and due to age-period-cohort effects. Objectives: We aim to first, provide data on the prevalence of retrospective self-reported CA and AT in a large population-based sample of older adults and, second, to discuss the data in the context of major methodological and sampling artefacts, and age-period-cohort effects. Method: Data are derived from the U.S. population-based Health and Retirement Study (N = 19,547, mean age = 67.24 ± 11.33, 59% female). Seven birth-cohorts were included (<1924, 1924–1930, 1931–1941, 1942–1947, 1948–1953, 1954–1959, >1959).Results: Overall, 35% of participants reported CA and 62% AT, with strong variability among birth-cohorts. Opposing trends were observed regarding prevalence of CA and AT. As age of cohorts increased, prevalence of CAs decreased while that of ATs increased. Investigating the distributions of incidence of specific ATs across age and period per cohort revealed incidence of exposure was associated with (1) age (e.g. having lost a child), (2) time-period (e.g. major disaster), and (3) cohort (e.g. military combat). Conclusions: Retrospective self-reported CA and AT in older samples should be interpreted with caution and with regard to major methodological challenges, including recall and selection biases. Untangling fact from artefact and examining age, period, and cohort effects will help elucidate profiles of lifetime exposures in older populations. VL - 11 UR - https://doi.org/10.1080/20008198.2020.1721146 ER - TY - JOUR T1 - Falls in community-dwelling older adults with heart failure: A retrospective cohort study JF - Heart & Lung Y1 - 2020 A1 - Kayoung Lee A1 - Matthew A. Davis A1 - John E. Marcotte A1 - Susan J Pressler A1 - Jersey Liang A1 - Nancy A. Gallagher A1 - Marita G. Titler KW - Aging KW - Falls KW - Heart Failure KW - Nursing KW - Older Adults AB - Background While heart failure (HF) in older adults is associated with fall risk, little is known about this in the U.S. Objective To examine the independent effect of functional impairments related to HF on falls among community-dwelling older adults in the U.S. Methods A retrospective cohort study was conducted with 17,712 community-dwelling older adults aged 65 and above with (n = 1693) and without HF, using mixed-effects logistic regression to examine the association between HF and falls. Results HF patients had 14% greater odds of falling than those without HF. Moreover, HF patients with functional difficulties in mobility, large muscle difficulty, instrumental activities of daily living difficulty, poor vision, and urinary incontinence demonstrated an increased likelihood of falling. Conclusion Community-dwelling older adults with HF and functional difficulties have a higher fall risk than those without HF, indicating that fall prevention programs should be developed, tested, and implemented for this population. UR - http://www.sciencedirect.com/science/article/pii/S014795631930559X ER - TY - JOUR T1 - Family caregiving in the community up to 8-years after onset of dementia JF - BMC Geriatrics Y1 - 2020 A1 - Jutkowitz, Eric A1 - Joseph E Gaugler A1 - Amal Trivedi A1 - Lauren L Mitchell A1 - Gozalo, Pedro KW - Alzheimer’s disease and related dementias KW - Community based long-term care KW - Health Services KW - Public Health AB - Background Persons with Alzheimer’s disease and related dementias (ADRD) receive care from family/friends, but how care changes from the onset of dementia remains less understood. Methods We used the Health and Retirement Study (2002–2012) to identify community-dwelling individuals predicted to have incident ADRD. We investigated the amount of caregiving received for activities of daily living in the 8-years after disease onset. Results At incidence (n = 1158), persons with ADRD received 151 h (SD = 231) of caregiving a month, 25 (SD = 26) caregiving days a month and had 1.3 (SD = 1.4) caregivers a month. By 8-years post incidence, 187 (16%) individuals transitioned to a nursing home and 662 (57%) died in the community. Community-dwelling persons with ADRD at 8-years post incidence (n = 30) received 283 h (SD = 257) of caregiving, 38 (SD = 24) caregiving days, and had 2.2 (SD = 1.3) caregivers. Conclusions Community-dwelling persons with ADRD receive a substantial amount of caregiving over the first 8-years after disease onset. VL - 20 SN - 1471-2318 IS - 1 ER - TY - JOUR T1 - Family embeddedness and older adult mortality in the United States JF - Population Studies Y1 - 2020 A1 - Patterson, Sarah E. A1 - Rachel Margolis A1 - Ashton M. Verdery KW - Family KW - health KW - kinless KW - kinship KW - Mortality KW - Social networks AB - Do different operationalizations of family structure offer different understandings of the links between family structure and older adult mortality? Using the American Health and Retirement Study (N?=?29,665), we examine mortality risks by three measures of family structure: whether respondents have different family statuses (e.g. married vs. unmarried), volume of family members available (e.g. having one vs. two living immediate family members), and family embeddedness (e.g. having neither spouse nor child vs. having spouse but no child). We focus on three kin types: partner/spouse, children, and siblings. We find that differences in empirical estimates across measures of family structure are not dramatic, but that family embeddedness can show some additional heterogeneity in mortality patterns over family status variables or the volume of ties. This paper tests different ways of operationalizing family structure to study mortality outcomes and advances our understanding of how family functions as a key social determinant of health. VL - 74 SN - 0032-4728 IS - 3 ER - TY - JOUR T1 - Family Member Death and Subjective Life Expectancy Among Black and White Older Adults. JF - Journal of Aging and Health Y1 - 2020 A1 - Rachel Donnelly A1 - Debra Umberson A1 - Tetyana Pudrovska KW - Bereavement KW - Mortality KW - Racial/ethnic differences AB -

OBJECTIVE: To examine whether exposure to family member deaths throughout the life course is associated with subjective life expectancy-a person's assessment of their own mortality risk-at age 65, with attention to differences by race.

METHOD: We analyzed 11 waves of data from a study of men and women above age 50 (Health and Retirement Study; n = 13,973).

RESULTS: Experiencing the deaths of multiple family members before the respondent is 50 years old is negatively associated with subjective life expectancy at age 65.

DISCUSSION: Understanding the life-course predictors of older adults' subjective life expectancy is particularly important because survival expectations influence long-term planning, health, and longevity. Moreover, Black Americans are exposed to more family member deaths earlier in their life compared with White Americans, with implications for long-term health and well-being.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/30451061?dopt=Abstract ER - TY - RPRT T1 - Family Support in Hard Times: Dynamics of Intergenerational Exchange after Adverse Events Y1 - 2020 A1 - Schaller, Jessamyn A1 - Eck, Chase KW - earned income KW - Health Shocks KW - Informal care KW - Intergenerational transfers KW - spousal death KW - Wealth AB - We use an event-study approach to examine changes in intergenerational financial transfers and informal care within families following wealth loss, job exit, widowhood, and health shocks. We find sharp reductions in parental giving to adult children following negative shocks to parents' wealth and earned income, particularly in low-wealth households. Parental giving also decreases with some health shocks and increases following spousal death. Meanwhile, children of low-wealth households increase financial transfers to their parents following adverse shocks and children in both high- and low-wealth households increase their provision of informal care to parents following a wide range of adverse shocks. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA ER - TY - THES T1 - Family Ties and Subjective Aging in Later Life T2 - Gerontology Y1 - 2020 A1 - Kim,Yijung K. KW - Aging anxiety KW - Attitudes toward own aging KW - Later life; Social relations KW - Subjective aging AB - Subjective aging refers to individuals’ understanding and expectations of aging-related changes. Although studies have consistently documented that subjective aging constructs are associated with individuals’ behaviors and well-being in later life, the link between one’s social environment and subjective aging beliefs remains understudied. This three-study dissertation examined how close social ties shape different subjective aging perceptions, by focusing on how individuals in later life view their aging-related changes in family contexts.Using data from the Boston Aging Together Study¸ the first study explored how health and relationship quality indicators are associated with aging perceptions of very old parents and their children. Findings indicated that individuals’ self-perceptions of aging were more similar within their age group. Very old parents’ self-perceptions of aging were associated with their own depressive symptoms as well as the children’s report of caregiver burden. Children’s self-perceptions of aging were only related to their own characteristics. The findings demonstrate some evidence for the interdependence of subjective aging experiences among very old parents and their children.The second study utilized data from the Korean Baby Boomer Panel Study to examine subjective aging experiences of married Korean baby boomers, namely, how their aging anxiety is shaped in the context of the parents’ and in-law’s financial and health characteristics in midlife. This study examined and found the cumulative effect, as well as the exposure effect, of the health and financial challenges of parents and in-laws on Korean baby boomers’ level of aging anxiety. Furthermore, frequency of contact moderated the effect of the financial condition of the poorest parent/in-law, such that individuals reporting more contact with the poorest parent/in-law showed higher levels of aging anxiety than those with less contact.Finally, drawing on three waves of quadrennial data (2008–2016) from the Health and Retirement Study, the third study examined how changes in health and relationship quality with a spouse over time contribute to aging perceptions of married older men and women. Multilevel models showed that there was no gender difference in self-perceptions of aging at baseline and how positive self-perceptions of aging changed over time. However, the changes in health and relationship quality affected men and women differently at both within-person and between-person level. Men’s self-perceptions of aging were particularly sensitive to changes in relationship quality, whereas women’s self-perceptions of aging were particularly sensitive to changes in functional limitations.In sum, the three studies aimed to form a cohesive body of work that examines multiple ways in which family members (i.e., spouse, parents, and children) mutually influence one another’s aging perceptions. The combination of findings provides support for adapting a life course framework in assessing individuals’ understanding of and attitudes toward own aging. Evidence suggests that interventions aimed at improving aging perceptions should investigate and target late-life family dynamics as one of the key components. JF - Gerontology PB - University of Massachusetts Boston CY - Boston VL - Doctor of Philosophy SN - 9798607346188 UR - https://search.proquest.com/openview/1a76d1369cff033b037b3f547e0f6c3f/1?pq-origsite=gscholar&cbl=18750&diss=y ER - TY - JOUR T1 - Female vulnerability to the effects of smoking on health outcomes in older people JF - PloS one Y1 - 2020 A1 - Haghani, Amin A1 - Thalida E. Arpawong A1 - Jung K Kim A1 - Lewinger, Juan Pablo A1 - Caleb E Finch A1 - Eileen M. Crimmins KW - Cardiovascular disease KW - Smoking KW - Women's Health AB - Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity. VL - 15 SN - 1932-6203 UR - https://pubmed.ncbi.nlm.nih.gov/32497122 IS - 6 U1 - 32497122[pmid] U4 - PONE-D-20-03538[PII] JO - PLoS One ER - TY - JOUR T1 - Financial Fraud Among Older Americans: Evidence and Implications JF - JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Y1 - 2020 A1 - DeLiema, Marguerite A1 - Deevy, Martha A1 - Annamaria Lusardi A1 - Olivia S. Mitchell KW - Financial literacy KW - Health and Retirement Study KW - Investment fraud KW - Lottery scam AB - Objectives: The consequences of poor financial capability at older ages are serious and include making mistakes with credit, spending retirement assets too quickly, and being defrauded by financial predators. Because older persons are at or past the peak of their wealth accumulation, they are often the targets of fraud. Methods: Our project analyzes a module we developed and fielded on people aged 50 an older years in the 2016 Health and Retirement Study (HRS). Using this data set, we evaluated the incidence and prospective risk factors (measured in 2010) for investment fraud and prize/lottery fraud using logistic regression (N = 1,220). Results: Relatively few HRS respondents mentioned any single form of fraud over the prior 5 years, but 5.0% reported at least one form of investment fraud and 4.4% recounted prize/lottery fraud. Greater wealth (nonhousing) was associated with investment fraud, whereas lower housing wealth and symptoms of depression were associated with prize/lottery fraud. Hispanics were significantly less likely to report either type of fraud. Other suspected risk factors-low social integration and financial literacy-were not significant. Discussion: Fraud is a complex phenomenon and no single factor uniquely predicts victimization across different types, even within the category of investment fraud. Prevention programs should educate consumers about various types of fraud and increase awareness among financial services professionals. VL - 75 IS - 4 ER - TY - THES T1 - Financial literacy, health shocks, and household liquidity T2 - Human Development and Family Studies Y1 - 2020 A1 - Rimi, Tamanna Afreen KW - Financial literacy KW - Health Shocks AB - This study investigates the role of financial literacy in portfolio allocation for older adults in response to a health shock. Given higher health costs and strained health insurance coverage for many families, understanding the role of financial literacy in the health-wealth relationship has become increasingly important. However, limited such research has been conducted in the health-wealth literature. This dissertation fills this gap in the literature investigating whether financial literacy has a moderating effect on household financial choices when a health shock occurs. This study used 2008, 2010, and 2012 waves from the Health and Retirement Study. It developed an advanced financial literacy index reflecting the right mix of knowledge required in making portfolio investment decisions. An objective measure based on the diagnosis information of a number of chronic diseases has been used to identify the health shock. Pooled Tobit estimation is used to test the relationship between financial literacy, health shocks, and household liquidity. Three important conclusions are drawn from the overall results. 1) A health shock appears to relate to liquid asset holdings immediately after the shock, but the apparent effect disappears two years after the shock; 2) Financial literacy plays a role in liquid asset allocation both in the short term and long term; 3) Financial literacy influences the allocation in liquid asset share in response to health-related uncertainty. In other words, families facing health shocks become less sensitive to a shock with a higher level of financial expertise and transfer fewer assets to liquid assets. The overall results reinforce the importance of financial literacy and highlight its role in dealing with financial and health challenges. The findings of this study that any impact of financial literacy on financial decisions can last longer than the impact of the health shock itself support the promotion of financial literacy programs. JF - Human Development and Family Studies PB - Iowa State University CY - Ames, IA VL - Doctor of Philosophy ER - TY - JOUR T1 - Financial Literacy in the Family Context: The Role of Spousal Education and Gender Among Older Couples JF - Innovation in Aging Y1 - 2020 A1 - Li, Yang KW - Education KW - Financial literacy KW - spouse AB - Despite recent advances in the literature on the association between one’s own education and financial literacy, the role of the family context in financial literacy has received limited attention. I examine whether spousal education is associated with one’s own financial literacy among older couples and whether this association differs by gender. Using data from the 2016 Health and Retirement Study (n=1,220), I employ a multilevel actor-partner interdependence model to examine the cross-partner effect of spousal education on own financial literacy among older couples. I analyze a set of regression models on pairwise data to estimate the moderating effect of gender. I find that having a college-educated spouse was associated with a higher likelihood of being financially literate and that wives’ education attainment was associated with a higher likelihood of financial literacy for husbands. Understanding the role of spousal education in late-life financial literacy adds to our knowledge about the role of the family context as related to individual financial knowledge and skills. Older adults may acquire financial literacy within the family, such as learning from a spouse. VL - 4 SN - 2399-5300 IS - Suppl 1 ER - TY - JOUR T1 - Financial Sophistication and Private Long-term Care Insurance Purchase Decision JF - Journal of Health Care Finance Y1 - 2020 A1 - Rashmita Basu KW - financial sophistication KW - Long-Term care insurance purchase KW - Retirement Planning AB - Despite significant financial risk associated with long-term care expenditure, the market for private long-term care insurance (LTCI) remains severely limited. Understanding the sources of such under-insurance is important to evaluate any potential reforms to strengthen the private LTCI market so that it becomes a significant source of financing long-term care services and supports for the elderly. Considering LTCI as a form of retirement planning, one would expect an individual's financial literacy to affect their LTCI purchasing decision. Implementing an instrumental variable approach, the current study isolates the causal impact of financial sophistication on optimal decision to purchase a private LTCI coverage. Consistent with the literature on retirement planning, results show that individuals with more sophisticated financial knowledge were likely to purchase a private LTCI coverage. UR - http://healthfinancejournal.com/index.php/johcf/article/view/208 ER - TY - THES T1 - Financial Stress and Loneliness in Older Adults T2 - Human Development & Family Science Y1 - 2020 A1 - Drost, Madeleine KW - Finances KW - Mental Health AB - The population of older adults is growing in developed nations worldwide. This demographic trend, attributed to falling fertility and mortality rates, has shifted the focus of researchers toward this population, with the goal of improving health and well-being outcomes. This study focuses on the economic and mental health well-being of older adults in the United States. Previous research indicates that low income status is associated with feelings of isolation and loneliness in older adults. This study builds on that prior research by examining how subjective and objective financial changes are associated with general loneliness in the population of older adults in the U.S. Subjectively, financial stress is represented by a measure of subjective financial strain, while it is measured objectively using changes in income and assets. Data from the Health and Retirement Study (HRS), a sample of U.S. older adults, will be used to examine the relationship between financial changes and loneliness, and to determine if the relationship is mediated by mental health, social participation, or personality. First-differencing analysis is used to determine if household financial changes are related tochanges in general loneliness. Preliminary analysis indicates that there is a relationship between the subjective measure of subjective financial strain and general loneliness, independent of mental health, social participation, and personality mediators. JF - Human Development & Family Science PB - Ohio Stat University CY - Columbus, OH VL - Master of Science ER - TY - JOUR T1 - Food Insecurity and Dietary Quality in Older Adults: Do Nutrition Assistance Programs Play a Protective Role? JF - Current Developments in Nutrition Y1 - 2020 A1 - Nicholas J Bishop A1 - Sarah Ullevig A1 - Krystle E Zuniga A1 - Wang, Kaipeng KW - acute hemorrhagic edema of childhood KW - Aging KW - diet AB - Objectives The emergence of food insecurity as a primary nutrition-related health issue among older adults suggests a need to examine how nutritional assistance programs are related to food insecurity and dietary quality in aging populations. This project examines food insecurity and dietary quality in US adults age 65 and older and the impact of nutrition assistance programs. Methods The sample was drawn from the 2012 Health and Retirement Study and 2013 Health Care and Nutrition Study and included 3779 respondents representing a population of 37,217,566 adults aged 65 and older. Food insecurity was a binary measure based on the USDA six-item US Adult Food Security Survey Module. Two forms of nutritional assistance included receipt of supplemental food from sources such as food banks and Meals-on-Wheels (1 = yes, 0 = no) and reported receipt of SNAP benefits (1 = yes, 0 = no). Dietary quality was measured using the Alternative Healthy Eating Index-2010 based on a food frequency questionnaire. General linear modeling adjusting for covariates and complex sampling design was used to test if nutritional assistance moderated the association between food insecurity and AHEI-2010. Results Around 10% of the sample was food insecure, 14% reported receipt of supplemental food, and 6.4% were SNAP benefit recipients. In covariate-adjusted models, food insecurity and receipt of SNAP benefits were not associated with AHEI-2010, but receipt of supplemental food was (b = −1.39, SE = 0.67, P = 0.038). Receipt of supplemental food moderated the association between AHEI-2010 and food insecurity (P = 0.001). Simple effect estimates suggested that among those not receiving supplemental food, the food insecure had lower AHEI-2010 scores than the food secure (b = −2.15, SE = 0.88, P = 0.014). Among those receiving supplemental food, the food insecure had greater AHEI-2010 scores than the food secure (b = 2.62, SE = 1.25, P = 0.035) and similar AHEI-2010 scores as the food secure not receiving supplemental food. Conclusions Preliminary analysis suggests that receipt of supplemental food appears to be associated with better dietary quality among food-insecure older adults and confirms the importance of food assistance programs in combating the negative effect of food insecurity on dietary quality. VL - 4 IS - 2 ER - TY - JOUR T1 - Food stamps, food insecurity, and health outcomes among elderly Americans JF - Preventive Medicine Y1 - 2020 A1 - Tae-Young Pak A1 - GwanSeon Kim KW - depression KW - Food assistance KW - Mental Health KW - Self-esteem KW - Stigma KW - Supplemental Nutrition Assistance Program AB - This study examined associations between very low food security and health outcomes in older adults, and tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) mitigates adverse health consequences associated with very low food security. Data were drawn from the 1998–2014 waves of the Health and Retirement Study (N = 148,138 from 27,281 persons). A longitudinal analysis of the relationship between very low food security and health condition depending on SNAP participation was conducted using the individual fixed effects regression. Respondents' health status was assessed by self-rated health, grip strength, and depressive symptoms. The correlations between very low food security and physical health outcomes were negatively significant prior to SNAP enrollment (p < 0.05) but became insignificant upon participation, indicating that SNAP may have prevented poor physical health resulting from very low food security. However, results concerning mental health showed that SNAP enrollment does not modify the association between very low food security and depression; very low food security remained a significant risk factor of depressive symptoms conditional on SNAP enrollment (p < 0.001). Further analyses showed that SNAP participation is correlated with negative self-attitudes (p < 0.05), and that the correlation between SNAP and depression becomes insignificant after controlling for self-attitudes. These results suggest that a stigma effect arising from welfare use may have reduced self-esteem and resulted in depressive moods. Future research needs to delve into whether reforms to the food assistance program aimed at reducing stigma can help alleviate emotional distress among welfare recipients. VL - 130 UR - http://www.sciencedirect.com/science/article/pii/S0091743519303470 ER - TY - NEWS T1 - For elderly couples, negative thoughts about aging can be detrimental to their spouses T2 - Michigan News Y1 - 2020 A1 - Wadley, Jared KW - elderly couples KW - health KW - Self-perception AB - Elderly husbands and wives can expect their health to decline—as well as that of their spouse—when their self-perceptions about aging become negative, a new study suggests. Led by researchers at the University of Michigan and Zhejiang University, the study found that health effects differ by gender among elderly couples. The husband’s self-perceptions about aging are associated with his wife’s depressive symptoms, whereas the wife’s views correlate with her husband’s physical disability, functional limitations and chronic diseases, the findings indicated. JF - Michigan News CY - Ann Arbor, MI UR - https://news.umich.edu/for-elderly-couples-negative-thoughts-about-aging-can-be-detrimental-to-their-spouses/ ER - TY - JOUR T1 - Forced retirement risk and portfolio choice JF - Journal of Empirical Finance Y1 - 2020 A1 - Chen, Guodong A1 - Lee, Minjoon A1 - Tong Yob Nam KW - Forced retirement KW - Human capital KW - Portfolio choice AB - Current literature on the effect of labor income on portfolio choice overlooks that workers face a risk of being forced to retire before their planned retirement age. Using data from the Health and Retirement Study, this paper finds that the forced retirement risk is both significant and highly correlated with stock market fluctuations. Using a life-cycle portfolio choice model, this paper shows that forced retirement risk makes labor income near retirement stock-like. Therefore, contrary to conventional wisdom, those who are still working but near retirement should have a lower share of risky assets in their financial portfolios than retirees do. VL - 58 SN - 0927-5398 ER - TY - JOUR T1 - Formal Volunteering Buffers the Negative Impact of Unemployment among Older Workers: A Longitudinal Analysis JF - Journal of Gerontological Social Work Y1 - 2020 A1 - Jie Yang KW - buffer KW - Jahoda KW - longitudinal KW - moderation AB - ABSTRACTGuided by Jahoda’s Latent Deprivation Theory, this study examined whether engaging in formal volunteering could moderate the negative impact of unemployment on older workers’ mental health. This study also explored the optimal intensity/hours of volunteering required to have a positive effect. This study analyzed six waves (12 years) of longitudinal data from the Health and Retirement Study using fixed effects modeling. The outcome variable was depressive symptoms, and the independent variables were labor force status and volunteering status. Observed time-varying confounders were controlled. There was a significant interaction between engaging in formal volunteering and unemployment status. Unemployed older workers who participated in volunteering fared better than those unemployed workers who did not volunteer. Further, those unemployed older workers who volunteered over 100 hours/year did not benefit from volunteering. Results from this study have important implications for future intervention development targeting the mental health of unemployed older workers. UR - https://www.tandfonline.com/doi/full/10.1080/01634372.2020.1744057?scroll=top&needAccess=true N1 - PMID: 32191615 ER - TY - JOUR T1 - Frailty Phenotype and Cause-Specific Mortality in the United States JF - The Journals of Gerontology: Series A Y1 - 2020 A1 - Matthew C. Lohman A1 - Amanda Sonnega A1 - Nicholas V Resciniti A1 - Amanda N Leggett KW - Cause of Death KW - Frailty KW - Incidence KW - Mortality KW - Prefrailty AB - Frailty is a common condition among older adults increasing risk of adverse outcomes including mortality; however, little is known about the incidence or risk of specific causes of death among frail individuals.Data came from the Health and Retirement Study (HRS; 2004–2012), linked to underlying cause-of-death information from the National Death Index (NDI). Community-dwelling HRS participants aged 65 and older who completed a general health interview and physical measurements (n = 10,490) were included in analysis. Frailty was measured using phenotypic model criteria—exhaustion, low weight, low energy expenditure, slow gait, and weakness. Underlying causes of death were determined using International Classification of Diseases, Version 10 codes. We used Cox proportional hazards and competing risks regression models to calculate and compare incidence of cause-specific mortality by frailty status.During follow-up, prefrail and frail older adults had significantly greater hazard of all-cause mortality compared to individuals without symptoms (adjusted hazard ratio [HR] prefrail: 1.85, 95\% CI: 1.51, 2.25; HR frail: 2.75, 95\% CI: 2.14, 3.53). Frailty was associated with 2.96 (95\% CI: 2.17, 4.03), 2.82 (95\% CI: 2.02, 3.94), 3.48 (95\% CI: 2.17, 5.59), and 2.87 (95\% CI: 1.47, 5.59) times greater hazard of death from heart disease, cancer, respiratory illness, and dementia, respectively.Significantly greater risk of mortality from several different causes should be considered alongside the potential costs of screening and intervention for frailty in subspecialty and general geriatric clinical practice. Findings may help investigators estimate the potential impact of frailty reduction approaches on mortality. VL - 75 IS - 10 N1 - glaa025 ER - TY - RPRT T1 - FUNCTIONAL TRAJECTORIES AT THE END OF LIFE FOR INDIVIDUALS WITH DEMENTIA: FINAL REPORT Y1 - 2020 A1 - Ila H. Broyles KW - Alzheimers disease KW - cognitive impairment KW - Dementia KW - end of life KW - Formal Hospice KW - Health Services KW - Mental Health AB - Dementia, including Alzheimer’s disease and related disorders, is a neurocognitive disease affecting an individual’s cognitive function and behavior. Dementia is a leading cause of death and is particularly prevalent at the end of life (EOL) in older adults. However, there is limited knowledge regarding the patterns of decline for adults with dementia, who may also have comorbid terminal conditions. This knowledge gap may prevent providers from offering palliative and hospice services, because they may not be able to identify when a dementia patient has entered the terminal phase of illness. It may also limit patients’ and families’ ability and willingness to access palliative services that can improve and complement EOL care. For this project, we used a sample of decedents from the 2000-2012 Health and Retirement Study to understand the trajectories of functional decline of older adults with dementia near the EOL, and how these trajectories differ from those of people without dementia. In addition, we examined whether and how these trajectories vary by other patient characteristics such as demographics, comorbidities, and access to caregiving. Overall, the findings from the point-in-time analyses indicated that people with dementia have significantly higher levels of functional impairments than do people without dementia up until the last year of life. However, the functional impairment of people with dementia at 2-4 years before death may look similar to people without dementia in the last 6-12 months before death, after controlling for other characteristics. PB - OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION, U.S. Department of Health & Human Services UR - https://aspe.hhs.gov/basic-report/functional-trajectories-end-life-individuals-dementia-final-report ER - TY - JOUR T1 - Facets of conscientiousness and longevity: Findings from the Health and Retirement Study. JF - Journal of Psychosomatic Research Y1 - 2019 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Martina Luchetti A1 - Antonio Terracciano KW - Conscientiousness KW - Longevity KW - Mortality AB - Objectives: Conscientiousness is the strongest personality predictor of longevity. The present study examined which facets of conscientiousness are the most strongly related to mortality risk in a large longitudinal sample of middle-aged and older adults. Method: Seven-year mortality data were obtained from participants (total N > 11,000) from the Health and Retirement Study (HRS, 2008–2014). Six facets of conscientiousness, demographic factors, disease burden, smoking and physical inactivity were assessed at baseline. Results: Controlling for demographic factors, every standard deviation higher order, traditionalism, virtue, and responsibility was related to an approximately 10% reduced risk of mortality; industriousness was associated with an almost 25% lower likelihood of mortality. Except for traditionalism, these associations were partially accounted by health and behavioral covariates. Self-control was not related to longevity. When all facets and the covariates were simultaneously included, only industriousness was significantly associated with mortality. Conclusions: The present study provides new evidence about the specific facets of conscientiousness that are related to longevity. VL - 116 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30654983?dopt=Abstract ER - TY - THES T1 - Factors Associated with Advance Care Plans and End-of-life Care Choices Among Elderly Americans: An Analysis of Health and Retirement Study Data T2 - Health Services and Policy Management Y1 - 2019 A1 - Ajmal,Agha KW - 0493:Aging KW - 0573:Public health KW - 0630:Public policy KW - Advance care planning KW - Advance directives KW - Aging KW - Durable Power of Attorney for Health Care KW - Elderly Americans KW - End-of-life care KW - Living will KW - Public Health KW - Public Policy AB - Introduction: Advance care plans (ACPs) allow people to plan for their end-of-life care before they become incompetent to make their treatment decisions. The umbrella term Advance Care Plans (ACP) includes the three most commonly used end-of-life care plans: Advance Care Planning Discussions (ACP discussions) and two advanced directives: living will and Durable Power of Attorney for Health Care (DPAHC). The ACP discussions are the verbal discussions about end-of-life plans, whereas the advance directives are written documents.ACPs are distinct nuances of end-of-life care planning. ACP discussions address a wide array of end-of-life care issues, including terminal care, funeral, burial and the place of death, etc. A living will outlines specific end-of-life care choices and elicits yes or no responses. The choices pertain to use of artificial respiration; artificial feeding and hydration; dialysis; or antibiotics; etc. A DPAHC, appoints a proxy to make treatment decisions on behalf of the incompetent patient at a terminal stage of life.While previous studies have used ACPs as distinct outcomes, in real life the ACPs exist in combinations. People who undertake ACP discussions are more likely to complete advance directives. More than 25 states have combined directives forms. Therefore, it is imperative to evaluate the factors associated with the combinations of ACPs: No ACP; ACP discussions only; a directive (a living will or DPAHC); a directive and ACP discussions; both directives (a living will and DPAHC); and all ACPs (a living will, DPAHC and ACP discussions).Among the factors associated with ACPs, health status has shown an inconsistent association. Some studies have shown that poor health is associated with higher ACP uptake rates, whereas others have noted no association. The possible reasons for inconsistent association include 1) examining the association without controlling for the change in health status and other health factors — prior research shows health status and change in health are closely related in influencing the uptake of ACPs and the end-of-life care choices 2) use of each ACP as a separate outcome instead of using them in combinations. Therefore, our first study attempted to clarify the association between health status, change in health status and interaction between the two measures with the combinations of ACPs.Our second study determined the factors associated with end-of-life care choices. Prior concerning the association between health status and end-of-life care choices have used prospect theory. However, previous research has used convenience samples and end-of-life care scenarios. We tested the prospect theory using a representative population-based sample and using the choices that people make considering their own health status and possible end-of-life circumstances.Methods: We used the Health and Retirement Study (HRS) panel data from 1992-2014 and the HRS exit interview data from 2002-2014. The HRS captures health and retirement characteristics of a representative sample of Americans over 50 years using biennial panel surveys since 1992. It also conducts one-time post-death interviews with the next-of-kin of HRS decedents in the survey waves following their death. The post-death surveys collect information about medical care expenditures and use; advance care planning and end-of-life care choices and distribution of assets towards end-of-life.We used the SAS version 9.4 to examine the association between health status and ACPs, we used a multinomial regression model. The combinations of ACPs were used as the study outcome. To study the association between health status and choices, a separate logistic regression model was used for each choice — limit care in certain situations, comfort care and all care possible.Results: In study 1, self-reported health was not associated with any category of ACP combinations. However, change in health status was associated with ACPs — “worse or somewhat worse” change in health status since the last survey wave was associated with a higher uptake of “two directives” and “all ACPs”, compared with “much or somewhat better or the same”. The number of health conditions and a history of cancer were also associated with “all ACPs”.In study 2, we did not find association between self-reports of health and its change with the two care-limiting choices, including “limit care in certain situations” and “comfort care”. However, change in health status was associated with the “all care possible” option — a decline in health status since the last wave was associated with a higher likelihood of “all care possible” choice than improvement or no change in health status since the last wave. Among other health factors, a psychiatric illness was associated a higher uptake of “all care possible” and a lower uptake of “comfort care”. The decedents with a history of stroke chose less “limit care in certain situations” option.Recommendations: We recommend further research on the factors associated with the combinations of ACPs. Future research should also use the combinations to determine the effects of ACPs on the cost and quality of end-of-life care. JF - Health Services and Policy Management PB - University of South Carolina VL - PhD SN - 9781085585590 UR - https://scholarcommons.sc.edu/etd/5126/ N1 - Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-09-20 ER - TY - JOUR T1 - Factors associated with becoming edentulous in the US Health and Retirement Study. JF - Journal of the American Geriatrics Society Y1 - 2019 A1 - Jane A Weintraub A1 - Orleans, Brian A1 - Mark Alan Fontana A1 - Phillips, Ceib A1 - Judith A Jones KW - Dental Care KW - Risk Factors KW - Smoking AB -

BACKGROUND/OBJECTIVE: To determine factors associated with older adults becoming edentulous (complete tooth loss).

DESIGN: Longitudinal study over a 6-year period.

SETTING: United States, 2006, 2012.

PARTICIPANTS: Nationally representative US sample of adults, aged 50 years and older (n = 9982), participating in the Health and Retirement Study in 2006 and 2012. At the outset, they were dentate and not institutionalized.

INTERVENTION: None.

MEASUREMENTS: Self-report of being dentate or edentulous, demographic variables, dental utilization and other health behaviors, self-rated general health, and incidence between 2006 and 2012 of comorbid medical conditions, functional limitations, and disabilities.

RESULTS: From 2006 to 2012, 563 individuals (5%) became edentulous and 9419 (95%) remained dentate. Adults who became edentulous by 2012 were more likely than those who remained dentate to be black/African American compared to white, to be less educated, were current smokers, had diabetes, and reported poorer self-rated general health, more functional limitations and disabilities, and fewer dental visits (all P < .0001), among other factors. Of those with regular dental visits (at least once every 2 years during the 6-year period), 2.3% became edentulous compared to 9.9% among those without regular dental visits. After adjusting for age and other potential confounders, there was a strong association with poor dental attendance and smoking. Nonregular dental attenders were more likely than regular attenders to become edentulous (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 2.12-3.53), and current smokers were more likely than never smokers to become edentulous (OR = 2.46; 95% CI = 1.74-3.46).

CONCLUSION: Although more contemporaneous data are needed to determine causality, regular dental utilization and smoking are modifiable factors that could prevent edentulism, even when many other comorbid conditions are present. J Am Geriatr Soc, 1-7, 2019.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/31335967?dopt=Abstract ER - TY - JOUR T1 - FACTORS ASSOCIATED WITH LIFE-SPACE CONSTRICTION IN LATER LIFE: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY JF - Innovation in Aging Y1 - 2019 A1 - Moon Choi A1 - Briana Mezuk KW - life-space KW - space constriction AB - This study aimed to examine factors associated with life-space constriction, using the data from the Health and Retirement Study, a nationally representative sample. We limited our analysis to those who were 65 years and older and answered to the 2012 experimental module on life-space (N=895; mean age=75.3; 59.4% women). Life-space was assessed with the modified version of the UAB Study of Aging Life-Space Assessment, ranging nine zones: room, home, own property, immediate neighborhood, town, community, county, state, and region. A series of logistic regression models were used to estimate odds ratios for life-space constriction by sociodemographic and health characteristics. The results showed that 3.0% and 6.7% of older adults reported that they had never been to places beyond their home and own property/apartment building for the past four weeks, i.e. the critical boundaries in terms of social isolation. The significant factor associated with the life-space constriction within home, immediate neighborhood, and town was physical mobility limitation (OR: 1.18, 1.09, 1.11, respectively), while the constriction within county was associated with education level (OR: 0.91). Driving a car was negatively associated with the life-space constriction within own property/apartment building and home (OR: 0.48 and 0.22, respectively). Policy makers need to pay more attention to social and environmental factors influencing social isolation among older adults such as transportation options and social class disparity. VL - 3 SN - 2399-5300 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841504/ IS - Suppl 1 JO - Innov Aging ER - TY - JOUR T1 - Factors that impact family perception of goal-concordant care at the end of life. JF - Journal of Palliative Medicine Y1 - 2019 A1 - Haines, Lindsay A1 - Rahman, Omari-Khalid A1 - Justin J Sanders A1 - Kimberly J. Johnson A1 - Amy Kelley KW - Advance care planning KW - Racial/ethnic differences AB -

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

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

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

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

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

U1 - http://www.ncbi.nlm.nih.gov/pubmed/30758243?dopt=Abstract ER - TY - JOUR T1 - The financial burden of paid home care on older adults: Oldest and sickest are least likely to have enough income JF - Health Affairs Y1 - 2019 A1 - Richard W. Johnson A1 - Wang, Claire Xiaozhi KW - Community-dwelling KW - Financial burden KW - Long-term Care AB - Paid home care can significantly improve the lives of older adults with disabilities and their families, but recipients often incur substantial out-of-pocket spending. We simulated the financial burden of paid home care for a nationally representative sample of non-Medicaid community-dwelling adults ages sixty-five and older. We found that 74 percent could fund at least two years of a moderate amount of paid home care if they liquidated all of their assets, and 58 percent could fund at least two years of an extensive amount of paid home care. Among older adults with significant disabilities, however, only 57 percent could fund at least two years of moderate paid home care by liquidating all of their assets, and 40 percent could fund at least two years of extensive paid home care. Paid home care could become less affordable if growing labor shortages raise future costs. VL - 38 UR - http://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00025 IS - 6 JO - Health Affairs ER - TY - JOUR T1 - Financial literacy of middle-aged and older Individuals: Comparison of Japan and the United States JF - The Journal of the Economics of Ageing Y1 - 2019 A1 - Satoshi Shimizutani A1 - Hiroyuki Yamada KW - Financial literacy KW - Household asset allocation KW - JSTAR AB - Financial literacy holds growing interest for managing assets/savings during the longer retirement period currently experienced in rapidly aging countries. We examine and compare levels and determinants of financial literacy as well as its association with asset allocation among middle-aged and older individuals of Japan and the United States. We present some interesting findings. First, financial literacy is generally influenced by educational attainment, cognitive skills, coursework in economics or finance, and income level. Second, financial literacy is associated with household asset allocation; individuals with higher literacy also have investment in stocks or securities. These patterns are commonly observed both in Japan and the United States. UR - http://www.sciencedirect.com/science/article/pii/S2212828X1930101X ER - TY - JOUR T1 - Financial Ratios and Financial Satisfaction: Exploring Associations Between Objective and Subjective Measures of Financial Well-Being Among Older Americans JF - Journal of Financial Counseling and Planning Y1 - 2019 A1 - Tenney, Jacob A. A1 - Charlene M. Kalenkoski KW - Finance KW - Financial hardship KW - financial satisfaction AB - This study explores the relationship between objective measures and perceptions of financial well-being for older Americans. Financial well-being is measured objectively using three financial ratios including the liquidity ratio, the debt-to-asset ratio, and the investment ratio. Individuals' perceptions of their financial well-being are measured by a question in the Health and Retirement Study that asks respondents how satisfied they are with their present financial condition. An ordered probit model is used to examine the relationship between the perceptions of financial well-being and the three financial ratios. The findings in this analysis suggest that there is a positive relationship between the investment ratio and perceptions of financial well-being. There is also a small but statistically significant improvement in the perception of financial well-being with increases in the liquidity ratio. For large categorical differences, the positive relationship also holds for the debt-to-asset ratio. VL - 30 UR - https://connect.springerpub.com/content/sgrjfcp/30/2/231 ER - TY - JOUR T1 - Five-factor model personality traits and cognitive function in five domains in older adulthood JF - BMC Geriatrics Y1 - 2019 A1 - Angelina R Sutin A1 - Yannick Stephan A1 - Martina Luchetti A1 - Antonio Terracciano KW - Cognition KW - cognitive function KW - five-factor model KW - Personality AB - Background Five-factor model (FFM) personality traits have been associated consistently with risk of Alzheimer’s disease and related dementias (ADRD). Less is known about how these traits are associated with functioning in specific domains of cognitive function in older adulthood. Methods Participants (N = 2865) were drawn from the 2016 Harmonized Cognitive Assessment Protocol sub-study of the Health and Retirement Study (HRS). Participants completed a battery of cognitive tasks that measured performance in five domains: Memory (eight tasks), speed-attention-executive (five tasks), visuospatial ability (three tasks), fluency (one task), and numeric reasoning (one task). Participants completed an FFM personality measure as part of the regular HRS assessment in either 2014 or 2016. Linear regression was used to examine the association between the traits and each cognitive task and composite scores for the five domains, controlling for age, sex, race, ethnicity, and education. We also tested whether the associations were moderated by these sociodemographic factors or mental status. Results Neuroticism was associated with worse performance on all of the cognitive tasks. Conscientiousness was associated with better performance across all five cognitive domains, although not necessarily with every task. Openness and Agreeableness were associated with better performance in all domains, except for numeric reasoning. Extraversion was associated with better speed-attention-executive and fluency. There was no robust evidence that the association between personality and cognition was moderated by sociodemographic characteristics or global cognitive function. Conclusions Personality traits have pervasive associations with functioning across five cognitive domains. Consistent with the literature on personality and risk of ADRD, Neuroticism and Conscientiousness were associated with cognitive performance in the expected direction in all domains. Extraversion was the only trait that showed domain-specific associations. The present research supports models of personality and health in the context of cognition and suggests that personality is associated with intermediate markers of cognitive health. VL - 19 UR - https://doi.org/10.1186/s12877-019-1362-1 ER - TY - JOUR T1 - Food deserts and diet-related health outcomes of the elderly JF - Food Policy Y1 - 2019 A1 - Fitzpatrick, Katie A1 - Nadia Greenhalgh-Stanley A1 - Michele Ver Ploeg KW - Diet-related disease KW - Elderly KW - Food access KW - Food desert KW - United States AB - It is hypothesized that residents of neighborhoods with limited access to affordable and nutritious food face greater barriers to eating a healthy diet, which may in turn, result in worse health outcomes for them. Low-income elderly in urban areas may be uniquely affected by these so-called “food deserts” due to limited transportation options, strong attachments to local neighborhoods, fixed incomes, physical limitations in food shopping and meal preparation, and chronic health problems. Using the 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS), the association between the food environment of elderly individuals living in urban Census tracts and their diet-related health was examined. Within urban areas, we find little evidence that food deserts negatively impact the health of lower income elderly individuals. Policies to address the needs of elderly residents of food deserts should be narrowly targeted and carefully justified. VL - 87 UR - https://www.sciencedirect.com/science/article/pii/S0306919219305640?via%3Dihub ER - TY - RPRT T1 - Food Insecurity among Older Adults in the US: The Role of Mortgage Borrowing Y1 - 2019 A1 - Stephanie Moulton A1 - Cäzilia Loibl A1 - Donald Haurin A1 - Edmunds, Chrisse KW - Food insecurity KW - mortgage KW - Mortgages AB - As of 2016, close to 10 million older adults faced the threat of hunger in the US, constituting an urgent food policy issue. For older adults, heterogeneity in household wealth is even more important than income in predicting whether or not a household is food insecure. Yet not all wealth is equally accessible for households experiencing food hardship. Housing wealth—an illiquid asset—is the primary source of wealth for many older adults, particularly those with lower incomes. We use data for homeowners aged 62 and older from the Health and Retirement Study to identify the mechanism that links housing wealth to food insecurity. The results document the critical role of home equity as a “protective buffer” and point to the importance of access to mortgage borrowing to reduce material hardship late in life. PB - Joint Center for Housing Studies of Harvard University UR - https://www.jchs.harvard.edu/research-areas/working-papers/food-insecurity-among-older-adults-us-role-mortgage-borrowing ER - TY - JOUR T1 - Food insecurity and geriatric hospitalization. JF - International Journal of Environmental Research and Public Health Y1 - 2019 A1 - Rachel S. Bergmans A1 - Briana Mezuk A1 - Zivin, Kara KW - Food insecurity KW - Hospitalization KW - Risk Factors AB - Food insecurity (FI) has been associated with hospitalization, although the pathways underlying this relationship are poorly understood, in part due to the potential for a bidirectional relationship. This study aimed to determine associations of FI with concurrent and future hospitalization among older adults; mediation by depression and; whether hospitalization increased risk of FI. Participants came from the 2012 and 2014 waves of the Health and Retirement Study (HRS; = 13,664). HRS is a prospective cohort representative of U.S. adults over the age of 50. Primary analyses included those who were not hospitalized in 2012 ( = 11,776). Not having enough money to buy necessary food or eating less than desired defined food insecurity. The Composite International Diagnostic Interview Short Form provided depression symptomology. Logistic and linear regression examined concurrent and longitudinal associations of FI in 2012 and 2014 with hospitalization in 2014. Path analysis tested mediation of FI with hospitalization frequency by depression symptomology. Finally, logistic regression examined whether hospitalization in 2012 was longitudinally associated with FI in 2014. FI was not associated with future hospitalization (odds ratio (OR) = 1.1; 95% confidence interval (CI) = 0.9-1.4), however; FI was associated with concurrent hospitalization status (OR = 1.4; 95% CI = 1.1-1.8). Depression symptomology explained 17.4% (95% CI = 2.8-32.0%) the association of FI with concurrent hospitalization frequency. Additionally, hospitalization was associated with becoming food insecure (OR = 1.5; 95% CI = 1.2-2.0). Findings may inform best practices for hospital discharge among older adults. VL - 16 IS - 13 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31261648?dopt=Abstract ER - TY - JOUR T1 - Food insecurity transitions and smoking behavior among older adults who smoke. JF - Preventative Medicine Y1 - 2019 A1 - Rachel S. Bergmans KW - Food insecurity KW - Health Behavior KW - Smoking AB - Cross-sectional data reveal that smoking cigarettes is highly prevalent among those who are food insecure. However, there is limited and conflicting evidence concerning whether causal factors may influence associations of food insecurity with smoking behavior. Additionally, temporality is a core feature of food insecurity that should be considered when examining linkages between food insecurity and health behaviors like smoking cessation. In 2019, data were extracted from waves 2012 and 2014 of the Health and Retirement Study-a representative sample of U.S. adults ≥50. Analyses were limited to those who smoked cigarettes in 2012 (n = 2197). Food insecurity was assessed in 2012 and 2014 to indicate food insecurity transitions: (1) initially food insecure (food insecure in 2012 only); (2) became food insecure (food insecure in 2014 only); (3) remained food insecure (food insecure in 2012 and 2014), and; (4) not food insecure (reference group). Multivariable logistic regression examined odds of smoking cessation in 2014 due to food insecurity transition. Becoming food insecure was associated with a 2.0 (95% confidence interval = 1.2-3.4) higher odds of smoking cessation. Employment loss or retirement (p ≤0.001) and diagnosis of a new chronic condition (p = 0.038) were also associated with higher odds of smoking cessation. In older U.S. adults, smoking cessation was associated with decreased spending power and new health problems. Future studies should examine whether findings of this study may be similar among younger adults and; whether those who quit smoking due to food insecurity are more susceptible to relapse than those who quit due to other factors. U1 - http://www.ncbi.nlm.nih.gov/pubmed/31325523?dopt=Abstract ER - TY - JOUR T1 - The forgotten middle: Many middle-income seniors will have insufficient resources for housing and health care JF - Health Affairs Y1 - 2019 A1 - Pearson, Caroline F. A1 - Quinn, Charlene C. A1 - Loganathan, Sai A1 - Datta, A. Rupa A1 - Mace, Beth Burnham A1 - David C Grabowski KW - Caregiving KW - Future KW - Medicare/Medicaid/Health Insurance AB - As people age and require more assistance with daily living and health needs, a range of housing and care options is available. Over the past four decades the market for seniors housing and care—including assisted living and independent living communities—has greatly expanded to accommodate people with more complex needs. These settings provide housing in a community environment that often includes personal care assistance services. Unfortunately, these settings are often out of the financial reach of many of this country’s eight million middle-income seniors (those ages seventy-five and older). The private seniors housing industry has generally focused on higher-income people instead. We project that by 2029 there will be 14.4 million middle-income seniors, 60 percent of whom will have mobility limitations and 20 percent of whom will have high health care and functional needs. While many of these seniors will likely need the level of care provided in seniors housing, we project that 54 percent of seniors will not have sufficient financial resources to pay for it. This gap suggests a role for public policy and the private sector in meeting future long-term care and housing needs for middle-income seniors. VL - 38 UR - http://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05233 IS - 5 JO - Health Affairs ER - TY - JOUR T1 - A Framework for Addressing Diabetes-Related Disparities in US Latino Populations JF - Journal of Community Health Y1 - 2019 A1 - Marquez, Ivan A1 - Calman, Neil A1 - Crump, Casey KW - Diabetes KW - Literature Review KW - Racial/ethnic differences AB - Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems. VL - 44 UR - http://link.springer.com/10.1007/s10900-018-0574-1http://link.springer.com/content/pdf/10.1007/s10900-018-0574-1.pdfhttp://link.springer.com/content/pdf/10.1007/s10900-018-0574-1.pdfhttp://link.springer.com/article/10.1007/s10900-018-0574-1/fulltext.html IS - 2 JO - J Community Health ER - TY - JOUR T1 - A friend in need? Exploring the influence of disease and disability onset on the number of close friends among older adults. JF - Journals of Gerontology, Series B: Psychological Sciences & Social Sciences Y1 - 2019 A1 - Kenzie Latham-Mintus KW - Disabilities KW - Health Conditions and Status KW - Social Support AB -

OBJECTIVES: This research examines whether onset of life-threatening disease (i.e., cancer, lung disease, heart disease, or stroke) or Activities of Daily Living (ADL) disability influences the reported number of close friends.

METHODS: Using data from the Health and Retirement Study (HRS) (2006-2012), this research capitalizes on panel data to assess changes in number of close friends over a four-year period. Lagged dependent variable (LDV) and change score (CS) approaches were employed.

RESULTS: Both the LDV and CS models provide evidence that onset of life-threatening disease was associated with reporting more friends four years later. In particular, onset of cancer was associated with reporting more close friends.

DISCUSSION: This research provides evidence of the network activation hypothesis following onset of life-threatening disease among older adults.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/31056663?dopt=Abstract ER - TY - JOUR T1 - From Snapshots to Movies: The Association Between Retirement Sequences and Aging Trajectories in Limitations to Perform Activities of Daily Living. JF - Journal of Aging and Health Y1 - 2019 A1 - Azar, Ariel A1 - Ursula M. Staudinger A1 - Slachevsky, Andrea A1 - Madero-Cabib, Ignacio A1 - Calvo, Esteban KW - Activities of Daily Living KW - Disabilities KW - Policy KW - Retirement Planning and Satisfaction AB -

OBJECTIVE: This study analyzes the dynamic association between retirement sequences and activities of daily living (ADLs) trajectories between ages 60 and 70.

METHOD: Retirement sequences previously established for 7,880 older Americans from the Health and Retirement Study were used in hierarchical linear and propensity score full matching models, analyzing their association with ADL trajectories.

RESULTS: Sequences of partial retirement from full- or part-time jobs showed higher baseline and slower decline in ADL than sequences characterized by early labor force disengagement.

DISCUSSION: The conventional model in which people completely retire from a full-time job at normative ages and the widely promoted new conventional model of late retirement are both associated with better functioning than early labor force disengagement. But unconventional models, where older adults keep partially engaged with the labor force are also significantly associated with better functioning. These findings call attention to more research on potential avenues to simultaneously promote productive engagement and health later in life.

VL - 31 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29952242?dopt=Abstract ER - TY - THES T1 - Functional Status and Muscle Evaluation in Older Women with Urinary Incontinence T2 - Epidemiology and Preventive Medicine Y1 - 2019 A1 - Tatiana V D Sanses KW - 0766:Epidemiology KW - Epidemiology KW - Functional status KW - Health and environmental sciences KW - Levator ani muscle KW - mobility KW - Pelvic floor muscle KW - Physical performance KW - Urinary incontinence AB - Background: Urinary incontinence (UI) and mobility limitations are prevalent in older women suggesting common pathophysiology. Objectives: 1) to evaluate Short Physical and Performance Battery (SPPB) and Modified Physical Performance Test (MPPT); 2) to describe lower extremities/pelvic floor muscles among older women with UI. Methods: Women age ≥ 70 years with UI underwent functional testing, clinical, and magnetic resonance imaging evaluation. Spearman correlation coefficients were calculated between UI and mobility limitations. Results: MPPT was inversely moderately associated with UI severity impact on daily activities. SPPB was negatively associated with UI but findings were not statistically significant. Levator ani muscles were atrophic in all participants. Obturator and gluteal muscles had mild and moderate fatty infiltration, respectively. Conclusions: Lower MPPT is associated with increased UI severity impact on daily activities. Further research into shared pathophysiology between UI and mobility JF - Epidemiology and Preventive Medicine PB - University of Maryland, Baltimore VL - M.S. SN - 9781392301593 UR - https://archive.hshsl.umaryland.edu/handle/10713/9585 N1 - Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-07-13 ER - TY - JOUR T1 - Facets of conscientiousness and objective markers of health status JF - Psychology & Health Y1 - 2018 A1 - Angelina R Sutin A1 - Yannick Stephan A1 - Antonio Terracciano KW - Biomarkers KW - BMI KW - Conscientiousness KW - Physical Ability KW - Risk Taking AB - Objective: To examine the association between six facets of conscientiousness (self-control, order, industriousness, traditionalism, virtue, responsibility) and objective markers of health status, including adiposity, blood markers and physical performance. Design: Cross-sectional analysis of participants from the health and retirement study (N = 12,188). Main Outcome Measures: Adiposity (body mass index, waist circumference), blood markers (A1c, HDL cholesterol, total cholesterol, cystatin c, c-reactive protein) and physical performance (lung function, grip strength, walking speed). Results: Four of the six facets of conscientiousness were associated with nearly all of the health markers: Self-control, organisation, industriousness and responsibility were related to lower adiposity, healthier metabolic, cardiovascular and inflammatory markers, and better performance on physical assessments. Traditionalism and virtue had fewer associations with these objective markers. Conclusion: This research took a facet-level approach to the association between conscientiousness and objective markers of health status. This research builds on models of conscientiousness and health to suggest that, in addition to health-risk behaviours, facets of conscientiousness are associated with more favourable biomedical markers of health status. © 2018 Informa UK Limited, trading as Taylor & Francis Group UR - https://www.tandfonline.com/doi/full/10.1080/08870446.2018.1464165https://www.tandfonline.com/doi/pdf/10.1080/08870446.2018.1464165 JO - Psychology & Health ER - TY - JOUR T1 - Facets of conscientiousness and risk of dementia. JF - Psychological Medicine Y1 - 2018 A1 - Angelina R Sutin A1 - Yannick Stephan A1 - Antonio Terracciano KW - Cognitive Ability KW - Conscientiousness KW - Dementia KW - Risk Factors AB -

BACKGROUND: Multiple studies have found Conscientiousness to be protective against dementia. The purpose of this study is to identify which specific aspects, or facets, of Conscientiousness are most protective against cognitive impairment and whether these associations are moderated by demographic factors and/or genetic risk.

METHODS: Health and Retirement Study participants were selected for analysis if they completed the facets of Conscientiousness measure, scored in the range of normal cognitive functioning at the baseline personality assessment, and had at least one follow-up assessment of cognition over the up to 6-year follow-up (N = 11 181). Cox regression was used to test for risk of incident dementia and risk of incident cognitive impairment not dementia (CIND).

RESULTS: Over the follow-up, 278 participants developed dementia and 2186 participants developed CIND. The facet of responsibility had the strongest and most consistent association with dementia risk: every standard deviation increase in this facet was associated with a nearly 35% decreased risk of dementia; self-control and industriousness were also protective. Associations were generally similar when controlling for clinical, behavioral, and genetic risk factors. These three facets were also independent predictors of decreased risk of CIND.

CONCLUSIONS: The present research indicates that individuals who see themselves as responsible, able to control their behavior, and hard workers are less likely to develop CIND or dementia and that these associations persist after accounting for some common clinical, behavioral, and genetic risk factors.

VL - 48 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28874220?dopt=Abstract ER - TY - JOUR T1 - Factors associated with the decision to withhold life-sustaining treatments among middle-aged and older adults who die in hospital JF - Korean Journal of Adult Nursing Y1 - 2018 A1 - Cheon, Jooyoung KW - Advance care planning KW - Decision making KW - Hospitalization AB - Purpose: As advanced medical care has resulted in the unintended consequence of prolonging deaths, there is a growing interest in the decision to withhold life-sustaining treatments. The purpose of this study was to determine factors associated with the decision to withhold life-sustaining treatments in middle-aged and older adults who die in hospital in the United States. Methods: This cross-sectional correlational study conducted secondary analysis of 2000-2012 exit interview data from the Health and Retirement Study. Adults aged 50 and older who died in hospital and who had made a decision regarding life-sustaining treatments were included. Multivariable logistic regression was used to identify factors related to the decision to withhold life-sustaining treatments. Results: Among 1,412 adults, the prevalence of the decision to withhold life-sustaining treatments was 61.1%. Significant factors associated with the decision to withhold life-sustaining treatments were being African American (Adjusted Odds Ratio [AOR]=0.50, 95% Confidential Interval [CI]=0.30~0.86), Catholic (AOR=0.5, 95% CI=0.32~0.93), having at least one private insurance policy (AOR=1.40, 95% CI=1.02~1.92), having a living will (AOR=1.71, 95% CI=1.04~2.83), and having discussed end-of-life care with someone (AOR=1.810, 95% CI=1.25~2.62). Conclusion: Differences in race and religious affiliation should be considered when older adults, family members, and health care providers make decisions regarding life-sustaining treatments at the end-of-life. Also, health insurance coverage for advance care planning makes it easier for people to discuss life-sustaining treatments with health care providers. VL - 30 UR - https://synapse.koreamed.org/DOIx.php?id=10.7475/kjan.2018.30.5.527 IS - 5 JO - Korean J Adult Nurs ER - TY - JOUR T1 - FALLS AMONG OLDER AMERICAN MEN: THE ROLE OF PAIN AND MILITARY EXPERIENCES IN THE HEALTH AND RETIREMENT STUDY JF - Innovation in Aging Y1 - 2018 A1 - Lien Quach A1 - Gagnon, D A1 - Kaiser, A A1 - Nguyen, U KW - Mens health KW - military KW - military experience KW - pain AB - Relatively little is known about if or how veteran status is related to pain and falls among community-dwelling older men. We investigated the association between pain and falls, and examined whether veterans status and combat experience might modify this association. The study sample included 2718 men from the Health and Retirement Study, a nationally representative sample of older Americans (mean age 76.6, range 68–99). The number of falls as the outcome was measured prospectively in 2012. Key independent variables, measured in 2010, included reporting trouble with pain, veteran status, and combat experience (fired a weapon in combat). Descriptive statistics include: 36% of the men fell during 2 years, 30% reported trouble with pain, 40% were non-veterans, and 14% and 46% were veterans with and without combat experiences, respectively. Multivariate Generalized Estimating Equation Poisson regression indicates that having trouble with pain increased the rate of experiencing a fall by 77% adjusting for age, race, marital status, education, income, alcohol consumption, physical activities, vision, depression, psychotropic medication, and comorbidities. There is an interaction between veteran status and pain on the risk of falls. Stratified analyses by veteran status and combat experiences show that having trouble with pain increased the rate of experiencing a fall by 80% and 97% in non-veterans and veterans without combat experience, respectively. There was no association between pain and falls among veterans with combat experience. Further research is recommended to understand how military experiences are related to the association between pain and falls in older adults. VL - 2 SN - 2399-5300 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6229441/ IS - Suppl 1 JO - Innov Aging ER - TY - Generic T1 - Family, Income, & Medicaid Policy: Multinomial Logistic Model of Long-Term Care Decisions Y1 - 2018 A1 - Selena Caldera KW - Family KW - Income KW - Long-term Care KW - Medicaid KW - medicaid beneficiaries KW - Policy AB - Providing care for older family members is a difficult and costly decision; in 2015, 34 million Americans provided care to an elder loved one (National Alliance for Caregiving & AARP Public Policy Institute, 2015). Formal long-term care (LTC) in a facility outside the home is expensive and caregivers that provide informal LTC at home may incur high opportunity costs, including limiting work hours or forgoing employment outside the home. Existing research focuses on this supply issue and ignores how characteristics of elders and their family members and Medicaid LTC policy jointly factor into the decision between formal and informal LTC. In this paper, I examine informal LTC in the context of all other alternatives for care (no care, informal LTC, formal LTC) and include demographic and economic measures of the elder care recipient and potential family caregivers as explanatory variables. UR - https://appam.confex.com/appam/2018/webprogram/Paper26576.html ER - TY - RPRT T1 - Feasibility and reliability of automated coding of occupation in the Health and Retirement Study Y1 - 2018 A1 - McFall, Brooke Helppie A1 - Amanda Sonnega KW - Meta-analyses KW - Survey Methodology AB - Due to advances in computing power and the increase in coverage of longitudinal datasets in the Health and Retirement Study (HRS) that provide information about detailed occupations, demand has increased among researchers for improved occupation and industry data. The detailed data are currently hard to use because they were coded at different times, and the codeframes are, therefore, not consistent over time. Additionally, the HRS gathers new occupation and industry information from respondents every two years, and coding of new data at each wave is costly and time-consuming. In this project, we tested the NIOSH Industry and Occupation Computerized Coding System (NIOCCS) to see if it could improve processes for coding data from the HRS. We tested results from NIOCCS against results from a human coder for multiple datasets. NIOCCs does reasonably well compared to coding results from a highly trained, professional occupation and industry coder, with kappa inter-rater reliability on detailed codes of just under 70 percent and agreement rates on broader codes of around 80 percent; however, code rates for NIOCCS for the datasets tested ranged from 60 percent to 72 percent, as compared to a professional coder’s ability to code those same datasets that ranged from 95 percent to 100 percent. In its current form, we find that NIOCCS is a tool that might be best used to reduce the number of cases human coders must code, either in coding historical data to a consistent codeframe or in coding data from future HRS waves. However, it is not yet ready to fully replace human coders. JF - Michigan Retirement Research Center Working Paper Series PB - Survey Research Center, Institute for Social Research, University of Michigan CY - Ann Arbor UR - https://mrdrc.isr.umich.edu/publications/papers/pdf/wp392.pdf ER - TY - NEWS T1 - Feel-Good, Age-Old Cliches; Researchers find there's some truth to notion that the older we get, the better we feel T2 - The Windsor Star Y1 - 2018 A1 - Cimons, Marlene KW - Cognitive Ability KW - Dementia KW - Stereotypes AB - [...]there is evidence that positive attitudes about aging may reduce the risk of dementia, which among the most dreaded consequences of aging. [...]people could be perpetually pushing what is considered an older adult into the future." Researchers at the Boston University School of Public Health compared healthy and long-living children of centenarians - average age 82 - with three groups: JF - The Windsor Star CY - Windsor, Ontario ER - TY - JOUR T1 - Feeling Better at This Age? Investigating Three Explanations for Self-Rated Health Improvements Among the Oldest-Old JF - The Gerontologist Y1 - 2018 A1 - Eric M Vogelsang KW - AHEAD KW - Chronic conditions KW - Health Shocks KW - Self-reported health AB - Background and Objectives Although the majority of individuals in their 80s or 90s do not experience improving health, a significant portion of this age group either (a) subjectively assess their health as improving; or (b) demonstrate self-rated health improvements when comparing consecutive surveys. While there is a body of research that examines self-rated health declines in older ages, much less work has studied possible determinants of self-rated health improvements. This is important, since there is increasing evidence that oldest-old adults have unique health evaluative processes that are not yet well-understood. Research Design and Methods Using 21,155 observations from eight waves of the Asset and Health Dynamics survey (the oldest-old portion of the Health and Retirement Study), I use hierarchical linear models to test three explanations as to why the oldest-old may report or demonstrate self-rated health improvements: (a) normalized pre-existing chronic conditions, (b) positive lifestyle changes, and (c) recovery from recent prior health shocks. Results Health improvements calculated by comparing consecutive surveys were related to a recovery from four particular serious health diagnoses (cancer, stroke, heart disease, and lung disease). Conversely, explicitly reported health improvements were associated with normalizing pre-existing conditions. Lastly, starting a regular exercise routine was related to both types of health improvements; while the cessation of negative health behaviors (i.e., drinking and smoking) was not related to either type. Discussion and Implications These results suggest that while subjective health “improvements” among the oldest-old may be a sign of successful aging, they should be interpreted critically and cautiously. VL - 58 UR - http://academic.oup.com/gerontologist/article/doi/10.1093/geront/gnx149/4107828/Feeling-Better-at-This-Age-Investigating-Threehttp://academic.oup.com/gerontologist/article-pdf/doi/10.1093/geront/gnx149/19718896/gnx149.pdf IS - 5 ER - TY - RPRT T1 - Feeling Squeezed? Impact of Social Security Benefit Cuts on Labor Supply and Savings of the Elderly Y1 - 2018 A1 - Christopher John Cruz KW - Labor KW - Labor Supply KW - Savings KW - Social Security AB - While there is a general consensus that reforms are needed to improve the financial viability of the Social Security program, these reforms may have welfare implications — both intended and unintended — that remain unexamined. I revisit the 1983 Social Security reforms to examine how a large, potentially unanticipated wealth shock affects elderly workers. I exploit the nonlinearity in the design of the reforms to estimate causal effects on the labor supply and on the savings of older workers at different stages of the lifecycle. The identification highlights the relevance of cohort effects which tend to be assumed away in previous research Evidence suggests that among men, affected cohorts responded by altering their labor supply, but only when they were very close to retirement. Women also contributed through increased labor supply, both at the extensive and intensive margins. In addition, there is evidence that affected workers also responded through higher savings prior to retirement. Nonetheless, the Social Security amendments appear to have disproportionate effects, with some lowereducated workers remaining in the labor force in later years. Enhancing public understanding of the implications of future reforms could mitigate potentially adverse effects particularly on vulnerable subpopulations. PB - University of Illinois at Chicago UR - http://www.christopherjohncruz.com/uploads/1/1/2/3/112318225/cruz_jpm2_socsec.pdf ER - TY - JOUR T1 - Financial and socio-economic factors influencing pre- and post-cancer therapy oral care. JF - Support Care Cancer Y1 - 2018 A1 - Derek K Smith A1 - Emily H. Castellanos A1 - Barbara A Murphy KW - Cancer screenings KW - Dental Care KW - Finances KW - Health Conditions and Status KW - Socioeconomic factors AB -

PURPOSE: The primary objective of this study is to evaluate how attendance at dental visits may change as cancer patients move through pre-diagnosis, diagnosis, and into survivorship.

METHODS: The Health and Retirement Study consists of longitudinal survey data collected biannually detailing financial and health information in subjects over 51 years old. We assessed a subset of 4195 patients who received a new cancer diagnosis during the study period. The odds of reporting a dental visit were examined using a mixed effects logistic regression model. A propensity score weighted analysis of the association between dental attendance and survival was also undertaken.

RESULTS: The odds of attending a dental visit were substantially lower in the peri-diagnosis period OR = 0.784 (0.700, 0.876) and the post-diagnosis period OR = 0.734 (0.655, 0.823) compared to pre-diagnosis. This effect persisted in patients who survived for at least 2 years indicating that the decline in oral health visits was not due to low expected survival. After propensity score weighting, patients who attended a dental visit in the peri-diagnosis period demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance.

CONCLUSIONS: Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite guideline recommendations encouraging dental referral and monitoring for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects.

VL - 26 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29372394?dopt=Abstract ER - TY - JOUR T1 - The Financial Burden of Cancer: Financial Ratio Analysis JF - Journal of Family and Economic Issues Y1 - 2018 A1 - Svynarenko, Radion A1 - Zhang, Qun A1 - Hyungsoo Kim KW - Cancer KW - Financial burden KW - Insurance AB - Using nine biannual waves (1998–2014) from the Health and Retirement Study, this study employed fixed-effects models to estimate the relationship between cancer and changes in financial status, measured by liquidity, solvency, and investment ratios. Results show that cancer survivors in the initial stage of cancer care increased their emergency fund equivalent to 15 days of living expenses, along with an increase in their debt to asset ratio by 0.8%, and a decrease of investment asset to net worth ratio by 0.4%. Furthermore, two additional years of post-cancer care and rehabilitation lead to an increase of five more days in emergency cash need and a decrease in investment asset to net worth ratio by 0.3%. UR - http://link.springer.com/10.1007/s10834-018-9587-2http://link.springer.com/content/pdf/10.1007/s10834-018-9587-2.pdfhttp://link.springer.com/content/pdf/10.1007/s10834-018-9587-2.pdfhttp://link.springer.com/article/10.1007/s10834-018-9587-2/fulltext.html JO - J Fam Econ Iss ER - TY - JOUR T1 - The financial feasibility of delaying Social Security: evidence from administrative tax data JF - Journal of Pension Economics and Finance Y1 - 2018 A1 - Gopi Shah Goda A1 - Ramnath, Shanthi A1 - John B. Shoven A1 - Sita Nataraj Slavov KW - Retirement Planning and Satisfaction KW - Social Security KW - Social Security linkage AB - Despite the large and growing returns to deferring Social Security benefits, most individuals claim Social Security before the full retirement age. In this paper, we use a panel of administrative tax data on individuals likely to financially benefit from delaying Social Security claiming to explore the relationship between Social Security claiming and distributions from tax-advantaged retirement savings accounts. We find that the majority of our sample claim Social Security prior to taking distributions from Individual Retirement Accounts (IRAs). We also find that a third of our sample have IRA balances equivalent to at least two additional years of Social Security benefits, and a quarter have IRA balances equivalent to at least 4 years of Social Security benefits. We complement our analysis with data from the Health and Retirement Study and find that these percentages are considerably higher when other financial assets are taken into account. Copyright © Cambridge University Press 2017 This is a work of the U.S. Government and is not subject to copyright protection in the United States. VL - 17 UR - https://www.cambridge.org/core/product/identifier/S147474721700004X/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S147474721700004X IS - 4 JO - Journal of Pension Economics and Finance ER - TY - RPRT T1 - Financial Fraud among Older Americans: Evidence and Implications Y1 - 2018 A1 - DeLiema, Marguerite A1 - Deevy, Martha A1 - Annamaria Lusardi A1 - Olivia S. Mitchell KW - Finances KW - Fraud KW - Risk Factors AB - The consequences of poor financial capability at older ages are serious and include making mistakes with credit, spending retirement assets too quickly, and being defrauded by financial predators. Because older persons are at or past the peak of their wealth accumulation, they are often the targets of fraud. Our project analyzes a module we developed and fielded in the 2016 Health and Retirement Study (HRS). Using this dataset, we evaluate the incidence and risk factors for investment fraud, prize/lottery scams, and account misuse, using regression analysis. Relatively few HRS respondents mentioned any single form of fraud over the prior five years, but nearly 5% reported at least one form of investment fraud, 4 % recounted prize/lottery fraud, and 30% indicated that others had used/attempted to use their accounts without permission. There were few risk factors consistently associated with such victimization in the older population. Fraud is a complex phenomenon and no single factor uniquely predicts victimization. The incidence of fraud could be reduced by educating consumers about various types of fraud and by increasing awareness among financial service professionals. JF - NBER Working Paper Series PB - National Bureau of Economic Research CY - Cambridge, MA UR - http://www.nber.org/papers/w24803.pdf ER - TY - JOUR T1 - Financial self-efficacy and the saving behavior of older pre-retirees JF - Journal of Financial Counseling and Planning Y1 - 2018 A1 - Asebedo, Sarah D. A1 - Martin C. Seay KW - Financial literacy KW - Savings KW - Self-efficacy AB - This study investigates the relationship between financial self-efficacy (FSE) and saving behavior within a sample of 847 U.S. pre-retirees aged 50 to 70 from the Health and Retirement Study. In accordance with the social cognitive theory of self-regulation, results revealed that FSE is positively related to saving behavior after controlling for sociodemographic attributes, financial characteristics, and saving motives. Understanding how FSE contributes to saving behavior is critical as older workers attempt to bridge the retirement saving gap. Financial counselors and planners can help this population save by cultivating and supporting clients 'FSE throughout the financial planning and counseling process. VL - 29 UR - http://connect.springerpub.com/lookup/doi/10.1891/1052-3073.29.2.357https://syndication.highwire.org/content/doi/10.1891/1052-3073.29.2.357 IS - 2 JO - Journal of Financial Counseling and Planning ER - TY - JOUR T1 - Financial status and body mass index of middle-aged and older men and women JF - Journal of Financial Counseling and Planning Y1 - 2018 A1 - Lee, Yoon G. KW - BMI KW - Financial Health KW - Gender Differences AB - Using data from the 2014 Health and Retirement Study (HRS), this study examined the association of financial status and body weight for retirement-aged men and women. The descriptive results show that more men (80.3%) were overweight or obese than women (77%). However, the prevalence of obesity was higher for women (46.3%) than men (39.2%), and obese women had significantly lower levels of income and net worth than those of normal weight and overweight women. The multivariate results indicate that poor financial status was significantly associated with high body mass index (BMI) for both men and women; however, poor health conditions played an even more important role than financial status in determining high BMI for men and women aged 51–64. VL - 29 UR - http://connect.springerpub.com/lookup/doi/10.1891/1052-3073.29.1.19https://syndication.highwire.org/content/doi/10.1891/1052-3073.29.1.19 IS - 1 JO - Journal of Financial Counseling and Planning ER - TY - JOUR T1 - Food insecurity, comorbidity, and mobility limitations among older U.S. adults: Findings from the Health and Retirement Study and Health Care and Nutrition Study. JF - Preventative Med Y1 - 2018 A1 - Nicholas J Bishop A1 - Wang, Kaipeng KW - Comorbidity KW - Disabilities KW - Food insecurity AB - Both food insecurity and comorbidity have been identified as precursors to functional limitation in older adults, yet whether food insecurity modifies the progression from chronic disease to disability has not been assessed. We examined 5986 respondents age 50 and older drawn from the 2012-2014 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Mobility limitations reported in 2014 and change in mobility limitations from 2012 to 2014 were regressed on measures of food insecurity, number of chronic conditions, and their interaction terms using Poisson regression. Around 17.3% of the sample was identified as food insecure. In 2012, respondents reported an average of 1.9 (SD = 1.5) chronic conditions and 2.4 mobility limitations (SD = 3.0). In 2014, individuals reported an average of 2.5 (SD = 3.1) mobility limitations. Food insecurity was associated with a greater number of mobility limitations (IRR = 1.20, 95% CI: 1.11-1.29, p < .001) and more rapid increase in mobility limitations over the two-year observational period (IRR = 1.06, 95% CI: 1.00-1.11, p = .047). Food security status also modified the association between comorbidity and both mobility limitation outcomes, with the food secure exhibiting a stronger positive association between chronic conditions and mobility limitations than the food insecure. The food insecure tended to have more mobility limitations than the food secure when few chronic conditions were reported. Our results suggest that food insecurity is associated with prevalence and change in mobility limitations among older adults. VL - 114 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30003897?dopt=Abstract ER - TY - NEWS T1 - For a Better Marriage, Act Like a Single Person T2 - The New York Times Y1 - 2018 A1 - Coontz, Stephanie KW - Couples KW - Interviews KW - News JF - The New York Times CY - New York City VL - 02/11/2018 UR - https://www.nytimes.com/2018/02/10/opinion/sunday/for-a-better-marriage-act-like-a-single-person.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region®ion=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region ER - TY - JOUR T1 - Frailty Index associates with GRIN2B in two representative samples from the United States and the United Kingdom. JF - PLoS One Y1 - 2018 A1 - Mekli, Krisztina A1 - Stevens, Adam A1 - Alan Marshall A1 - Thalida E. Arpawong A1 - Drystan F. Phillips A1 - Tampubolon, Gindo A1 - Lee, Jinkook A1 - Carol A Prescott A1 - James Nazroo A1 - Pendleton, Neil KW - ELSA KW - Frailty KW - Gene Ontology KW - Genome-Wide Association Study KW - Phenotype AB -

The concept of frailty has been used in the clinical and research field for more than two decades. It is usually described as a clinical state of heightened vulnerability to poor resolution of homeostasis after a stressor event, which thereby increases the risk of adverse outcomes, including falls, delirium, disability and mortality. Here we report the results of the first genome-wide association scan and comparative gene ontology analyses where we aimed to identify genes and pathways associated with the deficit model of frailty. We used a discovery-replication design with two independent, nationally representative samples of older adults. The square-root transformed Frailty Index (FI) was the outcome variable, and age and sex were included as covariates. We report one hit exceeding genome-wide significance: the rs6765037 A allele was significantly associated with a decrease in the square-root transformed FI score in the Discovery sample (beta = -0.01958, p = 2.14E-08), without confirmation in the Replication sample. We also report a nominal replication: the rs7134291 A allele was significantly associated with a decrease in the square-root transformed FI score (Discovery sample: beta = -0.01021, p = 1.85E-06, Replication sample: beta = -0.005013, p = 0.03433). These hits represent the KBTBD12 and the GRIN2B genes, respectively. Comparative gene ontology analysis identified the pathways 'Neuropathic pain signalling in dorsal horn neurons' and the 'GPCR-Mediated Nutrient Sensing in Enteroendocrine Cells', exceeding the p = 0.01 significance in both samples, although this result does not survive correction for multiple testing. Considering the crucial role of GRIN2B in brain development, synaptic plasticity and cognition, this gene appears to be a potential candidate to play a role in frailty. In conclusion, we conducted genome-wide association scan and pathway analyses and have identified genes and pathways with potential roles in frailty. However, frailty is a complex condition. Therefore, further research is required to confirm our results and more thoroughly identify relevant biological mechanisms.

VL - 13 IS - 11 ER - TY - THES T1 - From Cells to Mice: Mutations Conferring Oxidative Stress-resistance on Longevity Phenotypes in the Mouse T2 - Integrative Physiology Y1 - 2018 A1 - Breanne L Newell-Stamper KW - 0369:Genetics KW - 0719:Physiology KW - Biological sciences KW - Genetics KW - Healthspan KW - Mammalian genes KW - Oxidative stress KW - Physiology AB - Oxidative stress is one of the drivers of the aging process and resistance to oxidative stress is a common characteristic of long-lived organisms. For these reasons, stress resistance has been recognized as a surrogate marker of longevity. Efforts to promote stress resistance through boosting the antioxidant system did not extend lifespan, suggesting that other uncharacterized pathways mediate the relationship of stress resistance and longevity. To identify mammalian genes that enhance oxidative stress resistance and thus slow aging, our group developed a high-throughput platform for screening and selecting novel genetic mutants in the mouse. In the studies outlined here we report on the longitudinal assessment of healthspan and lifespan of two genetic mutant mice, Pigl and Tiam1, that were selected from our screening platform. We assessed two metrics of healthspan, body weight (BW) and grip strength (GS), across the lifespan in both male and female mice. BW and GS are measures of general and neuromuscular health and are commonly assessed in mice and humans. We found that Pigl and Tiam1 mice had lower BWs than control mice at younger ages, the Tiam1 mice reached comparable BWs to controls whereas the Pigl mice remained smaller. BW at 350 days was not predictive of lifespan, but maximal BW and age at maximal BW were. GS declined more slowly in Pigl and Tiam1 mice compared to controls, and GS at 350 days was predictive of lifespan. In general, male mice increased BW more quickly and lost GS more slowly than female mice. These characteristics are consistent with extended lifespan; however, we observed minimal longevity effects. The heterozygous Pigl female mice were longer lived than wildtype littermates and the Tiam1 mice regardless of genotype were shorter lived than controls. These studies are some of the few that longitudinally evaluate healthspan and lifespan in male and female mice of different genetic backgrounds. Collectively, our results show that genetic mutations conferring oxidative stress resistance slowed GS decline and reduced BW but did not extend lifespan. This suggests that increased stress resistance may preserve physiological function thereby extending healthspan and highlights the complex relationship between stress-resistance and longevity. JF - Integrative Physiology PB - University of Colorado at Boulder VL - PhD SN - 9780438386150 UR - https://scholar.colorado.edu/iphy_gradetds/69/ N1 - Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-10-08 ER - TY - THES T1 - Functional and Cognitive Status and Medication Complexity in Older Adults: The Health and Retirement Study T2 - Pharmaceutical Sciences Y1 - 2018 A1 - Duaa Bafail KW - Cognition KW - Cognitive Status KW - Medication KW - Medication Complexity KW - Older Adults AB - Introduction: Older adults have high prevalence of chronic illnesses that lead to have complex medication regimens. They are also more likely to have cognitive and functional impairments. Both cognitive/functional impairments and medication regimen complexity increase the risk of medication non-adherence. The objective of this study is to evaluate the association between prescription medication regimen complexity and cognitive/functional status at baseline and after two years, and to assess how changes in cognitive/functional status are associated with changes in medication regimen complexity. Methods: This study used nationally representative sample of community-dwelling older adults from the Health and Retirement Study, followed over a two-year period. The exposures examined were cognitive status, and two types of functional status (Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The association between cognitive/functional status and medication regimen complexity was examined at baseline and after two years. Similar models were used to examine the relationship between cognitive/functional impairment and sub-components of complexity, and to assess how changes in cognitive/functional impairment were associated with changes in medication complexity over two years. Results:Impairment in ADLs were associated with higher medication complexity at baseline (p=0.0029) and after two years (p=0.0243). Impairments in IADLs were associated with higher regimen complexity at baseline only (p=0.0130). Stratifying by depression status, IADL impairment was found to predict higher complexity at both time points, but only in participants without depression. Cognitive impairment was associated with lower medication regimen complexity at baseline (p Conclusion: ADL impairment was strongly associated with higher medication complexity. IADL impairment showed some association with higher medication complexity, but this relationship may vary according to depression status and requires further investigation. Recognition of these impairments may offer health care providers the opportunity to intervene by re-assessing medication regimens for patients with functional impairments. Cognitive impairment was associated with lower medication complexity. Changes in cognitive or functional were not associated with changes in complexity. Further study is needed to investigate this relationship over a longer period of time. JF - Pharmaceutical Sciences PB - Virginia Commonwealth University CY - Richmond, VA VL - PhD UR - https://scholarscompass.vcu.edu/etd/5355/ ER - TY - JOUR T1 - Further investigations of the social and material convoy: Exploring relationships between race, volunteering, and relocation JF - Social Work Research Y1 - 2018 A1 - Tam E Perry A1 - Shen, Huei-Wern A1 - Guillermo Ernest Gonzales KW - Aging in place KW - Racial/ethnic differences KW - Volunteerism AB - This study used the social and material convoy framework to explore how individual and social resources, including volunteer engagement, inform household transitions in later life by race. Data from the 2008 and 2010 Health and Retirement Study compared non-Hispanic whites' and non-Hispanic blacks' relocation patterns in 2010 (N = 8,361). Multinomial logistic regression models tested the relationships between economic, home environment, health, social, and sociodemographic variables with relocation by race. Greater household assets, poorer health, and changing marital status reduced the likelihood of moving out of area among older white adults. However, home ownership and education reduced older black adults' likelihood of out-of-area relocation. The social and material convoy framework demonstrated racial heterogeneity as older white adults who formally volunteered in 2008 were less likely to move out of area in 2010. Although policies on formal volunteering could help older white adults age in place, the same approach may not influence older black adults. VL - 42 UR - https://academic.oup.com/swr/article/42/4/290/5122750http://academic.oup.com/swr/article-pdf/42/4/290/26996817/svy024.pdf IS - 4 ER - TY - BOOK T1 - Future Directions for the Demography of Aging: Proceedings of a Workshop T2 - Demography of Aging Y1 - 2018 A1 - Mark D Hayward A1 - Malay K. Majmundar AB - Almost 25 years have passed since the Demography of Aging (1994) was published by the National Research Council. Future Directions for the Demography of Aging is, in many ways, the successor to that original volume. The Division of Behavioral and Social Research at the National Institute on Aging (NIA) asked the National Academies of Sciences, Engineering, and Medicine to produce an authoritative guide to new directions in demography of aging. The papers published in this report were originally presented and discussed at a public workshop held in Washington, D.C., August 17-18, 2017. The workshop discussion made evident that major new advances had been made in the last two decades, but also that new trends and research directions have emerged that call for innovative conceptual, design, and measurement approaches. The report reviews these recent trends and also discusses future directions for research on a range of topics that are central to current research in the demography of aging. Looking back over the past two decades of demography of aging research shows remarkable advances in our understanding of the health and well-being of the older population. Equally exciting is that this report sets the stage for the next two decades of innovative research–a period of rapid growth in the older American population. JF - Demography of Aging PB - The National Academies Press CY - Washington, DC ER - TY - NEWS T1 - Fact check: Deaths from a health care bill? T2 - Burlington Free Press Y1 - 2017 A1 - Lori Robertson A1 - Robert Farley KW - Medicare/Medicaid/Health Insurance KW - News JF - Burlington Free Press CY - Burlington, VT UR - https://www.burlingtonfreepress.com/story/news/politics/2017/07/07/fact-check-deaths-health-care-bill/460798001/ ER - TY - JOUR T1 - Feeling Older and the Development of Cognitive Impairment and Dementia. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Martina Luchetti A1 - Antonio Terracciano KW - Aged KW - Aged, 80 and over KW - Aging KW - Alzheimer disease KW - Cognitive Dysfunction KW - depression KW - disease progression KW - Female KW - Health Behavior KW - Humans KW - Life Style KW - Likelihood Functions KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Risk Factors KW - Self Concept AB -

Objective: Subjective age is a biopsychosocial marker of aging associated with a range of outcomes in old age. In the domain of cognition, feeling older than one's chronological age is related to lower cognitive performance and steeper cognitive decline among older adults. The present study examines whether an older subjective age is associated with the risk of incident cognitive impairment and dementia.

Method: Participants were 5,748 individuals aged 65 years and older drawn from the Health and Retirement Study. Measures of subjective age, cognition, and covariates were obtained at baseline, and follow-up cognition was assessed over a 2- to 4-year period. Only participants without cognitive impairment were included at baseline. At follow-up, participants were classified into one of the three categories: normal functioning, cognitive impairment without dementia (CIND), and dementia.

Results: An older subjective age at baseline was associated with higher likelihood of CIND (odds ratio [OR] = 1.18; 1.09-1.28) and dementia (OR = 1.29; 1.02-1.63) at follow-up, controlling for chronological age, other demographic factors, and baseline cognition. Physical inactivity and depressive symptoms partly accounted for these associations.

Conclusion: An older subjective age is a marker of individuals' risk of subsequent cognitive impairment and dementia.

VL - 72 UR - https://www.ncbi.nlm.nih.gov/pubmed/27436103 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27436103?dopt=Abstract ER - TY - JOUR T1 - Financial Care for Older Adults With Dementia. JF - Int J Aging Hum Dev Y1 - 2017 A1 - Pan, Xi A1 - Lee, Yeonjung A1 - Dye, Cheryl A1 - Laurie Theriot Roley KW - Adult children KW - Aged KW - Aged, 80 and over KW - Dementia KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States AB -

This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

VL - 85 UR - http://journals.sagepub.com/doi/abs/10.1177/0091415016685327?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28024418?dopt=Abstract ER - TY - ICOMM T1 - A Financial Literacy Test That Works Y1 - 2017 A1 - Olivia S. Mitchell KW - Big Three KW - Financial literacy KW - Survey Methodology JF - Forbes PB - Forbes CY - New York City, NY UR - https://www.forbes.com/sites/pensionresearchcouncil/2017/12/14/a-financial-literacy-test-that-works/#50783139641f ER - TY - RPRT T1 - The Financial Vulnerability of Former Disability Beneficiaries in Retirement Y1 - 2017 A1 - Jody Schimmel Hyde A1 - April Yanyuan Wu KW - Disabilities KW - Disability KW - disability discrimination KW - disability finance KW - Finance KW - Retirement AB - By their early 60s, one in four workers has experienced the onset of a work-limiting health condition (Johnson et al. 2007), and nearly four in five adults in this age group have experienced the onset of a chronic health condition (Smith 2003). Older workers who develop significant medical conditions or impairments face declines in earnings, income, and consumption and an increase in poverty (Schimmel and Stapleton 2012; Meyer and Mok 2014). In addition to these effects, leaving the labor force during peak earning years may have a lasting impact on financial security after retirement. In this brief, we consider the post-retirement financial well-being of workers based on whether they received Social Security Disability Insurance (DI). We compare their experiences to other workers who did not receive DI but claimed Old Age and Survivors’ Insurance (OASI) program. PB - Mathematica Policy Research UR - https://mathematica.org/publications/the-financial-vulnerability-of-former-disability-beneficiaries-in-retirement ER - TY - JOUR T1 - Food insecurity among veterans: Findings from the Health and Retirement study JF - The Journal of Nutrition, Health & Aging Y1 - 2017 A1 - Diana P Brostow A1 - Gunzburger, E. A1 - Kali S Thomas KW - Nutrition KW - Veterans AB - Objectives: We examined the prevalence of food insecurity in an older population, specifically assessing factors associated with food insecurity among U.S. military Veterans. Methods: Data from the 2012 wave of the Health and Retirement Study and the 2013 Health Care and Nutrition Mail Survey of 2560 male participants (1254 Veterans) were used to estimate the prevalence of food insecurity and to identify significant predictors of food insecurity among male Veterans. Results: Among male Veterans, 6.4% reported food insecurity, compared to 11.9% of male non-veterans (p < 0.01). Younger age, difficulty with daily activities and depression were significantly associated with increased odds of food insecurity among male Veterans aged 50 to 64. In male Veterans age 65 years and older, current smoking, a psychiatric diagnosis and depression were significantly associated with increased odds of food insecurity. Conclusions: This study identified significant factors that may be used to target interventions to improve nutritional status among older male Veterans © 2017 Serdi and Springer-Verlag France VL - 21 IS - 10 JO - J Nutr Health Aging ER - TY - JOUR T1 - Food insecurity and emotional health in the USA: a systematic narrative review of longitudinal research JF - Public Health Nutrition Y1 - 2017 A1 - Bruening, Meg A1 - Dinour, Lauren M. A1 - Chavez, Jose B. Rosales KW - Depressive symptoms KW - Food insecurity KW - Literature Review KW - Stress VL - 20 UR - https://www.cambridge.org/core/product/identifier/S1368980017002221/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1368980017002221 IS - 17 JO - Public Health Nutr. ER - TY - JOUR T1 - Foundations of Activity of Daily Living Trajectories of Older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Linda G Martin A1 - Zachary Zimmer A1 - Jinkook Lee KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic pain KW - cognitive aging KW - Disability Evaluation KW - disease progression KW - Female KW - Humans KW - Individuality KW - Male KW - Middle Aged KW - Socioeconomic factors KW - Statistics as Topic KW - United States AB -

OBJECTIVES: The disablement process can be viewed conceptually as a progression from disease to impairment to functional limitation and finally disability (frequently operationalized as activity limitation). This article assesses the extent to which early phases of the process are associated with individual-level disability trajectories by age.

METHOD: We use data from seven waves of the Health and Retirement Study, 1998 to 2010, to investigate for individuals aged 65-84 years how baseline sociodemographic characteristics and self-reported disease, pain, and functional limitation (physical, cognitive, or sensory) are related to the dynamics of limitations in activities of daily living (ADLs). Our modeling approach jointly estimates multiperiod trajectories of ADL limitation and mortality and yields estimates of the number of, shapes of, and factors associated with the most common trajectories.

RESULTS: Individual probability of ADL limitation can best be described by three common trajectories. In comparison with disease, pain, and functional limitation, sociodemographic characteristics have weak associations with trajectory group membership. Notably, neither sex nor education is strongly associated with group membership in multivariate models.

DISCUSSION: The analysis confirms the importance of the early phases of the disablement process and their relationships with subsequent trajectories of activity limitation.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/09/01/geronb.gbv074.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26333820?dopt=Abstract U4 - Disability/Disability/Functional health status/Health disparities/Mortality/Transition models ER - TY - JOUR T1 - Friendship and depression among couples in later life: The moderating effects of marital quality. JF - Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2017 A1 - Sae Hwang Han A1 - Kyungmin Kim A1 - Jeffrey A Burr KW - Depressive symptoms KW - Marriage KW - Social Relationships AB -

Objectives: The aims of the study were to examine within-person associations between social interactions with friends (one's own and partner's) and depressive symptoms over time among couples in later life and to investigate whether marital quality moderated the associations.

Methods: We used longitudinal data from the Health and Retirement Study (2004-2012) to examine a sample of coupled individuals (dyad N = 6,833). Dyadic growth curve models were employed to test the study hypotheses.

Results: Results indicated that more frequent social interactions with friends were associated with fewer depressive symptoms of individuals and there were cross-spousal effects for this association. Further, marital quality moderated the within-person association between social interaction with friends and depressive symptoms such that the association was stronger for individuals experiencing poor marital quality compared to those with better marital quality.

Discussion: Friendship is an important contributor to individuals' mental health in later life, with its benefits having far-reaching consequences for one's significant other. The implications of friendship interactions for other health domains also require investigation within the marital context.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/28449135?dopt=Abstract ER - TY - JOUR T1 - From Noise to Signal: The Age and Social Patterning of Intra-Individual Variability in Late-Life Health. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Lin, Jielu A1 - Jessica Kelley-Moore KW - Activities of Daily Living KW - Aged KW - cognitive aging KW - Cognitive Dysfunction KW - Disability Evaluation KW - Female KW - Health Behavior KW - Health Status Disparities KW - Humans KW - Individuality KW - Male KW - Middle Aged KW - Minority Groups KW - Models, Statistical KW - Multilevel Analysis KW - Reference Values KW - Sex Characteristics KW - Sex Factors KW - Socioeconomic factors AB -

OBJECTIVES: Despite a long tradition of attending to issues of intra-individual variability in the gerontological literature, large-scale panel studies on late-life health disparities have primarily relied on average health trajectories, relegating intra-individual variability over time to random error terms, or "noise." This article reintegrates the systematic study of intra-individual variability back into standard growth curve modeling and investigates the age and social patterning of intra-individual variability in health trajectories.

METHOD: Using panel data from the Health and Retirement Study, we estimate multilevel growth curves of functional limitations and cognitive impairment and examine whether intra-individual variability in these two health outcomes varies by age, gender, race/ethnicity, and socioeconomic status, using level-1 residuals extracted from the adjusted growth curve models.

RESULTS: For both outcomes, intra-individual variability increases with age. Racial/ethnic minorities and individuals with lower socioeconomic status tend to have greater intra-individual variability in health. Relying exclusively on average health trajectories may have masked important "signals" of life course health inequality.

DISCUSSION: The findings contribute to scientific understanding of the source of heterogeneity in late-life health and highlight the need to further investigate specific life course mechanisms that generate the social patterning of intra-individual variability in health status.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/08/26/geronb.gbv081.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26320123?dopt=Abstract U4 - Health disparities/Intra-individual variability/Multilevel growth curves/Residuals ER - TY - ICOMM T1 - Frugal retirees ditch 4 percent rule, hoard savings instead Y1 - 2017 A1 - Anderson, Tom KW - News KW - Savings JF - Your Money, Your Future PB - CNBC UR - http://www.cnbc.com/2017/05/16/frugal-retirees-ditch-4-percent-rule-hoard-savings-instead.html ER - TY - ICOMM T1 - FTD Takes a Greater Financial Toll Than Alzheimer's Y1 - 2017 A1 - Harrison, Pam KW - Alzheimer's disease KW - Finances KW - FTD JF - Medscape PB - WebMD CY - New York City, NY VL - 2017 UR - https://www.medscape.com/viewarticle/886562 ER - TY - JOUR T1 - Functional impairment: An unmeasured marker of Medicare costs for postacute care of older adults. JF - Journal of the American Geriatrics Society Y1 - 2017 A1 - S. Ryan Greysen A1 - Irena Cenzer A1 - W John Boscardin A1 - Kenneth E Covinsky KW - Functional limitations KW - Medicare linkage KW - Medicare/Medicaid/Health Insurance AB -

OBJECTIVES: To assess the effects of preadmission functional impairment on Medicare costs of postacute care up to 365 days after hospital discharge.

DESIGN: Longitudinal cohort study.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Nationally representative sample of 16,673 Medicare hospitalizations of 8,559 community-dwelling older adults from 2000 to 2012.

MEASUREMENTS: The main outcome was total Medicare costs in the year after hospital discharge, assessed according to Medicare claims data. The main predictor was functional impairment (level of difficulty or dependence in activities of daily living (ADLs)), determined from HRS interview preceding hospitalization. Multivariable linear regression was performed, adjusted for age, race, sex, income, net worth, and comorbidities, with clustering at the individual level to characterize the association between functional impairment and costs of postacute care.

RESULTS: Unadjusted mean Medicare costs for 1 year after discharge increased with severity of impairment in a dose-response fashion (P < .001 for trend); 68% had no functional impairment ($25,931), 17% had difficulty with one ADL ($32,501), 7% had dependency in one ADL ($39,928), and 8% had dependency in two or more ADLs ($45,895). The most severely impaired participants cost 77% more than those with no impairment; adjusted analyses showed attenuated effect size (33% more) but no change in trend. Considering costs attributable to comorbidities, only three conditions were more expensive than severe functional impairment (lymphoma, metastatic cancer, paralysis).

CONCLUSION: Functional impairment is associated with greater Medicare costs for postacute care and may be an unmeasured but important marker of long-term costs that cuts across conditions.

VL - 65 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28636200?dopt=Abstract ER - TY - JOUR T1 - Functional Impairment and Decline in Middle Age: A Cohort Study. JF - Annals of Internal Medicine Y1 - 2017 A1 - Rebecca T Brown A1 - L Grisell Diaz-Ramirez A1 - W John Boscardin A1 - Sei J. Lee A1 - Michael A Steinman KW - Activities of Daily Living KW - Functional limitations KW - Memory KW - Older Adults AB -

Background: Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.

Objective: To determine the epidemiology and clinical course of functional impairment and decline in middle age.

Design: Cohort study.

Setting: The Health and Retirement Study.

Participants: 6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.

Measurements: Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes.

Results: Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs.

Limitation: Functional status was self-reported.

Conclusion: Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age.

Primary Funding Source: National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.

VL - 167 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29132150?dopt=Abstract ER - TY - JOUR T1 - Functional limitations and health care resource utilization for individuals with cognitive impairment without dementia: Findings from a United States population-based survey. JF - Alzheimer's & Dementia Y1 - 2017 A1 - J. Scott Andrews A1 - Desai, Urvi A1 - Noam Y Kirson A1 - Caroline J. Enloe A1 - Ristovska, Ljubica A1 - King, Sarah A1 - Howard G. Birnbaum A1 - Adam S. Fleisher A1 - Ye, Wenyu A1 - Kahle-Wrobleski, Kristin KW - CIND KW - Cognitive Ability KW - Functional limitations KW - Older Adults AB -

INTRODUCTION: Little is known about functional limitations and health care resource utilization of people with cognitive impairment with no dementia (CIND).

METHODS: Respondents with stable or progressive cognitive impairment (CI) after the first (index) indication of CIND in 2000-2010 were identified from the Health and Retirement Study (HRS). Respondents never exhibiting CI were identified as potential controls. Propensity score-based optimal matching was used to adjust for differences in demographics and history of stroke. Differences between cohorts were assessed accounting for HRS survey design.

RESULTS: After matching, CIND respondents had more functional limitations (difficulty with ≥1 activities of daily living: 24% vs. 15%; ≥1 instrumental activities of daily living: 20% vs. 11%) and hospital stays (37% vs. 27%) than respondents with no CI (all P < .001). Seventy five percent of CIND respondents developed dementia in the observable follow-up (median time: ∼6 years).

DISCUSSION: Even before dementia onset, CI is associated with increased likelihood of functional limitations and greater health care resource use.

VL - 6 ER - TY - JOUR T1 - Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study JF - Journal of the American Geriatrics Society Y1 - 2017 A1 - Wu, Chenkai A1 - Smit, Ellen A1 - Peralta, Carmen A A1 - Sarathy, Harini A1 - Michelle C Odden KW - Blood pressure KW - Grip strength KW - Mortality KW - Older Adults AB - Objective To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality. Design Nationally representative cohort study. Setting Health and Retirement Study. Participants 7,492 U.S. adults aged ≥65 years. Measurements Grip strength was measured by a hand dynamometer and classified as normal (≥16 kg for female; ≥26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (≥0.60 m/s for female; ≥0.52 m/s for male) and slow. Results Over an average follow-up time of 6.0 years, 1,870 (25.0%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (≥150 mmHg) and DBP (≥90 mmHg) was associated with a 24% (95% CI, 7–43%) and 25% (95% CI, 5–49%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6% (95% CI, 31 to −27%) and a 16% (95% CI, 46 to −26%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death was 0.85 (95% CI, 0.56–1.29) and 0.53 (95% CI, 0.30–0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, associations of BP with death varied modestly by gait speed. Conclusion Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death. VL - 65 UR - http://doi.wiley.com/10.1111/jgs.14816http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.14816/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.14816 IS - 7 JO - J Am Geriatr Soc ER - TY - JOUR T1 - Factors Associated with Family Reports of Pain, Dyspnea, and Depression in the Last Year of Life. JF - J Palliat Med Y1 - 2016 A1 - Adam E Singer A1 - Meeker, Daniella A1 - Joan M Teno A1 - Lynn, Joanne A1 - June R Lunney A1 - Karl A Lorenz AB -

BACKGROUND: Pain, dyspnea, and depression are highly troubling near the end of life.

OBJECTIVE: To characterize factors associated with clinically significant pain and the presence of dyspnea and depression during the last year of life in a nationally representative sample.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study, a national sample of community-dwelling US residents aged 51 and older.

PARTICIPANTS: Family respondents of 8254 decedents who died between 1998 and 2012.

MEASUREMENTS: Clinically significant pain often during the last year of life; dyspnea and depression for at least one month during the last year of life.

RESULTS: Life support was associated with dyspnea (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.42-2.06) and depression (OR 1.20, CI 1.04-1.39), treatment for cancer with pain (OR 1.65, CI 1.41-1.92), and oxygen for a lung condition with dyspnea (OR 14.78, CI 11.28-19.38). More diagnoses were associated with dyspnea (OR 1.24, CI 1.17-1.30) and depression (OR 1.14, CI 1.08-1.21). More activities of daily living (ADL) dependencies were associated with clinically significant pain (OR 1.06, CI 1.03-1.09), dyspnea (OR 1.06, CI 1.02-1.10), and depression (OR 1.10, CI 1.07-1.12), and more instrumental activities of daily living (IADL) dependencies with depression (OR 1.12, CI 1.08-1.18). Worse self-rated health was associated with pain (OR 0.83, CI 0.77-0.88), dyspnea (OR 0.89, CI 0.84-0.95), and depression (OR 0.83, CI 0.78-0.89). Arthritis was associated with clinically significant pain (OR 2.24, CI 1.91-2.63).

CONCLUSIONS: Factors associated with common, burdensome symptoms in a national sample suggest clinical and population strategies for targeting symptom assessment and management.

VL - 19 UR - https://www.ncbi.nlm.nih.gov/pubmed/27454900 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27454900?dopt=Abstract ER - TY - THES T1 - Falls, Fall Injuries and the Aging Workforce T2 - Epidemiology Y1 - 2016 A1 - Kenneth A Scott KW - Falls KW - Health Shocks KW - Older Adults KW - Retirement Planning and Satisfaction AB - Health is a resource that enables an individual to act more freely within the labor market. A person in good health can initiate and maintain gainful employment, even in a physically or cognitively demanding occupation. Poor health can limit an individual’s functional abilities and job prospects, or the ability to work altogether. As individuals age, the likelihood of poor health increases as various health conditions and health events become more common. By informing which health conditions are likely to have significant economic consequences as the US population ages, epidemiologic research can help guide prevention strategies to reduce the economic burden of poor health and to maintain older adults’ quality of life through retirement. Falls and fall injuries become more common as people age. This is true for falls that occur in the workplace as well as falls that occur outside of work. Falls already have a significant effect on the economy – a trend that will likely increase as the workforce ages. The projected lifetime costs of fall injuries occurring during 2010 in the US was over $152.9 billion. Falls also are a useful window through which researchers can see how work and health interact to influence retirement decisions. Like some other public health issues, such as heart attacks and strokes, falls have a dual nature. Falls are, on the one hand, discrete events and, on the other, indicators of ongoing changes in health and social status. An individual’s labor force participation could, theoretically, be influenced by an injury subsequent to a fall, health changes that preceded and caused the fall or both. The dissertation research presented below is comprised of three research studies that explore how work and health, specifically the experience of falls, might influence older workers’ retirement decisions. The introductory chapter will begin by describing the epidemiology of falls and fall injuries. We present the unadjusted US rates of falls analyzed by age and other factors. We highlight epidemiologic research that has described fall injuries in the workplace and we compare the patterns of fall injuries to other types of occupational injuries, again focusing on age-related patterns. After summarizing the descriptive epidemiology, we highlight analytic research studies that have identified individual-level and environmental risk factors for fall injuries. The consequences of fall injuries are then described, including the types of injuries commonly caused by falls, as well as their effects on disability and retirement. Finally, we present several conceptual models that tie together research on falls and research on work disability. After the introductory chapter, each paper of the dissertation is presented as a chapter. The first paper examines the patterns of same-level fall injuries in US workplaces, exploring whether the relationship between age and fall injury incidence varies by industry. The second paper tests whether, among US workers 65 and older, falls - injurious and non-injurious – are associated with a shorter time to first report of a health-related limitation in the work they can perform. The third paper then examines whether falling is associated with a shorter time to labor force exit among US workers 65 and older. A concluding section compares the findings from each study in relation to the research and broader context covered in the introductory chapter. JF - Epidemiology PB - University of Colorado VL - Ph.D. ER - TY - JOUR T1 - Families and Disability Onset: Are Spousal Resources Less Important for Individuals at High Risk of Dementia? JF - The American Journal of Geriatric Psychiatry Y1 - 2016 A1 - Pamela M. Rist A1 - Sze Y Liu A1 - M. Maria Glymour KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - Objective To determine whether social contacts and spousal characteristics predict incident instrumental or basic activities of daily living (I/ADL) limitations and whether effects differ for individuals with high risk of dementia. Design Cohort study. Setting Biennial interviews of Health and Retirement Study participants over up to 12 years. Participants 4,125 participants aged 65 years and older without baseline I/ADL limitations. Measurements Participants' family characteristics (living arrangements, proximity to children, contacts with friends, marital status, and spouse's depression, employment, and education) and dementia probability (high versus low risk of dementia based on direct and proxy cognitive assessments) were characterized at baseline. Family characteristics and their interactions with dementia probability were used to predict incident I/ADL limitations in pooled logistic regressions. Results ADL limitation incidence was higher among the unmarried (odds ratio OR versus married: 1.14; 95 CI: 1.01 1.30); those married to a depressed spouse (OR versus nondepressed spouse: 1.56, 95 CI: 1.21 2.00); or whose spouse had less than high school education (OR versus spouse with high school or more: 1.29, 95 CI: 1.06 1.57). Living with someone other than a spouse compared with living with a spouse predicted higher risk of both incident ADL (OR: 1.35; 95 CI: 1.11 1.65), and IADL (OR: 1.30; 95 CI: 1.06 1.61) limitations. Effects were similar for respondents with high and low dementia probability. Conclusions Regardless of dementia risk, older adults may receive important marriage benefits, which help delay disability. The salience of spouse's education and depression status implicate modifiable mechanisms, such as information and instrumental support, which may be amenable to interventions. VL - 24 UR - http://www.sciencedirect.com/science/article/pii/S1064748116001561 IS - 7 U4 - disability/disability/cognitive function/epidemiology/social ties ER - TY - JOUR T1 - Feeling older and risk of hospitalization: Evidence from three longitudinal cohorts JF - Health Psychology Y1 - 2016 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Antonio Terracciano KW - Health Conditions and Status KW - Healthcare KW - Risk Taking AB - Objective: Subjective age is a biopsychosocial marker of aging with a range of health-related implications. Using 3 longitudinal samples, this study examined whether subjective age predicts hospitalization among older adults. Method: Participants were adults aged from 24 to 102 years old, drawn from the 1995 1996 and 2004 2005 waves of the Midlife in the United States Survey (MIDUS, N = 3209), the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 3779), and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 3418). In each sample, subjective age and covariates were assessed at baseline and hospitalization was assessed at follow-up. Results: Consistent across the 3 samples, participants who felt subjectively older at baseline had an increased likelihood of hospitalization (combined effect size: 1.17, 95 CI 1.11 1.23), controlling for age, sex, race, and education. Further adjusting for disease burden and depression reduced the magnitude of the association between subjective age and hospitalization in the 3 samples, but it remained significant in the MIDUS and HRS. Conclusion: This study provides consistent evidence that subjective age predicts incident hospitalization. Subjective age assessment can help identify individuals at greater risk of hospitalization, who may benefit from prevention and intervention efforts. (PsycINFO Database Record (c) 2016 APA, all rights reserved) PB - 35 VL - 35 IS - 6 U4 - Aging/Hospitalization/Major Depression/Risk Factors/Subjectivity/Symptoms ER - TY - JOUR T1 - Female disability disadvantage: a global perspective on sex differences in physical function and disability. JF - Ageing Soc Y1 - 2016 A1 - Felicia V Wheaton A1 - Eileen M. Crimmins AB -

The objectives were to determine whether women always fare more poorly in terms of physical function and disability across countries that vary widely in terms of their level of development, epidemiologic context and level of gender equality. Sex differences in self-reported and objective measures of disability and physical function were compared among older adults aged 55-85 in the United States of America, Taiwan, Korea, Mexico, China, Indonesia and among the Tsimane of Bolivia using population-based studies collected between 2001 and 2011. Data were analysed using logistic and ordinary least-squares regression. Confidence intervals were examined to see whether the effect of being female differed significantly between countries. In all countries, women had consistently worse physical functioning (both self-reported and objectively measured). Women also tended to report more difficulty with activities of daily living (ADL), although differences were not always significant. In general, sex differences across measures were less pronounced in China. In Korea, women had significantly lower grip strength, but sex differences in ADL difficulty were non-significant or even reversed. Education and marital status helped explain sex differences. Overall, there was striking similarity in the magnitude and direction of sex differences across countries despite considerable differences in context, although modest variations in the effect of sex were observed.

VL - 36 UR - http://www.journals.cambridge.org/abstract_S0144686X15000227 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27453613?dopt=Abstract JO - Ageing and Society ER - TY - JOUR T1 - Financial Assistance Patterns from Midlife Parents to Adult Children: A Test of the Cumulative Advantage Hypothesis JF - Journal of Family and Economic Issues Y1 - 2016 A1 - Padgett, C. S. A1 - R Corey Remle KW - Adult children KW - Demographics KW - Methodology AB - Young adults may receive financial assistance from midlife parents as they experience life course transitions often associated with establishing independent status, such as schooling, marriage or gaining full-time work. We used longitudinal data from the Health and Retirement Study (1992 2002) and hypothesized that adult children in the United States who received repeated financial transfers from midlife parents experienced cumulative advantages across time. We also examined the data using parental household characteristics to reinforce the importance of previous transfer behaviors. We found that the receipt of prior transfers, family structure and parental household income were the strongest determinants of the odds that parents gave financial assistance to adult children as both generations aged. The findings also supported the cumulative advantage theory due to the larger likelihood of continued transfers. 2015 Springer Science Business Media New York VL - 37 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84939824009andpartnerID=40andmd5=8057d7abf4ea23be7e57e35c87355ef3 IS - 3 U4 - Adult children/Cumulative advantage/Intergenerational transfers/Midlife parents ER - TY - THES T1 - Financial Literacy Continuing Professional Education Cognitive Needs Assessment for Florida Small Business Owners T2 - Adult, Career and Higher Education Y1 - 2016 A1 - Dahmen, Pearl J. KW - Cognitive Ability KW - Education KW - Financial literacy KW - Gender Differences KW - Older Adults KW - Small business owners KW - Women and Minorities AB - The purpose of this study was to assess the financial literacy continuing profession education cognitive needs of Florida small business owners through exploring their profile. To determine the financial literacy profile, an instrument containing 18 tested knowledge and 5 self-assessed knowledge questions was created. Using a panel of experts, the instrument was developed from previously tested financial literacy questions from several sources. Data were collected from clients of the West Central Region of the Florida Small Business Development Center at the University of South Florida. The online survey completed by participants included demographic questions to provide data to profile small business owners’ financial literacy by gender, age, education level, and small business classification. The results indicated small business owners have a high financial literacy. There were significant differences found between the financial literacy of men and women. Men’s scores were higher for both tested knowledge and self-assessed knowledge. Younger small business owners scored lower than older small business owners. There were significant scoring differences between the highest and lowest levels of education. Tested scores and self-assessed scores increased with higher education levels. Pre-venture/start-up business owners scored lower than the small-medium enterprise owners. Implications included developing educational programs attentive to women small business owner’s needs, as well as newer and/or younger small business owners. JF - Adult, Career and Higher Education PB - University of South Florida VL - Ph.D. SN - 9781339617862 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1781654615?accountid=14667 ER - TY - JOUR T1 - Financial Strain and Mental Health Among Older Adults During the Great Recession JF - The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Y1 - 2016 A1 - Lindsay R. Wilkinson KW - Health Conditions and Status KW - Public Policy AB - Objectives: The economic recession has garnered the interest of many scholars, with much attention being drawn to how the recession has affected labor force participation, household wealth, and even retirement decisions. Certainly, the Great Recession has influenced the financial well-being of older adults, but has it had discernible effects on mental health?Method: This study draws on 5,366 respondents from the Health and Retirement Study (2006 2010) to examine objective and subjective measures of financial well-being in the period surrounding the Great Recession. Guided by cumulative inequality theory, this research investigates whether the economic downturn contributed to worsening anxiety and depressive symptoms over a 4-year period.Results: Results from linear fixed effects models reveal that decreases in objective financial resources were associated with increased financial strain during the Great Recession. Unlike the objective indicators, however, financial strain was a strong and robust predictor of worsening mental health between 2006 and 2010.Discussion: Building on prior research, this study elucidates the factors that shape financial strain and provides evidence that the Great Recession not only affected the financial well-being of older adults but also had adverse effects on mental health. VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/02/17/geronb.gbw001.abstract IS - 4 U4 - Financial strain/Great Recession/Mental health ER - TY - NEWS T1 - Five Myths About Landing a Good Job Later in Life T2 - The Wall Street Journal Y1 - 2016 A1 - Anne Tergesen KW - Job loss KW - Jobs KW - Older Adults AB - The conventional wisdom says it’s impossible. The facts say otherwise. JF - The Wall Street Journal CY - New York City UR - http://www.wsj.com/articles/five-myths-about-landing-a-good-job-later-in-life-1480302842 ER - TY - JOUR T1 - The five-factor model of personality and self-reported versus biomarker diabetic control. JF - J Health Psychol Y1 - 2016 A1 - Phillips, Amanda S A1 - Charles A Guarnaccia KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Humans KW - Male KW - Middle Aged KW - Personality KW - Self Report AB -

Five-factor personality was examined as an element of self-report diabetic control accuracy versus biomarker control (HbA1c) for 1474 diabetics in the 2006 and 2008 Health and Retirement Study. Correlations of extraversion and self-reported control (r = -.06, p < .01), and extraversion and HbA1c (r = .03, non-significant), were significantly different (t = 2.87, p < .01). Correlations of openness and self-reported control (r = -.05, p < .05), and openness and HbA1c (r = .01, non-significant), were significantly different (t = 1.91, p < .05). Associations were found between self-reported control and conscientiousness (r = -.05, p < .05), neuroticism (r = .04, p < .05), and openness (r = -.05, p < .05). Neuroticism was associated with self-reports that diabetes was worse (r = .07, p < .01). Other correlations and comparisons were non-significant.

VL - 21 UR - http://hpq.sagepub.com/content/early/2015/03/24/1359105315576349.abstract IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25814165?dopt=Abstract U4 - adults/chronic illness/clinical health psychology/diabetes/illness perception ER - TY - JOUR T1 - Framing and Claiming: How Information-Framing Affects Expected Social Security Claiming Behavior JF - Journal of Risk and Insurance Y1 - 2016 A1 - Brown, Jeffrey R. A1 - Arie Kapteyn A1 - Olivia S. Mitchell AB - This article provides evidence that Social Security benefit claiming decisions are strongly affected by framing and are thus inconsistent with expected utility theory. Using a randomized experiment that controls for both observable and unobservable differences across individuals, we find that the use of a “breakeven analysis” encourages early claiming. Respondents are more likely to delay when later claiming is framed as a gain, and the claiming age is anchored at older ages. Additionally, the financially less literate, individuals with credit card debt, and those with lower earnings are more influenced by framing than others. VL - 83 UR - http://doi.wiley.com/10.1111/jori.v83.1http://doi.wiley.com/10.1111/j.1539-6975.2013.12004.xhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fj.1539-6975.2013.12004.x IS - 1 JO - Journal Risk and Insurance ER - TY - JOUR T1 - Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study. JF - Soc Sci Med Y1 - 2016 A1 - Sander K. R. van Zon A1 - Bültmann, Ute A1 - Reijneveld, Sijmen A A1 - Carlos F. Mendes de Leon KW - Aged KW - Aging KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Retirement KW - Social Class KW - United States AB -

OBJECTIVES: The aims of this study are to examine the pattern of pre- and post-retirement changes in functional health and to examine the degree to which socioeconomic position (SEP) modifies pre- and post-retirement changes in functional health.

METHOD: This longitudinal study was conducted using data from the Health and Retirement Study from 1992 to 2012. Piecewise linear regression analyses with generalised estimating equations were used to calculate trajectories of limitations in mobility and large muscle functions before and after retirement spanning a time period of 16 years. Interaction terms of three indicators of SEP with time before and after retirement were examined to investigate the modifying effect of SEP on changes in functional health before and after retirement.

RESULTS: Average levels of limitations in mobility and large muscle functions increased significantly in the years prior to retirement. This increase slowed down after retirement, most prominently for limitations in large muscle functions. Higher SEP was associated with a slower increase of functional limitations prior to retirement. After retirement, a less clear pattern was found as only wealth modified the increase of limitations in mobility functions.

DISCUSSION: Prevention of functional decline in older working adults may be essential in achieving longer and healthier working lives. Such strategies may have to give special consideration to lower SEP adults, as they tend to experience functional health declines prior to retirement at a greater rate than higher SEP adults.

VL - 170 UR - http://www.sciencedirect.com/science/article/pii/S0277953616305615 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27741444?dopt=Abstract ER - TY - JOUR T1 - Functional status in older women diagnosed with pelvic organ prolapse. JF - Am J Obstet Gynecol Y1 - 2016 A1 - Tatiana V D Sanses A1 - Nicholas K Schiltz A1 - Bruna M. Couri A1 - Sangeeta T Mahajan A1 - Holly E Richter A1 - David F Warner A1 - Jack M. Guralnik A1 - Siran M Koroukian KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Medicare KW - Middle Aged KW - Mobility Limitation KW - Muscle Strength KW - Pelvic Organ Prolapse KW - United States KW - Upper Extremity AB -

BACKGROUND: Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders.

OBJECTIVE: The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP).

STUDY DESIGN: This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age ≥65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age.

RESULTS: The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in ADL, and 13.6% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in ADL, and 30.6% vs 6.7% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age.

CONCLUSION: Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.

PB - 214 VL - 214 UR - http://www.sciencedirect.com/science/article/pii/S0002937815024783 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26704893?dopt=Abstract U2 - PMC4851569 U4 - activities of daily living/functional status/limitations/mobility/pelvic organ prolapse/strength ER - TY - JOUR T1 - Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2016 A1 - Esther M Friedman A1 - Margaret M Weden A1 - Regina A Shih A1 - Stephanie Kovalchik A1 - Singh, Reema A1 - José J Escarce KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognitive Dysfunction KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Population Dynamics KW - Residence Characteristics KW - United States AB -

OBJECTIVE: To examine whether the health and functioning of middle-aged and older adults are associated with an increased likelihood of community-based moves.

METHOD: Biennial data from adults aged 51 and older in the Health and Retirement Study (HRS) and discrete-time survival models were used to assess the likelihood of community-based moves from 2000 to 2010 as a function of 11 measures of health and functioning.

RESULTS: Respondents diagnosed with heart disease, stroke, hypertension, lung disease, and psychiatric problems were more likely to move during the study period than those with no such diagnosis. Changes in activities of daily living and instrumental activities of daily living functioning, cognitive impairment, and falls were also related to a greater likelihood of moving during the study period. Cancer and diabetes were not related to overall moves, although diabetes was associated with an increased likelihood of local moves. For the most part, it was longstanding not recent diagnoses that were significantly related to the likelihood of moving.

DISCUSSION: Although some health conditions precipitate moves among middle-aged and older adults, others do not. This work has important implications for understanding the role of different aspects of health and functioning in the likelihood of migration among older adults.

VL - 71 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26450960?dopt=Abstract U4 - Activities of daily living/Aging/Cognition/Health/HEALTH STATUS/health condition/Migration 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 - THES T1 - Familial Caregiving and Timing of Retirement: A Gendered Cohort Analysis Y1 - 2015 A1 - Rachel R Stoiko KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other KW - Retirement Planning and Satisfaction AB - Retirement timing has been linked to a host of outcomes for individuals, families, and communities. Well-known predictors of retirement timing include health, wealth, and cognitive capacity; a few studies have also linked gender and family caregiving to retirement timing. In the present study, data from the Health and Retirement Study were used to create profiles of pre-retirement family caregiving (operationalized as time and financial transfers to participants' aging parents and adult children). These profiles, as well as participant gender and cohort, were used to predict later retirement timing. All profiles retired, on average, earlier than their full eligibility for Social Security benefits. The Eldercare profile, which was characterized by high levels of time and financial transfers to aging parents, retired the earliest. On average, women retired earlier than men. Members of the War Babies cohort (b. 1941-1947) retired earlier than members of the HRS cohort (b. 1931-1941). There was not a significant interaction between caregiving profile and gender, revealing that when men enacted female-typical caregiving roles, their retirement timing resembled women's. Implications for individual retirement decision-making and policy are discussed. PB - West Virginia University CY - Morgantown, WV VL - 3718575 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1708653547?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ N1 - Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-09-02 First page - n/a U4 - 0620:Developmental psychology JO - Familial Caregiving and Timing of Retirement: A Gendered Cohort Analysis ER - TY - JOUR T1 - FASTKD2 is associated with memory and hippocampal structure in older adults. JF - Mol Psychiatry Y1 - 2015 A1 - Vijay K Ramanan A1 - Nho, Kwangsik A1 - Shen, Li A1 - Shannon L Risacher A1 - Brenna C McDonald A1 - Martin R Farlow A1 - Tatiana Foroud A1 - Gao, Sujuan A1 - Soininen, Hilkka A1 - Kloszewska, Iwona A1 - Mecocci, Patrizia A1 - Tsolaki, Magda A1 - Vellas, Bruno A1 - Lovestone, Simon A1 - Aisen, Paul S. A1 - Ronald C Petersen A1 - Jack, Clifford R. A1 - Shaw, Leslie M. A1 - Trojanowski, John Q. A1 - Weiner, Michael W. A1 - Green, Robert C. A1 - Arthur W. Toga A1 - Philip L de Jager A1 - Lei Yu A1 - David A Bennett A1 - Andrew J Saykin KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Female KW - Genetic Association Studies KW - Genome-Wide Association Study KW - Hippocampus KW - Humans KW - Longitudinal Studies KW - Male KW - Memory KW - Memory Disorders KW - Polymorphism, Single Nucleotide KW - Protein-Serine-Threonine Kinases KW - Structure-Activity Relationship AB -

Memory impairment is the cardinal early feature of Alzheimer's disease, a highly prevalent disorder whose causes remain only partially understood. To identify novel genetic predictors, we used an integrative genomics approach to perform the largest study to date of human memory (n=14 781). Using a genome-wide screen, we discovered a novel association of a polymorphism in the pro-apoptotic gene FASTKD2 (fas-activated serine/threonine kinase domains 2; rs7594645-G) with better memory performance and replicated this finding in independent samples. Consistent with a neuroprotective effect, rs7594645-G carriers exhibited increased hippocampal volume and gray matter density and decreased cerebrospinal fluid levels of apoptotic mediators. The MTOR (mechanistic target of rapamycin) gene and pathways related to endocytosis, cholinergic neurotransmission, epidermal growth factor receptor signaling and immune regulation, among others, also displayed association with memory. These findings nominate FASTKD2 as a target for modulating neurodegeneration and suggest potential mechanisms for therapies to combat memory loss in normal cognitive aging and dementia.

PB - 20 VL - 20 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25385369?dopt=Abstract U2 - PMC4427556 U4 - Genetic analysis/Alzheimer disease/Memory impairment/predictors/FASTKD2 ER - TY - JOUR T1 - Feeling younger, walking faster : subjective age and walking speed in older adults JF - Age Y1 - 2015 A1 - Yannick Stephan A1 - Angelina R Sutin A1 - Antonio Terracciano KW - Demographics KW - Expectations KW - Health Conditions and Status AB - Walking speed is a key vital sign in older people. Given the implications of slower gait speed, a large literature has identified health-related, behavioral, cognitive, and biological factors that moderate age-related decline in mobility. The present study aims to contribute to existing knowledge by examining whether subjective age, how old or young individuals experience themselves to be relative to their chronological age, contributes to walking speed. Participants were drawn from the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 2970) and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 5423). In both the HRS and the NHATS, linear regression analysis revealed that a younger subjective age was associated with faster walking speed at baseline and with less decline over time, controlling for age, sex, education, and race. These associations were partly accounted for by depressive symptoms, disease burden, physical activity, cognition, body mass index, and smoking. Additional analysis revealed that feeling younger than one s age was associated with a reduced risk of walking slower than the frailty-related threshold of 0.6 m/s at follow-up in the HRS. The present study provides novel and consistent evidence across two large prospective studies for an association between the subjective experience of age and walking speed of older adults. Subjective age may help identify individuals at risk for mobility limitations in old age and may be a target for interventions designed to mitigate functional decline. 2015, American Aging Association. PB - 37 VL - 37 IS - 5 N1 - Export Date: 9 September 2015 U4 - Mobility/Subjective age/Walking speed ER - TY - JOUR T1 - Financial Literacy and Economic Outcomes: Evidence and Policy Implications. JF - J Retire Y1 - 2015 A1 - Olivia S. Mitchell A1 - Annamaria Lusardi AB -

This paper reviews what we have learned over the past decade about financial literacy and its relationship to financial decision-making around the world. Using three questions, we have surveyed people in several countries to determine whether they have the fundamental knowledge of economics and finance needed to function as effective decision-makers. We find that levels of financial literacy are low not only in the United States. but also in many other countries including those with well-developed financial markets. Moreover, financial illiteracy is particularly acute for some demographic groups, especially women and the less-educated. These findings are important since financial literacy is linked to borrowing, saving, and spending patterns. We also offer new evidence on financial literacy among high school students drawing on the 2012 Programme for International Student Assessment implemented in 18 countries. Last, we discuss the implications of this research for policy.

VL - 3 UR - http://www.iijournals.com/doi/10.3905/jor.2015.3.1.107 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28553655?dopt=Abstract JO - Retirement ER - TY - THES T1 - Financial strain and the health of Black, White, and Hispanic older adults: Lingering effects of the Great Recession? Y1 - 2015 A1 - Lindsay R. Wilkinson KW - Health Conditions and Status KW - Public Policy AB - The Great Recession that began in late 2007 and ended in mid-2009 has influenced the financial well-being of older adults, but has it had discernible effects on health? Prior research has repeatedly shown the deleterious effects of financial strain on mental and physical health and mortality; however, less is known about how this relationship functions during a historical fluctuation in the economy. Guided by cumulative inequality theory, the objective of this dissertation is to examine pre-recession and post-recession financial strain and health and investigate whether financial strain (1) increased for older adults following the Great Recession, and (2) if so, the impact of the recession on health. Drawing on the Health and Retirement Study, this research uses data collected on 5,205 older adults in 2006 and 2010 to examine change in financial strain and three domains of health: mental health, somatic well-being, and sleep disturbances. This dissertation is divided into three main articles, with each article focused on a separate health domain. Findings from this research indicate that while older adults were more likely to experience decreases in financial strain following the Great Recession, both initial financial strain and change in financial strain between 2006 and 2010 explained change in anxiety and depressive symptoms, psychotropic drug use, acute physical symptoms, and sleep disturbances over roughly the same span of time. PB - Purdue University CY - West Lafayette, IN U4 - morbidity JO - Financial strain and the health of Black, White, and Hispanic older adults: Lingering effects of the Great Recession? ER - TY - JOUR T1 - Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending. JF - Health Affairs (Project Hope) Y1 - 2015 A1 - Melissa Favreault A1 - Gleckman, Howard A1 - Richard W. Johnson KW - Aged KW - Financing KW - Government KW - Humans KW - Insurance KW - Insurance Coverage KW - Long-term Care KW - Medicaid KW - Middle Aged KW - Policy Making KW - United States AB -

About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance's role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

VL - 34 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26572919?dopt=Abstract ER - TY - THES T1 - Frailty in Older Adults with Heart Failure T2 - Nursing Y1 - 2015 A1 - Xie, Boqin KW - Disabilities KW - Health Conditions and Status AB - Frailty is prevalent in older adults with heart failure (HF), which increases their risk for basic and instrumental activities of daily living (ADL/IADL) disability and a diminished quality of life (QOL). However, the issue of conceptualizing frailty remains unresolved. To date, the two predominant frailty models are the Fried model, which defines frailty as purely physical, and the Gobben model, which defines frailty as multi-domain with physical, psychological, and social domains. An integrative literature review of frailty components in existing frailty measures was conducted. The most commonly used frailty components were mobility and balance, nutrition, and cognitive function. Next, a cross-sectional, secondary data analysis was conducted using data from the Health and Retirement Study (HRS) to compare the capacity of the Fried model and the Gobbens model to predict ADL/IADL disability and QOL. Compared to the Fried physical frailty model, the inclusion of psychological components from the Gobbens model significantly increased the power to predict ADL/IADL disability, while the psychological and social components from the Gobbens' model significantly increased the ability to predict QOL. These findings support the view that frailty is a multidimensional syndrome with three domains (physical, psychological, and social). The levels of the three frailty domains were then compared, and older adults with HF were found to have higher levels of frailty across all three domains compared to older adults without HF. Lastly, a longitudinal examination of multidimensional frailty in older adults with HF was conducted, using HRS data collected at two time-points (2006/2008 to 2010/2012) from two cohorts. Across the two time-points, older adults with HF had higher levels of frailty across all three domains compared to older adults without HF. All HF and three frailty domains were associated with increased risks of ADL/IADL disability and decreased QOL. Each frailty domain mediated the relationship between HF and outcomes (ADL/IADL disability and QOL). The findings in this dissertation support frailty as a multidimensional syndrome. These findings have implications for the development of tailored, broad-based intervention aimed at preventing frailty or delaying its onset to reduce adverse outcomes of ADL/IADL disability and decreased QOL. JF - Nursing PB - University of Michigan CY - Ann Arbor, MI VL - Ph. D. U4 - Quality of Life JO - Frailty in Older Adults with Heart Failure 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 - Functional Limitations as Potential Mediators of the Effects of Self-Reported Vision Status on Fall Risk of Older Adults JF - Journal of Aging and Health Y1 - 2015 A1 - Bernard A Steinman A1 - Susan M Allen A1 - Chen, Jie A1 - Pynoos, Jon KW - Health Conditions and Status AB - Objective: To test whether limitations in mobility and large-muscle functioning mediate self-reported vision status to increase fall risk among respondents age 65 and above. Method: This study used two waves from the Health and Retirement Study. We conducted binary logistic and negative binomial regression analyses to test indirect paths leading from self-reported vision status to falls, via indices of mobility and large-muscle functioning. Results: Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status. Discussion: Implications of these findings are discussed including the need for prioritizing improved muscle strength of older men and women with poor vision as a preventive measure against falls. PB - 27 VL - 27 UR - http://jah.sagepub.com/content/early/2014/07/22/0898264314543473.abstract IS - 1 N1 - Steinman, Bernard A Allen, Susan M Chen, Jie Pynoos, Jon eng 2014/07/23 06:00 J Aging Health. 2015 Feb;27(1):158-76. doi: 10.1177/0898264314543473. Epub 2014 Jul 20. U4 - falls prevention/self-reported vision/functional impairment/mobility Limitation/Self assessed health ER - TY - JOUR T1 - Future Monetary Costs of Dementia in the United States under Alternative Dementia Prevalence Scenarios. JF - Journal of Population Ageing Y1 - 2015 A1 - Michael D Hurd A1 - Martorell, Paco A1 - Kenneth M. Langa KW - Dementia KW - Forecasting KW - Health Conditions and Status KW - Older Adults AB -

Population aging will likely lead to increases is health care spending and the ability of governments to support entitlement programs such as Medicare and Medicaid. Dementia is a chronic condition that is especially pertinent because of its strong association with old age and because care for dementia is labor intensive and expensive. Indeed, prior research has found that if current dementia prevalence rates persist population aging will generate very large increases in health care spending for dementia. In this study we considered two alternative assumptions or scenarios about future prevalence. The first adjusts the prevalence projections using recent research that suggests dementia prevalence may be declining. The second uses growth hypertension, obesity and diabetes, and the relationship between dementia and these conditions to adjust future prevalence rates. We find under the first scenario that if the rates of decline in age-specific dementia rates persist, future costs will be much less than previous estimates, about 40% lower. Under the second scenario, the growth in those conditions makes only small differences in costs.

VL - 8 IS - 1-2 ER - TY - RPRT T1 - Fact Sheet: Cohort Differences in Parental Survival Y1 - 2014 A1 - Maximiliane E Szinovacz KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - Increases in longevity and especially increased survival into very old age have implications not only for individuals own life course but also for that of their families. For example, if parents survive into very old age they will have more opportunities not only to become grandparents but also great-grandparents and to experience these family roles for a longer time period (the so-called beanpole family ). From their adult children s perspective, longer survival of parents also can mean that needs for companionship arising from one parent s widow(er)hood will be postponed into their adult children s later years, possibly after the child s retirement. Similarly, because spouses typically function as primary caregivers for their partners, primary caregiving roles on the part of adult children may be postponed into children s later years if both parents survive into very old age. Despite considerable evidence documenting increases in longevity, little research has been devoted to parental survival among adult children from the World War II babies and baby boom cohorts. We present data comparing parental survival across four cohorts of adult children using data from Health and Retirement Study (HRS). PB - Boston, ScholarWorks, University of Massachusetts Boston U4 - Longevity/caregiver burden/caregiving/adult Children/parental care/parental survival ER - TY - RPRT T1 - Fact Sheet: Cohort Differences in Parents Illness and Nursing Home Use Y1 - 2014 A1 - Maximiliane E Szinovacz KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Surviving parents of the war baby and baby boom cohorts are now reaching very old age. Given their increased longevity and postponement of morbidity into very old age (see Fact Sheets on parental mortality and care needs), it is essential to estimate whether and to what extent these parents will require informal or formal care. Such care is typically most burdensome and costly if it involves long-lasting illness prior to death. Furthermore, Medicare and especially Medicaid expenditures will depend on whether or not these parents require nursing home care. To obtain some estimates of the prevalence of long-lasting illness and nursing home care among these groups of parents, we investigated reports of parental illness preceding death and nursing home placement from four cohorts of adult children, using data from the Health and Retirement Study. PB - Boston, ScholarWorks, University of Massachusetts Boston U4 - caregiver burden/caregiving/Medicaid/medicare/nursing home/Long Term Care/long-lasting illness ER - TY - JOUR T1 - A factor mixture model for analyzing heterogeneity and cognitive structure of dementia JF - AStA Advances in Statistical Analysis Y1 - 2014 A1 - Cagnone, Silvia A1 - Cinzia Viroli KW - Health Conditions and Status KW - Methodology KW - Other AB - The Health and Retirement Study (HRS) is funded by the National Institute on Aging of US with the aim of investigating the health, social and economic implications of the aging of the American population. The participants of the study receive a thorough in-home clinical and neuropsychological assessment leading to a diagnosis of normal, cognitive impairment but not demented, or dementia. Due to the heterogeneity of the participants into three classes, we analyze some overall cognitive functioning responses through a factor mixture analysis model. The model extends recent proposals developed for binary and continuous data to general mixed data and to the situation of observed heterogeneity, typical of the HRS study. PB - 98 VL - 98 IS - 1 U4 - Latent variables/Categorical and ordinal data/Mixture models/Cognitive functioning/Statistics/Statistics/Statistics, general/Analysis/Econometrics/Dementia/Statistics for Business/Economics/Mathematical Finance/Insurance/Probability Theory and Stochastic Processes ER - TY - JOUR T1 - Factors influencing the use of intensive procedures at the end of life. JF - J Am Geriatr Soc Y1 - 2014 A1 - Evan C Tschirhart A1 - Qingling Du A1 - Amy Kelley KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cause of Death KW - Chronic disease KW - Critical Care KW - Female KW - Homes for the Aged KW - Humans KW - Life Support Care KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Neoplasms KW - Nursing homes KW - Odds Ratio KW - Terminal Care KW - United States KW - Utilization Review AB -

OBJECTIVES: To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life.

DESIGN: Retrospective cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of older adults.

PARTICIPANTS: HRS decedents aged 66 and older (N = 3,069).

MEASUREMENTS: Multivariable logistic regression was used to evaluate associations between individual and regional factors and receipt of five intensive procedures: intubation and mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life.

RESULTS: Approximately 18% of subjects (n = 546) underwent at least one intensive procedure in the last 6 months of life. Characteristics significantly associated with lower odds of an intensive procedure included aged 85-94 (vs 65-74, adjusted odds ratio (AOR) = 0.67, 95% confidence interval (CI) = 0.51-0.90), Alzheimer's disease (AOR = 0.71, 95% CI = 0.54-0.94), cancer (AOR = 0.60, 95% CI = 0.43-0.85), nursing home residence (AOR = 0.70, 95% CI = 0.50-0.97), and having an advance directive (AOR = 0.71, 95% CI = 0.57-0.89). In contrast, living in a region with higher hospital care intensity (AOR = 2.16, 95% CI = 1.48-3.13) and black race (AOR = 2.02, 95% CI = 1.52-2.69) each doubled one's odds of undergoing an intensive procedure.

CONCLUSION: Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.

PB - 62 VL - 62 IS - 11 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25376084?dopt=Abstract U2 - PMC4241150 U4 - end-of-life decisions/terminal care/intensive care/Medicare/Advance Directives/regional variations/MEDICARE EXPENDITURES/SUSTAINING TREATMENTS/PATIENT PREFERENCES ER - TY - RPRT T1 - Financial Literacy Among American Indians and Alaska Natives Y1 - 2014 A1 - Murphy, John L. A1 - Gourd, Alicia A1 - Begay, Faith KW - Net Worth and Assets KW - Retirement Planning and Satisfaction KW - Women and Minorities AB - Many Americans lack important financial skills and knowledge of critical concepts that can help ensure sound retirement planning and future economic security. Prior research has suggested that low levels of financial literacy are particularly acute among certain groups such as women, blacks, and persons with lower levels of educational attainment (Dunaway-Knight and others 2012; Hung, Parker, and Yoong 2009; Huston 2010; Lusardi 2008; A. Murphy 2005). This study adds to previous work on financial literacy among minority groups by examining the American Indian and Alaska Native (AIAN) population. Prior research on AIANs has often used convenience samples of university students and has been limited by the lack of nationally representative samples (for example, Anderson and others (2010); Chen and Volpe (2002); Mandell (2009); and Mandell and Klein (2007)). In this note, we use a nationally representative sample from the Health and Retirement Study (HRS) to analyze how AIAN respondents scored on the 2008 HRS financial literacy module compared with white respondents (reference group) and other minority groups. The HRS is one of the foremost sources of information on the population aged 50 or older. We use an 18-item financial sophistication and investment decision-making (FSIDM) questionnaire.1 Each correct answer receives one point; thus, the scale ranges from 0 to 18, with higher values representing more financial sophistication. The FSIDM questionnaire has been widely used in other studies to investigate financial literacy (for example, Agarwal and others (2009); Lusardi (2008); Lusardi and Mitchell (2007, 2008, 2011); and Lusardi, Mitchell, and Curto (2009)). Researchers have primarily used the FSIDM questionnaire to examine overall knowledge of financial literacy across broad swaths of the older U.S. population by sex, age, income, and race. However, racial differences in the aforementioned studies have been primarily limited to those between blacks and whites. Our analysis finds that the mean number of questions that AIAN respondents correctly answered was significantly lower than the comparable figures for white, black, and Asian respondents. For each of the 18 questions in the module, we find that there are specific financial literacy topics in which the knowledge gap between AIANs and other race/ethnic groups was particularly large. However, a limited sample size constrains this analysis, and additional data and research are needed to fully address financial literacy within the AIAN population. PB - Social Security Administration, Office of Retirement and Disability Policy, Office of Research, Evaluation, and Statistics UR - http://www.ssa.gov/policy/docs/rsnotes/rsn2014-04.html U4 - Native Americans/financial literacy/retirement planning/economic security/American Indians/Alaska Natives ER - TY - JOUR T1 - Financial literacy and financial sophistication in the older population JF - Journal of Pension Economics and Finance Y1 - 2014 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell A1 - Vilsa Curto KW - Demographics KW - Net Worth and Assets KW - Other KW - Retirement Planning and Satisfaction AB - Using a special-purpose module implemented in the Health and Retirement Study, we evaluate financial sophistication in the American population over the age of 50. We combine several financial literacy questions into an overall index to highlight which questions best capture financial sophistication and examine the sensitivity of financial literacy responses to framing effects. Results show that many older respondents are not financially sophisticated: they fail to grasp essential aspects of risk diversification, asset valuation, portfolio choice, and investment fees. Subgroups with notable deficits include women, the least educated, non-Whites, and those age 75 . In view of the fact that retirees increasingly must take on responsibility for their own retirement security, such meager levels of knowledge have potentially serious and negative implications. PB - 13 VL - 13 IS - 4 N1 - Export Date: 21 April 2014 Source: Scopus Article in Press U4 - Financial knowledge/framing/gender differences/retirement security/retirement security ER - TY - JOUR T1 - Financial literacy and mortgage equity withdrawals JF - Journal of Urban Economics Y1 - 2014 A1 - John V. Duca A1 - Kumar, Anil KW - Consumption and Savings KW - Net Worth and Assets KW - Public Policy AB - Mortgage equity withdrawals (MEW) are correlated with covariates consistent with a permanent income framework augmented for credit-constraints. We assess linkages between MEW and financial literacy/education using the Health and Retirement Study (HRS) and Panel Study of Income Dynamics (PSID). We find that the financially literate are 3-5 percentage points less likely to withdraw housing equity via non-home equity loan mortgages using the HRS, while college graduates are 5 percentage points less likely than those without a high school degree in the PSID. Among those withdrawing housing equity in the PSID, college graduates extract significantly less equity and are less likely to have high levels of housing leverage after doing so. 2013 Elsevier Inc. PB - 80 VL - 80 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84887604806andpartnerID=40andmd5=03717bfccf399874e90d42373861c89b N1 - Export Date: 29 January 2014 Source: Scopus U4 - Consumption/Credit constraints/Financial literacy/Mortgage equity withdrawals ER - TY - JOUR T1 - Fine particulate matter air pollution and cognitive function among older US adults. JF - Am J Epidemiol Y1 - 2014 A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cognition Disorders KW - Cross-Sectional Studies KW - Female KW - Humans KW - Inhalation Exposure KW - Male KW - Memory, Episodic KW - Middle Aged KW - Neuropsychological tests KW - Particulate Matter KW - Socioeconomic factors KW - United States KW - Urban Population AB -

Existing research on the adverse health effects of exposure to pollution has devoted relatively little attention to the potential impact of ambient air pollution on cognitive function in older adults. We examined the cross-sectional association between residential concentrations of particulate matter with aerodynamic diameter of 2.5 μm or less (PM2.5) and cognitive function in older adults. Using hierarchical linear modeling, we analyzed data from the 2004 Health and Retirement Study, a large, nationally representative sample of US adults aged 50 years or older. We linked participant data with 2000 US Census tract data and 2004 census tract-level annual average PM2.5 concentrations. Older adults living in areas with higher PM2.5 concentrations had worse cognitive function (β = -0.26, 95% confidence interval: -0.47, -0.05) even after adjustment for community- and individual-level social and economic characteristics. Results suggest that the association is strongest for the episodic memory component of cognitive function. This study adds to a growing body of research highlighting the importance of air pollution to cognitive function in older adults. Improving air quality in large metropolitan areas, where much of the aging US population resides, may be an important mechanism for reducing age-related cognitive decline.

PB - 180 VL - 180 UR - http://aje.oxfordjournals.org/content/early/2014/06/24/aje.kwu155.abstract IS - 4 N1 - Ailshire, Jennifer A Crimmins, Eileen M eng K99 AG039528/AG/NIA NIH HHS/ K99AG039528/AG/NIA NIH HHS/ P30 AG017265/AG/NIA NIH HHS/ P30AG17265/AG/NIA NIH HHS/ R00 AG039528/AG/NIA NIH HHS/ R21 AG045625/AG/NIA NIH HHS/ T32 AG000037/AG/NIA NIH HHS/ T32AG0037/AG/NIA NIH HHS/ U01 AG009740/AG/NIA NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Research Support, N.I.H., Extramural 2014/06/27 06:00 Am J Epidemiol. 2014 Aug 15;180(4):359-66. doi: 10.1093/aje/kwu155. Epub 2014 Jun 24. U1 - http://www.ncbi.nlm.nih.gov/pubmed/24966214?dopt=Abstract ER - TY - JOUR T1 - Five-factor model personality traits and inflammatory markers: new data and a meta-analysis. JF - Psychoneuroendocrinology Y1 - 2014 A1 - Martina Luchetti A1 - James M Barkley A1 - Yannick Stephan A1 - Antonio Terracciano A1 - Angelina R Sutin KW - Adult KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - C-reactive protein KW - Female KW - Humans KW - Inflammation KW - Male KW - Middle Aged KW - Personality AB -

The purpose of this research is to examine the association between five major dimensions of personality and systemic inflammation through (a) new data on C-reactive protein (CRP) from three large national samples of adults that together cover most of the adult lifespan and (b) a meta-analysis of published studies on CRP and interleukin-6 (IL-6). New data (total N=26,305) were drawn from the National Longitudinal Study of Adolescent Health, the Midlife in the United States study, and the Health and Retirement Study. PRISMA guidelines were used for the meta-analysis to combine results of up to seven studies on CRP (N=34,067) and six on IL-6 (N=7538). Across the three new samples, higher conscientiousness was associated with lower CRP. The conscientiousness-CRP relation was virtually identical controlling for smoking; controlling for body mass index attenuated this association but did not eliminate it. Compared to participants in the highest quartile of conscientiousness, participants in the lowest quartile had an up to 50% increased risk of CRP levels that exceeded the clinical threshold (≥3 mg/l). The meta-analysis supported the association between conscientiousness and both CRP and IL-6 and also suggested a negative association between openness and CRP; no associations were found for neuroticism, extraversion and agreeableness. The present work indicates a modest, but consistent, association between conscientiousness and a more favorable inflammatory profile, which may contribute to the role of conscientiousness in better health across the lifespan.

PB - 50 VL - 50 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25233337?dopt=Abstract U2 - PMC4544833 U4 - Personality/Personality/Conscientiousness/Conscientiousness/C-reactive protein/Interleukin-6/Meta-analysis ER - TY - THES T1 - Frailty and Depression: A Latent Trait Analysis Y1 - 2014 A1 - Matthew C. Lohman KW - Health Conditions and Status KW - Methodology KW - Public Policy AB - Background: Frailty, a state indicating vulnerability to poor health outcomes, is a common condition in later life. However, research and intervention progress is hindered by the current lack of a consensus frailty definition and poor understanding of relationships between frailty and depression. Objectives: The goal of this research is to understand the interrelationships between frailty and depression among older adults. Specifically, this project aims 1) to examine the construct overlap between depression and three definitions of frailty (biological syndrome, medical burdens, and functional domains), 2) to determine the degree to which this overlap varies by age, gender, race/ethnicity and other individual characteristics, 3) to evaluate how the association between frailty and depression influences prediction of adverse health outcomes. Methods: This project uses data from the 2004-2012 Health and Retirement Study (HRS), an ongoing, nationally-representative cohort study of adults over the age of 55. Frailty was indexed by three alternative conceptual models: 1) biological syndrome, 2) cumulative medical burdens, and 3) functional domains. Depressive symptoms were indexed by the 8-item Center for Epidemiologic Studies Depression (CESD) scale. Latent class analysis and confirmatory factor analysis were used to assess the construct overlap between depressive symptoms and frailty. Latent growth curve modeling were used to evaluate associations between frailty and depression, and to estimate their joint influence on two adverse health outcomes: nursing home admission and falls. Results: The measurement overlap of frailty and depression was high using a categorical latent variable approach. Approximately 73% of individuals with severe depressive symptoms, and 85% of individuals with primarily somatic depressive symptoms, were categorized as concurrently frail. When modeled as continuous latent factors, each of the three frailty latent factors was significantly correlated with depression: biological syndrome (ρ = .67, p <.01); functional domains (ρ = .70, p <.01); and medical burdens (ρ = .62, p <.01). Higher latent frailty trajectories were associated with higher likelihood of experiencing nursing home admission and serious falls. This association with adverse health outcomes was attenuated after adjustment for depression as a time-varying covariate. Conclusions: Findings suggest that frailty and frailty trajectories are potentially important indicators of vulnerability to adverse health outcomes. Future investigations of frailty syndrome, however it is operationalized, should account for its substantial association with depression in order to develop more accurate measurement and effective treatment. PB - Virginia Commonwealth University CY - Richmond, VA VL - 3619537 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1534601392?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/fmt:kev:mtx:disse N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-06-27 First page - n/a U4 - Public health JO - Frailty and Depression: A Latent Trait Analysis ER - TY - JOUR T1 - Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke. JF - Circ Cardiovasc Qual Outcomes Y1 - 2014 A1 - Deborah A Levine A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Kenneth M. Langa A1 - Mary A M Rogers A1 - Theodore J Iwashyna KW - Activities of Daily Living KW - Cognition KW - Cognition Disorders KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Hospitalization KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Odds Ratio KW - Retrospective Studies KW - Stroke KW - Time Factors KW - United States AB -

BACKGROUND: We assessed the acute and long-term effect of myocardial infarction (MI) and stroke on postevent functional disability and cognition while controlling for survivors' changes in functioning over the years before the event.

METHODS AND RESULTS: Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we determined within-person changes in functional limitations (basic and instrumental activities of daily living) and cognitive impairment after hospitalization for stroke (n=432) and MI (n=450), controlling for premorbid functioning using fixed-effects regression. In persons without baseline impairments, an acute MI yielded a mean acute increase of 0.41 functional limitations (95% confidence interval [CI], 0.18-0.63) with a linear increase of 0.14 limitations/year in the following decade. These increases were 0.65 limitations (95% CI, 0.07-1.23) and 0.27 limitations/year afterward for those with mild-to-moderate impairment at baseline. Stroke resulted in an acute increase of 2.07 (95% CI, 1.51-2.63) limitations because of the acute event and an increase of 0.15 limitations/year afterward for those unimpaired at baseline. There were 2.65 new limitations (95% CI, 1.86-3.44) and 0.19/year afterward for those with baseline mild-to-moderate impairment. Stroke hospitalization was associated with greater odds of moderate-to-severe cognitive impairment (odds ratio, 3.86; 95% CI, 2.10-7.11) at the time of the event, after adjustment for premorbid cognition but MI hospitalization was not.

CONCLUSIONS: In this population-based cohort, most MI and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterward. Survivors of MI and stroke warrant screening for functional disability over the long-term.

PB - 7 VL - 7 IS - 6 N1 - Times Cited: 1 0 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25387772?dopt=Abstract U4 - activities of daily living/cognitive impairment/myocardial infarction/stroke/functional decline/functional decline/Transient Ischemic Attack/Coronary Artery Disease/quality of life/medicare ER - TY - JOUR T1 - Fundamental resource dis/advantages, youth health and adult educational outcomes JF - Social Science Research Y1 - 2014 A1 - Elman, Cheryl A1 - Linda A. Wray A1 - Xi, Juan KW - Adult children KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Recent studies find lasting effects of poor youth health on educational attainment but use young samples and narrow life course windows of observation to explore outcomes. We apply a life course framework to three sets of Health and Retirement Study birth cohorts to examine early health status effects on education and skills attainment measured late in life. The older cohorts that we study were the earliest recipients of U.S. policies promoting continuing education through the GI Bill, community college expansions and new credentials such as the GED. We examine a wide range of outcomes but focus on GEDs, postsecondary school entry and adult human capital as job-related training. We find that older U.S. cohorts had considerable exposure to these forms of attainment and that the effects of youth health on them vary by outcome: health selection and ascription group effects are weak or fade, respectively, in outcomes associated with delayed or adult attainment. However, poorer health and social disadvantage in youth and barriers associated with ascription carry forward to limit attainment of key credentials such as diplomas and college degrees. We find that the human capital - health gradient is dynamic and that narrow windows of observation in existing studies miss much of it. National context also matters for studying health-education linkages over the life course. PB - 43 VL - 43 UR - http://www.ncbi.nlm.nih.gov/pubmed/24267756 N1 - Times Cited: 0 U4 - Life Course/Health Disparities/Adult Education/Low-Birth-Weight/Childhood Health/Cumulative Disadvantage/Socioeconomic-Status/Gender-Gap ER - TY - RPRT T1 - Fact Sheet: What Influences Plans to Work after Ages 62 and 65? Y1 - 2013 A1 - Maximiliane E Szinovacz KW - Employment and Labor Force KW - Expectations KW - Public Policy KW - Retirement Planning and Satisfaction AB - Timing of retirement and, implicitly, plans to work in later life have great policy relevance. They affect Social Security expenditures, employers pension expenditures, as well as labor force supply and demand. In light of the recent recession, it is particularly important to explore whether economic downturns and workers financial status influence their later-life work plans. To answer this question, we analyzed data from the nationally representative Health and Retirement Study (HRS), which included questions about expectations to work full-time after age 62 and age 65. PB - Boston, MA, University of Massachusetts Boston U4 - retirement planning/Public Policy/expectations/labor Force ER - TY - THES T1 - Factors Predicting the Perception of Positive Aging In the Presence of Chronic Stress Y1 - 2013 A1 - Ray-Mazumder, Shibani KW - Adult children KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status AB - The graying of the Baby Boomer generation brings with it increased longevity, higher prevalence of chronic illness, and changing expectations of the experience of growing old. Some people seem to experience aging better than others even in the face of life stressors. These individuals are defined as being resilient. Within a resilience and empowerment conceptual framework (O'Leary & Bhaju, 2006), the variables of sense of control, social support, loneliness, and optimism are important components that impact the positive aging experience. Using this model, the purpose of this study was to identify predictors of resilience that buffered males and females from chronic stress within the realm of the aging experience. This study was a secondary data analysis on a subsample of 3,262 individuals included in the 2004 core survey of the Health Retirement Study who were asked to complete the Psychosocial Leave-Behind Participant Lifestyle Questionnaire (PLBQ) after their initial interview. A surprising finding was that individuals with low to moderate optimism were more likely to predict their aging as positive even within the presence of chronic stress. In addition, resilient males were more likely to have social support and not be lonely as compared to their non-resilient counterparts. Resilient females were differentiated by non-resilient females by not letting their health get in the way of daily activities and by having a higher sense of control. Findings from this study inform how psychologists must take into account varying factors based on gender that enable individuals to be resilient in their aging experience. PB - Fielding Graduate University CY - United States -- California VL - 3552550 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1312508368?accountid=14667 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-03-07 DOI - 2901812701; 72177892; 66569; 9781267910776; 3552550 First page - n/a U4 - participant lifestyle JO - Factors Predicting the Perception of Positive Aging In the Presence of Chronic Stress ER - TY - JOUR T1 - Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study. JF - J Am Geriatr Soc Y1 - 2013 A1 - Nishant K. Sekaran A1 - Choi, Hwajung A1 - Rodney A. Hayward A1 - Kenneth M. Langa KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Aging KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Health Status KW - Humans KW - Male KW - Odds Ratio KW - Retrospective Studies KW - Risk Factors KW - United States KW - Wounds and Injuries AB -

OBJECTIVES: To determine whether falling would be a marker for future difficulty with activities of daily (ADLs) that would vary according to fall frequency and associated injury.

DESIGN: Longitudinal analysis.

SETTING: Community.

PARTICIPANTS: Nationally representative cohort of 2,020 community-living, functionally independent older adults aged 65 to 69 at baseline followed from 1998 to 2008.

MEASUREMENTS: ADL difficulty.

RESULTS: Experiencing one fall with injury (odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.29-2.48), at least two falls without injury (OR = 2.36, 95% CI = 1.80-3.09), or at least two falls with at least one injury (OR = 3.75, 95% CI = 2.55-5.53) in the prior 2 years was independently associated with higher rates of ADL difficulty after adjustment for sociodemographic, behavioral, and clinical covariates.

CONCLUSION: Falling is an important marker for future ADL difficulty in younger, functionally independent older adults. Individuals who fall frequently or report injury are at highest risk.

PB - 61 VL - 61 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23311555?dopt=Abstract U4 - falls/Fall prevention/disability/disability/older adults/ADL/IADL/activities of daily living/Mobility/functional impairment/health Status ER - TY - JOUR T1 - Financial Ratios and Perceived Household Financial Satisfaction JF - Journal of Financial Therapy Y1 - 2013 A1 - Garrett, Scott A1 - Russell N. James III KW - Methodology KW - Net Worth and Assets AB - This paper tests the relative strength of three objective measures of financial health (using the solvency, liquidity, and investment asset ratio) in predicting a household s subjective feeling of current financial satisfaction. Using a sample of 6,923 respondents in the 2008 Health and Retirement Study this paper presents evidence of two main findings: 1) the solvency ratio is most strongly associated with financial satisfaction levels based on a cross-sectional design and 2) changes in the investment asset ratio are most strongly associated with changes in financial satisfaction over time. PB - 4 VL - 4 IS - 1 U4 - Financial Satisfaction/Ratios/Financial Planning/Financial Counseling ER - TY - JOUR T1 - Financial Ratios and Perceived Household Financial Satisfaction JF - Journal of Financial Therapy Y1 - 2013 A1 - Garrett, Scott A1 - Russell N. James III KW - Methodology KW - Net Worth and Assets AB - This paper tests the relative strength of three objective measures of financial health (using the solvency, liquidity, and investment asset ratio) in predicting a household s subjective feeling of current financial satisfaction. Using a sample of 6,923 respondents in the 2008 Health and Retirement Study this paper presents evidence of two main findings: 1) the solvency ratio is most strongly associated with financial satisfaction levels based on a cross-sectional design and 2) changes in the investment asset ratio are most strongly associated with changes in financial satisfaction over time. PB - 4 VL - 4 IS - 1 U4 - financial satisfaction/ratios/financial therapy/financial planning/financial exploitation/Financial counseling ER - TY - JOUR T1 - Former stepparents' contact with their stepchildren after midlife. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2013 A1 - Claire Noël-Miller KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Child KW - Family Characteristics KW - Female KW - Health Surveys KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Parent-Child Relations KW - Parents KW - Social Support KW - Young Adult AB -

OBJECTIVES: Based on the life course perspective and gender differences in stepparental roles, this study examines frequency of social contact between mid- to late-life stepparents and their stepchildren after stepparents' marriage to their stepchildren's biological parent has been dissolved through widowhood or divorce.

METHOD: Using 5 waves of panel data on stepparent-stepchild pairs from the Health and Retirement Study (N = 12,947 stepchild observations on 4,063 stepchildren belonging to 1,663 stepparents) spanning 10 years (1998-2008), I estimate ordered logit multilevel models predicting former stepparent-stepchild contact frequency.

RESULTS: Results indicate that former stepparents have notably less frequent contact with their stepchildren than current stepparents, particularly following divorce. Widowed stepparents' contact with their stepchildren diminishes gradually following union disruption, whereas divorced stepparents' contact frequency drops abruptly. Former stepfathers have less contact with their stepchildren than former stepmothers. Finally, I uncover evidence of the moderating role of (step)parents' marriage length and stepparents' number of biological children on widowed stepparent-stepchild contact frequency.

DISCUSSION: Older stepparents' social contact with their stepchildren is largely conditional on stepparents' enduring marital bond to their stepchildren's biological parent. This study contributes to a growing literature portraying relatively weak ties between older adults and their stepchildren.

PB - 68 VL - 68 UR - http://search.proquest.com.proxy.lib.umich.edu/docview/1329184768?accountid=14667 IS - 3 N1 - Copyright - Copyright Oxford University Press, UK May 2013 Last updated - 2013-04-19 DOI - 2948942401; 77441762; 9698; PGN2; INODPGN20000698908 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23591569?dopt=Abstract U2 - PMC3693606 U4 - Middle age/Stepfamilies/intergenerational Transfers/Intergenerational relationships ER - TY - JOUR T1 - Functional disability, cognitive impairment, and depression after hospitalization for pneumonia. JF - Am J Med Y1 - 2013 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Deborah A Levine A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - depression KW - Hospitalization KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Middle Aged KW - Myocardial Infarction KW - Pneumonia KW - Stroke AB -

OBJECTIVE: The study objective was to examine whether hospitalization for pneumonia is associated with functional decline, cognitive impairment, and depression, and to compare this impairment with that seen after known disabling conditions, such as myocardial infarction or stroke.

METHODS: We used data from a prospective cohort of 1434 adults aged more than 50 years who survived 1711 hospitalizations for pneumonia, myocardial infarction, or stroke drawn from the Health and Retirement Study (1998-2010). Main outcome measures included the number of Activities and Instrumental Activities of Daily Living requiring assistance and the presence of cognitive impairment and substantial depressive symptoms.

RESULTS: Hospitalization for pneumonia was associated with 1.01 new impairments in Activities and Instrumental Activities of Daily Living (95% confidence interval [CI], 0.71-1.32) among patients without baseline functional impairment and 0.99 new impairments in Activities and Instrumental Activities of Daily Living (95% CI, 0.57-1.41) among those with mild-to-moderate baseline limitations, as well as moderate-to-severe cognitive impairment (odds ratio, 2.46; 95% CI, 1.60-3.79) and substantial depressive symptoms (odds ratio, 1.63; 95% CI, 1.06-2.51). Patients without baseline functional impairment who survived pneumonia hospitalization had more subsequent impairments in Activities and Instrumental Activities of Daily Living than those who survived myocardial infarction hospitalization. There were no significant differences in subsequent moderate-to-severe cognitive impairment or substantial depressive symptoms between patients who survived myocardial infarction or stroke and those who survived pneumonia.

CONCLUSIONS: Hospitalization for pneumonia in older adults is associated with subsequent functional and cognitive impairment. Improved pneumonia prevention and interventions to ameliorate adverse sequelae during and after hospitalization may improve outcomes.

VL - 126 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23499326?dopt=Abstract U2 - PMC3690157 U4 - Functional decline/Functional decline/cognitive Impairment/Depression/myocardial Infarction/Stroke/pneumonia/ADL/IADL/depressive symptoms/HOSPITALIZATION ER - TY - THES T1 - Functional limitations and chronic conditions predict CES-D-8 depression scores Y1 - 2013 A1 - Liu, Ying KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Women and Minorities AB - The role of functional limitations and self-reported chronic disease on CES-D-8 depression scores was investigated in the Health and Retirement Study's 2008 data. The sample included 5835 respondent's ranging in age from 50-83. Multivariate adaptive regression splines (MARS) modeling was employed to identify multiple linear splines. Possible predictors included functional limitations (ADL, IADL), chronic diseases (back pain, stroke, arthritis, cancer, high blood pressure, heart disease, lung disease, & diabetes) and demographic measures (age, education, gender, being white, being Hispanic). The MARS modeling process resulted in selection of the following measures in the final model: ADL limitations, IADL limitations, back pain, stroke, education, being female, and being Hispanic. The results indicated that ADL limitations included two splines with a large increase in depression score from zero to one limitation, and a more shallow increase from one to three limitations. IADL limitations included two splines with a linear increase in depression score from zero to two limitations and a decrease in score from two to three limitations. Reporting back pain or stroke resulted in higher depression scores compared to absence of disease. Two splines were identified for education in which the highest depression scores were associated with zero to 7 years of education; there was a linear decline in depression from seven to 17 years of education. Females and Hispanics were associated with higher depression scores compared to males and non-Hispanics. Results emphasize the importance of functional status and selected chronic health conditions on depression scores and provide more detailed descriptions of change than traditional regression-based models. PB - California State University, Los Angeles VL - 1542832 N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2013-08-30 First page - n/a U4 - women JO - Functional limitations and chronic conditions predict CES-D-8 depression scores ER - TY - JOUR T1 - Functional limitations in older adults who have cognitive impairment without dementia. JF - J Geriatr Psychiatry Neurol Y1 - 2013 A1 - Tanya R Gure A1 - Kenneth M. Langa A1 - Gwenith G Fisher A1 - John D Piette A1 - Brenda L Plassman KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Dementia KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Severity of Illness Index KW - Surveys and Questionnaires AB -

OBJECTIVE: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).

METHODS: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.

RESULTS: Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%).

CONCLUSIONS: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.

VL - 26 IS - 2 N1 - NLM Title Abbreviation: J Geriatr Psychiatry Neurol U1 - http://www.ncbi.nlm.nih.gov/pubmed/23559664?dopt=Abstract U2 - PMC3726208 U4 - ADAMS/Cognitive Impairment/ADL and IADL Impairments/Physical health/Dementia/Functional limitation ER - TY - JOUR T1 - Family Decision Making and Resource Protection Adequacy JF - The Journal of Consumer Affairs Y1 - 2012 A1 - Patryk D. Babiarz A1 - Robb, Cliff A. A1 - Woodyard, A. KW - Consumption and Savings KW - End of life decisions KW - Income KW - Methodology KW - Other AB - This study examines the correlation between resource protection and the intrahousehold distribution of bargaining power. Using data from the Health and Retirement Study, the analysis quantifies potential changes in the surviving individual's living standard to evaluate the adequacy of resource protection. Individuals who generate a larger share of family income, are more financially knowledgeable, or have the final say in family decisions leverage their bargaining power to secure higher protection of their hypothetical widowhood living standard. Consequently, spouses with more bargaining power are less likely to experience declines of their living standard in the event of their spouse passing away and are more likely to be overprotected. PB - 46 VL - 46 UR - www.jstor.org/stable/23860114 IS - 1 U4 - Correlation analysis/Studies/Standard of living/Standard of living/Decision making/Family income/Family income/Market research/Market research ER - TY - JOUR T1 - Family structure and the reproduction of inequality: Parents' contribution to children's college costs. JF - Soc Sci Res Y1 - 2012 A1 - John C Henretta A1 - Douglas A. Wolf A1 - Matthew F. Van Voorhis A1 - Beth J Soldo AB -

This article examines the role of family structure in the financial support parents provide for their children's college education. Data are from the Health and Retirement Study. We focus on aspects of family structure that affect parental support and estimate shared family variance in investments as well as within-family variation using a multilevel model. Family membership accounts for about 60% of the variance in payment of college costs. Small family size, living with both biological parents (compared to one biological parent and a stepparent), higher parental education, and having older parents are associated with greater parental expenditures.

PB - 41 VL - 41 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23017857?dopt=Abstract U4 - Parent educational background/Higher education/Higher education/Families and family life/Children and youth/Education finance/Education finance/Transfers ER - TY - THES T1 - Financial and health security in old age: Three essays Y1 - 2012 A1 - Diebold, Jeffrey KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Net Worth and Assets KW - Public Policy KW - Retirement Planning and Satisfaction AB - This dissertation is composed of three essays that examine issues and policies related to the well-being of the elderly in the United States. Using a randomized control design, I demonstrate the relative strength of incentives structured as a credit as opposed to an economically equivalent deduction within the framework of a retirement-based annuitization decision. Next, I exploit the natural experiment provided by the establishment of Medicare Part D in 2006 to evaluate health-related outcomes affected by this policy change. I provide evidence that Medicare Part D resulted in a number of positive health-related outcomes among those Medicare beneficiaries without prescription drug coverage prior to enrolling in Part D. Finally, I test whether the financially literate are more likely to make decisions that minimize the risks to their financial security. The results from this analysis are decidedly mixed. Financially literate individuals do not, necessarily make better financial and investment related decisions but appear more active in the decision-making process. PB - The University of North Carolina at Chapel Hill CY - Chapel Hill, NC VL - Ph.D. U4 - retirement planning ER - TY - JOUR T1 - Financial Knowledge and Financial Literacy at the Household Level JF - The American Economic Review Y1 - 2012 A1 - Alan L Gustman A1 - Thomas L. Steinmeier A1 - N. Tabatabai KW - Net Worth and Assets KW - Other KW - Public Policy KW - Retirement Planning and Satisfaction KW - Social Security AB - There is evidence of a relation between numeracy and wealth held outside of pensions and Social Security. With pensions and Social Security accounting for half of wealth at retirement, and evidence that those with pensions save more in other forms, one would expect to find knowledge of pensions and Social Security influencing retirement saving. Yet we find no evidence that knowledge of pensions and Social Security is related to nonpension, non-Social Security wealth, to numeracy, or that it plays an intermediate role in the numeracy-wealth relation. Our findings raise questions about policies that would enhance numeracy to increase retirement saving. PUBLICATION ABSTRACT PB - 102 VL - 102 IS - 3 U4 - numeracy/retirement planning/social security/Wealth/public policy ER - TY - RPRT T1 - Financial Sophistication in the Older Population Y1 - 2012 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell A1 - Vilsa Curto KW - Financial literacy KW - Retirement Planning and Satisfaction AB - This paper examines data on financial sophistication among the U.S. older population, using a special-purpose module implemented in the Health and Retirement Study. We show that financial sophistication is deficient for older respondents (aged 55+). Specifically, many in this group lack a basic grasp of asset pricing, risk diversification, portfolio choice, and investment fees. Subpopulations with particular deficits include women, the least educated, persons over the age of 75, and non-Whites. In view of the fact that people are increasingly being asked to take on responsibility for their own retirement security, such lack of knowledge can have serious implications. JF - NBER Working Paper Series PB - National Bureau of Economic Research CY - Cambridge, MA ER - TY - RPRT T1 - Financial Sophistication in the Older Population Y1 - 2012 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell A1 - Vilsa Curto KW - Consumption and Savings KW - Employment and Labor Force KW - Event History/Life Cycle KW - Net Worth and Assets KW - Other KW - Public Policy KW - Women and Minorities AB - This paper examines data on financial sophistication among the U.S. older population, using a special-purpose module implemented in the Health and Retirement Study. We show that financial sophistication is deficient for older respondents (aged 55 ). Specifically, many in this group lack a basic grasp of asset pricing, risk diversification, portfolio choice, and investment fees. Subpopulations with particular deficits include women, the least educated, persons over the age of 75, and non-Whites. In view of the fact that people are increasingly being asked to take on responsibility for their own retirement security, such lack of knowledge can have serious implications. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - Numeracy/Financial sophistication/Financial sophistication/Intertemporal Consumer Choice/Life Cycle Models and Saving/Portfolio Choice/Investment Decisions/Investment Decisions/Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination/Public Policy ER - TY - RPRT T1 - Functional Disabilities and Nursing Home Admittance Y1 - 2012 A1 - Joelle H Fong A1 - Benedict S K Koh A1 - Olivia S. Mitchell KW - Disabilities KW - Hospitalization KW - Long-term Care KW - Mortality KW - Older Adults AB - This paper examines how inability to perform activities of daily living relates to the risk of nursing home admission over older adults' life courses. Using longitudinal data on persons over age 50 from the Health and Retirement Study, we show that aging one year boosts the probability of having two or more disabilities by 9 to 12 percent in a multivariate logistic model. Moreover, at least three-fifths of all 65-year-old men and three-quarters of women will experience disability levels during their remaining lifetimes severe enough to trigger nursing home admission. Our analysis also suggests that certain types of disability are more important than others in predicting nursing home admittance and use, which has implications for the design and benefits triggers for long-term care insurance programs. JF - Pension Research Council Working Paper PB - Pension Research Council, University of Pennsylvania CY - Philadelphia, PA ER - TY - THES T1 - A functional use of response time data in cognitive assessment Y1 - 2012 A1 - John J. Prindle KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Other AB - The stimulus for the current body of work comes from the desire of researchers to have concise and accurate cognitive tasks implemented in their surveys. The main purpose of this work was to introduce collateral information as a way of making up for lost or forgone information when adaptive frameworks are adopted. The nature of ongoing surveys and the ubiquity of computers provides ample collateral, or nonintrusive, information which can help improve score accuracy. Information such as how long a respondent spends on certain items, their age, education, and other characteristics can improve score prediction beyond simple item responses. The importance of this work included methods to effectively decrease the number of items given to participants, as well as keep the accuracy high despite the loss in information. In the current study, the Woodcock Johnson - III (WJ-III) Number Series (NS) task was presented with 30 previously unpublished items as stimuli. First, a couple of scoring models were implemented to test for model fit and compare the implications of the fit values. Then methods outlined below systematically adjusted patterns of missingness to mimic reduced and adapted subsets. Once the smaller NS item sets were delineated, several methods of adding predictive accuracy were tested and compared. In scoring respondents a traditional Item Response Theory (IRT) model as proposed by Rasch (1960) was first used to provide evidence for a uni-dimensional scale and obtain baseline statistics for item difficulty and person abilities. The next model was a Conditionally Independent Response Time (CIRT) model. The latter model includes a response model as well as a joint response time model for scoring. It was shown that with the full item set these two models provide identical ability estimates and item parameters. The response time model of the CIRT framework provides ability scores and speededness scores based on response time patterns. Next, focus was placed on effectively decreasing the number of items used in scoring each respondent. Methods included item reduction, test forms in which the same item sets were used to score each respondent, and adaptive tests, where each respondent could receive a different item set. Reduced item sets fared better when item difficulties more closely matched sample ability levels (r=0.72-0.90). Adaptive item sets were more consistent in measuring ability (i.e. half-adaptive, block adaptive, fully adaptive), but accuracy was best for the fully adaptive method used (r=0.79-0.91). The last steps of analysis involved introducing response time and demographic variables as additional predictors of the 30 item scores. Item response, response times, and response/response time interactions provided small improvements in explained variance when used as predictors (1-8%). When CIRT ability and speededness scores were used as predictors, speededness provided limited improvements (<1%) to prediction. The addition of age, education, and gender to response models improved explained variance to a moderate degree (1-5%). In conclusion, we note that sample had a higher than average ability level for the NS task and this should color our findings for the methods outlined. The item sets that did not match respondent abilities as well were improved more so by response time and demographic data. If one can correctly identify the ability ranges of a sample before administration, then a more focused reduced item set would be advantageous. Adaptive item sets seem advantageous in a more general testing situation where ability levels are more variable. The advantage of using collateral information in predicting cognitive scores is the amount of time saved by omitting items, potentially lowering costs, and allowing researchers to move onto more tasks if desired. While the improvement due to response time in these methods was limited with NS, there is a good foundation for other cognitive tasks administered in computer assisted designs. PB - University of Southern California CY - Los Angeles, CA VL - Ph.D. UR - https://search.proquest.com/openview/3300180096d513fb0af4ff5ffc3eebf4/1.pdf?pq-origsite=gscholar&cbl=18750&diss=y U4 - Cognitive psychology ER - TY - JOUR T1 - Family Data and Research in the Health and Retirement Study JF - Forum for Health Economics and Policy Y1 - 2011 A1 - Suzanne M. Bianchi KW - Adult children KW - Methodology AB - I discuss the data in the Health and Retirement Study (HRS) that can be used to study family change and intergenerational family relationships and offer suggestions about what might be done to enhance the uses of the HRS family data going forward. A number of family demographic behaviors are altering the family context of more recent cohorts of the HRS. These family changes need to be well-captured in the data collection and and should also inform future design decisions. Changes include the higher rates of childlessness, delayed marriage and childbearing after age 30 among the Baby Boom cohorts just now being enrolled in the HRS. Cohorts coming into the study also have higher rates of (lifetime) labor force participation on the part of women and much higher rates of nonmarital childbearing, marital disruption, and informal cohabitation than the original HRS cohorts. There is also great heterogeneity in family patterns by race and class among Baby Boom cohorts. Many of these changes increase the value of collecting family data in the HRS but also complicate the collection of useful data on transfers between parents and children or among siblings. I offer four suggestions for enhancing data collection in the HRS in light of these family changes. These include the following: 1) Reevaluate decisions about the family members on whom to gather information, particularly the decisions about when to collect data on siblings. 2) Consider collecting more information directly from each spouse (and perhaps expanding the definition of spouse to include cohabiting partners as cohabitation is on the rise among cohorts now entering the HRS). 3) Begin to experiment with interviewing adult children of HRS respondents and consider broadening the content to include more on parent-child relationship quality and/or on everyday activities and exchanges. 4) Make the family data in the HRS easier to access and use. PB - 14 VL - 14 IS - 3 U4 - Methodology/Families/family demography/parent-Child Relations/mid-term review/mid-term review/Methodology ER - TY - JOUR T1 - Financial literacy and retirement planning in the United States JF - Journal of Pension Economics and Finance Y1 - 2011 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell KW - Education KW - Financial literacy KW - Older Adults KW - Retirement Planning and Satisfaction AB - We examine financial literacy in the US using the new National Financial Capability Study, wherein we demonstrate that financial literacy is particularly low among the young, women, and the less-educated. Moreover, Hispanics and African-Americans score the least well on financial literacy concepts. Interestingly, all groups rate themselves as rather well-informed about financial matters, notwithstanding their actual performance on the key literacy questions. Finally, we show that people who score higher on the financial literacy questions are much more likely to plan for retirement, which is likely to leave them better positioned for old age. Our results will inform those seeking to target financial literacy programmes to those in most need. VL - 10 IS - 04 ER - TY - JOUR T1 - FINANCIAL LITERACY AROUND THE WORLD: AN OVERVIEW. JF - J Pension Econ Financ Y1 - 2011 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell AB -

In an increasingly risky and globalized marketplace, people must be able to make well-informed financial decisions. Yet new international research demonstrates that financial illiteracy is widespread when financial markets are well developed as in Germany, the Netherlands, Sweden, Japan, Italy, New Zealand, and the United States, or when they are changing rapidly as in Russia. Further, across these countries, we show that the older population believes itself well informed, even though it is actually less well informed than average. Other common patterns are also evident: women are less financially literate than men and are aware of this shortfall. More educated people are more informed, yet education is far from a perfect proxy for literacy. There are also ethnic/racial and regional differences: city-dwellers in Russia are better informed than their rural counterparts, while in the U.S., African Americans and Hispanics are relatively less financially literate than others. Moreover, the more financially knowledgeable are also those most likely to plan for retirement. In fact, answering one additional financial question correctly is associated with a 3-4 percentage point higher chance of planning for retirement in countries as diverse as Germany, the U.S., Japan, and Sweden; in the Netherlands, it boosts planning by 10 percentage points. Finally, using instrumental variables, we show that these estimates probably underestimate the effects of financial literacy on retirement planning. In sum, around the world, financial literacy is critical to retirement security.

VL - 10 UR - http://www.journals.cambridge.org/abstract_S1474747211000448 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28553190?dopt=Abstract JO - Journal of Pension Economics and Finance ER - TY - BOOK T1 - Financial Literacy: Implications for Retirement Security and the Financial Marketplace T2 - Pension Research Council Series Y1 - 2011 A1 - Olivia S. Mitchell A1 - Annamaria Lusardi KW - Economics KW - Financial literacy KW - Older Adults KW - Retirement Planning and Satisfaction AB - As financial markets grow ever more complex and integrated, households must make increasingly sophisticated and all-too-often irreversible economic decisions. This is particularly evident in retirement decision-making. Traditional defined benefit pension schemes are being replaced with defined contribution pensions; employer and government judgment regarding how much to save and where to invest has been replaced by employees having to make these choices on their own (sometimes assisted by advisers); and retirees have become responsible for managing their own pension assets. This volume explores how financial literacy can enhance peoples’ ability to make informed economic choices. It proposes that financial literacy determines how well people make and execute saving, investing, borrowing, and planning decisions. It examines causality using controlled settings to disentangle whether financial literacy causes saving or vice versa, and demonstrates that financial education programs do indeed enhance financial decision-making and asset accumulation. JF - Pension Research Council Series PB - Oxford University Press CY - Oxford, UK SN - 0-19-969681-9 UR - https://pensionresearchcouncil.wharton.upenn.edu/publications/books/financial-literacy-implications-for-retirement-security-and-the-financial-marketplace/ ER - TY - JOUR T1 - Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. JF - Value Health Y1 - 2010 A1 - Zivin, Kara A1 - Scott M Ratliff A1 - Michele M Heisler A1 - Kenneth M. Langa A1 - John D Piette KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Female KW - Financing, Personal KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Medication Adherence KW - Models, Econometric KW - Multivariate Analysis KW - Prescription Fees KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: Although multiple noncost factors likely influence a patient's propensity to forego treatment in the face of cost pressures, little is known about how patients' sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults.

METHODS: We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone's risk of CRN, including income, comorbidities, and medication regimen complexity. We used data from the 2004 wave of the Health and Retirement Study and the 2005 HRS Prescription Drug Study to examine the influence of factors within each of these domains on measures of CRN (including not filling, stopping, or skipping doses) in a nationally representative sample of Americans age 65+ in 2005.

RESULTS: Of the 3071 respondents who met study criteria, 20% reported some form of CRN in 2005. As in prior studies, indicators of financial stress such as higher out-of-pocket payments for medications and lower net worth were significantly associated with CRN in multivariable analyses. Controlling for these economic pressures, relatively younger respondents (ages 65-74) and depressive symptoms were consistent independent risk factors for CRN.

CONCLUSIONS: Noncost factors influenced patients' propensity to forego treatment even in the context of cost concerns. Future research encompassing clinician and health system factors should identify additional determinants of CRN beyond patients' cost pressures.

PB - 13 VL - 13 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20070641?dopt=Abstract U2 - PMC3013351 U4 - health Care Costs/socioeconomic Status/cost-related nonadherence/risk factors ER - TY - JOUR T1 - Factors predicting glycemic control in middle-aged and older adults with type 2 diabetes. JF - Prev Chronic Dis Y1 - 2010 A1 - Chiu, Ching-Ju A1 - Linda A. Wray KW - Age Factors KW - Aged KW - Blood Glucose KW - Diabetes Mellitus, Type 2 KW - Female KW - Glycated Hemoglobin KW - Humans KW - Hypoglycemic Agents KW - Male KW - Middle Aged KW - Retrospective Studies KW - Socioeconomic factors AB -

INTRODUCTION: Few studies have prospectively assessed the explanatory effects of demographics, clinical conditions, treatment modality, and general lifestyle behaviors on glycemic control in large heterogeneous samples of middle-aged and older adults with type 2 diabetes. We hierarchically examined these factors, focused especially on the effects of modifiable factors (ie, general lifestyle behaviors), and compared predictive patterns between middle-aged and older adults.

METHODS: We used nationally representative data from the 1998 and 2000 Health and Retirement Study (HRS) and the HRS 2003 Diabetes Study. We analyzed data from 379 middle-aged adults (aged 51-64 y) and 430 older adults (aged >or=65 y) who self-reported having type 2 diabetes at baseline.

RESULTS: Among middle-aged adults, demographic factors and clinical conditions were the strongest predictors of hemoglobin A1c (HbA1c) levels. However, among older adults, treatment modality (diet only, oral medication, or insulin only or in combination with other regimens) significantly affected HbA1c levels. Lifestyle (physical activity, smoking, drinking, and body weight control), independent of the effects of demographics, clinical conditions, and treatment modality, significantly affected HbA1c levels. An increase of 1 healthy behavior was associated with a decrease in HbA1c levels of more than 1 percentage point.

CONCLUSION: Our findings provide support for current diabetes guidelines that recommend a lifestyle regimen across the entire span of diabetes care and highlight the need to help both sociodemographically and clinically disadvantaged middle-aged adults with type 2 diabetes as well as older adults who exhibit poor adherence to medication recommendations to achieve better glycemic control.

PB - 7 VL - 7 IS - 1 N1 - Using Smart Source Parsing Jan, :A08 Index Medicus U1 - http://www.ncbi.nlm.nih.gov/pubmed/20040223?dopt=Abstract U2 - PMC2811503 U4 - diabetes/demographics/treatment modality/lifestyle/hemoglobin A1c (HbA1c) levels ER - TY - Generic T1 - Family Data and Research in the Health and Retirement Study (HRS) Y1 - 2010 A1 - Suzanne M. Bianchi KW - children KW - family data KW - spouse PB - National Institute on Aging CY - Bethesda, MD ER - TY - RPRT T1 - Family Status Transitions, Latent Health, and the Post-Retirement Evolution of Assets Y1 - 2010 A1 - James M. Poterba A1 - Steven F Venti A1 - David A Wise KW - Adult children KW - Housing KW - Net Worth and Assets KW - Pensions AB - We consider the evolution of assets after retirement. We ask whether total assets--including housing equity, personal retirement accounts, and other financial assets--tend to be husbanded for a rainy day and drawn down primarily at the time of precipitating shocks, or whether they are drawn down throughout the retirement period. We focus on the relationships between family status transitions, latent health status, and the evolution of assets. Our analysis is based primarily on longitudinal data from the HRS and AHEAD cohorts of the Health and Retirement Study. We find that the evolution of assets is strongly related to family status transitions. For both single individuals and married couples who do not experience a death or divorce, total assets increase well into old age. In contrast, individuals in married couples that experience a family status transition, either a death or a divorce, exhibit much slower asset growth and often experience a large decline in asset values at the time of the transition. In addition, the level and evolution of assets is very strongly related to health, measured by a latent health index. For example, for continuing two-person HRS households between the ages of 56 and 61 in 1992 the ratio of assets of households in the top health quintile to the assets of those in the bottom quintile was 1.7 in 1992. It had increased to 2.2 by the end of 2006. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - Asset allocation/housing Equity/personal retirement accounts/family transfers, structure ER - TY - JOUR T1 - Financial Decision Making and Cognition in a Family Context. JF - Econ J (London) Y1 - 2010 A1 - James P Smith A1 - John J McArdle A1 - Robert J. Willis AB -

In this paper, we studied the association of cognitive traits and in particular numeracy of both spouses on financial outcomes of the family. We found significant effects, particularly for numeracy for financial and non-financial respondents alike, but much larger effects for the financial decision maker in the family. We also examined who makes these financial decisions in the family and why. Once again, cognitive traits such as numeracy were an important component of that decision with larger effects of numeracy for husbands compared to wives.

PB - 120 VL - 120 IS - 549 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21116477?dopt=Abstract U2 - PMC2992344 U4 - cognition/numeracy/financial decision-making/financial decision-making/Families ER - TY - RPRT T1 - Financial Knowledge and Financial Literacy at the Household Level Y1 - 2010 A1 - Alan L Gustman A1 - Thomas L. Steinmeier A1 - N. Tabatabai KW - Health Conditions and Status KW - Net Worth and Assets KW - Other KW - Pensions AB - This paper uses data from the Health and Retirement Study to explore the mechanism that underlies the robust relation found in the literature between cognitive ability, and in particular numeracy, and wealth, income constant. We have a number of findings. First, the more valuable the pension, the more knowledgeable are covered workers about their pensions. We suggest that causality is more likely to run from pension wealth to pension knowledge, rather than the other way around. Second, most measures of cognitive ability, including numeracy, are not significant determinants of pension and Social Security knowledge. Third, standardizing for incomes and other factors, a pension of higher value does not substitute for other forms of wealth. Rather, counting pensions in total wealth, those with more valuable pensions save more for retirement, other things the same. Fourth, there is no evidence that wealth held outside of pensions is influenced by knowledge of pensions. In sum, numeracy does not influence wealth in whole or in part by affecting financial knowledge of one's pension plan, where financial knowledge of the pension then influences other decisions about retirement saving. These findings raise questions about the mechanism that underlies the relation between cognition, especially numeracy, and wealth. From a policy perspective, they suggest that the numeracy-wealth relation should not be taken as evidence that increasing financial literacy will increase the wealth of households as they enter into retirement. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - cognitive ability/numeracy/wealth/pensions ER - TY - RPRT T1 - Financial Literacy and Mortgage Equity Withdrawals Y1 - 2010 A1 - John V. Duca A1 - Kumar, Anil KW - Consumption and Savings KW - Other KW - Public Policy AB - The recent U.S. consumption boom has been linked to mortgage equity withdrawals (MEW s). MEW s are correlated with covariates consistent with a permanent income framework augmented for credit-constraints. Nevertheless, many households are financially illiterate. We assess the unexplored linkages between MEWs and different measures of financial literacy using panel data from the Health and Retirement Study (HRS). Findings indicate that declines in mortgage interest rates encouraged MEWs. Nevertheless, financially illiterate households were significantly more likely to withdraw housing equity. Also significant were state differences in debtor versus creditor interests in bankruptcy, with loan demand effects outweighing loan supply effects across states. UR - http://www.kansascityfed.org/publicat/events/research/2011DayAhead/DucaKumar.pdf U4 - financial crisis/consumption/credit constraints/financial frictions ER - TY - JOUR T1 - Financial Literacy Lacking Among Older Population JF - Journal of Financial Planning Y1 - 2010 A1 - Anonymous KW - Demographics KW - Net Worth and Assets KW - Other AB - A new look at the financial literacy and sophistication of people 55 and older reveals the need for educational efforts targeted to specific demographics. Financial Literacy and Financial Sophistication in the Older Population: Evidence from the 2008 HRS, a University of Michigan Retirement Research Center working paper by Annamaria Lusardi, Olivia S. Mitchell, and Vilsa Curto, analyzes new data on financial literacy from the University of Michigan's 2008 Health and Retirement Study. According to the authors, their research suggests it may be particularly important to build retirement human capital through seminars, educational programs, and retirement planning products. PB - 23 VL - 23 IS - 2 U4 - Financial literacy/Older people/Research ER - TY - RPRT T1 - Financial Literacy, Schooling, and Wealth Accumulation Y1 - 2010 A1 - Behrman, Jere R. A1 - Olivia S. Mitchell A1 - Soo, Cindy A1 - Bravo, David A1 - The Wharton School KW - Educational attainment KW - Financial literacy KW - household wealth AB - Financial literacy and schooling attainment have been linked to household wealth accumulation. Yet prior findings may be biased due to noisy measures of financial literacy and schooling, as well as unobserved factors such as ability, intelligence, and motivation that could enhance financial literacy and schooling but also directly affect wealth accumulation. Here we use a new household dataset and an instrumental variables approach to isolate the causal effects of financial literacy and schooling on wealth accumulation. While financial literacy and schooling attainment are both strongly positively associated with wealth outcomes in linear regression models, our approach reveals even stronger and larger effects of financial literacy on wealth. It also indicates no significant positive effects of schooling attainment conditional on financial literacy in a linear specification, but positive effects when interacted with financial literacy. Estimated impacts are substantial enough to suggest that investments in financial literacy could have large positive payoffs. JF - PARC Working Paper Series PB - Pension Research Council, University of Pennsylvania CY - Philadelphia, PA UR - https://repository.upenn.edu/cgi/viewcontent.cgi?article=1031&context=parc_working_papers U4 - Financial literacy/education/wealth Accumulation ER - TY - JOUR T1 - The fiscal consequences of trends in population health.(Forum: America's Looming Fiscal Crisis) JF - National Tax Journal Y1 - 2010 A1 - Dana P Goldman A1 - Pierre-Carl Michaud A1 - Darius Lakdawalla A1 - Yuhui Zheng A1 - Adam Gailey A1 - Vaynman, Igor KW - Medicare/Medicaid/Health Insurance KW - Other KW - Public Policy AB - The public burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy--with a concomitant decrease in the public sector's annuity burden--but these savings may be offset by worsening functional status which increases health care spending, reduces labor supply, and increases public assistance. Using a health microsimulation model we quantify the competing public finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures. We find that the trends in obesity and smoking have different fiscal consequences and that, because of its more profound effects on morbidity and health care expenditures, obesity represents a larger immediate risk from a fiscal perspective. Uncertainty in residual mortality improvements represents by far the largest risk. Keywords: disability, health care costs, social security, microsimulation JEL Codes: 110, 138, J26 PB - 63 VL - 63 IS - 2 N1 - Magazine/Journal Academic OneFile Gale 2011/02/17 COPYRIGHT 2010 National Tax Association U4 - Influence/Research/Public finance_Influence/Public health_Research/Medical care, Cost of_Research ER - TY - CHAP T1 - Fiscal Effects of Social Security Reform in the United States T2 - Social Security Programs and Retirement around the World Y1 - 2010 A1 - Courtney Coile A1 - Gruber, Jonathan ED - Gruber, Jonathan ED - David A Wise KW - Other KW - Public Policy KW - Social Security JF - Social Security Programs and Retirement around the World T3 - A National Bureau of Economic Research conference report PB - University of Chicago Press CY - Chicago U4 - social security/OASDI/earnings and Benefits File/actuarial reform/common reform/social security wealth JO - Fiscal Effects of Social Security Reform in the United States ER - TY - JOUR T1 - Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference? JF - Soc Sci Med Y1 - 2010 A1 - Muramatsu, Naoko A1 - yin, Hongjun A1 - Hedeker, Donald KW - Activities of Daily Living KW - Aged KW - Cognition KW - Community Health Services KW - depression KW - Disabled Persons KW - Female KW - Home Care Services KW - Humans KW - Logistic Models KW - Male KW - Mental Health KW - Multilevel Analysis KW - Risk Factors KW - Social Support KW - Spouses KW - State Government KW - Stress, Psychological KW - United States AB -

This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (>or=70 years old) covering the period 1993-2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.

PB - 70 VL - 70 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20117865?dopt=Abstract U2 - PMC3360961 U4 - Stress/Home Care Services/community-based services/mental Health/depression ER - TY - JOUR T1 - Factors associated with long-stay nursing home admissions among the U.S. elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work. JF - Soc Work Health Care Y1 - 2009 A1 - Cai, Qian A1 - J. Warren Salmon A1 - Mark E. Rodgers KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Geriatric Assessment KW - Health Status KW - Homes for the Aged KW - Humans KW - Logistic Models KW - Male KW - Mental Health KW - Nursing homes KW - Proportional Hazards Models KW - Risk Factors KW - Sex Factors KW - Social work KW - Socioeconomic factors KW - United States AB -

Two statistical methods were compared to identify key factors associated with long-stay nursing home (LSNH) admission among the U.S. elderly population. Social Work's interest in services to the elderly makes this research critical to the profession. Effectively transitioning the "baby boomer" population into appropriate long-term care will be a great societal challenge. It remains a challenge paramount to the practice of social work. Secondary data analyses using four waves (1995, 1998, 2000, and 2002) of the Health Retirement Study (HRS) coupled with the Assets and Health Dynamics among the Oldest Old (AHEAD) surveys were conducted. Multivariable logistic regression and Cox proportional hazards model were performed and compared. Older age, lower self-perceived health, worse instrumental activities of daily living (IADL), psychiatric problems, and living alone were found significantly associated with increased risk of LSNH admission. In contrast, being female, African American, or Hispanic; owning a home; and having lower level of cognitive impairment reduced the admission risk. Home ownership showed a significant effect in logistic regression, but a marginal effect in the Cox model. The Cox model generally provided more precise parameter estimates than logistic regression. Logistic regression, used frequently in analyses, can provide a good approximation to the Cox model in identifying factors of LSNH admission. However, the Cox model gives more information on how soon the LSNH admission may happen. Our analyses, based on two models, dually identified the factors associated with LSNH admission; therefore, results discussed confidently provide implications for both public and private long-term care policies, as well as improving the assessment capabilities of social work practitioners for development of screening programs among at-risk elderly. Given the predicted surge in this population, significant factors found from this study can be utilized in a strengths-based empowerment approach by social workers to aid in avoiding LSNH utilization.

PB - 48 VL - 48 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19197772?dopt=Abstract U3 - 19197772 U4 - Nursing Homes/Old Age/SELF-RATED HEALTH/ADL and IADL Impairments ER - TY - THES T1 - Factors Associated with Sleep Disruption among Community-Dwelling Older Adults in the Health and Retirement Study Y1 - 2009 A1 - Williams, Laura L. KW - Health Conditions and Status AB - The purpose of this study was to examine behavioral outcomes and sleep disruption in aging adults using data from the 2004 wave of the longitudinal Health and Retirement Study (HRS). It was hypothesized that sleep disruption is associated with behavioral outcomes and sociodemographic variables in a population-based sample. Methods. The 2004 HRS data (N=20,129) represents a cross-sectional analysis of community dwelling aging adults born in the US at or before 1923 through 1953. Data are stratified by date of birth to provide five cohorts of aging elderly. The HRS Psychosocial Leave-Behind Participant Lifestyle Questionnaire (PLBQ) was given to a random sample of participants (N=1,439; 52.5% male; 47.5% female; 91.5% White; 5.2% Black; Response Rate 76.8%) who completed the 2004 HRS wave. Portions of the HRS including age, gender, race, marital status, education, income, comorbidities, and sleep measures were matched to the subjects who completed the PLBQ. An index of sleep disruption items was computed and sleep sensitive behaviors (cynical hostility, optimism, pessimism and social participation) were computed according to instrument directions. Results. After controlling for sociodemographic variables, sleep disruption independently predicted social integration ( t =2.135, p <.0001), pessimism ( t =3.995, p <.0001), cynical hostility ( t =3.854, p <.0001), and negatively predicted optimism ( t =-4.876, p <.0001). Oldest-old adults had no greater sleep disruption than younger aging adults (? 2 =1.234, p =.872), although 59% of the oldest-old subset reported frequent waking during the night. Women reported more sleep disruption than men ( t =3.270, p <.001), but all subjects reported frequent waking during the night (Men=58%; Women=68%). Married participants reported more sleep disruption than divorced or widowed participants ( t =2.161, p =.03). Blacks had no greater sleep disruption than Whites ( t =.812, p =.417). Higher education was the most influential SES predictor for sleep disruption ( F =15.309, p <.0001), and income did not independently predict sleep disruption ( t =1.297, p =.195). Conclusion. Sleep disruption predicts negative behavioral outcomes, when controlling for sociodemographic variables. Sleep disruption was greater among women and married participants, but there were no racial differences. Education was also a strong influence on sleep disruption. Further research should examine the role of sleep disruption in other behavioral and attitudinal traits. PB - The University of Alabama CY - Birmingham, Alabama UR - https://www.semanticscholar.org/paper/Factors-associated-with-sleep-disruption-among-in-Williams/ea13b2694467094535428eccd393cc95e22cdb40 U4 - Personality Assessment ER - TY - JOUR T1 - Fall risk in older adults: roles of self-rated vision, home modifications, and limb function. JF - J Aging Health Y1 - 2009 A1 - Bernard A Steinman A1 - Pynoos, Jon A1 - Anna Q D Nguyen KW - Accidental Falls KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Disabled Persons KW - Educational Status KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Musculoskeletal Physiological Phenomena KW - Risk KW - Risk Factors KW - Self-Assessment KW - Self-Help Devices KW - Surveys and Questionnaires KW - Vision, Low KW - Visual Acuity KW - White People AB -

Objective. To assess direct effects of self-rated vision, home modifications, and limb functioning, and moderating effects of self-rated vision on change in functioning of upper and lower limbs on fall risk in older adults. Method. Logistic regression was used to analyze 2004 and 2006 waves of the Health and Retirement Study. Results. Effects of self-rated vision and home modifications in predicting falls decreased after controlling functioning in upper and lower extremities. Declines/gains in functioning across short periods of time superseded self-rated vision in predicting falls. No evidence was found for a moderating effect of vision status on limb functioning. Discussion. Poor self-rated vision may not be a good indicator of fall risk in older adults. Thus, for older adults with visual impairments, preserving residual limb functioning through exercise and activity has the important potential to reduce fall risk in addition to improving muscle and bone strength as well as improving balance and gait.

PB - 21 VL - 21 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19494362?dopt=Abstract U3 - 19494362 U4 - Home Modifications/exercise/Visually Impaired Persons/Falls/risk factors ER - TY - JOUR T1 - Financial hardship and mortality among older adults using the 1996-2004 Health and Retirement Study. JF - Ann Epidemiol Y1 - 2009 A1 - Reginald D. Tucker-Seeley A1 - Li, Yi A1 - Subramanian, S V A1 - Sorensen, Glorian KW - Aged KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Male KW - Medicaid KW - Middle Aged KW - Mortality KW - Poverty KW - Proportional Hazards Models KW - Prospective Studies KW - Retirement KW - Risk KW - Sex Factors KW - United States AB -

PURPOSE: We investigated the effect of financial hardship on mortality risk in a community-dwelling sample of adults 50 years of age and olderin the United States.

METHOD: The 1996 Health and Retirement Study cohorts were followed prospectively to 2004 (N = 8,377). Gender-stratified grouped Cox models were used to estimate the difference in the relative risk (RR) of mortality between a specific number of financial hardships (one, two, or three or more) and no hardships; and the predictive utility of each individual financial hardship for mortality during the follow-up period.

RESULTS: Gender-stratified models adjusted for demographics, socioeconomic characteristics, and functional limitations in 1996 showed that women reporting one (hazard ratio [HR] = 1.42; 95% confidence interval [CI]: 1.05-1.92) or three or more (HR = 1.60; 95% CI: 1.05-2.46) and men reporting two (HR = 1.80; 95% CI: 1.21-2.69) financial hardships had a substantially higher probability of mortality compared to those reporting no financial hardships. Individual financial hardships that predicted mortality in fully adjusted models for women included receiving Medicaid (HR = 2.23; 95% CI: 1.68-2.98) and for men receiving Medicaid (HR = 2.11; 95% CI: 1.57-2.84) and receiving food stamps (HR = 1.59; 95% CI: 1.09-2.33).

CONCLUSIONS: These findings suggest that over and above the influence of traditional measures of socioeconomic status, financial hardship exerts an influence on the risk of mortality among older adults and that the number and type of hardships important in predicting mortality may differ for men and women.

PB - 19 VL - 19 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19944348?dopt=Abstract U2 - PMC2835519 U4 - financial resources/socioeconomic status/Mortality/GENDER-DIFFERENCES ER - TY - RPRT T1 - Financial Literacy and Financial Sophistication Among Older Americans Y1 - 2009 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell A1 - Vilsa Curto KW - Consumption and Savings KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - This paper analyzes new data on financial literacy and financial sophistication from the 2008 Health and Retirement Study. We show that financial literacy is lacking among older individuals and for the first time explore additional questions on financial sophistication which proves even scarcer. For this sample of older respondents over the age of 55, we find that people lack even a rudimentary understanding of stock and bond prices, risk diversification, portfolio choice, and investment fees. In view of the fact that individuals are increasingly required to take on responsibility for their own retirement security, this lack of knowledge has serious implications. JF - NBER Working Paper PB - The National Bureau of Economic Research CY - Cambridge, MA U4 - Financial Management/Portfolio Choice/Retirement planning/Retirement Saving ER - TY - THES T1 - Financial resources, Living Arrangements and Private Transfers Y1 - 2009 A1 - Ma, Qiufei KW - Adult children KW - Net Worth and Assets AB - In the first part, we investigate the role of children's characteristics, primarily wealth and wages, in determining coresidency outcomes using data collected as part of the Health and Retirement Study. We find that the effect of children's wealth and wages is highly non-linear: primarily found at the lower end of the distribution and inexistent elsewhere. We show that this is best explained by children being helped by parents rather than providing help themselves. Second, we show that omitting one of the children or parent's SES variables tends to overestimate the relationship between SES of the remaining member and coresidency outcomes. Together these two results highlight the value of considering rich information on characteristics of both parents and children when investigating the determinants of coresidency. In the second part, we analyze new intergenerational transfer data that has recently become available in the Chinese Social Survey of Family Dynamics (CSSFD) and assess whether or not it is useful to measure family support. In particular, we analyze the relationship between income and transfers in urban and rural areas. We argue that a social security pension system could not be effective without paying attention to its crowding out effect on intergenerational private transfers. In the third part of the dissertation, we analyze the determinants of financial and time transfers from adult children to their elderly parents in rural areas using the matched sample from the 2002 Chinese Social Survey of Family Dynamics (CSSFD) and the 2002 Chinese Longitudinal Healthy Longevity Survey (CLHLS). This is the first survey containing rich private transfers information in China. We find that wealthy children are more likely to give money transfers and give more; poor parents are more likely to receive money transfers and receive more. Interestingly, we also find that children and parental income are uncorrelated with time transfers. The evidence suggests that money transfers are more determined by children's financial status, while time transfers respond strongly to parental need. Results highlight the existence of strong private transfers from adult children to their elderly parents in rural China. PB - The Pardee RAND Graduate School CY - Santa Monica, CA UR - https://www.rand.org/pubs/rgs_dissertations/RGSD241.html U4 - Family transfers, structure 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 - RPRT T1 - Food Prices and the Dynamics of Body Weight Y1 - 2009 A1 - Dana P Goldman A1 - Darius Lakdawalla A1 - Yuhui Zheng KW - Consumption and Savings KW - Health Conditions and Status KW - Public Policy AB - A popular policy option for addressing the growth in weight has has been the imposition of a fat tax on selected foods that are deemed to promote obesity. Understanding the public economics of fat taxes requires an understanding of how or even whether individuals respond to changes in food prices over the long-term. We study the short- and long-run body weight consequences of changing food prices, in the Health and Retirement Study (HRS). We found very modest short-term effects of price per calorie on body weight, and the magnitudes align with the previous literature. The long-term effect is much bigger, but it takes a long time for the effect to reach the full scale. Within 30 years, a 10 permanent reduction in price per calorie would lead to a BMI increase of 1.5 units (or 3.6 ). The long term effect is an increase of 1.9 units of BMI (or 4.2 ). From a policy perspective, these results suggest that policies raising the price of calories will have little effect on weight in the short term, but might curb the rate of weight growth and achieve weight reduction over a very long period of time. PB - National Bureau of Economic Research, NBER Working Paper 15096 U4 - Weight/Costs and Cost Analysis/Obesity/POLICY ER - TY - JOUR T1 - Formal Home Health Care, Informal Care, and Family Decision Making JF - International Economic Review Y1 - 2009 A1 - Byrne, David A1 - Hiedemann, Bridget A1 - Goeree, Michelle S. A1 - Steven N. Stern KW - Healthcare AB - We use the 1993 wave of the Assets and Health Dynamics Among the Oldest Old (AHEAD) data set to estimate a game-theoretic model of families' decisions concerning the provision of informal and formal care for elderly individuals. The outcome is the Nash equilibrium where each family member jointly determines her consumption, transfers for formal care, and allocation of time to informal care, market work, and leisure. We use the estimates to decompose the effects of adult children's opportunity costs, quality of care, and caregiving burden on their propensities to provide informal care. We also simulate the effects of a broad range of policies of current interest. PB - 50 VL - 50 UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2354.2009.00566.x/abstract IS - 4 ER - TY - JOUR T1 - Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers. JF - J Am Geriatr Soc Y1 - 2009 A1 - Sei J. Lee A1 - Rebecca L. Sudore A1 - Brie A Williams A1 - Lindquist, Karla A1 - Helen L. Chen A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Alcohol Drinking KW - Comorbidity KW - Education KW - Female KW - Humans KW - Income KW - Male KW - Obesity KW - Risk Factors KW - Sex Factors KW - Smoking KW - Socioeconomic factors AB -

OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN: Prospective cohort.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95% CI=0.57-0.91).

CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

PB - 57 VL - 57 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19473456?dopt=Abstract U2 - PMC2847409 U4 - Alcohol Drinking/socioeconomic status/ADL and IADL Impairments/Mobility/Survival Analysis ER - TY - THES T1 - Factors associated with purchase of long-term care insurance Y1 - 2008 A1 - Holve, Erin KW - Healthcare KW - Public Policy AB - Spending on long-term care (LTC) is projected to increase from $194 billion in 2004 (with 49% coming from Medicaid) to $540 billion in 2040. In response, efforts have been made to bolster the market for private long-term care insurance (LTCI) to reduce Medicaid spending. Private insurers want to understand what motivates people who purchase LTCI and how to expand the private market; consumers want to understand whether LTCI is an appropriate strategy for them to cover long-term care costs; and policymakers want to understand what the potential role of private LTCI is in terms of meeting future needs to fund LTC and what can be done to encourage purchase of LTCI. These papers aim to respond to these questions by reviewing sources of LTCI market failure and understanding the extent to which assets, income maintenance savings (savings that may set aside for 3 or more years), taste for insurance, and prior experience with a parent in nursing home care is associated with purchase of LTCI. Analysis of data from the 2004 Health and Retirement Study (HRS) shows that the most likely market of those for whom it might be worth purchasing LTCI is limited to approximately one-quarter of those over 50. Analyses were conducted within a target market of individuals (with $100,000 - $2 million in assets) who have medical insurance other than Medicaid, and are younger than 85. Logistic regression models were conducted with data from the HRS in 2000, 2002, and 2004. Data are weighted to represent the population of adults over 50 in the US as of 2004. Among those in the target market, individuals with a very high level of income maintenance savings (>/$100,000), who could presumably self-insure against all but the greatest risk of LTC; those with life insurance; and those with a parent who lived or lives in a nursing home, are associated with a greater likelihood of purchasing LTCI. However, with the exception of life insurance, none of these factors is independently associated with more than a forty percent higher likelihood of LTCI purchase, demonstrating that factors motivating purchase of LTCI are diffuse. The data presented suggest it important to re-evaluate expectations for the private market for LTCI based on individuals' personal and financial circumstances, taste for insurance, and prior experience. Realistically assessing the factors that influence long-range planning for LTC among those capable of purchasing LTCI illustrates the largely separate roles of the public and private sector in terms of financing LTC. PB - The Johns Hopkins University CY - Baltimore, MD VL - Doctor of Philosophy U4 - Health care management ER - TY - CHAP T1 - Family Care and Assisted Living: An Uncertain Future? T2 - The Assisted Living Residence: A Vision for the Future Y1 - 2008 A1 - Douglas A. Wolf A1 - Jenkins, Carol ED - Golant, Steven M. ED - Hyde, Joan KW - Healthcare KW - Retirement Planning and Satisfaction JF - The Assisted Living Residence: A Vision for the Future PB - Johns Hopkins University Press CY - Baltimore N1 - ProCite field 6 : In ProCite field 8 : eds U4 - Assisted Living/Caregiving JO - Family Care and Assisted Living: An Uncertain Future? ER - TY - JOUR T1 - Financial Transfers from Living Parents to Adult Children: Who Is Helped and Why? JF - The American Journal of Economics and Sociology Y1 - 2008 A1 - Berry, Brent M. KW - Adult children AB - To what extent can young adult children rely on their parents for financial support? This question will take on added importance if the commitments of the Social Security system put greater strain on the children of retirees. Despite the critical role that parents have in supporting their children, why they help some and not others remains unclear. Findings using two waves of data from the Health and Retirement Study that control for the needs of children and the resources of parents suggest that parents give more inter vivos financial assistance to their disadvantaged children rather than focusing on children most able to give financial help in return. Other measures of child well-being besides income, including home ownership, education, parental status, and marital status, also suggest that parents help needier children more. Children who live nearby also receive more, a finding consistent with exchange motives or simply the ability of these children to more stridently demand support. Neither altruism nor exchange theories explain why stepchildren receive substantially less support than naturally born or adopted children. The diversity of effects suggests that giving is based on heterogeneous motives - parents may temper their altruism for children by the degree to which they feel responsible and by the stridency of some children in seeking support. Findings are robust upon allowing for unobserved differences across families by estimating fixed effect models. PB - 67 VL - 67 IS - 2 U4 - Adult Children/Inter Vivos Transfers ER - TY - CHAP T1 - First and Higher Order Transition Models with Covariate Dependence T2 - Progress in Applied Mathematical Modeling Y1 - 2008 A1 - M. Ataharul Islam A1 - Rafiqul I Chowdhury ED - F. Yang KW - Demographics KW - Methodology AB - The covariate dependent Markov models can be employed in various fields of research for analyzing time series or repeated measures data. This paper highlights the covariate dependent Markov models for the first and higher orders. The first order covariate dependent Markov model developed by Muenz and Rubinstein (1985) is reviewed and then second and higher order models for binary sequence are developed along with their estimation and test procedures based on Islam and Chowdhury (2006). The models for more than two outcomes are also shown. A general procedure based on the Chapman-Kolmogorov equations is proposed here in order to take account of the transitions at unequal intervals. A simple test procedure is suggested here to determine the order of the underlying Markov models. The proposed methods are illustrated with the Health and Retirement Survey data from the USA on the mobility difficulty of the elderly population. The results indicate the utility of the transitional models for first or higher orders of underlying transitions with binary or multiple outcomes. JF - Progress in Applied Mathematical Modeling PB - Nova Science Publishers CY - USA UR - https://www.researchgate.net/publication/258212212_First_and_Higher_Order_Transition_Models_with_Covariate_Dependence_Chapter_4_ed_F_Yang_Nova_Science_Publishers_Hauppage_NY_pp_153-196_2008 N1 - ProCite field 6 : Chapter 4 in ProCite field 8 : ed U4 - Mobility/Models, Statistical/Elderly JO - First and Higher Order Transition Models with Covariate Dependence ER - TY - RPRT T1 - Forecasting Labor Force Participation and Economic Resources of the Early Baby Boomers Y1 - 2008 A1 - Pierre-Carl Michaud A1 - Susann Rohwedder KW - Demographics KW - Employment and Labor Force KW - Net Worth and Assets KW - Pensions AB - This paper forecasts the retirement patterns and resources of the Early Baby Boomers by estimating forward-looking dynamic models of labor force participation, wealth accumulation and pension and Social Security benefit claiming for older workers using seven waves of HRSdata. The two most important innovations of our proposed approach are the use of alternative measures of pension entitlements and the associated incentives, and accounting for subjective expectations about future work. Our main findings are that the Early Baby Boomers will work longer and claim Social Security later. JF - University of Michigan Retirement Research Center Working Paper PB - The University of Michigan Retirement Research Center CY - Ann Arbor, MI UR - https://deepblue.lib.umich.edu/handle/2027.42/60324 U4 - Labor Force Participation/Wealth Accumulation/Pensions/Baby Boomers ER - TY - JOUR T1 - Functional Ability and Disability among Older Adults with Arthritis: The impact of age, duration of arthritis, and severity of arthritis JF - Research in the Sociology of Health Care Y1 - 2008 A1 - Leah Rohlfsen A1 - Jennie J. Kronenfeld KW - Disabilities KW - Health Conditions and Status AB - Arthritis is the most prevalent chronic condition in persons ages 65 and older and is projected to increase substantially as the population ages. The purpose of this research is to assess if age, duration of arthritis, and severity of arthritis exert independent effects on various aspects of the disability process: functional limitations, activities of daily living (ADL) limitations, and instrumental activities of daily living (IADL) limitations. Type of arthritis, socio-demographic factors, behavioral factors, and additional health statuses are also examined. Using longitudinal data from the Health and Retirement study, results show age and severity of arthritis are related to the number of functional limitations one has and to the odds of having ADL and IADL limitations. Duration of arthritis is positively related to functional limitations and to the odds of reporting ADL limitations. Duration of arthritis is not significantly related to IADL limitations, which are strongly linked to performing social roles and have less to do with physical functioning compared to ADL tasks and functional tasks. There is no difference between those with established arthritis compared to those who have had it for a shorter time period, suggesting those with arthritis adapt to social tasks better than physical tasks. The resources used to cope with IADL limitations may be more effective over time compared to those used to cope with functional limitations and ADL disability. Understanding the context of functional limitations and disability among those with arthritis may lead to improved support and care for those living with arthritis. PB - 26 VL - 26 U4 - arthritis/DISABILITY/DISABILITY/Age Factors ER - TY - JOUR T1 - Formal and Informal Volunteer Activity and Spousal Caregiving Among Older Adults JF - Research on Aging Y1 - 2007 A1 - Namkee G Choi A1 - Jeffrey A Burr A1 - Jan E Mutchler A1 - Francis G. Caro KW - Adult children KW - Healthcare AB - On the basis of data from the 1998 and 2000 waves of the Health and Retirement Study, this study tested two alternative hypotheses, role overload and role extension, about the relationship between volunteering and spousal caregiving among older married persons. Spousal caregiving was not significantly associated with the likelihood of formal or informal volunteering for men; however, female caregivers were found to be less likely than noncaregivers to have engaged in formal or informal volunteering to a certain extent, thus lending partial support to the role overload hypothesis. Functional health status and other human and cultural capital resources were significant predictors of both formal and informal volunteering for both men and women. Future studies need to examine in more depth the effect of spousal caregiving on volunteering, taking caregiving burden and stress into consideration, to more fully understand these two types of productive activity in later life. PB - 29 VL - 29 IS - 2 U4 - Spouse/Caregiving ER - TY - JOUR T1 - Future Social Security Entitlements and the Retirement Decision JF - Review of Economics and Statistics Y1 - 2007 A1 - Courtney Coile A1 - Gruber, Jonathan KW - Employment and Labor Force KW - Methodology KW - Public Policy KW - Retirement Planning and Satisfaction KW - Social Security AB - A critical question for Social Security policy is how program incentives affect retirement behavior. We use the Health and Retirement Survey (HRS) to examine the impact of Social Security incentives on male retirement. We implement forward-looking models whereby individuals consider the incentives to work in all future years. We find that forwardlooking incentive measures for Social Security are significant determinants of retirement. We also find that private pension incentives have roughly similar effects. Our findings suggest that Social Security policies that increase the incentives to work at older ages can significantly reduce the labor force exit rate of older workers. PB - 89 VL - 89 IS - 2 U4 - Retirement planning/Labor Supply/Social Security Research/Social Security benefit claiming/Entitlements ER - TY - RPRT T1 - Financial Literacy and Retirement Preparedness: Evidence and Implications for Financial Education Programs Y1 - 2006 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Economists are beginning to investigate the causes and consequences of financial illiteracy to better understand why retirement planning is lacking and why so many households arrive close to retirement with little or no wealth. Our review reveals that many households are unfamiliar with even the most basic economic concepts needed to make saving and investment decisions. Such financial illiteracy is widespread: the young and older people in the United States and other countries appear woefully under-informed about basic financial computations, with serious implications for saving, retirement planning, mortgages, and other decisions. In response, governments and several nonprofit organizations have undertaken initiatives to enhance financial literacy. The experience of other countries, including a saving campaign in Japan as well as the Swedish pension privatization program, offers insights into possible roles for financial literacy and saving programs. JF - Michigan Retirement Research Center Publication PB - Michigan Retirement Research Center, University of Michigan CY - Ann Arbor, MI U4 - Financial Management/Retirement Planning/Investments ER - TY - THES T1 - Financial Planning and Risk Management for Retirement: Optimal investment-consumption choices under multiple risk exposures T2 - Decision Sciences and Engineering Systems Y1 - 2006 A1 - Li, Zhisheng KW - Net Worth and Assets KW - Risk Taking AB - With an increase in life expectancy and a shift from defined benefit to defined contribution plans for retirement funding, individuals are exposed to and need to manage more risks on their own. This research addresses optimal consumption and investment selections with consideration for health, financial and longevity risk. We define a health evolution model for identifying and measuring health risks in retirement planning. We construct a health status index to summarize an individual's health status, as well as a health risk factor system to identify the level of health risk of an individual. Based on maximum likelihood estimate and nonlinear least squares fitting, model calibration is formulated as mixed-integer nonlinear optimization problems. Data from the National Health Interview Survey is used to calibrate the model for specific risk groups. Longitudinal data from the Health and Retirement Study is used to validate the model. Annuities can be effective tools in managing longevity risk. In order to address this risk management problem, we develop a framework that merges annuity purchase decisions with consumption-investment selections in retirement planning. After introducing a pricing model and a benefit payment model for an annuity, we construct a multi-period wealth evolution model. An optimization problem is formulated with the objective of maximizing lifetime utility of consumptions and wealth. Optimal decisions are determined as a trade off between consumption and investment among an annuity, a risky and a risk-free asset. The health evolution model is used to capture the longevity risk in the framework. For a more sophisticated study of the management of financial risk, we formulate a wealth risk management framework which provides downside protection and upside potential. From the perspective of individual investors, we identify three major risk dimensions and construct risk measures for each risk dimension. Available assets are classified into the three risk dimensions, protective, market and aspirational, based on their risk-return profiles. All risk dimensions are optimized simultaneously through appropriate allocation of total wealth in the investment assets. We implement the framework in different market scenarios to test it, along with utilizing market data to check its performance in real world. JF - Decision Sciences and Engineering Systems PB - Rensselaer Polytechnic Institute CY - Troy, NY VL - Doctor of Philosophy UR - http://digitool.rpi.edu:8881/R/6UBH1N52GXNGT5FIP7EK3QVKUXI4XQY887RMB84AHKCI4YTATN-00036?func=dbin-jump-full&object_id=6134&local_base=GEN01&pds_handle=GUEST U4 - Financial Management ER - TY - RPRT T1 - Financial Risk, Retirement, Saving and Investment. Y1 - 2006 A1 - Alan L Gustman A1 - Thomas L. Steinmeier KW - Economics KW - financial risk KW - Investments KW - Retirement AB - This paper considers the prospects for adding choice of portfolio composition to a life cycle model of retirement and saving, while preserving the ability of the model to continue to explain the course of saving and retirement. If eventually successful, such a modification might be used to improve understanding of retirement and saving behavior both under the current Social Security system, and under variations involving personal accounts. In particular we consider the implications of separating parameters that now reflect both risk aversion and time preference PB - Michigan Retirement and Research Center CY - Ann Arbor, MI ER - TY - JOUR T1 - Functional impairment, race, and family expectations of death. JF - J Am Geriatr Soc Y1 - 2006 A1 - Brie A Williams A1 - Lindquist, Karla A1 - Sandra Y. Moody-Ayers A1 - Louise C Walter A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Attitude to Death KW - Black or African American KW - Cross-Sectional Studies KW - Disabled Persons KW - Family KW - Female KW - Hispanic or Latino KW - Humans KW - Male KW - White People AB -

OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race.

DESIGN: Cross-sectional.

SETTING: Community based.

PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older.

MEASUREMENTS: Families were interviewed within 2 years of the HRS participant's death. The primary outcome was whether death was expected. The primary predictors were the decedent's functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent's race.

RESULTS: Overall, 58% of families reported that their family member's death was expected. Expecting death was strongly associated with functional impairment; 71% of families of decedents with ADL disability expected death, compared with 24% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60%) than African Americans (49%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95% CI = 0.46-0.86).

CONCLUSION: Family members of older adults expected death only 58% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.

PB - 54 VL - 54 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17087694?dopt=Abstract U4 - Activities of Daily Living/Minorities/Hispanic/African Americans/functional impairment/expectations/death ER - TY - JOUR T1 - Female Labor Force Intermittency and Current Earnings: A Switching Regression Model with Unknown Sample Selection JF - Applied Economics Y1 - 2005 A1 - Hotchkiss, Julie L. A1 - Pitts, M. Melinda KW - Employment and Labor Force KW - Income KW - Women and Minorities AB - Using the Health and Retirement Survey, this paper finds a 16 percent selectivity-corrected wage penalty among women who engage in intermittent labor market activity. This penalty is experienced at a low level of intermittent activity but appears not to play an important role in a woman's decision to undertake such activity. In addition, employer preferences appear to play a larger role than human capital atrophy in the determination of the wage penalty. PB - 37 VL - 37 IS - 5 U4 - Labor Force/Income/Women, Working ER - TY - RPRT T1 - Financial Literacy and Planning: Implications for Retirement Well-Being Y1 - 2005 A1 - Annamaria Lusardi A1 - Olivia S. Mitchell KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - Only a minority of American households feels confident about retirement saving adequacy, and little is known about why people fail to plan for retirement, and whether planning and information costs might affect retirement saving patterns. To better understand these issues, we devised and fielded a purpose-built module on planning and financial literacy for the 2004 Health and Retirement Study (HRS). This module measures how workers make their saving decisions, how they collect the information for making these decisions, and whether they possess the financial literacy needed to make these decisions. Our analysis shows that financial illiteracy is widespread among older Americans: only half of the age 50 respondents could correctly answer two simple questions regarding interest compounding and inflation, and only one-third correctly answered these two questions and a question about risk diversification. Women, minorities, and those without a college degree were particularly at risk of displaying low financial knowledge. We also evaluate whether people tried to figure out how much they need to save for retirement, whether they devised a plan, and whether they succeeded at the plan. In fact, these calculations prove to be difficult: fewer than one-third of our age 50 respondents ever tried to devise a retirement plan, and only two-thirds of those who tried actually claim to have succeeded. Overall, fewer than one-fifth of the respondents believed they engaged in successful retirement planning. We also find that financial knowledge and planning are clearly interrelated: those who displayed financial knowledge were more likely to plan and to succeed in their planning. Moreover, those who did plan were more likely to rely on formal methods such as retirement calculators, retirement seminars, and financial experts, and less likely to rely on family/relatives or co-workers. PB - The University of Michigan, Michigan Retirement Research Center U4 - Financial Management/Retirement Planning ER - TY - THES T1 - Financial Management Assistance Use by the Vulnerable Elderly Y1 - 2005 A1 - Kim, Eun-Jin KW - Health Conditions and Status KW - Net Worth and Assets AB - The rapid growth of the elderly population raises concerns in the United States for older people's well-being. Effective financial management is important to the well-being of retired people since the elderly are more likely to face limited financial resources and complicated financial management tasks, such as navigating health care insurance payments and managing stocks. One way for the elderly to successfully manage their finances is to seek assistance from others. This study uses the 2000 Health and Retirement Study to examine factors affecting financial management assistance use by the elderly (individuals 65 years and older) facing difficulties managing their own finances. "Vulnerability" is suggested as a factor affecting financial management assistance use by the elderly. Vulnerability is a multidimensional concept incorporating health status, cognitive ability, and social interaction factors. The vulnerable elderly have health problems, reduced cognitive skills, and are often socially isolated due to the death of a spouse or retirement. Persons 65 years and older were found to be more vulnerable than persons younger than 65 years in terms of health status, cognitive ability, and social interaction. (n = 11,492). Since vulnerability is more prevalent among the older people, the study sample was limited to persons 65 years and older. Elderly persons reporting difficulty with financial management were studied to identify factors affecting financial management assistance use by the vulnerable elderly (n = 271). Logistic regression analysis revealed that age, presence of an IADL problem, depression, and computation ability affect older people's financial management assistance use. Elderly who are older, not depressed, and have an IADL problem and computation inability are more likely to use financial management assistance. Since depressed elderly persons are less likely to use assistance even if they have difficulties managing finances, the depressed elderly may be in a vulnerable situation with respect to effective financial management. Interventions related to financial management may improve the financial well-being of the depressed elderly. The findings of this study suggest that the factors determining older people's use of financial management assistance are physical and mental health status and cognitive ability rather than economic status. PB - The Ohio State University CY - Columbus, OH VL - Doctor of Philosophy UR - https://search.proquest.com/openview/d0634e9707b21bd4b553b149b5d2c8e9/1?cbl=18750&diss=y&pq-origsite=gscholar U4 - Financial Management ER - TY - JOUR T1 - Functional impairment as a risk factor for urinary incontinence among older Americans. JF - Neurourol Urodyn Y1 - 2005 A1 - Kristi Rahrig Jenkins A1 - Fultz, Nancy H. KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disability Evaluation KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Motor Activity KW - Risk Factors KW - Socioeconomic factors KW - Urinary incontinence AB -

AIMS: Using a large nationally representative sample of older Americans we investigate four domains of functional impairment as possible risk factors for the subsequent development of urinary incontinence (UI) symptoms.

METHODS: Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics among the Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UI symptoms.

RESULTS: A greater number of serious chronic conditions and functional impairment in the lower body mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors that contributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, being represented by a proxy respondent, and functional impairment in the strength domain.

CONCLUSIONS: Understanding the possible relationship between functional impairment and UI is an important step toward developing appropriate interventions for the prevention, treatment, or management of urine loss.

PB - 24 VL - 24 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15578629?dopt=Abstract U4 - WOMEN/Epidemiology/DISABILITY/DISABILITY ER - TY - RPRT T1 - Family Care, Nursing Home Transitions, and States' Long-Term Care Policies Y1 - 2004 A1 - Muramatsu, Naoko A1 - Richard T. Campbell A1 - Ruby L Hoyem A1 - Martha A. Jacob A1 - Chris Ross A1 - yin, Hongjun KW - Healthcare PB - University of Illinois-Chicago N1 - RDA U4 - Caregiving/Nursing Homes/Long-Term Care ER - TY - CHAP T1 - Financial Education and Saving T2 - Pension Design and Structure: New Lessons from Behavioral Economics Y1 - 2004 A1 - Annamaria Lusardi ED - Olivia S. Mitchell ED - Utkus, S. KW - Education KW - Net Worth and Assets KW - Retirement Planning and Satisfaction AB - In this paper, I examine the financial situation of older households. In addition, I examine whether employers' initiatives to reduce planning costs via retirement seminars have an effect on workers' saving. Using data from the Health and Retirement Study, I first show that many families arrive close to retirement with little or no wealth. Portfolios are also rather simple, and many families, particularly those with low education, hold little or no high-return assets. I further show that seminars foster saving. This is particularly the case for those with low education and those who save little. By offering financial education, both financial and total net worth increase sharply, particularly for families at the bottom of the wealth distribution and those with low education. Retirement seminars also increase total wealth (inclusive of pension and Social Security) for both high and low education families. Taken together, this evidence suggests that retirement seminars can foster wealth accumulation and bolster financial security in retirement. JF - Pension Design and Structure: New Lessons from Behavioral Economics PB - Oxford University Press UR - https://www.dartmouth.edu/~alusardi/Papers/Financial_Education_2004.pdf N1 - RDA 1998-002 ProCite field 6 : In ProCite field 8 : eds. U4 - Financial Management/Retirement Education/Retirement Planning/Education, Financial JO - Financial Education and Saving ER - TY - JOUR T1 - Financial Status of Older Americans Aged 70 and Above: A comparison of successive age cohorts JF - Hallym International Journal of Aging Y1 - 2004 A1 - Lee, Yoon G. KW - Demographics KW - Health Conditions and Status KW - Net Worth and Assets AB - Using data from the 1994 Survey of Asset and Health Dynamics among the Oldest Old (AHEAD), this study examines the economic status of older individuals aged 70 or older, while comparing income sources and financial portfolios across four age cohorts (70-74, 75-79, 80-84, and 85 or older). Ordinary least squares (OLS) regression analyses with dummy variables for age were used to identify the effects of different age cohorts on the level of financial assets, home equity, and net worth. Older individuals aged 85 and older had significantly lower net worth than did those aged 70-74 older. This study further investigates the factors influencing the level of net worth for each of the four age groups. Implications and conclusions are drawn based on the findings of the study. PB - 6 VL - 6 IS - 1 U4 - Old Age/Net Worth/Racial Differences/Assets ER - TY - THES T1 - Fall Risk Factors in Older Americans Y1 - 2003 KW - Demographics KW - Health Conditions and Status AB - Older American consumers require accurate and complete information to make informed decisions regarding health. Falls are a significant problem in older Americans and are negatively associated with quality of life and health. Current fall risk models are costly, expensive, and do not represent all reasons for falls. The purpose of this study was to investigate demographic and psychological well being variables to determine if they could improve the information provided from current fall risk models. This information could be used preventatively to reduce fall risk in older Americans. The study was a cross sectional, longitudinal survey design using the Health and Retirement Study (HRS) database. The sample consists of over 11,000 Americans 65 and older and is generalizable to the older population within the United States. An association between the demographic risk factors (age, marital status, gender education, and monthly expenditure) as well as psychological well being risk factors (positive attitude, loneliness, anxiety, activity level, depression, and perceived health) was compared with the variables fall incidence, fall with injury and fall frequency in a population of Americans 65 and older. The sample was limited to those who were home dwelling in the contiguous 48 states. Several variables were significant in their association with fall incidence, fall with injury and fall frequency. The variables age, depression and anxiety were positively associated with fall incidence, fall with injury and fall frequency. The variables Black, and report of good perceived health were associated negatively with fall incidence, fall with injury and fall frequency. Other variables had mixed associations. Being male was negatively associated with fall incidence, and fall with injury but positively associated with fall frequency. Positive attitude was positively associated with falls but negatively associated with fall frequency. Being Hispanic was negatively associated and increased monthly expenditure was positively associated with fall frequency. The results of this study could improve current fall risk models and may assist in providing preventative intervention for "at-risk" older Americans. PB - Texas Tech University U4 - Falls JO - Fall Risk Factors in Older Americans ER - TY - RPRT T1 - Fiscal Effects of Social Security Reform in the United States Y1 - 2003 A1 - Courtney Coile A1 - Gruber, Jonathan KW - Public Policy KW - Retirement Planning and Satisfaction KW - Social Security AB - Social Security is the largest social insurance program in the U.S., and has been shown to be a major determinant of the labor supply decisions of older workers. As such, reforming the Social Security system can have two fiscal impacts: a mechanical effect through changing the rules on benefits entitlements or taxation, and a behavioral effect through individual responses to these changes in benefits or taxes. We build a simulation model that computes these effects for major reforms to the system, building on estimated retirement responses to changing net Social Security entitlements. We then estimate the fiscal impact of reform for the 1931-1941 cohort of workers represented by the Health and Retirement Survey. We find that raising the early and normal retirement age by three years would reduce net costs for this cohort by roughly 30 , and that moving to a much higher benefit level would raise net costs by roughly 55 . Importantly, we find that in both cases the behavioral impacts on net costs are relatively small, at most one-third, and generally less than one-fifth of the total. The reason for these small effects is that the U.S. Social Security system is roughly actuarially fair, so that delaying or inducing retirement has relatively little impact on system balances; most of the effects that do arise are due to changes in general income and consumption taxes. JF - Center for Retirement Research at Boston College Working Papers PB - Center for Retirement Research at Boston College CY - Boston UR - https://crr.bc.edu/working-papers/fiscal-effects-of-social-security-reform-in-the-united-states/ N1 - RDA U4 - Retirement Behavior/Public Policy/Social Security ER - TY - RPRT T1 - Food Stamps and the Elderly: Why is Participation So Low? Y1 - 2003 A1 - Steven Haider A1 - Robert F. Schoeni A1 - Jacknowitz, Alison KW - Households KW - pension eligibility KW - Public Assistance AB - Estimates imply that only one-third of elderly persons who are eligible for food stamps actually participate in the program, which is half the rate that exists among younger people. This study investigates potential reasons for the relatively low take-up rate among the elderly. Analyzing new data, we conclude that the low take-up rate is not explained by measurement error and little is explained by various behavioral factors. Despite this much lower take-up rate, elderly who are eligible for assistance but not enrolled in the program do not appear to be especially needy. JF - National Poverty Center Working Paper Series PB - National Poverty Center, University of Michigan CY - Ann Arbor, MI UR - http://www.npc.umich.edu/publications/working_papers/paper2/03-02.pdf ER - TY - JOUR T1 - Food Stamps and the Elderly: Why is Participation So Low? JF - Journal of Human Resources Y1 - 2003 A1 - Steven Haider A1 - Robert F. Schoeni A1 - Jacknowitz, Alison KW - Households KW - pension eligibility KW - Public Assistance AB - Estimates imply that only one-third of elderly persons who are eligible for food stamps actually participate in the program, which is half the rate that exists among younger people. This study investigates potential reasons for the relatively low take-up rate among the elderly. Analyzing new data, we conclude that the low take-up rate is not explained by measurement error and little is explained by various behavioral factors. Despite this much lower take-up rate, elderly who are eligible for assistance but not enrolled in the program do not appear to be especially needy. PB - 38 VL - 38 IS - Suppl N1 - National Institute on Aging U4 - food stamps ER - TY - JOUR T1 - The Fraction of Disability Caused at Work JF - Social Security Bulletin Y1 - 2003 A1 - Reville, Robert T. A1 - Robert F. Schoeni KW - Disabilities KW - Employment and Labor Force AB - Disability has high societal and personal costs. Various disparate federal and state programs attempt to address the economic and social needs of people with disabilities. Presumably workplace injuries and accidents are an important source of disability. Yet separate public policies and research literatures have evolved for these two social problems disability and workplace injuries despite their relatedness. This article seeks to document the overlap between these two phenomena in estimating the proportion of the disabled population whose disability was caused by workplace injury, accident, or illness using the Health and Retirement Study of 1992. The results point toward the need for initiatives to reduce disability that focus on workrelated causes, which are a common pathway to disability, and that may result in substantial savings in federal programs. PB - 65 VL - 65 UR - https://www.ssa.gov/policy/docs/ssb/v65n4/v65n4p31.html IS - 4 U4 - Disability/Disability/Workplace ER - TY - JOUR T1 - Functional Status and Health Outcomes in Older Americans with Diabetes: Should diabetes management be targeted to health status? JF - Journal of the American Geriatrics Society Y1 - 2003 A1 - Caroline S Blaum A1 - Mary Beth Ofstedal A1 - Kenneth M. Langa A1 - Linda A. Wray KW - Diabetes Mellitus KW - Functional status KW - Older Adults AB - OBJECTIVES: To determine how baseline functional status affects health outcomes in older adults with diabetes mellitus (DM). DESIGN: Nationally representative cross‐sectional and longitudinal health interview survey. SETTING: Waves I (1993) and II (1995) of the Assets and Health Dynamics of the Oldest Old Survey (AHEAD) in the United States. PARTICIPANTS: AHEAD respondents aged 70 and older (n = 7,447, including 995 with DM). MEASUREMENTS: At baseline, the entire sample was divided into three groups: high‐functioning group, defined as having no physical limitations or instrumental activities of daily living/activities of daily living (IADL/ADL) disabilities (39%); low‐functioning group, having three or more limitations or IADL/ADL disabilities (24%); and intermediate‐functioning group, those in the middle (36%). Older adults with and without DM, within each of the functioning groups, were compared at 2‐year follow‐up with respect to demographic characteristics, weight/body mass index, baseline and incident chronic diseases and conditions, and follow‐up functioning. RESULTS: Of people aged 70 and older, 28% with DM and 41% without were high functioning; 38% with DM and 22% without were low functioning (both P < .001). High‐functioning people with DM remained high functioning at 2 years but had a significantly higher incidence of heart disease and mortality than high‐functioning people without DM. Low‐functioning people with DM were significantly more likely to have vascular comorbidities at baseline than low‐functioning people without DM, but their 2‐year outcomes were similar. The intermediate‐functioning group showed the most differences between those with and without DM; those with DM were significantly (P < .01) more likely to have baseline vascular disease, low cognitive performance, increased incident vascular disease, and significantly worse 2‐year functioning and to have experienced falls (P < .001). CONCLUSION: Differences in baseline functional status in older adults with DM were associated with outcome differences. High‐functioning older people with DM tended to remain high functioning but demonstrated significantly higher incidence of heart disease and mortality than those without DM, whereas low‐functioning people with and without DM had similar outcomes. However, intermediate‐functioning older diabetics had worse health and functioning outcomes than a similarly impaired group without DM. DM management adjusted to functional status can potentially address the most‐relevant outcomes in the heterogeneous older population with DM. PB - 51 VL - 51 IS - 6 U4 - Diabetes/Health Status ER - TY - CHAP T1 - The Family, Social Security, and the Retirement Decision T2 - Social Security and the Family: Addressing Unmet Needs in an Underfunded System Y1 - 2002 A1 - Melissa Favreault A1 - Richard W. Johnson ED - Melissa Favreault ED - Sammartino, F. ED - Steuerle, C. Eugene KW - Adult children KW - Social Security JF - Social Security and the Family: Addressing Unmet Needs in an Underfunded System PB - The Urban Institute Press CY - Washington, DC N1 - RDA 1998-006 ProCite field 6 : Chapter 9 in ProCite field 8 : eds. U4 - Social Security/Family transfers, structure JO - The Family, Social Security, and the Retirement Decision ER - TY - JOUR T1 - Federal Tax Policy, Employer Matching, and 401(k) Saving: Evidence from HRS W-2 Records JF - National Tax Journal Y1 - 2002 A1 - Christopher R. Cunningham A1 - Gary V. Engelhardt KW - Employment and Labor Force KW - Event History/Life Cycle KW - Pensions KW - Public Policy AB - This paper uses panel data from W-2 records for households in the Health and Retirement Study (HRS) to examine the responsiveness of 401(k) saving to taxation, employer matching, and lifecycle factors. The limit on the tax deductibility of IRA contributions enacted in the Tax Reform Act of 1986 appears to have raised 401(k) saving by 6 . Individuals eligible for employer matching contribute substantially more, but this result is not robust once job and firm characteristics are taken into account. Alternative pension coverage greatly reduces 401(k) saving, whereas the ability to direct the investment of funds is associated with higher saving. PB - LV VL - LV IS - 3 N1 - RDA 1996-007 U4 - Life Cycle Models/Tax Policy/401(k) participation and balances/Deferred compensation/Fiscal policy/Fiscal policy/Tax deductions/Employer contributions ER - TY - JOUR T1 - Florida Migration in the AHEAD Study, 1993-1995: A note on the flight of the oldest retirees JF - Research on Aging Y1 - 2002 A1 - Hays, Judith C. A1 - Charles F Longino KW - Demographics KW - Health Conditions and Status AB - Explores the migration patterns of people older than age 70. If the life course perspective on retirement migration is correct, then this older category should be somewhat less inclined to enter the key national destination states and more likely to be moving toward the usual sending states, unlike younger retirees. The Asset and Health Dynamics Among the Oldest Old (AHEAD) Study is critical to this study goal because it contains an oversample of Florida residents older than age 70. Respondents were interviewed in 1993 and again in 1995. The older movers who were identified tend to move locally, or within the state, but those who migrate across state lines are more often leaving Florida than entering it, as suggested by the life course theory. PB - 24 VL - 24 UR - http://roa.sagepub.com/archive/ IS - 4 U4 - Florida/Migration/Old Age ER - TY - RPRT T1 - Financial Transfers from Parents to Adult Children: Issues of Who is Helped and Why Y1 - 2001 A1 - Berry, Brent M. KW - Adult children AB - To what extent can young adult children rely on their parents for financial support? Despite the critical role parents have in supporting their children, parental motives for financial support remain unclear. Findings using two waves of data from the Health and Retirement Study that control for the needs of children and the resources of parents suggest that parents give more inter vivos financial assistance to their more disadvantaged children rather than focusing on children most able to give them financial help in return. Assistance is unevenly distributed among children in the direction favoring the most financially needy, supporting altruism as a motivation. Other measures of child well being besides income, including home ownership, education, parental status, and marital status, also suggest that parents help needy children more. Living near by, an indicator of a child's potential helpfulness, results in receiving more, a finding consistent with exchange motives. Neither altruism nor exchange theories, however, address the finding that stepchildren receive substantially less support than naturally born or adopted children. An alternative explanation incorporating this finding suggests that giving of support is mediated by the degree to which parents feel a child is their dependent. Findings are robust upon allowing for unobserved differences across families by estimating fixed effect models. PB - Population Studies Center at the Institute for Social Research CY - Ann Arbor, MI UR - https://www.psc.isr.umich.edu/pubs/abs/1306 U4 - Intergenerational Transfers/Altruism ER - TY - RPRT T1 - Family Support of the Elderly and Female Labor Supply: Tradeoffs Among Caregiving, Financial Transfers, and Work Y1 - 2000 A1 - Richard W. Johnson A1 - LoSasso, Anthony T. KW - Adult children KW - Employment and Labor Force KW - Healthcare KW - Women and Minorities PB - The Urban Institute U4 - Transfers/Women, Working/Caregiving/Labor Supply ER - TY - NEWS T1 - Fatter women end up with thinner wallets T2 - USA Today Y1 - 2000 A1 - Elias, Marilyn KW - Health Conditions and Status KW - Income KW - Women and Minorities JF - USA Today PB - USA Today U4 - Women/Income/Health Risk JO - Fatter women end up with thinner wallets ER - TY - RPRT T1 - The Financial Impact of Health Insurance Y1 - 2000 A1 - Helen G Levy KW - Consumption and Savings KW - Medicare/Medicaid/Health Insurance AB - What are the financial benefits of having health insurance? Although health insurance is ostensibly intended to help protect households from economic risks related to poor health, very little is known about the magnitude of this effect. Alternative mechanisms (such as informal health insurance or depleting assets) may be equally important in allowing households to smooth consumption in the event of a health shock. This paper analyzes the role of health insurance in buffering the impact of health shocks on household consumption and wealth. Using data from the Health and Retirement Study, I find very little evidence that household consumption or wealth is affected by the onset of a serious illness regardless of the household s insurance status. This suggests that on average, other insurance mechanisms may be at least as important as formal health insurance in protecting households from health-related economic risk. PB - University of California at Berkeley U4 - Health Insurance/Consumption ER - TY - BOOK T1 - Forecasting Retirement Needs and Retirement Wealth Y1 - 2000 A1 - Olivia S. Mitchell A1 - P. Brett Hammond A1 - Anna M. Rappaport KW - Consumption and Savings KW - Health Conditions and Status KW - Healthcare KW - Pensions KW - Retirement Planning and Satisfaction KW - Women and Minorities AB - Thirteen papers draw on data from the Health and Retirement Study and from other sources to explore people's preparation for and the financial challenges of retirement in the United States. Papers discuss new paths to retirement; how prepared Americans are for retirement; projected retirement wealth and saving adequacy; individual savings and investment choices associated with 401(k) plans; factors explaining retirement savings shortfalls; women's economic well -being at the end of their work lives and the factors that appear to be associated with the poorer economic status of older women relative to older men; the prospects for widow poverty; minorities facing retirement; early retirement windows; the relationship between people's expectations about their retirement, their realizations of retirement, and the role of health shocks in this process; planning for health care needs in retirement; the evaluation of pension entitlements; social security earnings and projected benefits. Mitchell is at the Wharton School, University of Pennsylvania. Hammond is with the Teachers Insurance Annuity Association-College Retirement Equities Fund (TIAA -CREF). Rappaport is at William M. Mercer, Inc. Index. PB - University of Pennsylvania Press CY - Philadelphia, PA UR - https://pensionresearchcouncil.wharton.upenn.edu/publications/books/forecasting-retirement-needs-and-retirement-wealth/ N1 - RDA 1996-002 ProCite field 8 : eds. U4 - Retirement/Retirement Policies/Economics of the Elderly/401(k) participation and balances/Women/Minorities/Health Care/Health Shocks ER - TY - MGZN T1 - Forecasting Retirement Needs and Retirement Wealth (Book Review) Y1 - 2000 A1 - Hardcastle, Peter A1 - Pryor, Bob KW - Retirement Planning and Satisfaction JF - The Actuary U4 - Retirement Planning JO - Forecasting Retirement Needs and Retirement Wealth (Book Review) ER - TY - RPRT T1 - A Framework for Analyzing and Managing Retirement Risks Y1 - 2000 A1 - Olivia S. Mitchell A1 - Zvi Bodie KW - Retirement Planning and Satisfaction AB - This paper provides an overview of new approaches and products to help people assess and meet their old-age security goals. We first examine retirement planning models and conclude that many do not yet incorporate key types of uncertainty deemed essential to economists and finance experts, including cross-asset correlations. Many financial planners also fall short of using the full range of tools of risk management – hedging, insurance, and diversification – to guide those making retirement plans. Turning to innovation, we examine several financial products that appear to offer new opportunities to protect against old-age risk. These products include inflation-linked annuities, survivor bonds, long-term care insurance, and reverse annuity mortgages. Some of the innovations arise from bundling existing insurance products. We also suggest that the arrival of new products to market that could protect retirement income have been slowed by market failures and institutional rigidities as well as information barriers; these have limited international diversification in investments, among other outcomes. There remains a profoundly important role for additional economic and financial research to better inform stakeholders on the costs and benefits of developing innovative products for retirement security PB - University of Pennsylvania UR - https://d1wqtxts1xzle7.cloudfront.net/44924857/A_Framework_for_Analyzing_and_Managing_R20160420-17161-ufe5km.pdf?1461169548=&response-content-disposition=inline%3B+filename%3DA_Framework_for_Analyzing_and_Managing_R.pdf&Expires=1593708427&Signature=ZBcdaC U4 - Retirement Policies/Retirement Planning ER - TY - JOUR T1 - The Future of Age Integration in Unemployment JF - The Gerontologist Y1 - 2000 A1 - John C Henretta KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Methodology KW - Other KW - Retirement Planning and Satisfaction KW - Social Security AB - This article discusses the direction and implications of current and possible future trends in workplace age integration. The study used HRS respondents' attitudes towards work as a way of examining the possible supply of older workers. Overall, there are a number of underlying trends that will combine in the near future that will likely result in an increase of older persons remaining in the work force for longer. The shifting population age composition and the high education and ability levels of the cohorts born around 1950 are some of the trends that contribute to the increased demand for older workers. Other trends, such as changes in Social Security eligibility ages, the shift to DC pension plans, and the improving health of older cohorts, contribute to the increase in the supply of older workers. HRS data indicate that an overwhelming majority, 77 of men and 71 of women, say that they would like to continue some paid work when they retire. Evidence also suggests that since job flexibility among this cohort is limited, that either significant job changing from pre-retirement to postretirement jobs will be required, or significant job redesign must occur. PB - 40 VL - 40 IS - 3 U4 - Adult/Employment/Trends/Female/Human/Intergenerational Relations/Middle Age/Population Dynamics/Retirement/Social Security/Support, U.S. Government--PHS/United States ER - TY - JOUR T1 - Financial assistance from middle-aged couples to parents and children: racial-ethnic differences. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1999 A1 - Rebeca Wong A1 - Capoferro, C. A1 - Beth J Soldo KW - Aged KW - Child KW - ethnicity KW - Family Relations KW - Female KW - Financing, Personal KW - Humans KW - Intergenerational Relations KW - Male KW - Middle Aged KW - Parent-Child Relations KW - Racial Groups AB -

OBJECTIVES: To examine racial-ethnic differences in the allocation of financial transfers to parents, children, and others by middle-aged couples.

METHODS: Multinomial specification of alternative recipients of financial transfers, using data from the 1992 Health and Retirement Survey.

RESULTS: Transfer patterns are sensitive to parental health and wealth, to children being young or in school, as well as to the donors' health and wealth. Controlling for these and other factors, including family size and structure, Blacks and Whites are the most likely, and Hispanics the least likely, to financially help their parents compared to assisting offspring. Black couples are the most likely to sacrifice their own consumption to assist parents financially.

DISCUSSION: Future research on transfers should attempt to capture unmeasured noneconomic sources of variation proxied by the race-ethnicity indicator.

PB - 54B VL - 54 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10363045?dopt=Abstract U4 - Child/Ethnicity/Gender/Family Relations/Financing, Personal/Intergenerational Transfers/Intergenerational Relations/Middle Age/Parent Child Relations/Support, U.S. Government--PHS ER - TY - JOUR T1 - Formal and Informal Community Care to Older Adults: Comparative Analysis of the United States and Great Britain JF - Journal of Family and Economic Issues Y1 - 1999 A1 - Adam Davey A1 - Patsios, Demi KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - This article examines four components of community-based care for older adults with ADL limitations from a cross-national perspective, focusing on the U.S. and Great Britian. Surveys of older adults were used to determine whether differences exist between the two countries with respect to: the type of support that is primarily provided (informal sector vs. formal sector), the overall likelihood that those with at least 1 ADL limitations receive assistance, and the extent of unmet needs. Results show that the likelihood of receiving formal and informal support was significantly greater in G.B. than in the U.S. However, while high in both, the rates of unmet need did not differ between the two countries. The data also shows that community-based formal support does not substitute family help. This finding emphasizes the importance of family caregivers and further reinforces the already existing effort made by both countries to provide support for these primary support agents. PB - 20 VL - 20 IS - 3 U4 - Community Health Services/Health Services/Family/Health Status/Activities of Daily Living ER - TY - JOUR T1 - Formation of Trusts and Spend Down to Medicaid JF - The Journals of Gerontology: Social Sciences Y1 - 1999 A1 - Donald H. Taylor Jr. A1 - Frank A Sloan A1 - Edward C Norton KW - Adult children KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Medicare/Medicaid/Health Insurance KW - Methodology KW - Net Worth and Assets AB - OBJECTIVE: To identify the proportion of community-dwelling elderly persons (70 ) who could affect their eligibility for Medicaid financing of a nursing home stay through the use of a trust and to quantify the prevalence and predictors of trusts. METHODS: State-specific Medicaid eligibility regulations were used to determine eligibility and to identify those who could affect the same through the use of trusts. Multivariate logistic regression was used to identify correlates of having a trust. Wave 1 of the Assets and Health Dynamics of the Oldest Old (AHEAD) data base was used. RESULTS: Four in 10 elderly community dwellers could potentially qualify for Medicaid by using a trust; however, less than 10 had a trust. On average, wealthier persons had trusts. Avoidance of probate and controlling assets after death appear to be stronger motivations for trust creation among the elderly than achieving Medicaid spend down. DISCUSSION: The use of trusts was not common, and motives other than spend down were more important for those with trusts. Our results suggest little need for policy efforts to limit the use of trusts to achieve spend down. PB - 54B VL - 54B UR - https://watermark.silverchair.com/54B-4-S194.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAArkwggK1BgkqhkiG9w0BBwagggKmMIICogIBADCCApsGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMp0UUg1PuPyPtW2TQAgEQgIICbKvSCKf7gEQSGvy-WxqpuojGLR3OKgcObNMZ3E6gB4hR IS - 4 U4 - Aged, 80 and Over/Assets/Eligibility Determination/Financing, Personal/Homes for the Aged/Intergenerational Transfers/Medicaid/Nursing Homes/Support, U.S. Government--PHS/United States ER - TY - RPRT T1 - Family Structure and Economic Well-Being of Black, Hispanic, and White Pre-Retirement Adults Y1 - 1998 A1 - Chenoa Flippen A1 - Tienda, Marta KW - Adult children KW - Net Worth and Assets KW - Women and Minorities AB - This paper examines how family structure is related to racial and ethnic inequality among older populations. We show that intergenerational living serves the economic needs of minority and unmarried female elders more than non-minority and married elders. The greater economic motivation for co-residence among minority and female elders was suggested both by their higher reliance on the income of co-resident kin and by their subjective evaluations of who benefited most from co-residence. However, when the contributions of co-resident kin are weighed against the additional costs they bring to the household, the inequality-reducing effect of extension falls considerably. The contributions per co-resident kin are smaller in minority households, and thus the economic well-being of elders living in extended households is often no better, and occasionally worse, than had they lived alone. Only unmarried women receive a substantial net boost from co-residence, primarily because adult offspring who co-reside with unmarried women contribute more than their counterparts in unmarried male or couple households. JF - Office of Population Research working paper PB - Princeton University CY - Princeton UR - https://ideas.repec.org/p/pri/opopre/opr9802.pdf.html U4 - Family Structure/Economic Status/Black Americans/Hispanic Americans ER - TY - RPRT T1 - Functional Limitation, Disability and Perceived Health of the Oldest Old: An examination of health status in AHEAD Y1 - 1998 A1 - Lee A. Lillard A1 - Farmer, Melissa M. KW - Disabilities KW - Health Conditions and Status AB - This research focuses on the effects of functional limitation and disability on perceived health status in those age 70 and older. It uses the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) and provides a new methodology for the solving methodological issues of threshold response indicators of limitations and disability and conditional wording of questions. The study provides support for the disability process model outlined by Verbrugge and Jette (1994) and also provided insight into the dynamics that operate between demographics, pathology, functional limitation, disability and perceived health status. For functional limitation, the two domains were confirmed: immobility and cognition. Disability also had two domains confirmed: personal care, and household management. Pathologies were found to have a substantial impact on all four domains as well as perceived health status. Controlling for immobility, personal care and household management were not significant predictors of perceived health status. U4 - Aged, 80 and Over/Disability/Disability/Health Status ER - TY - RPRT T1 - Family, Employment Status, and Residential Mobility in the Health and Retirement Study Y1 - 1996 A1 - Regina M. Bures KW - Adult children KW - Demographics KW - Employment and Labor Force KW - Housing KW - Net Worth and Assets AB - Understanding the relationship between mobility and the family and work transitions experienced by individuals approaching retirement is an important research topic. Both family transitions, such as divorce, widowhood or children leaving home, and work transitions, particularly retirement, influence where individuals will reside and, as they age, how much assistance they may need. This paper uses Waves 1 and 2 of the Health and Retirement Survey (HRS) to examine the residential mobility of the HRS cohort in the context of family and work status changes. The results demonstrate that respondents experiencing both household change and change in work status were more likely to have moved. While household change is a strong predictor of mobility, neighborhood and regional effects are significant predictors of mobility as well. These findings are discussed in the context of the migration and mobility data available in the HRS. Currently, the greatest limitation of using the HRS data for migration research is the lack of information on distance moved. An appendix discusses this issue in detail and suggests ways to make the HRS data more useful for understanding the relationships between mobility and the life transitions experienced by this cohort. PB - University of Michigan UR - http://www.psc.isr.umich.edu/pubs/series.html hr U4 - Mobility/Labor/Economic Status/Family Structure/Housing/Basic Demographics ER - TY - RPRT T1 - Family Structure and Intergenerational Transfers: A Comparison of 55-63 Year Olds in the U.S. and Britain Y1 - 1996 A1 - Glaser, Karen A1 - Emily M D Grundy A1 - John C Henretta A1 - Murphy, Michael J. KW - Adult children AB - This study uses data from wave two of the HRS (1994/95) and the broadly comparable British Retirement and Retirement Plans Survey (1988) to compare two middle generation cohorts in order to examine the impact of differing demographic histories on the potential demographic and expectation 'burdens' experienced by those in late middle-age. There are a number of reasons for supposing that the family responsibilities of those in their late fifties may vary between the US and Britain. In the cohorts under consideration achieved fertility was higher in the US. Moreover, much higher proportions of young adults attend college in the US and state support is much lower than in Britain. As a result adult children may remain economically dependent for longer in the US and this, combined with fertility differences, places a higher burden on adults in later mid life. An added factor of importance is that more of the US respondents will have experienced marital disruption, making the ratio of supported to dependants possibly even less favourable. In addition, Americans in later middle age may more often have responsibilities for their own ageing parents than their British peers as the life expectancy of individuals over 65 is higher in the US than in Britain. The study's findings show that middle generation adults in the US have more surviving children than in Britain and that a higher proportion of parents of middle generation individuals are alive in the US than in Britain. Although differences in question wording between the two surveys are substantial and therefore caution must be exercised in the interpretation of results, as expected a higher proportion of American respondents provide financial assistance to children, whereas it appears that British respondents are more likely to provide time transfers to children than their American counterparts. With respect to the older generation, British respondents also appear more likely to provide assistance to their parents and are more likely to coreside with an elderly parent when compared to the Americans. Thus it is important not only to look at demographic factors, but it also becomes necessary to examine the expectation burden, that is differences in policy and attitudes that affect time transfers to parents/children, and the financial assistance required by adult children and elderly parents. PB - University of Michigan UR - http://www.psc.isr.umich.edu/pubs/series.html hr U4 - Transfers/Family Structure ER - TY - RPRT T1 - The Florida AHEAD Respondents: Characteristics of Florida's Elderly Population Aged Seventy and Over Y1 - 1996 A1 - Berry, Brent M. A1 - John C Henretta KW - Demographics AB - This paper uses the first wave of data from the Asset and HEAlth Dynamics (AHEAD) Among the Oldest Old survey to compare the characteristics of the Florida oversample to the U.S. elderly population aged seventy and older. The goal of the AHEAD survey is to understand the interrelationship among changes and transitions in three major domains health, income and assets, and family transfers. Based on interviews of 8,223 respondents (1,088 Florida, 7,134 non-Florida), our comparison of Florida and non-Florida elderly indicates: Florida elderly are generally healthier, less impaired, and have greater financial resources than non-Florida elderly. Particularly among the unmarried, Floridians have lower levels of physical and cognitive impairment and higher income and asset levels. Floridians expect to live longer and to give an inheritance, and not to need nursing care or receive financial help in the future. Impaired Floridians are more likely to be married and equally likely to receive some help in dealing with impairment. That help is more likely to come from a spouse rather than a child. Even among the impaired, Floridians have greater assets than non-Floridians. The finding that unmarried Floridians are healthier and have more financial resources may suggest that the combination of widowhood, depletion of assets, absence of nearby children, and impairment triggers migration of elderly out of Florida or institutionalization. By following the migration patterns of respondents over time, future waves of AHEAD will provide the panel data needed to discern how important return migration and institutionalization are in shaping the characteristics of the Florida elderly population. PB - University of Michigan UR - http://www.psc.isr.umich.edu/pubs/series.html hr U4 - Florida ER - TY - JOUR T1 - Family Structure and Transfer Measures in the Health and Retirement Study: Background and Overview JF - Journal of Human Resources Y1 - 1995 A1 - Beth J Soldo A1 - Martha S. Hill KW - Adult children KW - Demographics KW - Net Worth and Assets AB - This paper describes the rationale for and the measures of family structure and inter-vivos giving in the Health and Retirement Study (HRS). Of particular interest to the HRS is the extent to which transfers affect the labor supply of donors, especially women. Because all children and parents are individually profiled, HRS data can be used to examine the joint allocation of space, time, and money among competing kin. Data on siblings of respondents with living parents provide further opportunities to consider how adult children distribute the burden of parent care among themselves. Using the baseline HRS, we describe the quality of data on kin attributes and the correlations among family structures, transfers, and work. PB - 30 VL - 30 IS - 0 Suppl. N1 - ProCite field 3 : Georgetown U; Institute for Social Research, U MI U4 - Family Structure/Demographic Trends and Forecasts/Household Production/Transfers/Adult Children/Parent Child Relations ER - TY - NEWS T1 - Family Aid to Elderly is Very Strong, Study Shows T2 - The New York Times Y1 - 1993 A1 - Gina Kolata KW - Adult children JF - The New York Times PB - The New York Times Co. CY - New York, NY U4 - Family/Transfers JO - Family Aid to Elderly is Very Strong, Study Shows ER -