TY - JOUR T1 - Validation of Self-Reported Cancer Diagnoses by Respondent Cognitive Status in the U.S. Health and Retirement Study. JF - The Journals of Gerontology. Series A Y1 - Forthcoming A1 - Mullins, Megan A A1 - Kabeto, Mohammed A1 - Wallner, Lauren P A1 - Lindsay C Kobayashi KW - Cognition KW - Dementia KW - self-reported diagnoses KW - sensitivity KW - specificity KW - Validation AB -

BACKGROUND: Cancer and dementia are becoming increasingly common co-occurring conditions among older adults. Yet, the influence of participant cognitive status on the validity of self-reported data among older adults in population-based cohorts is unknown. We thus compared self-reported cancer diagnoses in the US Health and Retirement Study (HRS) against claims from linked Medicare records to ascertain the validity of self-reported diagnoses by participant cognitive and proxy interview status.

METHODS: Using data from HRS participants aged ≥67 who had at least 90% continuous enrollment in fee-for-service Medicare, we examined the validity of self-reported first incident cancer diagnoses from biennial HRS interviews against diagnostic claim records in linked Medicare data (reference standard) for interviews from 2000-2016. Cognitive status was classified as normal, cognitive impairment no dementia (CIND), or dementia using the Langa-Weir method. We calculated the sensitivity, specificity, and κfor cancer diagnosis.

RESULTS: Of the 8,280 included participants, 23.6% had cognitive impairment without dementia (CIND) or dementia ,and 10.7% had a proxy respondent due to an impairment. Self-reports of first incident cancer diagnoses for participants with normal cognition had 70.2% sensitivity and 99.8% specificity (κ=0.79). Sensitivity declined substantially with cognitive impairment and proxy response (56.7% for CIND, 53.0% for dementia, 60.0% for proxy respondents), indicating poor validity for study participants with CIND, dementia, or a proxy respondent.

CONCLUSION: Self-reported cancer diagnoses in the US HRS have poor validity for participants with cognitive impairment, dementia, or a proxy respondent. Population-based cancer research among older adults will be strengthened with linkage to Medicare claims.

ER - TY - JOUR T1 - Variation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults. JF - Journals of Gerontology. Series A Biological Sciences and Medical Sciences Y1 - 2024 A1 - Burgdorf, Julia G A1 - Ornstein, Katherine A A1 - Liu, Bian A1 - Leff, Bruce A1 - Brody, Abraham A A1 - McDonough, Catherine A1 - Ritchie, Christine S KW - Aged KW - Delivery of Health Care KW - Dementia KW - Home Care Services KW - Hospitalization KW - Humans KW - Medicare KW - United States AB -

BACKGROUND: Medicare-funded home healthcare (HHC) delivers skilled nursing, therapy, and related services through visits to the patient's home. Nearly one-third (31%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differ for persons living with dementia (PLwD).

METHODS: We drew on linked 2012-2018 Health and Retirement Study and Medicare claims for a national cohort of 1 940 community-living older adults. We described differences in HHC admission, length of stay, and referral source by patient dementia status and used weighted, multivariable logistic and negative binomial models to estimate the relationship between dementia and HHC visit type and intensity while adjusting for sociodemographic characteristics, health and functional status, and geographic/community factors.

RESULTS: PLwD had twice the odds of using HHC during a 2-year observation period, compared to those without dementia (odds ratio [OR]: 2.03; p < .001). They were more likely to be referred to HHC without a preceding hospitalization (49.4% vs 32.1%; p < .001) and incurred a greater number of HHC episodes (1.4 vs 1.0; p < .001) and a longer median HHC length of stay (55.8 days vs 40.0 days; p < .001). Among post-acute HHC patients, PLwD had twice the odds of receiving social work services (unadjusted odds ratio [aOR]: 2.15; p = .008) and 3 times the odds of receiving speech-language pathology services (aOR: 2.92; p = .002).

CONCLUSIONS: Findings highlight HHC's importance as a care setting for community-living PLwD and indicate the need to identify care delivery patterns associated with positive outcomes for PLwD and design tailored HHC clinical pathways for this patient subpopulation.

VL - 79 IS - 3 ER - TY - JOUR T1 - The value of Medicare coverage on depressive symptoms among older immigrants. JF - Gerontologist Y1 - 2023 A1 - Jun, Hankyung A1 - Mattke, Soeren A1 - Chen, Alice A1 - Aguila, Emma KW - depression KW - Disparities KW - Health Insurance AB -

BACKGROUND AND OBJECTIVES: The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the U.S.

RESEARCH DESIGN AND METHODS: Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity.

RESULTS: Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants - Black, Hispanic, and Asian/Pacific Islander - even when holding socioeconomic status constant.

DISCUSSION AND IMPLICATIONS: Our findings imply that immigration policies that expand healthcare protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.

ER - TY - JOUR T1 - Vision and Hearing Difficulties and life expectancy without ADL/IADL-limitations: Evidence from the English Longitudinal Study of Ageing and the Health and Retirement Study. JF - J Gerontol A Biol Sci Med Sci Y1 - 2023 A1 - Zaninotto, Paola A1 - Maharani, Asri A1 - Di Gessa, Giorgio AB -

BACKGROUND: Hearing and vision difficulties are some of the most common deficits experienced by older adults. Having either visual or hearing difficulty increases the risk of comorbidity, disability, and poor quality of life. So far, however, few studies have examined the association between vision and hearing difficulties on life expectancy without activities of daily living (ADL) instrumental ADL (IADL) limitations (LEWL).

METHODS: Data came from the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) in the US from 2002 to 2013. The outcome was defined as reporting 2+ limitations with ADL/IADL. Life expectancy was estimated by discrete-time multistate life table models, for hearing and vision difficulty separately as well as for combined vision and hearing difficulties, by sex and age.

RESULTS: 13% of men in England and the US had ADL/IADL-limitations, whereas for women was 16% and 19% in England and the US. At all ages, either vision or hearing difficulty was associated with shorter LEWL compared to no difficulties. Dual sensory difficulty (vision and hearing) reduced LEWL by up to 12 years in both countries. At the ages of 50 and 60 in England, hearing difficulty was associated with fewer years lived without ADL/IADL-limitations than vision difficulty. In contrast, in the US, vision difficulty led to fewer years lived without ADL/IADL-limitations than hearing difficulty.

CONCLUSIONS: The implementation of strategies to reduce the prevalence and incidence of vision and hearing difficulties has the potential to increase the number of years spent without ADL/IADL-limitations.

ER - TY - JOUR T1 - Volunteering and Changes in Cardiovascular Biomarkers: Longitudinal Evidence from the Health and Retirement Study JF - Innovation in Aging Y1 - 2023 A1 - Kim, Seoyoun A1 - Halvorsen, Cal A1 - Han, Sae Hwang AB - Growing body of research shows that volunteering is beneficial for those served, the volunteers, and the larger communities. However, major challenges remain that hinder the practical implications for volunteer activity as a public health intervention, including potential selection effects, lack of longitudinal studies that adjust for baseline characteristics, and a paucity of studies that consider multiple physical health outcomes in a single model.Data from 2006-2016 waves of the Health and Retirement Study (2006-2016) was used (N=18,847). Outcome-wide analyses were utilized to evaluate if changes in volunteering between 2006/2008 (t0) and 2010/2012 (t1) were associated with seven cardiovascular disease biomarkers four years later (2014/2016, t2). These models were adjusted for demographic factors, socioeconomic status, health behaviors, chronic conditions, and baseline biomarkers and volunteering. Additionally, selection into volunteering and attrition were taken into account.Compared to non-volunteers, volunteering more than 200 hours a year was associated with a lower risk for clinically high diastolic blood pressure. In addition, increased volunteering effort (change from 1-99 hours at t0 to \>100 hours at t1) was associated with a lower likelihood of clinically high systolic and diastolic blood pressure levels. Sustained high volunteering (\>100 hours at both t0 and t1) was associated with lower diastolic blood pressure.The current study adds to the evidence on health benefits of volunteering for adults 50 and older by inferring a potential causal link between high-intensity volunteering and reduced blood pressure. ER - TY - JOUR T1 - Validation of Claims Algorithms to Identify Alzheimer's Disease and Related Dementias. JF - The Journals of Gerontology, Series A Y1 - 2022 A1 - Ellen P McCarthy A1 - Chang, Chiang-Hua A1 - Tilton, Nicholas A1 - Mohammed U Kabeto A1 - Kenneth M. Langa A1 - Julie P W Bynum KW - Accuracy KW - algorithm KW - Dementia KW - Diagnosis KW - Medicare AB -

BACKGROUND: Using billing data generated through healthcare delivery to identify individuals with dementia has become important in research. To inform tradeoffs between approaches, we tested the validity of different Medicare claims-based algorithms.

METHODS: We included 5,784 Medicare-enrolled, Health and Retirement Study participants aged >65 years in 2012 clinically assessed for cognitive status over multiple waves and determined performance characteristics of different claims-based algorithms.

RESULTS: Positive predictive value (PPV) of claims ranged from 53.8-70.3% and was highest using a revised algorithm and 1-year of observation. The trade-off of greater PPV was lower sensitivity; sensitivity could be maximized using 3-years of observation. All algorithms had low sensitivity (31.3-56.8%) and high specificity (92.3-98.0%). Algorithm test performance varied by participant characteristics, including age and race.

CONCLUSIONS: Revised algorithms for dementia diagnosis using Medicare administrative data have reasonable accuracy for research purposes, but investigators should be cognizant of the trade-offs in accuracy among the approaches they consider.

VL - 77 IS - 6 ER - TY - JOUR T1 - Validation of self-reported cancer diagnoses using Medicare diagnostic claims in the U.S. Health and Retirement Study, 2000-2016. JF - Cancer Epidemiology, Biomarkers & Prevention Y1 - 2022 A1 - Megan Mullins A1 - Jasdeep S Kler A1 - Eastman, Marisa R A1 - Mohammed U Kabeto A1 - Lauren P Wallner A1 - Lindsay C Kobayashi KW - cancer diagnoses KW - medicare diagnostic claims KW - Self-reported health AB -

BACKGROUND: The US Health Retirement Study (HRS) is an ongoing population-representative cohort of US adults aged >50 with rich data on health during aging. Self-reported cancer diagnoses have been collected since 1998, but they have not been validated. We compared self-reported cancer diagnoses in HRS interviews against diagnostic claims from linked Medicare records.

METHODS: Using HRS-Medicare linked data, we examined the validity of first incident cancer diagnoses self-reported in biennial interviews from 2000-2016 against ICD-9 and ICD-10 diagnostic claim records as the gold standard. Data were from 8,242 HRS participants aged {greater than or equal to}65 with 90% continuous enrollment in fee-for-service Medicare. We calculated the sensitivity, specificity, and k for first incident invasive cancer diagnoses (all cancers combined, and each of bladder, breast, colorectal/anal, uterine, kidney, lung, and prostate cancers) cumulatively over the follow-up and at each biennial study interview.

RESULTS: Overall, self-reports of first incident cancer diagnoses from 2000-2016 had 73.2% sensitivity and 96.2% specificity against Medicare claims (k=0.73). For specific cancer types, sensitivities ranged from 44.7% (kidney) to 75.0% (breast), and specificities ranged from 99.2% (prostate) and 99.9% (bladder, uterine, and kidney). Results were similar in sensitivity analyses restricting to individuals with 100% continuous fee-for-service Medicare enrollment and when restricting to individuals with at least 24 months of Medicare enrollment.

CONCLUSION: Self-reported cancer diagnoses in the HRS have reasonable validity for use in population-based research that is maximized with linkage to Medicare.

IMPACT: These findings inform the use of the HRS for population-based cancer and aging research.

VL - 31 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/34737206?dopt=Abstract ER - TY - JOUR T1 - The Validity and Reliability of Retrospective Measures of Childhood Socioeconomic Status in the Health and Retirement Study: Evidence from the 1940 U.S. Census. JF - The Journals of Gerontology, Series B Y1 - 2022 A1 - Warren, John Robert A1 - Lee, Mark A1 - Theresa L Osypuk KW - Data quality KW - family income KW - Measurement KW - Parental education AB -

OBJECTIVES: Retrospective measures of childhood socioeconomic status (SES) in widely used cohort studies of aging that first observe people late in life-such as the Health and Retirement Study (HRS)-are widely used. However, their measurement validity and reliability are unknown. We assess the reliability and validity of the HRS's retrospective measures of parental education and childhood family finances.

METHODS: We use records for 6,343 HRS sample members who were children in 1940 that have been linked to records from the complete-count 1940 U.S. Census. We assess interrater reliability by comparing (a) retrospective reports of childhood SES collected from sample members in the 1992-2018 HRS to (b) prospective measures of parallel concepts collected from HRS sample members' parents in the 1940 Census. We assess predictive validity by comparing the results of analyses that model later-life outcomes as a function of childhood SES as measured both prospectively and retrospectively.

RESULTS: Interrater reliabilities of retrospective measures of parental education are high; however, the same is not true of the retrospective measure of childhood family finances. Both retrospective and prospective measures of childhood SES are predictive of later-life outcomes, and with similar strengths and directions of associations for most outcomes.

DISCUSSION: Researchers who rely on retrospective indicators of childhood SES from the HRS should be aware of their measurement properties. They are measured with error, and that error modestly attenuates estimates of their associations with later-life outcomes. However, prospective and retrospective measures of childhood SES have similar predictive validity. These findings should reassure researchers who rely on retrospective measures of childhood SES in the HRS and similarly designed surveys.

VL - 77 IS - 9 ER - TY - ICOMM T1 - Vision impairment is associated with as many as 100,000 U.S. dementia cases Y1 - 2022 A1 - National Institute on Aging KW - Dementia KW - vision impairment JF - News & Events PB - National Institute on Aging UR - https://www.nia.nih.gov/news/vision-impairment-associated-many-100000-u-s-dementia-cases ER - TY - JOUR T1 - Volunteer Engagement and Systemic Inflammation: Does Helping Others Benefit Oneself? JF - Gerontologist Y1 - 2022 A1 - Bell, Mallory A1 - Ferraro, Kenneth F A1 - Sauerteig-Rolston, Madison R KW - C-reactive protein KW - Inflammation KW - Prosocial activity KW - volunteer AB -

BACKGROUND AND OBJECTIVES: Although research on the health benefits of volunteering has proliferated, most studies are cross-sectional and rely on self-reported measures of health. Drawing from role theory, the objectives of this study are to examine if (1) volunteering engagement is related to systemic inflammation in later life, as measured by C-reactive protein (CRP), (2) the effect of volunteering varies by age and (3) volunteering is related to change in CRP over time.

RESEARCH DESIGN AND METHODS: This study uses four waves of data from the Health and Retirement Study, a nationally representative survey of adults 50 years or older. Nested linear regression models were used to examine the relationship between volunteer engagement and CRP concentration in later life. Residualized regression models were used to examine the effects of volunteer engagement on change in CRP.

RESULTS: Results revealed that volunteering is modestly associated with lower CRP concentration, but only for respondents 65+. Highly engaged volunteers had lower CRP than both mid-level and non-volunteers. Longitudinal analyses revealed a leveling of the beneficial effect of volunteering by age, indicative of reduced returns among the oldest respondents in our sample.

DISCUSSION AND IMPLICATIONS: These results support previous studies that volunteering, and doing so at a high engagement level, is associated with slightly lower levels of CRP. Leaders in medicine, public health, and social services should consider implementing volunteering programs for older adults.

ER - TY - JOUR T1 - Volunteering and loneliness in older adults: A parallel mediation model. JF - Aging & Mental Health Y1 - 2022 A1 - Lee, Sunwoo KW - loneliness intervention KW - mediation model KW - Volunteering AB -

This study aimed to examine the relationship between participation in volunteer work and loneliness among older adults, and to explore the mediating role of perceived control and perceived social self-efficacy in this association. This study was developed as a secondary data analysis using the data sampled from the 2016 Health and Retirement Study in USA. The sample comprised 9,944 individuals aged between 65 and 107 years (mean = 75.94, SD = 7.70; 59.4% females). Using a multi-item survey questionnaire, frequent participation in volunteer youth work and charity work, loneliness, perceived control, and social self-efficacy were assessed. To examine the mediating effects of perceived control and social self-efficacy on the association between volunteer work and loneliness, the bootstrapping technique was performed. The study's findings put forward a need to develop policy provisions that facilitate supporting systems and organizations for life-long education and recruitment of older volunteers. Community-based organizations should create and promote volunteer opportunities in older adults, thereby alleviating later-life loneliness. Two forms of volunteer works, namely, volunteer youth work and charity work, significantly predicted perceived control, social self-efficacy, and lower levels of loneliness. Perceived control and social self-efficacy appeared to significantly mediate the relationship between volunteer activities and loneliness.

VL - 26 IS - 6 ER - TY - JOUR T1 - Volunteering Dynamics and Life Satisfaction: Self-Perceptions of Aging as a Buffer. JF - The Journals of Gerontology: Series B Y1 - 2022 A1 - Huo, Meng A1 - Kim, Kyungmin KW - age stereotype KW - cessation KW - Subjective well-being KW - volunteer AB -

OBJECTIVES: Research has extensively documented the concurrent benefits of being a volunteer (versus a non-volunteer), but little is known about older adults who once served as a volunteer but then stopped at some point in their lives (i.e., former volunteers). The current study tracked changes in older adults' overall life satisfaction and compared these changes among former volunteers, continuous volunteers, and continuous non-volunteers. We also examined whether self-perceptions of aging may serve as a long-term psychological buffer and protect former volunteers' life satisfaction after they quit volunteering.

METHOD: Data were from the Health and Retirement Study (2006-2016). A pooled sample of participants age 50+ (N = 10,441) indicated volunteer behaviors every other year, and we identified volunteering dynamics based on their volunteering history across 4 waves (8 years). Participants reported on self-perceptions of aging and life satisfaction in the Leave Behind Questionnaire once every 4 years.

RESULTS: Continuous volunteers reported greater subsequent life satisfaction than former volunteers and continuous non-volunteers 4 years later, when we adjusted for their baseline life satisfaction. Yet, the difference between continuous volunteers and former volunteers was absent among participants with more positive self-perceptions of aging.

DISCUSSION: This study reveals a potential discontinuity in the benefits of volunteering as older adults transition out of their volunteer activities. Findings, however, also reveal individual differences by self-perceptions of aging, offering suggestive evidence that may refine interventions to prolong the benefits of volunteering.

VL - 72 IS - 2 ER - TY - JOUR T1 - Validation of self-reported incident cancer diagnoses in the U.S. Health and Retirement Study: A tool for population-based cancer and aging research. JF - Journal of Clinical Oncology Y1 - 2021 A1 - Megan Mullins A1 - Jasdeep S Kler A1 - Eastman, Marissa A1 - Mohammed U Kabeto A1 - Lauren P Wallner A1 - Lindsay C Kobayashi KW - biomarker data KW - cancer diagnoses KW - Medicare KW - self-report AB - Background: Population aging and improving cancer survival rates are resulting in a growing population of older cancer survivors in the United States (US). As a result, there is an increasing need for longitudinal, population-representative data for interdisciplinary cancer research among older adults. The US Health Retirement Study (HRS) is an ongoing population-representative cohort of US adults over age 50 that contains rich interview and biomarker data on health during aging. Interviews have collected self-reported cancer diagnoses since 1998, but these self-reports have not been validated. We compared first incident cancer diagnoses self-reported in HRS interviews against diagnostic claims from linked Medicare records. Methods: We examined the validity of first incident cancer diagnoses self-reported in biennial HRS interviews from 2000 through 2016 against ICD-9 and ICD-10 diagnostic claim records among 8,242 HRS participants aged ≥65 with 90% continuous enrollment in fee-for-service Medicare, using the claim records as the gold standard. We calculated the sensitivity, specificity, and k for first incident cancer diagnoses (all cancers combined, excluding non-melanoma skin cancer, and each of bladder, breast, colorectal/anal, uterine, kidney/renal, lung/bronchus, and prostate cancers) cumulatively over the follow-up, and at each biennial study interview. Results: Self-reports of first incident cancer diagnosis (agnostic of site) between 2000 and 2016 had 73.2% sensitivity and 96.2% specificity against Medicare claims (k = 0.73). For site-specific self-reports, sensitivities ranged from 44.7% (kidney) to 75.0% (breast), and specificities ranged from 99.2% (prostate) to 99.9% (bladder, uterine, and kidney). Results were similar in sensitivity analyses restricting to individuals with 100% continuous fee-for-service Medicare enrollment and when restricting to individuals with at least 24 months of Medicare enrollment. Conclusions: Self-reported cancer diagnoses in the HRS have reasonable validity for population-based research on cancer and aging across cancer types. Apart from breast cancer, cancer site specific analyses will greatly benefit from the improved validity of self-report with Medicare claim linkage. VL - 39 IS - 28_suppl ER - TY - JOUR T1 - Validation of Self-Reported Rheumatoid Arthritis Using Medicare Claims: A Nationally Representative Longitudinal Study of Older Adults. JF - ACR Open Rheumatology Y1 - 2021 A1 - Booth, Michael J A1 - Daniel Clauw A1 - Mary R Janevic A1 - Lindsay C Kobayashi A1 - John D Piette KW - Medicare claims KW - rheumatoid arthritis KW - self reported AB -

OBJECTIVE: To determine the validity of self-reported physician diagnosis of rheumatoid arthritis (RA) using multiple gold-standard measures based on Medicare claims in a nationally representative sample of older adults and to verify whether additional questions about taking medication and having seen a physician in the past two years for arthritis can improve the positive predictive value (PPV) and other measures of the validity of self-reported RA.

METHODS: A total of 3768 Medicare-eligible respondents with and without incident self-reported RA were identified from the 2004, 2008, and 2012 waves of the United States Health and Retirement Study. Self-reported RA was validated using the following three claims-based algorithms: 1) a single International Classification of Diseases, ninth edition, Clinical Modification claim for RA, 2) two or more claims no greater than 2 years apart, and 3) two or more claims with at least one diagnosis by a rheumatologist. Additional self-report questions of medication use and having seen a doctor for arthritis in the past two years were validated against the same criteria.

RESULTS: A total of 345 respondents self-reported a physician diagnosis of RA. Across all three RA algorithms, the PPV of self-report ranged from 0.05 to 0.16., the sensitivity ranged from 0.23 to 0.55., and the κ statistic ranged from 0.07 to 0.15. Additional self-report data regarding arthritis care improved the PPV and other validity measures of self-report; however, the values remained low.

CONCLUSION: Most older adults who self-report RA do not have a Medicare claims history consistent with that diagnosis. Revisions to current self-reported RA questions may yield more valid identification of RA in national health surveys.

VL - 3 IS - 4 ER - TY - JOUR T1 - Verbal memory is associated with adherence to COVID-19 protective behaviors in community dwelling older adults. JF - Aging Clinical and Experimental Research Y1 - 2021 A1 - O'Shea, Deirdre M A1 - Davis, Jennifer D A1 - Tremont, Geoffrey KW - Adherence KW - Aging KW - community living KW - COVID-19 KW - Memory AB -

BACKGROUND: Adherence to protective behaviors is central to limiting the spread of COVID-19 and associated risk of serious illness and mortality in older populations. Whether cognition predicts adherence to protective behaviors has not been examined in older adults.

AIMS: To examine whether specific cognitive abilities predict adherence to COVID-19 protective behaviors in older adults, independent of other relevant factors.

METHODS: Data from 431 older adults (i.e., ≥ 65 years) who took part in the COVID-19 module of the Health and Retirement Study were included in the present study. Separate binary logistic regression models were used to examine whether performance on measures of immediate and delayed recall and working memory predicted adherence to COVID-19 protective behaviors, controlling for demographics, level of COVID-19 concern, depressive symptoms, and medical conditions.

RESULTS: For every unit increase in immediate and delayed recall, the probability of adhering to COVID-19 protective behaviors increased by 47% and 69%, respectively. There was no association between the measure of working memory and adherence.

DISCUSSION: It is of public interest to understand the factors that reduce adherence to protective behaviors so that we can better protect those most vulnerable and limit community spread. Our findings demonstrate that reduced memory predicts non-adherence to COVID-19 protective behaviors, independent of virus concern, and other relevant demographic and health factors.

CONCLUSIONS: Public health strategies aimed at increasing adherence to COVID-19 protective behaviors in community dwelling older adults, should account for the role of reduced cognitive function in limiting adherence.

VL - 33 IS - 7 ER - TY - JOUR T1 - Volunteering as an Equalizer: A Quasi-Experimental Study Using Propensity Score Analysis JF - American Journal of Preventive Medicine Y1 - 2021 A1 - Kim, Seoyoun A1 - Cal J. Halvorsen KW - health KW - Volunteering KW - Wealth AB - Formal volunteering in later life is beneficial for both physical and psychological well-being. However, research points to potential selection bias because older adults with key advantages, such as wealth, are more likely to volunteer and reap its benefits. Accordingly, this study addresses this selection bias by considering the characteristics of volunteers and nonvolunteers using the inverse probability of treatment weighting. It also examines whether volunteering has differential impacts between the highest and lowest wealth quintiles using inverse probability of treatment weighting. Methods Data were analyzed from the 2004–2016 waves of the Health and Retirement Study (N=90,881). The weights, created using a machine learning method, were incorporated in the analysis to estimate the treatment effects along with relevant covariates. Analyses were conducted in 2020. Results Volunteering enhanced self-reported health and reduced depressive symptoms in the full sample. Furthermore, those in the lowest wealth quintile experienced significantly better self-reported health from volunteering than their wealthy counterparts. Volunteering was associated with fewer depressive symptoms regardless of wealth status. Conclusions The study enhances the understanding of formal volunteering and health while suggesting that volunteers with low wealth may benefit more from volunteering in terms of their health. Hindrances to volunteering among the least wealthy, such as financial distress, discrimination, or lack of organizational support, may attenuate the benefits of voluntary activity. VL - 61 IS - 5 ER - TY - JOUR T1 - Volunteering, Self-Perceptions of Aging, and Mental Health in Later Life. JF - Gerontologist Y1 - 2021 A1 - Huo, Meng A1 - Miller, Lisa M Soederberg A1 - Kim, Kyungmin A1 - Liu, Siwei KW - age stereotype KW - depression KW - Subjective aging KW - volunteer AB -

BACKGROUND AND OBJECTIVES: Scholars argue that volunteering enhances social, physical, and cognitive activities that are increasingly valued as people age, which in turn improves older adults' well-being via a host of psychosocial and neurobiological mechanisms. This study explicitly tested older adults' self-perceptions of aging as a mechanism underlying the mental health benefits of volunteering.

RESEARCH DESIGN AND METHODS: Using 2-wave data from the Health and Retirement Study (2008/2010 for Wave 1 and 2012/2014 for Wave 2), we analyzed reports from a pooled sample of older adults aged 65+ (N = 9,017). Participants reported on demographic characteristics, volunteer work (did not volunteer, 1-99 hours per year, 100+ hours per year), self-perceptions of aging, and depressive symptoms. We estimated an autoregressive cross-lagged panel model.

RESULTS: Volunteering for 100 hours or more per year was associated with older adults' more positive and less negative self-perceptions of aging in the subsequent wave (i.e., 4 years later), which in turn predicted fewer depressive symptoms.

DISCUSSION AND IMPLICATIONS: This study suggests the promising role of volunteering in shaping older adults' self-perceptions of aging on a sustained basis and refines our understanding of the benefits volunteering brings. Findings shed light on future interventions aimed at improving older adults' adjustment to age-related changes and lessening ageism in society.

VL - 61 IS - 7 ER - TY - JOUR T1 - Volunteering Served as a Transitional Role That Enhances the Well-Being and Cognitive Health Among Older Adults With Cognitive Impairments. JF - Journal of Applied Gerontology Y1 - 2021 A1 - Lee, Kathy A1 - Dabelko-Schoeny, Holly A1 - Virginia E. Richardson KW - community KW - Psychosocial KW - Self-rated health KW - social engagement AB -

OBJECTIVES: We examined whether volunteering among older adults with cognitive impairments serves as a transitional role that can enhance these older persons' well-being and cognitive health.

METHODS: Using data from the Health and Retirement Study, we selected older adults with cognitive impairments ( = 472) and developed linear mixed models to assess associations between volunteering and health outcomes.

RESULTS: Volunteers in our sample were mostly females, non-Hispanic whites, those with higher income, and those with a high-school diploma. Volunteering was associated with higher levels of self-rated health, and consistent participation in volunteer work was related to stronger feelings of purpose in life. Cognitive health slightly improved over time only among those who volunteered.

DISCUSSION: We demonstrate that cognitive impaired older adults' participation in the volunteer role can benefit cognitive health while strengthening their late life resilience.

VL - 40 IS - 11 ER - TY - JOUR T1 - Validation of a hybrid approach to standardize immunophenotyping analysis in large population studies: The Health and Retirement Study JF - Scientific Reports Y1 - 2020 A1 - Hunter-Schlichting, DeVon A1 - Lane, John A1 - Cole, Benjamin A1 - Flaten, Zachary A1 - Barcelo, Helene A1 - Ramasubramanian, Ramya A1 - Cassidy, Erin A1 - Jessica Faul A1 - Eileen M. Crimmins A1 - Pankratz, Nathan A1 - Bharat Thyagarajan KW - Bioinformatics KW - high-throughput screening AB - Traditional manual gating strategies are often time-intensive, place a high burden on the analyzer, and are susceptible to bias between analyzers. Several automated gating methods have shown to exceed performance of manual gating for a limited number of cell subsets. However, many of the automated algorithms still require significant manual interventions or have yet to demonstrate their utility in large datasets. Therefore, we developed an approach that utilizes a previously published automated algorithm (OpenCyto framework) with a manually created hierarchically cell gating template implemented, along with a custom developed visualization software (FlowAnnotator) to rapidly and efficiently analyze immunophenotyping data in large population studies. This approach allows pre-defining populations that can be analyzed solely by automated analysis and incorporating manual refinement for smaller downstream populations. We validated this method with traditional manual gating strategies for 24 subsets of T cells, B cells, NK cells, monocytes and dendritic cells in 931 participants from the Health and Retirement Study (HRS). Our results show a high degree of correlation (r ≥ 0.80) for 18 (78%) of the 24 cell subsets. For the remaining subsets, the correlation was low (<0.80) primarily because of the low numbers of events recorded in these subsets. The mean difference in the absolute counts between the hybrid method and manual gating strategy of these cell subsets showed results that were very similar to the traditional manual gating method. We describe a practical method for standardization of immunophenotyping methods in large scale population studies that provides a rapid, accurate and reproducible alternative to labor intensive manual gating strategies. VL - 10 SN - 2045-2322 IS - 1 ER - TY - JOUR T1 - Valuing pain using the subjective well-being method JF - Economics & Human Biology Y1 - 2020 A1 - Thorhildur Ólafsdóttir A1 - Tinna Laufey Ásgeirsdóttir A1 - Edward C Norton KW - Compensating variation KW - pain KW - Subjective well-being method KW - Value KW - Willingness-To-Pay AB - Chronic pain clearly lowers utility, but valuing the reduction in utility is empirically challenging. Here, we use improvements over prior applications of the subjective well-being method to estimate the implied trade-off between pain and income using four waves of the Health and Retirement Study (2008-2014), a nationally representative survey on individuals age 50 and older. We model income with a flexible functional form, allowing the trade-off between pain and income to vary across income groups. We control for individual fixed effects in the life-satisfaction equations and instrument for income in some models. We find values for avoiding pain ranging between 56–145 USD per day. These results are lower than previously reported and suggest that the higher previous estimates may be heavily affected by the highest income level and confounded by endogeneity in the income variable. As expected, we find that the value of pain relief increases with pain severity. VL - 37 ER - TY - RPRT T1 - VC-BART: Bayesian trees for varying coefficients Y1 - 2020 A1 - Deshpande, Sameer K. A1 - Bai, Ray A1 - Balocchi, Cecilia A1 - Starling, Jennifer E. A1 - Weiss, Jordan KW - Cognition KW - Methodology KW - socioeconomics AB - Many studies have reported associations between later-life cognition and socioeconomic position in childhood, young adulthood, and mid-life. However, the vast majority of these studies are unable to quantify how these associations vary over time and with respect to several demographic factors. Varying coefficient (VC) models, which treat the covariate effects in a linear model as nonparametric functions of additional effect modifiers, offer an appealing way to overcome these limitations. Unfortunately, state-of-the-art VC modeling methods require computationally prohibitive parameter tuning or make restrictive assumptions about the functional form of the covariate effects. In response, we propose VCBART, which estimates the covariate effects in a VC model using Bayesian Additive Regression Trees. With simple default hyperparameter settings, VCBART outperforms existing methods in terms of covariate effect estimation and prediction. Using VCBART, we predict the cognitive trajectories of 4,167 subjects from the Health and Retirement Study using multiple measures of socioeconomic position and physical health. We find that socioeconomic position in childhood and young adulthood have small effects that do not vary with age. In contrast, the effects of measures of mid-life physical health tend to vary with respect to age, race, and marital status. PB - Cornell University CY - Ithaca, NY UR - https://arxiv.org/abs/2003.06416 ER - TY - JOUR T1 - Vision and Hearing Impairments in Relation to Disability-Free Life Expectancy in People From England and the United States JF - Innovation in Aging Y1 - 2020 A1 - Zaninotto, Paola A1 - Giorgio Di Gessa A1 - Head, Jenny KW - disability-free life expectancy KW - Hearing impairment KW - vision impairment AB - Both hearing and vision impairments are some of the most common deficits experienced by older adults. We examined the impact of self-reported vision and hearing impairments on disability-free life expectancy (DFLE). We used harmonized data from the Gateway to Global Aging Data from the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA). We used discrete-time multistate life table models to estimate disability-free life expectancy by sex, age and country. In both countries and at all ages either vision or hearing impairment was associated with shorter DFLE compared to those who reported no impairments. Reporting both vision and hearing impairments reduced DFLE. For example, at the age of 50, men and women with both vision and hearing impairments could expect to live up to 12 fewer years free from disability compared with men and women with no impairments, similar results were found in both countries. VL - 4 SN - 2399-5300 IS - Suppl 1 ER - TY - JOUR T1 - Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach JF - American Journal of Preventive Medicine Y1 - 2020 A1 - Eric S Kim A1 - Whillans, Ashley V. A1 - Lee, Matt A1 - Ying Chen A1 - Tyler J VanderWeele KW - Prosocial Behavior KW - Volunteering KW - Well-being AB - Growing evidence documents strong associations between volunteering and favorable health and well-being outcomes. However, epidemiological studies have not evaluated whether changes in volunteering are associated with subsequent health and well-being outcomes. VL - 59 UR - https://www.hbs.edu/faculty/Pages/item.aspx?num=57873 IS - 2 ER - TY - JOUR T1 - Volunteering, polygenic risk for Alzheimer's disease, and cognitive functioning among older adults JF - Social Science & Medicine Y1 - 2020 A1 - Sae Hwang Han A1 - J Scott Roberts A1 - Jan E Mutchler A1 - Jeffrey A Burr KW - cognitive aging KW - Cognitive decline KW - Dementia KW - Health intervention KW - Prosocial Behavior KW - social engagement KW - Social integration AB - Objective In the context of the public health burden posed by increases in Alzheimer’s Disease (AD) prevalence around the globe and the related research efforts to identify modifiable risk factors for the disease, we sought to provide an empirical test of earlier claims that volunteering may be considered as a health intervention that could help to prevent or delay the onset of AD. Method Using nine waves of panel data from the U.S. Health and Retirement Study (n=9,697), we examined whether volunteering conferred cognitive health benefits in later life and whether volunteering served a gene-regulatory function to help alleviate cognitive decline associated with polygenic risk for AD. Multilevel models were used to estimate associations between volunteering, polygenic risk for AD, and cognitive functioning over time. Results We found robust within-person associations between volunteering (assessed as volunteer status and time commitment) and cognitive functioning over time, such that volunteering was associated with higher levels of cognitive functioning and slower cognitive decline. The findings also provided evidence that the within-person associations for volunteering and cognitive decline were more pronounced for older adults at higher genetic risk for developing AD. Conclusions Our findings are in line with a growing body of theoretical frameworks and empirical evidence suggesting that prosocial behaviors are directly associated with biological systems and may modify gene regulation to confer health benefits. The analytic approach taken in this study also provided a useful framework for investigating the effectiveness of other modifiable risk factors that vary over time in the context of cognitive decline related to genetic risk for AD. VL - 253 UR - https://www.ncbi.nlm.nih.gov/pubmed/32278238 ER - TY - JOUR T1 - Validation of a Claims-Based Frailty Index Against Physical Performance and Adverse Health Outcomes in the Health and Retirement Study. JF - Journals of Gerontology, Series A: Biological Sciences and Medical Sciences Y1 - 2019 A1 - Dae H Kim A1 - Robert J Glynn A1 - Avorn, Jerry A1 - Lewis A Lipsitz A1 - Rockwood, Kenneth A1 - Pawar, Ajinkya A1 - Schneeweiss, Sebastian KW - Frailty KW - Medicare expenditures KW - Medicare linkage KW - Medicare/Medicaid/Health Insurance AB -

Background: A claims-based frailty index (CFI) was developed based on a deficit-accumulation approach using self-reported health information. This study aimed to independently validate the CFI against physical performance and adverse health outcomes.

Methods: This retrospective cohort study included 3,642 community-dwelling older adults who had at least 1 health care encounter in the year prior to assessments of physical performance in the 2008 Health and Retirement Study wave. A CFI was estimated from Medicare claims data in the past year. Gait speed, grip strength, and the 2-year risk of death, institutionalization, disability, hospitalization, and prolonged (>30 days) skilled nursing facility stay were evaluated for CFI categories (robust: <0.15, pre-frail: 0.15-0.24, mildly frail: 0.25-0.34, moderate-to-severely frail: ≥0.35).

Results: The prevalence of robust, pre-frail, mildly frail, and moderate-to-severely frail state was 52.7%, 38.0%, 7.1%, and 2.2%, respectively. Individuals with higher CFI had lower mean gait speed (moderate-to-severely frail vs robust: 0.39 vs 0.78 m/sec) and weaker grip strength (19.8 vs 28.5 kg). Higher CFI was associated with death (moderate-to-severely frail vs robust: 46% vs 7%), institutionalization (21% vs 5%), activity-of-daily-living disability (33% vs 9%), instrumental-activity-of-daily-living disability (100% vs 22%), hospitalization (79% vs 23%), and prolonged skilled nursing facility stay (17% vs 2%). The odds ratios per 1-standard deviation (=0.07) difference in CFI were 1.46-2.06 for these outcomes, which remained statistically significant after adjustment for age, sex, and a comorbidity index.

Conclusion: The CFI is useful to identify individuals with poor physical function and at greater risks of adverse health outcomes in Medicare data.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/30165612?dopt=Abstract ER - TY - JOUR T1 - Variability of Pain Outcomes and Physical Activity Among a Diverse Sample of Older Men: Is It More Than Just Race? JF - GERONTOLOGY AND GERIATRIC MEDICINE Y1 - 2019 A1 - Tamara A. Baker A1 - Elizabeth Vasquez A1 - Minahan, Jacquelyn A. KW - older men KW - pain KW - Physical activity KW - race AB - There is a compendium of data documenting the increasing number of older adults. This suggests the continued need to understand identified health outcomes across domains of pain and physical activity, particularly among older men. Therefore, the aim of this study was to evaluate race similarities and/or differences in pain and rates of physical activity among White, Black, and Hispanic men 60+ years of age. Data were taken from the Health and Retirement Study, a longitudinal panel study surveying a representative sample of people in the United States. Logistic regression analysis was used to examine associations between race and pain and the odds of regular physical activity. Results showed that Black men were less likely to participate in light or moderate/vigorous physical activity. Similarly, pain increased the odds of physical activity among Hispanics, but decreased the odds of physical activity among White men. Findings may reflect a number of factors that impact the well-being of what it means to experience pain and physical functioning, while also assuming a masculine identity. This perspective may allow for a better understanding of short- and long-term implications of the pain experience and the pain and physical functioning dyad among this group of men. VL - 5 ER - TY - JOUR T1 - Verbal fluency and risk of dementia. JF - International Journal of Geriatric Psychiatry Y1 - 2019 A1 - Angelina R Sutin A1 - Yannick Stephan A1 - Antonio Terracciano KW - Alzheimer's disease KW - Cognition & Reasoning AB -

OBJECTIVE: Verbal fluency is a common neuropsychological test that is impaired in dementia. We test whether verbal fluency is a prospective risk factor for incident dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia.

METHODS: Participants (N = 18 189) from the Health and Retirement Study were administered a standard test of verbal fluency and were assessed for cognitive status every 2 years between baseline and 6 years' follow-up.

RESULTS: Every standard deviation increase in verbal fluency was associated with an approximately 60% reduced risk of incident dementia, an approximately 25% reduced risk of incident CIND, and an approximately 25% reduced risk of conversion from CIND to dementia. These associations were independent of age, gender, education, race, ethnicity, and APOE risk status. The associations were slightly weaker (but still significant) for African Americans and individuals with lower education. There was no interaction between verbal fluency and APOE risk status.

CONCLUSION: Verbal fluency is an easily administered task that is predictive of incident cognitive impairment.

VL - 34 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30729575?dopt=Abstract ER - TY - JOUR T1 - Visual and hearing impairments are associated with cognitive decline in older people. JF - Age and Ageing Y1 - 2018 A1 - Maharani, Asri A1 - Dawes, Piers A1 - James Nazroo A1 - Tampubolon, Gindo A1 - Pendleton, Neil KW - Cognitive Ability KW - Cross-National KW - GWAS KW - Hearing loss KW - Visual function AB -

Introduction: highly prevalagent hearing and vision sensory impairments among older people may contribute to the risk of cognitive decline and pathological impairments including dementia. This study aims to determine whether single and dual sensory impairment (hearing and/or vision) are independently associated with cognitive decline among older adults and to describe cognitive trajectories according to their impairment pattern.

Material and methods: we used data from totals of 13,123, 11,417 and 21,265 respondents aged 50+ at baseline from the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE), respectively. We performed growth curve analysis to identify cognitive trajectories, and a joint model was used to deal with attrition problems in longitudinal ageing surveys.

Results: respondents with a single sensory impairment had lower episodic memory score than those without sensory impairment in HRS (β = -0.15, P < 0.001), ELSA (β= -0.14, P< 0.001) and SHARE (β= -0.26, P < 0.001). The analysis further shows that older adults with dual sensory impairment in HRS (β= -0.25, P < 0.001), ELSA (β= -0.35, P< 0.001) and SHARE (β= -0.68, P < 0.001) remembered fewer words compared with those with no sensory impairment. The stronger associations between sensory impairment and lower episodic memory levels were found in the joint model which accounted for attrition.

Conclusions: hearing and/or vision impairments are a marker for the risk of cognitive decline that could inform preventative interventions to maximise cognitive health and longevity. Further studies are needed to investigate how sensory markers could inform strategies to improve cognitive ageing.

VL - 47 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29697748?dopt=Abstract ER - TY - ICOMM T1 - Volunteering 2 hours a week can help ease loneliness, study finds Y1 - 2018 A1 - Pawlowski, A. KW - Loneliness KW - News KW - Volunteerism JF - TODAY PB - Today CY - New York City UR - https://www.today.com/home/should-you-rinse-your-dishes-you-put-them-dishwasher-t129325 ER - TY - ICOMM T1 - Volunteering has some surprising health benefits. Here's how to find the right project for you. Y1 - 2018 A1 - Sarah DiGiulio KW - News KW - Volunteerism JF - NBCNews.com PB - NBC CY - New York City VL - 2018 UR - https://www.nbcnews.com/better/pop-culture/volunteering-has-some-surprising-health-benefits-here-s-how-find-ncna932196 ER - TY - THES T1 - Volunteering Helps Unemployed Older Workers' Mental Health: How, Why, and Does It Work for All? T2 - Social Work Y1 - 2018 A1 - Jie Yang KW - 0452:Social work KW - health KW - Helps KW - Mental KW - Older KW - Social Sciences KW - Social work KW - Unemployed KW - Volunteering KW - Work KW - Workers AB - Despite the fact that older workers (50+) are much overrepresented among the long-term unemployed and often suffer from multiple mental health problems, the social work literature has rarely tackled this issue. In my dissertation, guided by Jahoda’s Latent Deprivation Theory and the productive aging framework, I examined the positive coping strategies of unemployed older workers. I set out to understand whether engaging in formal volunteering in an organization would buffer the negative impact of unemployment on older workers’ mental health. I also fill out the gap in the literature regarding the mechanism of the positive effect of volunteering on mental health by examining two latent benefits from working as mediators: purpose in life and perceived social status. I used fixed effects modeling for the moderation analysis. I analyzed six waves (12 years) of longitudinal data from the Health and Retirement Study (HRS). I used structural equation modeling and analyzed two waves of HRS for the mediation analysis. I used full information maximum likelihood method to handle missing values. I found that there was a significant moderation between engaging in formal volunteering and unemployment status on older workers’ depressive symptoms. Unemployed older workers who engaged in volunteering fared better than those unemployed workers who did not volunteer. Consistent with previous studies using the HRS, I also found that those unemployed older workers who volunteered over 200 hours/year did not benefit from volunteering compared to those volunteered under 100 hours/year. Mediation analysis results showed that perceived social status and purpose in life mediate the protective effect of volunteering. Both the moderation and mediation results varied by race and ethnicity. Results from this dissertation have important implications for future intervention development. For example, interventions targeting the unemployed older workers may incorporate formal volunteering as one element for participants to gain social contact, purpose in life, and enhance perceived social status. Interventions can also create an environment that mirrors an office to enhance these latent benefits (mediators) in order to improve mental health. JF - Social Work PB - Boston College VL - PhD SN - 9780438245907 UR - https://dlib.bc.edu/islandora/object/bc-ir:108094 N1 - Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-08-28 ER - TY - JOUR T1 - Validating the 11-Item Revised University of California Los Angeles Scale to Assess Loneliness Among Older Adults: An Evaluation of Factor Structure and Other Measurement Properties. JF - American Journal of Geriatric Psychiatry Y1 - 2017 A1 - Lee, Joonyup A1 - John G. Cagle KW - Depressive symptoms KW - Loneliness KW - R-UCLA KW - Survey Methodology AB -

OBJECTIVE: To examine the measurement properties and factor structure of the short version of the Revised University of California Los Angeles (R-UCLA) loneliness scale from the Health and Retirement Study (HRS).

METHODS: Based on data from 3,706 HRS participants aged 65 + who completed the 2012 wave of the HRS and its Psychosocial Supplement, the measurement properties and factorability of the R-UCLA were examined by conducting an exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) on randomly split halves.

RESULTS: The average score for the 11-item loneliness scale was 16.4 (standard deviation: 4.5). An evaluation of the internal consistency produced a Cronbach's α of 0.87. Results from the EFA showed that two- and three-factor models were appropriate. However, based on the results of the CFA, only a two-factor model was determined to be suitable because there was a very high correlation between two factors identified in the three-factor model, available social connections and sense of belonging.

CONCLUSION: This study provides important data on the properties of the 11-item R-UCLA scale by identifying a two-factor model of loneliness: feeling isolated and available social connections. Our findings suggest the 11-item R-UCLA has good factorability and internal reliability.

VL - 25 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28864097?dopt=Abstract ER - TY - JOUR T1 - Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study. JF - PLoS One Y1 - 2017 A1 - Anusha M Vable A1 - Paola Gilsanz A1 - Thu T Nguyen A1 - Ichiro Kawachi A1 - M. Maria Glymour KW - Childhood adversity KW - Meta-analyses KW - Socioeconomic factors KW - Validation AB - Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992-2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was <16 years (at least 34 years prior). We assessed internal consistency reliability (Cronbach's alpha) for the scales (cSC and cFC), and construct validity, and predictive validity for all measures. Validity was assessed with hypothesized correlates of cSES (educational attainment, measured adult height, self-reported childhood health, childhood learning problems, childhood drug and alcohol problems). We then compared the performance of our validated measures with other indices used in HRS in predicting self-rated health and number of depressive symptoms, measured in 2010. Internal consistency reliability was acceptable (cSC = 0.63, cFC = 0.61). Most measures were associated with hypothesized correlates (for example, the association between educational attainment and cSC was 0.01, p < 0.0001), with the exception that measured height was not associated with cFC (p = 0.19) and childhood drug and alcohol problems (p = 0.41), and childhood learning problems (p = 0.12) were not associated with cHC. Our measures explained slightly more variability in self-rated health (adjusted R2 = 0.07 vs. <0.06) and number of depressive symptoms (adjusted R2 > 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes. VL - 12 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29028834?dopt=Abstract ER - TY - JOUR T1 - Validation of abridged mini-mental state examination scales using population-based data from Sweden and USA JF - European Journal of Ageing Y1 - 2017 A1 - Ericsson, Malin Christina A1 - Margaret Gatz A1 - Kåreholt, Ingemar A1 - Parker, Marti G. A1 - Fors, Stefan KW - Cognitive Ability KW - Cross-National KW - Older Adults AB - The objective of this study is to validate two abridged versions of the mini-mental state examination (MMSE): one intended for use in face-to-face interviews, and the other developed for telephonic interviews, using data from Sweden and the US to validate the abridged scales against dementia diagnoses as well as to compare their performance to that of the full MMSE scale. The abridged versions were based on eight domains from the original MMSE scale. The domains included in the MMSE-SF were registration, orientation, delayed recall, attention, and visual spatial ability. In the MMSE-SF-C, the visual spatial ability item was excluded, and instead, one additional orientation item was added. There were 794 participants from the Swedish HARMONY study [mean age 81.8 (4.8); the proportion of cognitively impaired was 51 %] and 576 participants from the US ADAMS study [mean age 83.2 (5.7); the proportion of cognitively impaired was 65 %] where it was possible to compare abridged MMSE scales to dementia diagnoses and to the full MMSE scale. We estimated the sensitivity and specificity levels of the abridged tests, using clinical diagnoses as reference. Analyses with both the HARMONY and the ADAMS data indicated comparable levels of sensitivity and specificity in detecting cognitive impairment for the two abridged scales relative to the full MMSE. Receiver operating characteristic curves indicated that the two abridged scales corresponded well to those of the full MMSE. The two abridged tests have adequate validity and correspond well with the full MMSE. The abridged versions could therefore be alternatives to consider in larger population studies where interview length is restricted, and the respondent burden is high. VL - 14 UR - https://link.springer.com/article/10.1007/s10433-016-0394-z IS - 2 JO - Eur J Ageing ER - TY - RPRT T1 - Valuing pain using the subjective well-being method Y1 - 2017 A1 - Thorhildur Ólafsdóttir A1 - Tinna Laufey Ásgeirsdóttir A1 - Edward C Norton KW - Chronic pain KW - Consumption and Savings KW - Well-being AB - Chronic pain clearly lowers utility, but it is empirically challenging to estimate the monetary compensation needed to offset this utility reduction. We use the subjective well-being method to estimate the value of pain relief among individuals age 50 and older. We use a sample of 64,205 observations from 4 waves (2008-2014) of the Health and Retirement Study, a nationally representative individual-level survey data, permitting us to control for individual heterogeneity. Our models, which allow for nonlinear effects in income, show the value of avoiding pain ranging between 56 to 145 USD per day. These results are lower than previously reported, suggesting that the value of pain relief varies by income levels. Thus, previous estimates of the value of pain relief assuming constant monetary compensation for pain across income levels are heavily affected by the highest income level. Furthermore, we find that the value of pain relief increases with pain severity. JF - NBER Working Paper Series PB - National Bureau of Economic Research CY - Cambridge, MA UR - http://www.nber.org/papers/w23649.pdf ER - TY - RPRT T1 - Venous Blood Collection and Assay Protocol in the 2016 Health and Retirement Study Y1 - 2017 A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Bharat Thyagarajan A1 - David R Weir PB - Survey Research Center, Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan ER - TY - JOUR T1 - Validating a summary measure of weight history for modeling the health consequences of obesity. JF - Ann Epidemiol Y1 - 2016 A1 - Andrew C. Stokes A1 - Ni, Yu KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Body Weight KW - Chronic disease KW - Female KW - Health Surveys KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Obesity KW - Self Report KW - United States AB -

PURPOSE: Data on weight history may enhance the predictive validity of epidemiologic models of the health risks of obesity, but collecting such data is often not feasible. In this study, we investigate the validity of a summary measure of weight history.

METHODS: We evaluated the quality of reporting of maximum weight in a sample of adults aged 50-84 years using data from the Health and Retirement Study. Recalled max body mass index (BMI, measured in kilogram per square meter) based on recalled weight in 2004 was compared with calculated max BMI based on self-reported weight collected biennially between 1992 and 2004. Logistic regression was used to assess similarity between the measures in predicting prevalent conditions.

RESULTS: The correlation coefficient between recalled and calculated max weight in the overall sample was 0.95. Recalled max BMI value was within three BMI units of the calculated value 91.4% of the time. The proportions of individuals with obese I (BMI: 30.0-34.9), obese II (BMI: 35.0-39.9), and obese III (BMI: 40.0 and above) were 28.8%, 12.7%, and 6.6% using recalled values compared with 27.1%, 10.5%, and 4.9% using calculated values. In multivariate analyses, the two BMI measures similarly predicted disease prevalence across a number of chronic conditions.

CONCLUSIONS: Recalled max BMI was strongly correlated with max BMI calculated over the 12-year period before recall, suggesting that this measure can serve as a reliable summary measure of recent weight status.

VL - 26 UR - http://linkinghub.elsevier.com/retrieve/pii/S1047279716304070http://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/plain IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27894565?dopt=Abstract JO - Annals of Epidemiology ER - TY - RPRT T1 - Validating Mortality Ascertainment in the Health and Retirement Study Y1 - 2016 A1 - David R Weir AB - Accurate tracking of mortality is of central importance in longitudinal studies of older populations, both as an important health outcome and as a necessary part of accounting for the representativeness of the panel over time. For nationally representative studies where good population life tables exist the quality of mortality ascertainment can be validated by comparison with life tables. This is demonstrated here for the Health and Retirement Study (HRS), using both period and cohort comparisons from 1992-2011. Mortality ascertainment in the HRS is effectively complete. PB - Survey Research Center, Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan ER - TY - Generic T1 - The Value of the Health and Retirement Study for Health Economics Research Y1 - 2016 A1 - Courtney Coile A1 - Nicole Maestas KW - Health Economics PB - National Institute on Aging CY - Bethesda, MD ER - TY - BOOK T1 - Veterans’ Health T2 - The Civilian Lives of US Veterans: Issues and Identities [2 volumes] Y1 - 2016 A1 - Leitz, Lisa KW - Medicare/Medicaid/Health Insurance KW - Older Adults KW - Veterans JF - The Civilian Lives of US Veterans: Issues and Identities [2 volumes] ER - TY - JOUR T1 - Volunteering Is Associated with Lower Risk of Cognitive Impairment. JF - J Am Geriatr Soc Y1 - 2016 A1 - Frank J Infurna A1 - Morris A Okun A1 - Kevin J. Grimm KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Interviews as Topic KW - Male KW - Middle Aged KW - Risk Factors KW - United States KW - Volunteers AB -

OBJECTIVES: To examine whether psychosocial factors that can be a target for interventions, such as volunteering, are associated with risk of cognitive impairment.

DESIGN: Health and Retirement Study (HRS) data from 1998 to 2012, a nationally representative longitudinal panel survey of older adults assessed every 2 years, were used.

SETTING: The HRS interviews participants aged 50 and older across the contiguous United States.

PARTICIPANTS: Individuals aged 60 and older in 1998 (N = 13,262).

MEASUREMENTS: Personal interviews were conducted with respondents to assess presence of cognitive impairment, measured using a composite across cognitive measures.

RESULTS: Volunteering at the initial assessment and volunteering regularly over time independently decreased the risk of cognitive impairment over 14 years, and these findings were maintained independent of known risk factors for cognitive impairment. Greater risk of onset of cognitive impairment was associated with being older, being female, being nonwhite, having fewer years of education, and reporting more depressive symptoms.

CONCLUSION: Consistent civic engagement in old age is associated with lower risk of cognitive impairment and provides impetus for interventions to protect against the onset of cognitive impairment. Given the increasing number of baby boomers entering old age, the findings support the public health benefits of volunteering and the potential role of geriatricians, who can promote volunteering by incorporating "prescriptions to volunteer" into their patient care.

VL - 64 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27696342?dopt=Abstract ER - TY - JOUR T1 - Volunteering is prospectively associated with health care use among older adults JF - Social Science and Medicine Y1 - 2016 A1 - Eric S Kim A1 - Konrath, Sara H. KW - Adult children KW - Health Conditions and Status KW - Healthcare AB - lthough observational and experimental studies have shown that volunteering is linked with better mental health, physical health, and health behaviors, no studies have examined whether volunteering is associated with patterns of health care use. Objective The purpose of this study was to prospectively examine whether volunteering was associated with a greater use of preventive health care services, but fewer doctor visits and nights spent in the hospital. Methods Participants (n = 7168) were drawn from the 2006 wave of the Health and Retirement Study, a nationally representative panel study of American adults over the age of 51, and tracked for one wave (2 years). Logistic regression and generalized linear models were used for analyses. Results In analyses that adjusted for sociodemographic factors and baseline health, volunteers were 30 more likely to receive flu shots (OR = 1.30, 95 CI = 1.16 1.47), 47 more likely to receive cholesterol tests (OR = 1.47, 95 CI = 1.24 1.74); female volunteers were 53 more likely to receive mammograms/x-rays (OR = 1.53, 95 CI = 1.28 1.83) and 21 more likely to receive Pap smears (OR = 1.21, 95 CI = 1.03 1.41); male volunteers were 59 more likely to receive prostate exams (OR = 1.59, 95 CI = 1.29 1.95). In a model that adjusted for sociodemographic factors, volunteers spent 38 fewer nights in the hospital (RR = 0.62, 95 CI = 0.52 0.76), however volunteering was not associated with frequency of doctor visits (RR = 0.94, 95 CI = 0.87 1.02). The association between volunteering and number of nights spent in the hospital was minimally affected after adjusting for potential confounding (baseline health) and explanatory variables (health behaviors, social integration, stress, positive psychological factors, personality). Conclusion This is the first known study to examine the association between volunteering and health care use. If future studies replicate these findings, the results may be used to inform the development of new strategies for increasing preventive health screenings, lowering health care use and costs, and enhancing the health of older adults. PB - 149 VL - 149 UR - http://www.sciencedirect.com/science/article/pii/S0277953615302495 U4 - Volunteering/Volunteer/Health care use/Physician visits/Physician visits/Preventive health screening/Psychological/Aging ER - TY - JOUR T1 - Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort. JF - BMC Public Health Y1 - 2015 A1 - Hui Zheng A1 - Dmitry Tumin KW - Aged KW - Aged, 80 and over KW - Body Weight KW - Cohort Studies KW - ethnicity KW - Family Characteristics KW - Female KW - Health Behavior KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Male KW - Middle Aged KW - Obesity KW - Prospective Studies KW - Qualitative Research KW - Retirement KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

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

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

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

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

PB - 15 VL - 15 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84934903370andpartnerID=40andmd5=b19c15d412d4437881f0111906f49570 N1 - Export Date: 9 September 2015 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26088317?dopt=Abstract U2 - PMC4474348 U4 - Birth place/Early-life conditions/Gender/Life course/Mothers education/Obesity ER - TY - JOUR T1 - Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort JF - BMC Public Health Y1 - 2015 A1 - Hui Zheng A1 - Dmitry Tumin KW - Adult children KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status AB - Background: Studies have identified prenatal and early childhood conditions as important contributors to weight status in later life. To date, however, few studies have considered how weight status in adulthood is shaped by regional variation in early-life conditions, rather than the characteristics of the individual or their family. Furthermore, gender and life course differences in the salience of early life conditions to weight status remain unclear. This study investigates whether the effect of family background and birth region on adult obesity status varies by gender and over the life course. Methods: We used data from a population-based cohort of 6,453 adults from the Health and Retirement Study, 1992-2008. Early life conditions were measured retrospectively at and after the baseline. Obesity was calculated from self-reported height and weight. Logistic models were used to estimate the net effects of family background and birth region on adulthood obesity risk after adjusting for socioeconomic factors and health behaviors measured in adulthood. Four economic and demographic data sets were used to further test the birthplace effect. Results: At ages 50-61, mother's education and birth region were associated with women's obesity risk, but not men's. Each year's increase in mother's education significantly reduces the odds of being obese by 6 (OR = 0.94; 95 CI: 0.92, 0.97) among women, and this pattern persisted at ages 66-77. Women born in the Mountain region were least likely to be obese in late-middle age and late-life. Measures of per capita income and infant mortality rate in the birth region were also associated with the odds of obesity among women. Conclusions: Women's obesity status in adulthood is influenced by early childhood conditions, including regional conditions, while adulthood health risk factors may be more important for men's obesity risk. Biological and social mechanisms may account for the gender difference. PB - 15 VL - 15 IS - 1 U4 - Life course/Obesity/health status/Socioeconomic Status/body Mass Index/Early-life conditions/Gender/Mothers education/Birth place ER - TY - JOUR T1 - The Vicious Cycle of Parental Caregiving and Financial Well-being: A Longitudinal Study of Women JF - Journals of Gerontology Series B-Psychological Sciences and Social Sciences Y1 - 2015 A1 - Lee, Yeonjung A1 - Tang, Fengyan A1 - Kim, Kevin H. A1 - Steven M. Albert KW - Adult children KW - Healthcare KW - Net Worth and Assets KW - Women and Minorities AB - Objectives. This study examines the relationship between caring for older parents and the financial well-being of caregivers by investigating whether a reciprocal association, or vicious cycle, exists between female caregiver's lower household incomes and caring for elderly parents. Method. Data for women aged 51 or older with at least 1 living parent or parent-in-law were drawn from the Health and Retirement Survey 2006, 2008, and 2010 (N = 2,093). A cross-lagged panel design was applied with structural equation modeling. Results. We found support for the reciprocal relationship between parental caregiving and lower household income. Female caregivers were more likely than noncaregivers to be in lower household income at later observation points. Also, women with lower household income were more likely than women with higher household income to assume caregiving at later observation points. Discussion. This study suggests that there exists a vicious cycle of parental care and lower household income among women. A key concern for policy is female caregivers' financial status when care of older parents is assumed and care burden when women's financial status declines. PB - 70 VL - 70 IS - 3 N1 - Times Cited: 0 0 U4 - older parents/caregiver burden/household income/women/parental care/financial status ER - TY - JOUR T1 - Validation of a polygenic risk score for dementia in black and white individuals. JF - Brain Behav Y1 - 2014 A1 - Jessica R Marden A1 - Stefan Walter A1 - Eric J. Tchetgen Tchetgen A1 - Ichiro Kawachi A1 - M. Maria Glymour KW - African Americans KW - Aged KW - Aged, 80 and over KW - Dementia KW - European Continental Ancestry Group KW - Female KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Polymorphism, Genetic KW - Reproducibility of Results KW - Risk Assessment KW - Risk Factors KW - Surveys and Questionnaires KW - United States AB -

OBJECTIVE: To determine whether a polygenic risk score for Alzheimer's disease (AD) predicts dementia probability and memory functioning in non-Hispanic black (NHB) and non-Hispanic white (NHW) participants from a sample not used in previous genome-wide association studies.

METHODS: Non-Hispanic white and NHB Health and Retirement Study (HRS) participants provided genetic information and either a composite memory score (n = 10,401) or a dementia probability score (n = 7690). Dementia probability score was estimated for participants' age 65+ from 2006 to 2010, while memory score was available for participants age 50+. We calculated AD genetic risk scores (AD-GRS) based on 10 polymorphisms confirmed to predict AD, weighting alleles by beta coefficients reported in AlzGene meta-analyses. We used pooled logistic regression to estimate the association of the AD-GRS with dementia probability and generalized linear models to estimate its effect on memory score.

RESULTS: Each 0.10 unit change in the AD-GRS was associated with larger relative effects on dementia among NHW aged 65+ (OR = 2.22; 95% CI: 1.79, 2.74; P < 0.001) than NHB (OR=1.33; 95% CI: 1.00, 1.77; P = 0.047), although additive effect estimates were similar. Each 0.10 unit change in the AD-GRS was associated with a -0.07 (95% CI: -0.09, -0.05; P < 0.001) SD difference in memory score among NHW aged 50+, but no significant differences among NHB (β = -0.01; 95% CI: -0.04, 0.01; P = 0.546). [Correction added on 29 July 2014, after first online publication: confidence intervalshave been amended.] The estimated effect of the GRS was significantly smaller among NHB than NHW (P < 0.05) for both outcomes.

CONCLUSION: This analysis provides evidence for differential relative effects of the GRS on dementia probability and memory score among NHW and NHB in a new, national data set.

VL - 4 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25328845?dopt=Abstract ER - TY - JOUR T1 - Validation of blood-based assays using dried blood spots for use in large population studies. JF - Biodemography Soc Biol Y1 - 2014 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Heather McCreath A1 - Jessica Faul A1 - David R Weir A1 - Teresa Seeman KW - Biomarkers KW - C-reactive protein KW - Cholesterol KW - Cholesterol, HDL KW - Cystatin C KW - Dried Blood Spot Testing KW - Glycated Hemoglobin A KW - Humans KW - Middle Aged KW - Reference Values KW - Reproducibility of Results AB -

Assessment of health in large population studies has increasingly incorporated measures of blood-based biomarkers based on the use of dried blood spots (DBS). The validity of DBS assessments made by labs used by large studies is addressed by comparing assay values from DBS collected using conditions similar to those used in the field with values from whole blood samples. The DBS approach generates values that are strongly related to whole blood levels of HbA1c, cystatin C, and C-reactive protein. Assessing lipid levels reliably with DBS appears to be a greater challenge. However, even when DBS values and values from venous blood are highly correlated, they are often on a different scale, and using conventional cutoffs may be misleading.

VL - 60 UR - http://www.tandfonline.com/doi/abs/10.1080/19485565.2014.901885 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24784986?dopt=Abstract JO - Biodemography and Social Biology ER - TY - JOUR T1 - The Value of Delaying Alzheimer's Disease Onset. JF - Forum Health Econ Policy Y1 - 2014 A1 - Julie M Zissimopoulos A1 - Eileen M. Crimmins A1 - Clair, Patricia A. St. AB -

Alzheimer's disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998-2008) and Aging Demographics and Memory Study (2001-2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD.

VL - 18 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27134606?dopt=Abstract ER - TY - JOUR T1 - Veteran Status and Men s Later-Life Cognitive Trajectories: Evidence from the Health and Retirement Study JF - Journal of Aging and Health Y1 - 2014 A1 - Maria T. Brown A1 - Janet M Wilmoth A1 - Andrew S London KW - Demographics KW - Event History/Life Cycle KW - Health Conditions and Status AB - Objective: The aim of this study is to determine the extent to which men s later-life cognitive trajectories vary by veteran status. Method: We use Health and Retirement Study (HRS) data to estimate growth curve models examining men s later-life cognitive trajectories by veteran status, war service status, and period of service. Analyses control for early-life characteristics that influence selection into military service and later-life cognition, and mid- to late-life characteristics that potentially mediate the relationship between military service and later-life cognition. Results: Veterans have higher cognition scores relative to nonveterans around retirement age, but their cognition scores decline more rapidly with increasing age, such that cognition scores are similar in both groups among the oldest old. Veterans who served during the Korean War have lower cognition scores around retirement age, but less steep age-related declines, than veterans who served during World War II. Discussion: Findings are discussed in relation to the extant literature, future research, potential service needs, and study limitations. UR - http://jah.sagepub.com/content/early/2014/05/23/0898264314534893.abstract U4 - cognitive trajectories/veterans/life course/Military service ER - TY - JOUR T1 - Veterans and risk of heart disease in the United States: a cohort with 20 years of follow up. JF - Int J Prev Med Y1 - 2014 A1 - Shervin Assari AB -

THE AIM OF THE CURRENT STUDY WAS TWOFOLD: To investigate the effect of veteran status on risk of developing heart disease over a period of 20 years in the United States and to test if socio-economic characteristics, chronic conditions, health behaviors, body mass index (BMI) and depressive symptoms explain the association between veteran status and risk of heart disease.

METHODS: Data came from the Health and Retirement Study, a 20 year national cohort from 1992 to 2012. The study enrolled a representative sample of Americans over the age of 50. We included 8,375 individuals who were older than 50 years at entry, did not have heart disease at baseline and provided data on heart disease over the next 20 years. Veteran status was considered to be the independent variable. Self-reported data on physician diagnosis of heart disease, which was measured on a biannual basis, was the outcome. Baseline socio-economic data (i.e. age, gender, race, marital status and education), chronic conditions (diabetes and hypertension), health behaviors (i.e. drinking, smoking, and exercise), BMI and depressive symptoms (modified Center for Epidemiologic Studies Depression Scale) were entered into logistic regressions. Logistic regression was used for data analysis.

RESULTS: Veterans were at higher risk of having a new onset of heart disease (unadjusted relative risk [RR] = 1.996, 95% confidence interval [CI] =1.694-2.351), compared with non-veterans. Logistic regression confirmed the association between veteran status and heart disease (adjusted RR = 1.483, 95% CI = 1.176-1.871) after controlling for all covariates.

CONCLUSIONS: Veterans may be at higher risk for heart disease over time and this link may be independent of baseline socio-economic characteristics, chronic medical conditions, health behaviors, BMI and depressive symptoms. Veterans may require more rigorous cardiovascular prevention programs.

PB - 5 VL - 5 IS - 6 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25013689?dopt=Abstract U2 - PMC4085922 U4 - alcohol/depression/drinking/exercise/heart disease/smoking/Military service/veterans ER - TY - THES T1 - Vascular depression: An early indicator of decline T2 - Psychology Y1 - 2013 A1 - Daniel Paulson KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Women over the age of 80 represent a rapidly growing demographic group. While older women live longer than men, they do so with more years of disability and frailty. The emergence of geriatric disorders such as vascular disease, depression, frailty and cognitive decline in the aging US population place additional strain and expense on the already over-burdened public health care system. Meanwhile, integrated models of care are associated with preserved functional independence, reduced medical costs, and greater satisfaction for both health care providers and patients. Implementation of integrated care demands process-models of disease that contextualize symptoms within broader patterns of decline. This dissertation proposes a model representing a hypothesized late-life clinical trajectory following from high cerebrovascular burden. The hypothesized trajectory includes higher rates of depression (of vascular origin), cognitive decline, frailty and shortened remaining lifespan. Different facets of this model are tested in the four studies that comprise this dissertation. The sample was drawn from the Health and Retirement Study; a longitudinal, demographically-representative data sample of older adults in the United States. The sub-sample used in this dissertation included 1,368 stroke-free women over the age of 80 at baseline (1998). This sub-sample was followed for 10 years. The first study tested the hypotheses that high CVB predicts greater depression symptoms, and that brain reserve (i.e.: education) protects elders from developing depression symptoms. A latent growth curve was used to identify differences in depression at baseline and over time based on CVB, cognitive functioning, education and age. Results indicate that at any level of CVB, older women with more education experienced fewer depression symptoms. Results support brain reserve theory and the vascular depression hypothesis. These results suggest that having greater education may postpone development of clinically-significant depressive symptoms resulting from high CVB, thereby preserving mood in late life. The second study tested the hypothesis that variables representing the three domains of Rowe and Kahn's Healthy Aging framework predict longevity in this sample of stroke-free women over the age of 80. The "avoidance of disease" domain was characterized in this paper as CVB - chronic comorbidites that slowly erode adaptive functioning over many years. The "sustained engagement" criteria was conceptualized as depression, and deficits in the "preservation of cognitive and physical functioning" domain were identified as rapid cognitive decline. We found that at most waves (2002, 2004, 2006) mortality was predicted by CVB, depressive symptoms and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8-years. Older women with the greatest longevity had low CVB, robust cognitive functioning and few depression symptoms, supporting successful aging theory and terminal cognitive drop. The third study tested the hypothesis that vascular depression is a prodrome for frailty. At baseline, the prevalence of frailty was 31.5%. Over a 4-years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL functioning, arthritis, pulmonary disorders, cancer, and self-rated health, vascular depression significantly predicted new cases of frailty. These findings suggest that vascular depression is a prodrome for frailty. The fourth study tested the proposed model using structural modeling. The model demonstrated good overall fit and a significant indirect pathway from vascular depression to mortality through frailty was identified. Results support the proposed theoretical framework and suggest that vascular depression symptoms are associated with a clinical trajectory including more frailty symptoms and shorted remaining lifespan. This finding supports integrated care for geriatric p tients and suggests specific targets for intervention with older patients experiencing vascular depressi n symptoms. JF - Psychology PB - Wayne State University CY - Detroit, MI VL - Ph.D. UR - https://digitalcommons.wayne.edu/oa_dissertations/737/ U4 - IADLs ER - TY - JOUR T1 - Vascular depression: an early warning sign of frailty. JF - Aging Ment Health Y1 - 2013 A1 - Daniel Paulson A1 - Peter A Lichtenberg KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Cerebrovascular Disorders KW - depression KW - Disabled Persons KW - Female KW - Follow-Up Studies KW - Frail Elderly KW - Geriatric Assessment KW - Health Status KW - Humans KW - Incidence KW - Logistic Models KW - Male KW - Prevalence KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: Frailty is a common geriatric disorder associated with activities of daily living (ADL) impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004 ), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis.

METHODS: We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first represented respondents with either high cerebrovascular burden (CVB; at least two cerebrovascular risk factors) or probable depression (score ≥3 on the 8-item Center for Epidemiological Studies Depression Scale (CES-D)), and the second represented respondents with both high CVB and probable depression.

RESULTS: At baseline, the prevalence of frailty was 31.5%. Over four years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004.

DISCUSSION: These findings suggest that vascular depression is a prodrome for frailty.

VL - 17 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22724516?dopt=Abstract U2 - PMC3492543 U4 - activities of daily living/depression/cerebrovascular burden/frailty ER - TY - THES T1 - Volunteering among surviving spouses: The impact of volunteer activity on the health of the recently widowed T2 - Gerontology Y1 - 2013 A1 - Kimberly J. Johnson KW - Adult children KW - Health Conditions and Status KW - Healthcare KW - Methodology KW - Net Worth and Assets AB - Numerous studies link volunteering to positive mental and physical health for older adults, and recent studies have suggested that volunteering may be particularly beneficial for those who are widowed. This research examines the potential of volunteering to buffer participants from stress-related health declines associated with the death of a spouse. Using the Health and Retirement Study (HRS), this research investigates the moderating role of volunteering on the self-rated health and depressive symptoms of recently widowed older adults. Consecutive waves of the HRS are used to identify respondents who experience the death of a spouse or who remain married, and those married or widowed respondents who participate in volunteer work over a two-year period. Waves 1998 through 2004 are used to construct three observation periods: 1998-2000, 2000-2002, and 2002-2004. A series of logistic and negative binomial regression analyses are used to estimate the direct effect and interactive effect of widowed status and volunteer status on self-rated health and depressive symptoms respectively. Results indicate that while volunteering decreases the odds of being in fair or poor health and decreases the expected number of depressive symptoms for volunteers compared with nonvolunteers, volunteering does not buffer recent widows from declines in self-rated health or reduce the risk of more depressive symptoms. The results do not support the idea that volunteering serves as a source of social support for older adults when dealing with the stress of spousal loss. However, the findings do support the idea that participating in volunteering helps older adults remain socially integrated through a meaningful role in their community. JF - Gerontology PB - University of Massachusetts, Boston CY - Boston, MA VL - Ph.D. UR - https://scholarworks.umb.edu/doctoral_dissertations/114/ U4 - Aging ER - TY - JOUR T1 - Variation in cognitive functioning as a refined approach to comparing aging across countries. JF - Proc Natl Acad Sci U S A Y1 - 2012 A1 - Skirbekk, V. A1 - Loichinger, E. A1 - Daniela Weber KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Data collection KW - Databases as Topic KW - Humans KW - Internationality KW - Male KW - Middle Aged AB -

Comparing the burden of aging across countries hinges on the availability of valid and comparable indicators. The Old Age Dependency Ratio allows only a limited assessment of the challenges of aging, because it does not include information on any individual characteristics except age itself. Existing alternative indicators based on health or economic activity suffer from measurement and comparability problems. We propose an indicator based on age variation in cognitive functioning. We use newly released data from standardized tests of seniors' cognitive abilities for countries from different world regions. In the wake of long-term advances in countries' industrial composition, and technological advances, the ability to handle new job procedures is now of high and growing importance, which increases the importance of cognition for work performance over time. In several countries with older populations, we find better cognitive performance on the part of populations aged 50+ than in countries with chronologically younger populations. This variation in cognitive functioning levels may be explained by the fact that seniors in some regions of the world experienced better conditions during childhood and adult life, including nutrition, duration and quality of schooling, lower exposure to disease, and physical and social activity patterns. Because of the slow process of cohort replacement, those countries whose seniors already have higher cognitive levels today are likely to continue to be at an advantage for several decades to come.

PB - 109 VL - 109 IS - 3 N1 - Skirbekk, Vegard Loichinger, Elke Weber, Daniela 2R01AG017644/AG/NIA NIH HHS/United States 2R01AG7644-01A1/AG/NIA NIH HHS/United States P01 AG005842/AG/NIA NIH HHS/United States P01 AG08291/AG/NIA NIH HHS/United States P30 AG12815/AG/NIA NIH HHS/United States R21 AG025169/AG/NIA NIH HHS/United States U01 AG09740-13S2/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Y1-AG-4553-01/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Proc Natl Acad Sci U S A. 2012 Jan 17;109(3):770-4. Epub 2011 Dec 19. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22184241?dopt=Abstract U2 - PMC3271876 U4 - Age Distribution/Aged, 80 and over/Aging/ physiology/Aging/ physiology/Cognition/ physiology/Cognition/ physiology/Data Collection/Middle Aged/Cross Cultural Comparison ER - TY - JOUR T1 - Volunteer transitions among older adults: the role of human, social, and cultural capital in later life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Tay K. McNamara A1 - Guillermo Ernest Gonzales KW - Aged KW - Aging KW - Caregivers KW - Community Participation KW - Cost of Illness KW - Educational Status KW - Employment KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Likelihood Functions KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Religion and Psychology KW - Social Environment KW - Social Identification KW - Social Support KW - Socioeconomic factors KW - United States KW - Volunteers AB -

OBJECTIVES: We aim to understand how human, social, and cultural capitals are associated with the volunteer process, that is, engagement (starting), intensity (number of hours), and cessation (stopping), among older adults.

METHOD: Data from the 2000 through 2008 Health and Retirement Study and the 2001 through 2009 Consumption and Activity Mail Survey provide a sample of 4,526 respondents. Random-effects pooled time series analyses incorporate not only the presence of various types of capital but also the quality of that capital.

RESULTS: Human and cultural capitals were positively associated with increased volunteer involvement. Effects of social capital (relationships in the family, employment status, and the community) depended on the quality of the relationships, not necessarily on their presence alone.

DISCUSSION: Results suggest that bolstering older adults' capitals, particularly among lower socioeconomic status groups, can increase volunteer engagement and intensity and reduce cessation. Additionally, a variety of organizational policies including respite programs for caregivers and employer policies allowing employees to reduce their work hours might indirectly affect participation rates and commitment. Potential pools of volunteers exist in families, workplaces, and religious organizations, but more research is necessary to identify how to recruit and retain individuals in social networks where volunteer participatory rates are low.

PB - 66B VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21743042?dopt=Abstract U4 - Older people/Volunteers/Human capital/Social capital ER - TY - JOUR T1 - Volunteering and hypertension risk in later life. JF - J Aging Health Y1 - 2011 A1 - Jeffrey A Burr A1 - Jane Tavares A1 - Jan E Mutchler KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Confidence Intervals KW - Female KW - Health Behavior KW - health policy KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Odds Ratio KW - Psychometrics KW - Regression Analysis KW - Risk Factors KW - Social Support KW - Surveys and Questionnaires KW - Volunteers AB -

OBJECTIVE: This study examined the relationship between volunteer activity and hypertension, a risk factor for cardiovascular disease, renal failure, and cognitive impairment.

METHOD: Employing data from the Health and Retirement Study, we estimated regression models of hypertension status that include volunteer activity and psychosocial and health behavior risk factors for middle-aged and older persons.

RESULTS: Multivariate analyses showed volunteers had lower hypertension risk and lower systolic and diastolic blood pressure than nonvolunteers and that a threshold effect was present, whereby a modest amount of volunteer time commitment (but not a high amount) was associated with lower risk of hypertension. We did neither find support that psychosocial and health behaviors mediated this relationship nor find support for a moderating effect of volunteering for the relationships among health behaviors and hypertension.

DISCUSSION: The results of this study indicate that research is needed to determine what mediates the relationship between volunteering and hypertension.

PB - 23 VL - 23 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20971920?dopt=Abstract U3 - 20971920 U4 - Volunteers/Hypertension/Risk factors/Cardiovascular disease/Aging/Geriatrics/Older people ER - TY - JOUR T1 - Volunteering, driving status, and mortality in U.S. retirees. JF - J Am Geriatr Soc Y1 - 2011 A1 - Sei J. Lee A1 - Michael A Steinman A1 - Erwin J Tan KW - Activities of Daily Living KW - Aged KW - Automobile Driving KW - Female KW - Health Status KW - Humans KW - Male KW - Prospective Studies KW - Retirement KW - Risk Factors KW - Social Behavior KW - Survival Rate KW - United States KW - Volunteers AB -

OBJECTIVES: To evaluate how accounting for driving status altered the relationship between volunteering and mortality in U.S. retirees.

DESIGN: Observational prospective cohort.

SETTING: Nationally representative sample from the Health and Retirement Study in 2000 and 2002 followed to 2006.

PARTICIPANTS: Retirees aged 65 and older (N=6,408).

MEASUREMENTS: Participants self-reported their volunteering, driving status, age, sex, race or ethnicity, presence of chronic conditions, geriatric syndromes, socioeconomic factors, functional limitations, and psychosocial factors. Death by December 31, 2006, was the outcome.

RESULTS: For drivers, mortality in volunteers (9%) and nonvolunteers (12%) was similar; for limited or non-drivers, mortality for volunteers (15%) was markedly lower than for nonvolunteers (32%). Adjusted results showed that, for drivers, the volunteering-mortality odds ratio (OR) was 0.90 (95% confidence interval (CI)=0.66-1.22), whereas for limited or nondrivers, the OR was 0.62 (95% CI=0.49-0.78) (interaction P=.05). The effect of driving status was greater for rural participants, with greater differences between rural drivers and rural limited or nondrivers (interaction P=.02) and between urban drivers and urban limited or nondrivers (interaction P=.81).

CONCLUSION: The influence of volunteering in decreasing mortality seems to be stronger in rural retirees who are limited or nondrivers. This may be because rural or nondriving retirees are more likely to be socially isolated and thus receive more benefit from the greater social integration from volunteering.

PB - 59 VL - 59 IS - 2 N1 - Lee, Sei J Steinman, Michael A Tan, Erwin J K23 AG030999/AG/NIA NIH HHS/United States KL2RR024130/RR/NCRR NIH HHS/United States P30-AG02133/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Journal of the American Geriatrics Society Nihms289698 J Am Geriatr Soc. 2011 Feb;59(2):274-80. doi: 10.1111/j.1532-5415.2010.03265.x. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21314648?dopt=Abstract U2 - PMC3089440 U4 - Activities of Daily Living/Automobile Driving/driving Patterns/Health Status/Prospective Studies/Retirement planning/Risk Factors/Social Behavior/Social Behavior/Survival/volunteering ER - TY - RPRT T1 - Validating Diabetes Disease Status in Claims and Survey Data. Proceedings of the 2010 International Methodology Symposium: The Interplay among Censuses, Surveys and Administrative Data Y1 - 2010 A1 - Joseph W Sakshaug A1 - David R Weir A1 - Lauren Hersch Nicholas KW - Health Conditions and Status KW - Methodology PB - Ottawa U4 - Diabetes/methodology/ADMINISTRATIVE DATA ER - TY - JOUR T1 - Vascular health, diabetes, APOE and dementia: the Aging, Demographics, and Memory Study. JF - Alzheimers Res Ther Y1 - 2010 A1 - David J Llewellyn A1 - Iain A Lang A1 - Fiona E Matthews A1 - Brenda L Plassman A1 - Mary A M Rogers A1 - Lewis B Morgenstern A1 - Gwenith G Fisher A1 - Mohammed U Kabeto A1 - Kenneth M. Langa AB -

INTRODUCTION: Evidence from clinical samples and geographically limited population studies suggests that vascular health, diabetes and apolipoprotein epsilon4 (APOE) are associated with dementia.

METHODS: A population-based sample of 856 individuals aged 71 years or older from all contiguous regions of the United States received an extensive in-home clinical and neuropsychological assessment in 2001-2003. The relation of hypertension, diabetes, heart disease, stroke, medication usage, and APOE epsilon4 to dementia was modelled using adjusted multivariable logistic regression.

RESULTS: Treated stroke (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.0, 7.2), untreated stroke (OR 3.5, 95% CI 1.7, 7.3), and APOE epsilon4 (OR 2.8, 95% CI 1.7, 4.5) all increased the odds of dementia. Treated hypertension was associated with lower odds of dementia (OR 0.5, 95% CI 0.3, 1.0). Diabetes and heart disease were not significantly associated with dementia. A significant interaction was observed between APOE epsilon4 and stroke (P = 0.001).

CONCLUSIONS: Data from the first dementia study that is representative of the United States population suggest that stroke, the APOE epsilon4 allele and their interaction are strongly associated with dementia.

PB - 2 VL - 2 UR - http://alzres.com/content/2/3/19 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20576093?dopt=Abstract U2 - PMC2919699 U4 - Dementia/Vascular dementia/Stroke ER - TY - JOUR T1 - Volunteer dynamics of older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2009 A1 - Barbara A Butrica A1 - Richard W. Johnson A1 - Sheila R Zedlewski KW - Aged KW - Aging KW - Cross-Sectional Studies KW - Female KW - Humans KW - Life Change Events KW - Male KW - Middle Aged KW - Probability KW - Retirement KW - United States KW - Volunteers AB -

OBJECTIVES: The impending retirement of boomers has spurred interest in tapping their productive energies to benefit society. This study examined volunteer transitions among older adults to understand the factors that affect volunteer dynamics.

METHODS: Using data from the Health and Retirement Study, the analysis examined entries into and exits from formal volunteer activities between 1996 and 2004 by adults aged 55-65 at study baseline. The study showed the duration of volunteer activities, the probability that older adults start and stop volunteering, and the factors that significantly predict volunteer transitions.

RESULTS: The findings reveal considerable stability among both volunteers and nonvolunteers; however, older adults are more likely to stop volunteering than to start. Volunteers who contribute intensely and for many years and who are married to volunteers are the least likely to quit. And nonvolunteers are more likely to start volunteering if they have been uninvolved for few years and their spouses volunteer.

CONCLUSIONS: The results point to the need to focus efforts on retaining older volunteers to maximize volunteer engagement during later years. Recruiting older adults in volunteer activities early on, ideally before they retire, could also help meet volunteer needs.

PB - 64B VL - 64 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19213847?dopt=Abstract U3 - 19213847 U4 - ADULTS/Time Utilization/Volunteering ER - TY - JOUR T1 - VALUING LOST HOME PRODUCTION OF DUAL EARNER COUPLES. JF - Int Econ Rev (Philadelphia) Y1 - 2008 A1 - Christopher L House A1 - John Laitner A1 - Stolyarov, Dmitriy AB -

Using a life-cycle model in which women divide their time between home and market work, we establish a link between retirement wealth and the value of forgone home production. We use data from the Health and Retirement Study to estimate the model's parameters and adjust the growth rate of GDP to reflect reductions in non-market output. We find that the value of forgone home production is modest - about 25 percent of women's measured earnings.

PB - 49 VL - 49 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20052402?dopt=Abstract U2 - PMC2801081 U4 - Women, Working/Retirement Wealth ER - TY - THES T1 - Veteran Status, Health Status, and Use of Health Services Y1 - 2007 A1 - Paul R Brezinski KW - Health Conditions and Status KW - Healthcare AB - There are more than seven million veterans aged 70 and older in the United States. Prior research indicates differences in health status and health resource utilization of older veterans, compared with nonveterans of the same age cohort. Improved understanding of these differences can inform fiscal and social policy. One important contributing factor to these differences is the impact of the G.I. Bill. Education is strongly associated with improved health status. Results have implications for health care and education policy, as well as for retirement benefits. This longitudinal research evaluates hypotheses regarding veterans' health status, physician use, and hospital use compared to nonveterans. Education is expected to mediate the veteran effects. The study draws on the Andersen Behavioral Model (1995) for its conceptual framework and is among the most comprehensive applications of the predisposing, enabling, and need paradigm to date. Six waves (1993-2004) of the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD) are analyzed. Primary analyses were conducted using a dichotomous veteran variable (veteran/nonveteran). Separate veteran subgroup analyses (early/late entry, disabled/not disabled, career/noncareer) were also conducted. The study finds evidence of a positive effect of veteran status on both health status and physician utilization, but not hospital utilization. Compared to nonveterans, early entry veterans, non-career veterans and non-disabled veterans have higher health status. Late entry veterans, non-career veterans, and disabled veterans use more physician services relative to nonveterans. The study finds a strong positive effect of education on both health status and physician utilization. Education mediates the veteran status effect on health status and has a direct effect on physician utilization for both veterans and nonveterans. Veteran status also has effects on physician utilization that can not be attributed to education. Further research is warranted to discover specific effects among other veteran cohorts that could be applied to reshape the Veterans' Health Administration and the Military Health delivery systems, as well as to Medicare benefits. PB - University of Iowa U4 - Health Care Utilization JO - Veteran Status, Health Status, and Use of Health Services ER - TY - JOUR T1 - The validation of the Texas revised inventory of grief on an older Latino sample. JF - J Soc Work End Life Palliat Care Y1 - 2006 A1 - Wilson, Steve KW - Aged KW - Aged, 80 and over KW - Bereavement KW - Culture KW - Factor Analysis, Statistical KW - Female KW - Grief KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Psychometrics KW - Reproducibility of Results KW - Socioeconomic factors KW - Surveys and Questionnaires KW - Texas AB -

PURPOSE: Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample.

DESIGN AND METHODS: Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos.

RESULTS: While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice.

IMPLICATIONS: This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context.

VL - 2 IS - 4 ER - TY - JOUR T1 - Veterans and Functional Status Transitions in Older Americans JF - Military Medicine Y1 - 2006 A1 - Xian Li A1 - Engel, Charles C. A1 - Han Kang A1 - Armstrong, David W. KW - Older Adults KW - Retirement Planning and Satisfaction KW - Transitions KW - Veterans AB - Objectives: This research examines the relationship of veteran status with functional status transitions in older Americans. Methods: Data for this study come from the Survey of Asset and Health Dynamics among the Oldest Old. We use a structural multinomial logit model to decompose the effect of older veterans into the direct effect and the indirect effects via physical health conditions and mental disorders on functional status transitions. Results: Although there is no distinct association among those functionally independent at baseline, veteran status significantly impacts age-dependent transitions from functional dependence to other statuses. At age 85, the excess mortality and the lower level of functional resolution among functionally dependent veterans are considerable. Conclusions: Physical health is more important than mental health in transmitting the effect of veteran status on functional status transitions in functionally dependent persons. VL - 171 IS - 10 ER - TY - RPRT T1 - Valuing Lost Home Production in Dual-Earner Couples Y1 - 2005 A1 - John Laitner A1 - Christopher L House A1 - Stolyarov, Dmitriy KW - Employment and Labor Force KW - Net Worth and Assets KW - Women and Minorities AB - Economists principal tool for studying household behavioral responses to changes in tax and other government policies, and the magnitude and determinants of private saving, is the life cycle model. The purpose of this paper is to attempt to incorporate into that model one of the most conspicuous changes in the U.S. economy in the last 50 years, the rise in labor market participation for married women. The increased presence of married women in the labor force has obvious benefits: women now earn much more income than they did in the past. On the other hand, working women presumably spend less time doing housework and other types of home production, and the forgone value of time at home reduces the net benefit of their work in the market. Conventional accounts do not provide measurements of the costs of lost home production, but we attempt to use comparisons of household net worth at retirement to deduce valuations indirectly. This paper modifies a standard life cycle model to include women s labor supply decisions, estimates key parameters of the new specification, and attempts to assess the significance of rising female labor market participation for aggregate national saving in the U.S. Using panel data from the Health and Retirement Study, we find that the difference between measured labor market earnings for married women and earnings net of the value of lost home production seems moderately small about 30 percent and that the corresponding long run effect on the overall rate of private saving is minor. JF - Michigan Retirement Research Center Publication PB - The University of Michigan, Michigan Retirement Research Center CY - Ann Arbor, MI UR - https://mrdrc.isr.umich.edu/pubs/valuing-lost-home-production-in-dual-earner-couples/ U4 - Household Production/Labor Force Participation/WOMEN ER - TY - JOUR T1 - A variables associated with occupational and physical therapy stroke rehabilitation utilization and outcomes. JF - J Allied Health Y1 - 2005 A1 - Chad Cook A1 - Stickley, Lois A1 - Ramey, Kevin A1 - Knotts, Valerie J. KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Disability Evaluation KW - Female KW - Health Services Accessibility KW - Humans KW - Male KW - Occupational therapy KW - Physical Therapy Modalities KW - Risk Factors KW - Socioeconomic factors KW - Stroke Rehabilitation KW - United States AB -

Many studies have reported the benefits of a comprehensive stroke team including occupational therapy/physical therapy (OT/PT) services; however, factors associated with access to these services are less known. This study used a subsample of the Health and Retirement Study database, a cross-sectional survey of more than 11,126 Americans aged 65 to 106 years within the contiguous United States. The purposes of this study were to determine the associational factors that contribute to attending OT/PT and determine if attending OT/PT leads to a reduced report of stroke-related problems. The findings indicated that fewer than 10% of stroke survivors in a noninstitutionalized, community-based setting were currently accessing OT/PT. Additionally, access to OT/PT services was highly associated with report of having an attending physician, report of stroke-related weakness, higher monthly income, and older age. The increased odds of reported continued problems associated with a past stroke were associated with failure to access OT/PT services, lower monthly income, Hispanic culture, and age. OT/PT services were typically provided to patients who reported a higher level of physical dysfunction. Despite the greater degree of severity, OT/PT intervention led to reports of lower levels of disability and problems over time.

PB - 34 VL - 34 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15839599?dopt=Abstract U4 - Health Services/Disability/Disability/Stroke/Physical Therapy ER - TY - RPRT T1 - The Value of the Medicare Benefit for Social Security Disability Insurance Recipients and Applicants Y1 - 2002 A1 - Bhattacharya, Jay A1 - Michael Schoenbaum KW - Disabilities KW - Medicare/Medicaid/Health Insurance KW - Social Security PB - RAND Corporation CY - Santa Monica, CA U4 - Medicare/Disability/Disability/Social Security ER - TY - JOUR T1 - Valuation of life: a concept and a scale. JF - J Aging Health Y1 - 2001 A1 - Lawton, M. Powell A1 - Moss, Miriam A1 - Hoffman, Christine A1 - Kleban, Morton H. A1 - Ruckdeschel, Katy A1 - Winter, Laraine KW - Factor Analysis, Statistical KW - Humans KW - Psychometrics KW - Quality of Life KW - United States AB -

OBJECTIVES: The objective was to derive and test the psychometric characteristics of a scale to measure Valuation of Life (VOL).

METHODS: Four samples were used in successive phases of exploratory factor analysis, confirmatory factor analysis, reliability and validity testing, and exploration of response-error effects. Estimates of Years of Desired Life were obtained under a variety of hypothetical quality-of-life (QOL)-compromising conditions of poor health.

RESULTS: Confirmed 13-item (Positive VOL) and 6-item (Negative VOL) factors were obtained. A significant relationship between VOL and most Years of Desired Life estimates remained when demographic, health, quality of life, and mental health measures were controlled. Analysis of Negative VOL revealed that some respondents misunderstand the meaning of an agree response to negatively phrased items.

DISCUSSION: VOL is a cognitive-affective schema whose function as a mediator and moderator between health and end-of-life decisions deserves further research.

PB - 13 VL - 13 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11503845?dopt=Abstract U4 - Longevity/quality of life ER -